Instruction:
Conjugate of the diagonal is 'a' cm, obstetric conjugate will be:
A. a+1 cm
B. a+2 cm
C. a-1 cm
D. a-2 cm

Response:
Ans. is d, i.e. (a -2) cmRef. Williams Obs. 24/e, p 32Obstetric conjugate cannot be measured clinically but can be diagnosed by substracting 1.5-2 cm from diagonal conjugate. Hence if diagonal conjugate is 'a' cm obstetric conjugate will be (a -2) cmObstetric conjugate normally measures 10 cm or more Q.The pelvic inlet is considered to be contracted, if obstetric conjugate is less than 10 cm. Q

So the answer to this question is D


Instruction:
Advantages of amoxicillin over ampicillin are all except-
A. Better bioavailability & faster action
B. Spectrum includes H. influenzae & Shigella
C. Incidence of diarrhea is lower
D. Food does not interfere with its absorption

Response:
Ans. is 'b' i.e., Spectrum includes H. influenzae & Shigellao Amoxicillin is a close congener of ampicillin; similar to it in all respects except:Oral absorption is better; food does not interfere with absorption; higher and more sustained blood levels are produced.Incidence of diarrhea is lower.It is less active against Shigella and H. influenzae.o It is now preferred over ampicillin for bronchitis, urinary infections, SABE and gonorrhoea.

So the answer to this question is B


Instruction:
At what blood alcohol level, there is Nystagmus, marked slurring of speech and alcoholic blackouts?
A. 150mg/dL
B. 200 mg/dL
C. 250 mg/dL
D. 300 mg/dL

Response:
(B) 200 mg/dLLevelLikely impairment20-30 mg/dLSlowed motor performance and decreased thinking ability30-80 mg/dLIncreases in motor and cognitive problems80-200 mg/dLIncreases in incoordination and judgment errsMobilityDeterioration in cognition200-300 mg/dLNystagmus, marked slurring of speech, and alcoholic blackouts> 300 mg/dLImpaired vital signs and possible deathPharmacologic toleranceApproximately 150 mg/dLOne does not show significant levels of impairment in motor and mental performanceIn that range, most people without tolerance also experience nausea and vomitingOne drinkIs likely to raise the blood alcohol level by approximately 15 to 20 mg/dL for an average70 kg person who has average amount of body fatThe same metabolized in an hour# DSM-IV-TR Diagnostic Criteria for Alcohol Intoxication> Recent ingestion of alcohol.> Clinically significant maladaptive behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning) that developed during, or shortly after, alcohol ingestion.> Signs, developing during, or shortly after, alcohol use: slurred speech incoordination unsteady gait nystagmus impairment in attention or memory stupor or coma> The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.# Blackouts> Alcohol-related blackouts are not included in DSM-IV-TR's diagnostic classification, although the symptom of alcohol intoxication is common. Blackouts are similar to episodes of transient global amnesia in that they are discrete episodes of anterograde amnesia that occur in association with alcohol intoxication.> The periods of amnesia can be particularly distressing when persons fear that they have unknowingly harmed someone or behaved imprudently while intoxicated.> During a blackout, persons have relatively intact remote memory but experience a specific short-term memory deficit in which they are unable to recall events that happened in the previous 5 or 10 minutes.> Because their other intellectual faculties are well preserved, they can perform complicated tasks and appear normal to casual observers.> The neurobiological mechanisms for alcoholic blackouts are now known at the molecular level; alcohol blocks the consolidation of new memories into old memories, a process that is thought to involve the hippocampus and related temporal lobe structures.

So the answer to this question is B


Instruction:
Extra Mammary Paget's disease is associated with which other cancer:
A. Vulva
B. Vagina
C. Cervix
D. Uterus

Response:
Extra Mammary Paget's disease is associated with Vulva cancer Occurs in a postmenopausal woman as a sharply demarcated and slightly elevated white indurated or eczematous lesion Adenocarcinomas of the vulva usually arise in a Baholin gland or occur in association with Paget disease. The treatment is local excision or vulvectomy if no underlying lesion is detected. With underlying lesion, treatment is as of invasive cancer. Radiotherapy is employed for women unfit for surgery but prolonged follow-up for recurrence is obligatory. Local and systemic 5FU and bleomycin is also tried.

So the answer to this question is A


Instruction:
Which of the following diuretic can lead to hyperglycemia and hyperlipidemia?
A. Carbonic anhydrase inhibitors
B. Loop diuretics
C. Thiazide diuretics
D. Vasopressin antagonists

Response:
Thiazide diuretics decreases insulin release and leads to hyperglycemia and it also causes hyperlipidemia.

So the answer to this question is C


Instruction:
Direction of sound is differentiated by
A. Auditory cortex
B. Medial geniculate body
C. Lateral geniculate body
D. Inferior colliculus

Response:
Ans. (d) Inferior colliculus(Ref: Kandel, Principle of Neural Sciences, 5th ed, p.697)All auditory pathways ascending through the brain stem converge in inferior colliculusHelps in localization of sound and the direction from which the sound comes

So the answer to this question is D


Instruction:
Deficiency of enzyme hexosaminidase, α subunit causes -
A. Tay-Sach's disease
B. Hurler syndrome
C. Fabry disease
D. Pompe disease

Response:
None

So the answer to this question is A


Instruction:
The health promotional phase in public health is between
the years:
A. 1880-1920
B. 1920-1960
C. 1960-1980
D. 1981-2K

Response:
Disease control phase: 1880 - 1920
Health promotional phase: 1920 - 1960
Social engineering phase: 1960 - 1980
Health for all phase: 1981-2000

Essentials of preventive and community dentistry
Soben Peter
5th edition

So the answer to this question is B


Instruction:
A 7-year old boy presents with a right-sided hemangioma and left-sided focal seizures. The most likely diagnosis is:
A. Neurofibromatosis
B. Incontinetia pigmenti
C. Hypermelanosis of Ito
D. Sturge-Weber disease

Response:
Ans. d. Sturge-Weber disease

So the answer to this question is D


Instruction:
Which of the following is dental formula of a 9 year
old child:
A. 6EDC21/6EDC21
B. 6EDCBA/6EDC21
C. EDC21/EDC21
D. 76EDC21/76EDC21

Response:
None

So the answer to this question is A


Instruction:
Placenta develops from
A. Decidua capsularis and Chorion frondosum
B. Decidua capsularis and Decidua basalis
C. Decidua basalis and Chorion frondosum
D. Decidua parietalis and Chorion frondosum

Response:
Development of placenta: - Placenta has two components : Maternal & Fetal When the blastocyst attaches to uterus in endometrium, the endometrium is called as decidua which is of three types: - Decidua basalis , Decidua capsularis & Decidua parietalis. Fetus will also have some chorionic membrane developing leading to villi formation : Chorion Frondosum & Chorion laeve. Chorion laeve will disappear. Chorionic Frondosum persists & contributes to placenta along with Decidua Basalis .

So the answer to this question is C


Instruction:
The maturation index on vaginal cytology is a diagnostic method for evaluating :
A. Adequacy of cytotoxic drug therapy
B. Gender of an anatomically abnormal child
C. Malignant change at squamocolumnar junction of cervix
D. Endocrine status of vagina

Response:
Maturation index of Vaginal cellsIt is a ratio of vaginal cellsThree major cell typesBasal and Parabasal cells: Least mature cells; Not influenced by hormonesIntermediate cells: Progesterone influences the maturation Superficial cells: Most matured cells; Estrogen affects the maturity Cell counts are expressed as a percentage; Basal/Intermediate/SuperficialUsed for hormonal evaluationPredominance of parabasal cells indicates absence of estrogen stimulationPredominance of Superfical cells indicates estrogen presenceMaturation index examplesMenstrual cycleProliferative phase: 0/40/60Secretory phase: 0/70/30Pregnancy: 0/90/10Menopause: 100/0/0Ref: D.C. Dutta&;s Textbook of Gynaecology, 6th edition, page no: 58

So the answer to this question is D


Instruction:
True statement about sebaceous cyst:-
A. Arise in the epidermis
B. Mobile over skin
C. Commonly seen in scalp
D. Rarely contains central punctum

Response:
Generally sebaceous cyst is derived from infundibulum of hair follicles / caused by traumatic inclusion Sites are scalp, face, trunk and scrotum Usually sebaceous cyst contains a punctum (except scalp and scrotum) Skin is fixed over the cyst

So the answer to this question is C


Instruction:
Which is pathognomic for motor neuron disease -
A. Fasciculation
B. Bladder, bowel involvement
C. Pseudohypertrophy
D. Sensory loss in patchy manner

Response:
None

So the answer to this question is A


Instruction:
A patient died and relatives complain that it is due to negligence of doctor. According to a recent Supreme Cou judgement, doctor can be charged for Medical Negligence under section 304-A, only if:
A. If he is from corporate hospital
B. If negligence is from inadveent error
C. Gross negligence
D. Res Ipsa Loquitor

Response:
C i.e. Gross negligence A/t recent supreme cou judgement, doctor can be charged for medical negligence under section 304-A IPC (ie criminal negligence), only if he shows gross lack of competence/ skills, gross inattention, or inaction or recklessness or wanton (gross) indifference to the patient's safety or gross negligenceQ

So the answer to this question is C


Instruction:
Acridine orange is a fluorescent dye used to bind
A. DNA and RNA
B. Protein
C. Lipid
D. Carbohydrates

Response:
DNA and RNA Acridine orange is a nucleic acid selective metachromatic stain useful for cell cycle determination Acridine orange interacts with DNA and RNA by intercalation or electrostatic attraction respectively - DNA intercalated Acridine orange fluoresces green - RNA electrostatically bound acridine orange fluoresces red It may distinguish between quiescent and activated proliferating cells and may also allow differential detection of )multiple GI compaments. - Acridine orange is also a useful method for measuring apoptosis and for detecting intracellular pH gradients and the measurement of proton pump activity. Uses of Acridine orange Demonstration of mucin Staining of DNA and RNA As a stain for electron microscopy study of mitochondria) osteoclasts Distinguish proliferating and resting cells Genetic determination of plasmodium falciparum and H. Pylori Also know D.N.A. can be best demonstrated by --> Feulgen Other methods of demonstrate D.N.A --> Methyl green pyronin, Gallocyanin chrome alum method Method of choice for demonstrating R.N.A --> Methyl green pyronin Other methods to demonstrate R.N.A. - Gallocyanin chroms alum, Acridine orange

So the answer to this question is A


Instruction:
Circumcision is contraindicated in
A. Balanitis
B. Hypospadias
C. Paraphimosis
D. Meatal stenosis

Response:
Circumcision is not done in patients with hypospadias as the prepuce can later be used in surgical repair. Circumcision is mostly done for cultural reasons. The medical indications for circumcision are: Phimosis & Paraphimosis Recurrent balanoposthitis. (i.e. inflammation of the foreskin) Recurrent urinary tract infection. (Circumcision is occasionally justified in boys with an abnormal upper urinary tract and recurrent urinary infection. It may also help boys with spina bifida who need to perform clean intermittent urethral catheterization.) An emerging and still controversial indication for circumcision is in the prevention of sexually acquired human immunodeficiency virus (REV) infection in communities where this disease is common; large clinical trials have recently shown that circumcision reduces the risk of HIV transmission. Circumcision for medical reasons is best performed under general anesthesia. Reference : page 1056 SRB's manual of surgery 5th edition and page1371 Bailey and Love's sho practice of surgery 25th edition

So the answer to this question is B


Instruction:
Mental foramen is located near
A. First premolar of mandible
B. Second molar of mandible
C. Canine of mandible
D. Canine of maxilla

Response:
On the medial surface of the mandible is the mandibular foramen for inferior alveolar nerve and vessels. The foramen leads in to mandibular-canal which opens on the lateral surface of the mandible at mental foramen, situated below the second premolar tooth.
Fracture of mandible most commonly involves neck.

So the answer to this question is A


Instruction:
The spine of the scapula can be palpated at which of the following level of veebrae?
A. T 1
B. T 3
C. T 5
D. T 7

Response:
Spine of the scapula lies at the level of T3 veebrae. Scapular spine is seen on the posterior surface of the scapula and it expands into a terminal process called acromion process. The scapulae overlie the posterior poion of the thoracic wall, and cover the upper seven ribs. The superior angle of scapula can be palpated at the T1 veebral level and the inferior angle lies at the level of T7 veebrae.

So the answer to this question is B


Instruction:
Term schizophrenia was coined by -
A. Eugene bleuler
B. Kahlbaum
C. Hecker
D. Emil Kraepelin

Response:
Ans. is 'a' i.e., Eugene Bleuler Term related to schizophreniaCoined byo Demence precoceo Catatoniao Hebephreniao Dementia procoxo SchizophreniaMorelKahlbaumHeckerEmil kraepelinEugen bleuler

So the answer to this question is A


Instruction:
Which of the following is not a side effect of clozapine -
A. Agranulocytosis
B. Seizure
C. Sialosis
D. Weight loss

Response:
Ans. is 'd' i.e., Weight loss Clozapine causes weight gain.

So the answer to this question is D


Instruction:
A 52 year old male with a history of hea disease presents with sudden painless loss of vision in one eye. Examination reveals cherry red spot. Diagnosis is:
A. Central retinal vein occlusion
B. Central retinal aery occlusion
C. Diabetic retinopathy
D. Acute ischemic optic neuritis

Response:
Central retinal aery occlusion: It occurs due to obstruction at the level of lamina cribrosa. Causes sudden painless loss of vision. Retina becomes white due to oedema & a cherry red spot is seen at the fovea. Aerioles become narrow & blood column within the retinal vessels is segmented. Resuscitation time of the human retina following retinal ischemia is 11/2 hours. Ref: Review of Ophthalmology by A.K. Khurana, 5th Edition, Page 113

So the answer to this question is B


Instruction:
Which muscle is responsible for sitting to standing position?
A. Gluteus medius
B. Gluteus maximus
C. Gluteus minimus
D. Tensor fascia lata

Response:
Ans. B Gluteus maximusRef: Grays Anatomy, 41st ed. pg. 1318The muscles of the gluteal region include:* Three named gluteal muscles and* The deeper short lateral rotators of the hip jointGluteus maximus lies most superficially* Origin: Iliac, sacrum and coccyx* Insertion: Gluteal tuberosity, iliotibial band* Function: It is a powerful extensor of the hip joint, acting more often to extend the trunk on the femur than to extend the limb on the trunk.* Therefore used for changing position from sitting to standing.Gluteus medius and minimus* Attachment: Proximally to the outer surface of the ilium and distally to the greater trochanter of the femur* Function:# They are abductors of the hip;# Their most important action is to stabilize the pelvis on the femur during locomotion, and they are helped in this function by tensor fasciae latae.

So the answer to this question is B


Instruction:
Drug-induced colitis is most frequently associated with
A. Neomycin
B. Vancomycin
C. Clindamycin
D. Chloramphenicol

Response:
Clindamycin: This potent lincosamide antibiotic is similar in mechanism of action (inhibits protein synthesis by binding to 50S ribosome) and spectrum of activity to erythromycin with which it exhibits paial cross resistance. Modification of the ribosomal binding site by constitutive methylase enzyme confirs resistance to both. It inhibits most gram-positive cocci (including penicillinase producing Staph., but not MRSA), C. diphtheriae, Nocardia, Actinomyces, Toxoplasma, but the distinctive feature is its high activity against a variety of anaerobes, especially Bact. fragilis. Aerobic gram-negative bacilli, spirochetes, Chlamydia, Mycoplasma and Rickettsia are not affected. Side effects are rashes, uicaria, abdominal pain, but the major problem is diarrhoea and pseudomembranous enterocolitis due to Clostridium difficile superinfection which is potentially fatal. The drug should be promptly stopped and metronidazole (alternatively vancomycin) given to treat it. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:731

So the answer to this question is C


Instruction:
Delusions are not likely to be seen in:
A. Dementia
B. Depression with psychotic symptoms
C. Schizophrenia
D. Conversion disorder

Response:
Delusion is a false, firm ,fixed and unshakable belief. It is not a feature of conversion disorder. It can be a feature of- schizophrenia depression with psychotic symptoms Dementia.

So the answer to this question is D


Instruction:
All of the following is complications of mumps
A. Meningoencephalitis
B. Myocarditis
C. pancreatitis
D. Myositis

Response:
The complications of mumps includes meningitis ,encephalitis ,oophoritis,epididymoorchitis,facial neuritis,transverse myelitis,cerebellar ataxia,auditory nerve damage,pancreatitis ,nephritis,myocarditis, mastitis Reference : Ghai essential pediatrics 8th edition pg no 217

So the answer to this question is D


Instruction:
Manifestation of epidemic Dropsy are all except -
A. Gastrointestinal bleed
B. Cutaneous hemangiomas
C. Breathlessness
D. C HF

Response:
The symptoms of epidemic dropsy are sudden non inflammatory bilateral swelling of legs with diarrhoea,dyspnoea cardiac failure glaucoma, and even deathREF.PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE.Editon-21.Page no.-608.

So the answer to this question is A


Instruction:
A man presents to a ST clinic with urethritis and urethral discharge. Gram stain shows numerous pus cells but no microorganism. The culture is negative on the routine laboratory media. The most likely agent is -
A. Chlamydia trachomatis
B. Haemophilus ducreyi
C. Treponema pallidum
D. Neisseria gonorrhoeae

Response:
None

So the answer to this question is A


Instruction:
The most common site for intestinal TB is
A. Distal ileum
B. Jejunum
C. Sigmoid colon
D. Ascending colon

Response:
Most common sites - Distal ileum and caecum Ref : Sabiston 20th edition Pgno : 1217

So the answer to this question is A


Instruction:
Barr body is absent in female having –
A. 46 XX genome
B. 45 XO genome
C. 47 XXX
D. All of above

Response:
Barr body (Sex - chromatin)

It is a densely staining inactivated condensed 'X' chromosome that is present in each somatic cells of the female.
It is found in the nucleus.
It is used as a test of genetic femaleness → it is possible to determine the genetic sex of an individual according as to whether there is a chromatin mass present on the inner surface of the nuclear membrane of cells with resting or intermittent nuclei. Remember the following fact and the question will seem very easy.
Chromatid body (Barr body or sex chromatin) is derived from one of the two X-chromosomes which becomes inactivated.
The number of Barr bodies is thus one less than the number of X-chromosomes.

Note -

Barr body is found in female But -
Kleinefelter syndrome is male with Barr body.
Turner syndrome is female without Barr body.

So the answer to this question is B


Instruction:
Complication of total parenteral nutrition is:-
A. CHF
B. Hypochloremia
C. Metabolic acidosis
D. Leukopenia

Response:
One of the complication of total parenteral nutrition is metabolic acidosis. COMPLICATIONS OF TPN MC complication of central venous catheterization (CVC): Catheter related sepsisQ Most dangerous complication following CVC: PneumothoraxQ Electrolyte Abnormalities in TPN Hyponatremia and hypernatremiaQ Hypokalemia and HyperkalemiaQ Hypophosphatemia and hyperphosphatemiaQ Hypomagnesemia and HypermagnesemiaQ Hypocalcemia and hypercalcemiaQ High zinc and low zincQ High copper and low copperQ Hyperchloremic metabolic acidosisQ

So the answer to this question is C


Instruction:
The corduroy sign refers to
A. Veically oriented thickened trabeculae in hemangioma
B. Horizontally oriented thickened trabeculae in hemangioma
C. Veically oriented thickened trabeculae in chordoma
D. Horizontally oriented thickened trabeculae in chordoma

Response:
The corduroy sign refers to veically-oriented, thickened trabeculae seen in intraosseous haemangiomas of the spine. It is the sagittal/coronal equivalent of the polka-dot sign seen on axial imaging. It is caused by the replacement of the normal cancellous bone by thickened veical trabeculae surrounded by fat marrow or vascular lacunae in intraosseous haemangiomas.

So the answer to this question is A


Instruction:
Endemic ascites is caused by –
A. Argemone mexicana seed
B. Khesari dal
C. Jhunjhunia seeds
D. Ergot poisoning

Response:
None

So the answer to this question is C


Instruction:
Single umblical aery is associated with?
A. NTD
B. Hydrops fetalis
C. Congenital hea disease
D. In utero death

Response:
Ans. is `c'i.e., Congenital hea disease Approximately 30% of infants with a single umbilical aery have congenital abnormalities. Trisomy 18 is one of the more frequent abnormalities. The most common congenital anomalies in chromosomally normal fetuses and neonates were. Genitourinary (6.48%) Cardiovascular (6.25%) Musculoskeletal (5.44%).

So the answer to this question is C


Instruction:
HLA is present on –
A. Short arm of chromosomes 6
B. Short term of chromosomes 3
C. Long arm of chromosomes 3
D. Long arm of chromosomes 6

Response:
o HLA complex (MHC) gene is located on the short arm of chromosome 6.
o The histocompatibility antigens (human leukocyte antigens - HLA) are cell surface antigens that induce
an immune response leading to the rejection of allografts.
o The principal physiologic function of the cell surface histocompatibility molecules is to bind peptide
fragments of foreign proteins for presentation to antigen-specific T cells.
o The histocompa

So the answer to this question is A


Instruction:
Rhabditiform  larvae in freshly passed stools are seen with -
A. Toxoplasma
B. Trichuris
C. Ankylostoma
D. Strongyloides

Response:
None

So the answer to this question is D


Instruction:
Lipodermatosclerosis is most commonly seen on:
A. Anterior aspect of leg
B. Medial aspect of leg
C. Anterior aspect of thigh
D. Posterior aspect of thigh

Response:
Lipodermatosis is mostly seen over the medial aspect of the leg above the medial malleolus. Lipodermatosclerosis: It is also known as sclerosing panniculitis. It is characterized by tender, subcutaneous nodules accompanied by hyperpigmentation, telangiectasias, touous veins, edema and woody infiltration. It usually affects women older than 40 years of age. Histopathology shows inflammation of the panniculitis in addition to dermal sclerosis. Treatment consist of application of suppo stockings with a 30 -40 mmHg gradient. Ref: Primer on the Rheumatic Diseases edited by John H. Klippel, 13th edn, page 496

So the answer to this question is B


Instruction:
Which of the following ulcers are characteristically painless
A. Trauma
B. Tuberculosis
C. Primary syphilis
D. Herpes

Response:
None

So the answer to this question is C


Instruction:
Tarso-metatarsal amputation is k/a?
A. Chopa's amputation
B. Lisfranc amputation
C. Pirogrof amputation
D. Syme's amputation

Response:
Mid-foot Amputation Type Level of Amputation Lisfranc Tarsometatarsal joint Chopa Intearsal joint (Chopa's - Intearsal = CIT) Pirogoff Calcaneus is rotated forward to be fused to tibia after veical section through its middle. Syme's 0.6cm above talar dome

So the answer to this question is B


Instruction:
Most common site for carcinoid tumor is
A. Esophagus
B. Lung
C. Appendix
D. Ileum

Response:
Carcinoid tumour arise from the enterochromaffin cells (Kulchitsky cells) found in the crypts of Lieberkuhn. These cells are capable of APUD (Amine precursor uptake and Decarboxylation) and can secrete vasoactive amines like 5- HT, 5-HIAA, 5-HTP; tachykinins, peptides (chromogranins)and PGs. It commonly occurs in appendix (45%), ileum (25%) and rectum (15%). Other (15%) sites are--other pas of GIT (including pancreas and biliary tract), bronchus and testis. Reference: page 877 SRB's manual of surgery 5th edition.

So the answer to this question is C


Instruction:
Even in large dosages used in malaria, quinine does not cause toxicity, because -
A. It enters in fat cells
B. Elevated plasma alpha acid glycoprotein
C. Deposited in infected RBC's
D. Excreted rapidly in urine

Response:
Ans. is 'b' i.e., Elevated plasma alphai acid glycoprotein o Patient with malaria can achieve high plasma level of quinine with few signs of toxicity because of the elevated plasma alphal acid glvcoproteins, produced during acute phase of infection. It prevents quinine toxicity through binding of most of the drug in the plasma.

So the answer to this question is B


Instruction:
Which of the following is associated with hyponatremia and low osmolality
A. Hyperlipidemia
B. SIADH
C. CHF
D. CKD

Response:
Ans. is 'c' i.e., CHF CHF is characterised by low perfusion of kidneys stimulating R.A.A.S and resultant absorption of salt and dispropoionate amout of water would lead to hyponatremia with decreased osmolality. Isotonic hyponatremia is seen with hyperlipidemia and hvperproteinemia like in paraproteinemia. Intravenous immunoglobulin therapy also interferes with measurement of serum sodium. Major causes of hyponatremia Disorders in which ADH levels are elevated Effective circulating volume depletion True volume depletion Hea failure Cirrhosis Thiazide diuretics Syndrome of inappropriate ADH secretion, including reset osmostat pattern Hormonal changes Adrenal insufficiency Hypothyroidism Pregnancy Disorders in which ADH levels may be appropriately suppressed Advanced renal failure Primary polydipsia Beer drinker's potomania Hyponatremia with normal or elevated plasma osmolality High plasma osmolality (effective osmols) Hyperglycemia Mannitol High plasma osmolality (ineffective osmols) Renal failure Alcohol intoxication with an elevated serum alcohlo concentration Normal plasma osmolality Psedohyponatremia (laboratory aifact) High triglycerides Chloestatic and obstructive jaundice (lipoprotein x) Multiple myeloma Absorption of irrigant solutions Glycine Sorbitol Mannitol

So the answer to this question is C


Instruction:
A 30-year-old man is noted to be anemic, with clinical jaundice and a palpable spleen on abdominal exam. Splenectomy is the only treatment for this patient's autosomal dominant disorder. Select the most likely diagnosis.
A. Thalassemia
B. Hereditary spherocytosis
C. Sickle cell disease
D. Idiopathic autoimmune hemolytic anemia

Response:
Hereditary spherocytosis is the most common symptomatic familial hemolytic anemia and is transmitted as an autosomal dominant trait. A defect in the red cell membrane causes increased trapping in the spleen and hemolysis. Anemia, jaundice, and splenomegaly are clinical findings. Splenectomy is the only treatment. Thalassemia is transmitted as a dominant trait; anemia is the result of a defect in hemoglobin synthesis. Thalassemia major, or homozygous thalassemia, is associated with anemia, icterus, splenomegaly, and early death. Transfusions are usually required. Splenectomy may reduce hemolysis and transfusion requirements. Sickle cell anemia is hereditary hemolytic anemia. Serum bilirubin may be mildly elevated. Splenomegaly often precedes auto infraction. Splenectomy may be indicated for chronic hypersplenism or acute splenic sequestration.

So the answer to this question is B


Instruction:
Hanging drop sign in x-ray is seen in -
A. Orbital floor fracture
B. Medial wall fracture
C. Lateral wall fracture
D. Superior margin fracture

Response:
Ans: a (Orbital floor fracture) Ref: AK Khurana, 4th ed, p. 398Hanging drop sign in roentgenogram is seen in orbital floor fracture.Orbital floor fractureThe most useful projection for detecting orbital floor fracture is waters view:Findings in x-ray include:Fragmentation and irregularity of orbital floorDepression of bony fragments"Hanging drop" opacity in the superior maxillary antrum. It is due to the herniation of orbital contents through the floor.

So the answer to this question is A


Instruction:
A primigravida is fully dilated with veex presentation. The head is well rotated and the station is +2. There is late deceleration on fetal hea monitoring. If the pelvis is adequate, the most appropriate management is this case would be :
A. Waiting for spontaneous delivery
B. Forceps delivery
C. Vaccum extraction
D. Cesarean section

Response:
Forceps delivery

So the answer to this question is B


Instruction:
Which of the following has the worst prognosis
A. Cholecystectomy
B. Splencetomy
C. Nephrectomy
D. Appendicetomy

Response:
None

So the answer to this question is B


Instruction:
Best marker for prediction of coronary aery disease aEUR'
A. LDIJHDL
B. Serum cholesterol
C. Cholesterol/TG
D. Blood cholesterol

Response:
LDL/HDL Risk factors for atherosclerosis and cardiovascular complications (Braunwald) Abnormalities in plasma lipoproteins and derangement in lipid metabolism rank as the most firmly established risk factors for atherosclerosis. Adjusted relative risk for future cardiovascular events for selected lipid fractions and lipid rations in decreasing order are given in the following table Relative risk for future Lipid Fractions and lipid Cardiovascular events Ratios cardio * Total chotesterol : HDL Cholestrol Ratio (TC : HDLC) * Apopratein B100: HDL Cholesterol Ratio (APo B100: HDLC) * LDL Cholesterol : HDL Cholesterol Ratio (LDLC: HDLC) * Apoprotein 8100: Apoprotein A -1 (APO B100: APO Al) * Non HDL Cholesterol fraction * Apolipoprotein B -1 Fraction * * HDL cholesterol Fraction * Total cholesterol Fraction Decreasing Predictivity * Apolipoprotein Al Fraction of Risk * LDL cholesterol Fraction

So the answer to this question is A


Instruction:
Killian's Dehiscence is seen at the level of:
A. Superior Constrictor
B. Middle constrictor
C. Inferior Constrictor
D. Thyroepiglottis

Response:
Killian dehiscence also known as "Gateway of tears'' M/C site for esophageal tear (perforation) In posterior pharyngeal wall the inferior constrictor muscle is divide into two pa thyropharyngeus and cricopharyngeus. Thyropharyngeus has oblique fibers Cricopharyngeus has Transverse fibers. And that creates a triangular space. This is anatomical week space is known as Killian dehiscence.

So the answer to this question is C


Instruction:
The renal veins are derived from which of the following?
A. Vitelline veins
B. Umbilical veins
C. Anterior cardinal veins
D. Subcardinal veins

Response:
Subcardinal veins forms :- poion of IVC Renal veins Gonadal veins

So the answer to this question is D


Instruction:
Stereognosis will be lost in the lesion of:
A. Fasciculus gracilis
B. Fasciculus cuneatus
C. Anterior spinothalamic tract
D. Lateral spinothalamic tract

Response:
Stereognosis is the ability to identify an object by its touch, texture. The object is placed in hands and is identified without seeing it. Fine touch sensation from the upper limb is carried toward coex in fasciculus cuneatus. The tract also carries the finer aspects of touch. Perception of touch occurs in the somatosensory coex I (areas 3, 1, 2); analysis and interpretation of the touch is done in the somatosensory coex II (areas 5, 7).

So the answer to this question is B


Instruction:
A 65-year-old woman has noticed a slowly enlarging nodule on her face for the past 3 years. On physical examination, a 3-cm, nontender, mobile, discrete mass is palpable on the left side of the face, anterior to the ear and just superior to the mandible. The mass is completely excised, and histologic examination shows ductal epithelial cells in a myxoid stroma containing islands of chondroid like tissue and bone. This patient is most likely to have which of the following neoplasms?
A. Acinic cell tumor
B. Mucoepidermoid carcinoma
C. Pleomorphic adenoma
D. Primitive neuroectodermal tumor

Response:
Pleomorphic adenoma is the most common tumor of the parotid gland. These tumors are rarely malignant, although they can be locally invasive. An acinic cell tumor is composed of cells resembling the serous cells of the salivary gland; they are generally small, but about one sixth metastasize to regional lymph nodes. Mucoepidermoid tumors are less common than pleomorphic adenomas in major salivary glands. They may be high-grade and aggressive. Primitive neuroectodermal tumor, also known as an olfactory neuroblastoma, is a small, round, blue cell tumor that occurs in childhood. It is likely to arise in the nasopharyngeal region. Squamous cell carcinomas arise in the buccal mucosa and are invasive. Warthin tumors are uncommon and indolent, although they may be bilateral or multicentric.

So the answer to this question is C


Instruction:
Bromocriptine can be used in following conditions except
A. Hyperprolactinoma
B. Acromegaly
C. Parkinsonism
D. Diabetes insipudus

Response:
Refer KDT 7th/e Pg 239. Bromocripine is approved in diabetes mellitus not diabetes insipudus Bromocriptine is an ergoline derivative and dopamine agonist that is used in the treatment of pituitary tumors, Parkinson's disease, hyperprolactinaemia, neuroleptic malignant syndrome, and type 2 diabetes.

So the answer to this question is D


Instruction:
21 year old female presents with history of mild bilateral ptosis, proximal muscle weakness and easy fatiguability which among the following is best in diagnosing this condition aEUR'
A. Muscle biopsy
B. Edrophonium test
C. Repetitive nerve stimulation
D. Electro myography

Response:
Edrophonium test [Ref: Harrison 17th/e p. 2674; 16 /e p. 2520; Kanski 5th/e p. 6541 Occular involvement, proximal muscle weakness and easy fatiguability points towards myasthenia gravis. Diagnosis of myaesthenia gravis Several special diagnostic Tests for mysthenia gravis Electrophysiological Testing : (Repetitive nerve stimulation test) * Characteristic of myasthenia on electrophysiological testing is rapid reduction in the amplitude of muscle action potentials evoked during a series of repetitive stimulations of a peripheral nerve at a rate of 3 per second (decrementing response) * The traditional and simple method is to stimulate the nerve at 3 Hz and to measure the compound muscle action potential (a decrement of more than 10% when comparing the fifth to the first response is abnormal) Single fibre electromyography * This is more sensitive but technically more difficult than electrophysiological testing * Confirmatory but not specific. * This technique demonstrates an inconstancy in the firing of fibres connected to the same motor unit or a blocking of successive discharges from single muscle fibre belonging to the same motor unit. Edrophonium and Neostigmine test/Tensilon test * When edrophonium and neostigmine are given intravenously, it produces a transient improvement in strength in patients with myasthenia. * Edrophonium and neostigmine are anti cholinesterase so they prolong and exaggerate the effect of acetylcholine in the synapse and therefore provide an increment in muscle power in patient with myasthenia, * It is highly sensitive with 85%2 sensitivity in ocular and 95%e sensitivity in systemic myaesthenia. Measurement of receptor antibodies in the blood: ... * * Measurement of antiacetylclzoline receptor antibodies provides a sensitive and highly specific test for the diagnosis of myasthenia. Presence of Ach antibodies is viually diagnostic of Myaesthenia graves. * Sensitivity is limited to about 50% in purely occular myasthenia and about 85% in generalized myasthenia. * Definitive if positive but negative test does not rules out the diagnosisdeg. The question has specifically asked which test would be most useful "to diagnose" myaesthenia gravis. The electrophysiological tests such as EMG and repetitive nerve stimulation test are quite sensitive test used for the diagnosis of myasthenia gravis, but they are not diagnostic. Abnormality in these tests denotes some defect in neuromuscular conduction. It does not mean that these neuromuscular conduction defects are due to myasthenia gravis. Edrophonium test is more diagnostic than electrophysiological test for the diagnosis of myasthenia gravis. Also know Most specific test to diagnose myaesthenia gravis Anti - AchR antibody test (presence of Anti - AchR antibody is viually Diagnostic of myaesthenia gravis) Most sensitive test to diagnose myaesthenia gravis Single fibre electromyography

So the answer to this question is B


Instruction:
Due to fear which of the following hormones increases rapidly?
A. Growth hormones
B. Epinephrine
C. Corticosteroid
D. Thyroid hormone

Response:
Adrenaline increases the activity of brain. Adrenaline secretion increases during ‘fight or flight reactions’ after exposure to stress. It enhances the cortical arousal and other facilitatory functions of central nervous system.
Reference: Essentials of Medical Physiology K. Sembulingam, Prema Sembulingam 6th ED P:442

So the answer to this question is B


Instruction:
Spalding's sign is seen in:
A. Still born
B. Live born
C. Premature
D. Dead born

Response:
Ans. is d, i.e. Dead bornRef. Dutta Obs. 9/e, p 303; Sheila Balakrishnan, p 249; Reddy 26/e, p 378, 379Spalding sign: It is the irregular overlapping of the cranial bones on one another, due to liquefaction of the brain matter and softening of the ligamentous structures supporting the vault.Appears 7 days after death.Is evident on both ultrasound and radiology?Similar features may be found in extrauterine pregnancy with live fetus.

So the answer to this question is D


Instruction:
A 52-year-old man presents to the eye clinic with painless vision loss of his right eye. He describes the visual loss as a gradual progression from blurry to total blackout over the past two hours. He has no history of prior visual problems. Past medical history is significant for a myocardial infarction three years ago. The patient takes 70mg of aspirin daily. Vital signs are normal. Physical examination reveals 20/20 vision of the left eye but no vision in the right eye. Extraocular muscles are intact. The neurologic examination is normal. The cardiac examination reveals an S4 hea sound. At the molecular level, which of the following components is essential for the first step of the visual cascade?
A. 11-cis-retinal
B. All-cis-retinal
C. All-trans-retinal
D. Meta-rhodopsin ll

Response:
The visual cascade: 11-cis-retinal + opsin -> rhodopsin + light -> meta-rhodopsin II. Meta-rhodopsin II dissociates after light exposure to form all-trans-retinal. 11-cis retinal and opsin are essential first steps in generating the photochemical visual cascade. All-cis-retinal is not a pa of the visual cascade. All-trans-retinal, meta-rhodopsin II, rhodopsin is a later pa of the visual cascade: 11-cis-retinal + opsin -> rhodopsin + light -> meta-rhodopsin II. Meta-rhodopsin II dissociates after light exposure to form all-trans-retinal. 11-cis retinal and opsin are essential first steps in generating the photochemical visual cascade.

So the answer to this question is A


Instruction:
Most common infection in patients with prosthetic valves is -
A. Pneumococcus
B. Pseudomonas
C. Staphylococcus
D. Enterococci

Response:
Ans. is 'c' i.e., Staphylococcus Microbiology of the infective endocarditiso A variety of microorganism can cause infective endocarditis.o Staphylococci and streptococci can account for the majority of cases# Staphylococcal infective endocarditis is substantially more common in health care asociated cases of infective endocarditis.# Streptococci remain common cause of community acquired infective endocarditis.The pathogens in infective endocarditiso S. Aureus-31%o Viridans group streptococci-17%o Enterococci-11%o Coagulase negative Staphylococci-11%o Streptococcus bovis-7%o Other streptococci-5%o Non HACEK gram negative bacteria-2%o Fungi-2%o HACEK-2%o Staphylococcus aureus accounts for more than half cases of infective endocarditis.o Streptococci and enterococci are the next most common pathogens.o Injection drug use endocarditis occure more commonly in young males.o Most cases of injection drug use endocarditis involve the right side of the heart.o The tricuspid valve is involved more commonly than the pulmonary valve.Prosthetic valve Endocarditis|||Early prosthetic valveEndocarditis(Within two months of implantation)Most frequently encounteredpathogens in late PVEo Staphylococcus aureus and coagulate negative staphylococci.o Next in frequency# Gram negative bacilli.# Fungal infection.o Streptococci and Staphylococcus aureus followed by coagulase negative staphylococci and enterococci.

So the answer to this question is C


Instruction:
Minimum dose of estrogen in combined OCP&;s
A. 20mcg
B. 30cg
C. 35mcg
D. 50mcg

Response:
.

So the answer to this question is A


Instruction:
Normal IQ is
A. 45
B. 85
C. 65
D. 100

Response:
IQ ranges of 70-80 Boderlline deficiency 80-90 dullness 90-110 normal/ average intelligence 110-120 superior intelliegnce 120-140 very superior intelligence >140 genius Ref: Wikipedia.

So the answer to this question is D


Instruction:
Hepatitis with cholestatic jaundice occurs most frequently as an adverse reaction to the following preparation of erythromycin :
A. Erythromycin base
B. Erythromycin stearate
C. Erythromycin estolate
D. Erythromycin ethyl succinate

Response:
None

So the answer to this question is C


Instruction:
Carcinoma cervix is caused by :
A. Herpes simplex type I
B. Papova virus
C. Ebstein virus
D. Adeno virus

Response:
Papova virus

So the answer to this question is B


Instruction:
Organ of corti is situated in
A. Basilar membrane
B. Utricle
C. Saccule
D. None of the above

Response:
Basilar membrane which support the organ of corti.

So the answer to this question is A


Instruction:
All are pas of low pressure system except:-
A. Flow meters
B. Hypoxia prevention safety device
C. Vaporiser
D. Pipeline system

Response:
Pipeline system comes under intermediate pressure system. Normal hospital pipeline supply pressure of all gases is at50-55 psig(USA). In India, it is 60 psig. Intermediate pressure system It includes the components of the machine which receive gases at reduced pressures usually 37-55 PSIG. This in older machines includes the O2 failure alarms and O2flush and in modern machines also include O2pressure fail safe systems, pipeline inlet connections, pipeline pressure gauges and ventilator power outlets. Low pressure system includes flowmeter assembly, vapouriser, hypoxia guard and common gas oulet.

So the answer to this question is D


Instruction:
A positive "Stallwohy&;s sign" is suggestive of which of the following conditions:
A. Twin pregnancy
B. Breech presentation
C. Vesicular mole
D. Low lying placenta

Response:
If the earlier scan showed placenta completely over the internal os it is most likely to persist in the later scans.If the 18 -20 weeks scan revealed a low lying placenta or marginal placenta prae,placental localization is best repeated around 32 weeks (refer pgno:130 sheila textbook of obstetrics 2 nd edition)

So the answer to this question is D


Instruction:
All are true about chromosomal instability syndrome except-
A. DNA repair defect
B. Autosomal dominant inheritance
C. Increased risk of malignancy
D. Associated immunodeficiency

Response:
Ans. is 'b' i.e., Autosomal dominant inheritanceo Chromosomal instability syndromes are typically transmitted in an autosomal recessive mode of inheritanceChromosome instability syndromeso They are a group of inherited conditions associated with chromosomal instability and breakage. The disorders are characterized by a defect in DNA repair mechanisms or genomic instabilityo Susceptibility to exogenous genotoxic agents such as ultraviolet (UV) light, oxidative stress, and chemical mutagens, can also lead to a variety of nucleotide modifications and DNA strand breakso Patients with these disorders show increased predisposition to cancer.o Another hallmark of these disorders is immunodeficiency, a phenotype caused by an inability to properly repair DNA strand breaks that occur during development of the immune system,o Important chromosomal syndromes are1) Ataxia telangiectasia2) Ataxia telangiectasia-like disorder3) Bloom syndrome4) Fanconi anaemia5) Nijmegen breakage syndrome6) Xeroderma pigmentosum,7) Cockayne's syndrome

So the answer to this question is B


Instruction:
A dense persistent nephrogram may be seen in all of the following except:
A. Acute ureteral obstruction
B. Systemic hypeension
C. Severe hydronephrosis
D. Dehydration

Response:
B i.e. Systemic hypeension

So the answer to this question is B


Instruction:
Good prognosis factors of ALL are all except ?
A. Hyperdipoidy
B. W BC cound < 5000
C. Age > 10 years
D. T (12:21) translocation

Response:
Ans. is 'c' i.e., Age > 10 years o Age more than 10 years has bad prognosis.

So the answer to this question is C


Instruction:
Oxidative injury of the red blood cells leading to heamolysis is associated with of the following clinical conditions?
A. G6PD deficiency
B. Hereditary spherocytosis
C. Sickle cell anemia
D. Hemophilia

Response:
Glucose-6-phosphate dehydrogenase catalyzes the initial step in the hexose monophosphate (HMP) shunt, oxidizing glucose-6-phosphate to 6- phosphogluconolactone and reducing nicotinamide adenine dinucleotide phosphate (NADP) to NADPH. The main function of the HMP shunt is to protect red blood cells against oxidative injury the production of NADPH. Red blood cells contain relatively high concentrations of reduced glutathione (GSH) which is protective against oxidant injury. The oxidants, such as super oxide anion (O2-) and hydrogen peroxide, are formed within red cells due to reactions of hemoglobin with oxygen and due to drugs or infections. They accumulate within red cells and cause oxidation of hemoglobin and other proteins leading to loss of function and cell death. The combined effect of HMP shunt to glutathione metabolism is responsible for protecting intracellular proteins from oxidative stress. G6PD deficiency results in hemolytic episodes related to altered HMP shunt and glutathione metabolism. The cells that over express G6PD are protected against oxidative injury.

So the answer to this question is A


Instruction:
A 26 yr. old woman with a known case of mitral valve replacement done 2 years back for severe MS, currently on therapeutic anticoagulation with 5mg daily Warfarin, wants to conceive and has come for preconception counseling. All are true except:
A. The risk for warfarin embryopathy is around 6%
B. Warfarin should be stopped periconceptionally and switch over to heparin
C. Anticoagulation has to continue throughout pregnancy
D. The prognosis for her pregnancy depends on her NYHA class

Response:
Ans. B. Warfarin should be stopped periconceptionally and switch over to heparinThe pregnancy outcome and prognosis of mitral stenosis is related to the functional capacity of the woman with the mortality rising considerably in the NYHA class III & IV group. Prognosis is also worsened when the mitral valve area is <2cm2. Therefore, pregnancy is contraindicated in these women and termination is advised. Such lesions should be treated, and cardiac status optimized before conceiving.Women who have undergone valve replacement are on therapeutic anticoagulation with warfarin when they have a metallic valve in situ. Warfarin is the most effective for preventing maternal thromboembolic complications. But warfarin also leads to embryopathy, 6%, the risk being highest when the mean daily dose exceeded 5mg.Therefore, warfarin is stopped once pregnancy is confirmed and heparin is substituted till 12 weeks, following which warfarin is restarted for the remainder of pregnancy till 36 weeks. Warfarin is not recommended during labor as it can lead to post-partum hemorrhage.Beyond 36 weeks' heparin is started again because its effect can be controlled, it does not affect the synthesis of clotting factors and a specific antidote in the form of protamine sulfate is available. Heparin is also discontinued just before delivery.Anticoagulant therapy with warfarin or heparin may be restarted 6hr following vaginal delivery or 24hr after caesarean section.

So the answer to this question is B


Instruction:
Cyclodevelopmental stage is seen in -
A. Malaria
B. Filaria
C. Plague
D. Cholera

Response:
(A) propagative: The agent merely multiplies in the vector but no change in the form e.g plague bacilli in rat fleas (B) cyclopropagative : The agent changes in number and form e.g malaria parasite in the mosquito (C) cyclodevelopmental: The disease agent undergoes only developmental but no multiplication e.g microfilaria in mosquito (refer pgno:98 park 23 rd edition)

So the answer to this question is B


Instruction:
Putrefaction is delayed in all, except: NEET 14
A. Warm moist atmosphere
B. Carbolic acid poisoning
C. Anemia
D. Heavy metal poisoning

Response:
Ans. Warm moist atmosphere

So the answer to this question is A


Instruction:
Roth spots are seen in:
A. Infective endocarditis
B. Central retinal vein occlusion
C. Retintits pigmentosa
D. Diabetic retinopathy

Response:
Ans: A (Infective endocarditis) Ref; Harrisons Principles of Internal Medicine 18th edition ROTH SPOTS in Infective Endocarditis They are retinal hemorrhages with pale centres. They represent capillary hemorrhages and not bacterial infection. Apart from IE, they can also be seen in vasculitis, anemia, leukemia, diabetes and carbon monoxide poisoning. Explanation: Roth's spots are retinal hemorrhages with w hite or pale centers composed of coagulated fibrin. They are typically seen using an ophthalmoscope or slit lamp exam. They are usually caused by immune complex mediated vasculitis often resulting from bacterial endocarditis. Roth's spots may also be seen in Leukemia Diabetes Subacute bacterial endocarditis Pernicious anemia Ischemic events HIV retinopathy Manifestations of Infective Endocarditis HISTORY Prior congenital or rheumatic heart disease Preceding dental, urinary tract, or intestinal procedure Intravenous drug use Central venous catheter Prosthetic heart valve SYMPTOMS Fever Chills Chest and abdominal pain Arthralgia, myalgia Dyspnea Malaise, weakness Night sweats Weight loss CNS manifestations (stroke, seizures, headache) SIGNS Elevated temperature Tachycardia Embolic phenomena (Roth spots, petechiae, splinter nail bed hemorrhages, Osier nodes, CNS or ocular lesions) Janeway lesions (painless small erythematous or hemorrhagic lesions on the palms and soles) New or changing murmur Splenomegaly Arthritis Heart failure Arrhythmias Metastatic infection (arthritis, meningitis, mycotic arterial aneurysm, pericarditis, abscesses, septic pulmonary emboli) Clubbing LABORATORY Positive blood culture Elevated erythrocyte sedimentation rate Elevated C-reactive protein Anemia Leukocytosis Hypergammaglobulinemia Hypocomplementemia Cryoglobulinemia Rheumatoid factor Hematuria Renal failure: azotemia, high creatinine (glomerulonephritis) Chest radiograph: bilateral infiltrates, nodules, pleural effusions Echocardiographic evidence of valve vegetations, prosthetic valve dysfunction or leak, myocardial abscess, new-onset valve insufficiency

So the answer to this question is A


Instruction:
Which of the following is not used in pre-eclampsia?
A. Methyldopa
B. Atenolol
C. Labetalol
D. Hydralazine

Response:
(B) Atenolol[?]Objectives of treatment of Pre-Eclampsia:To stabilise hypertension & to prevent its progression to severe pre-eclampsia.To prevent the complicationsTo prevent eclampsiaDelivery of a healthy baby in optional time.Restoration of the health of the mother in puerperium.ANTIHYPERTENSIVE DRUGS USED IN PREGNANCYThese agents* may be used with chronic hypertension (DBP>100mmHg) or acute hypertension (DBP>105mmHg)Central Alpha agonistsMethyldopa is the drug of choiceBeta blockers & Alpha, beta blockersAtenolol, metoprolol & labetalo) appear safe & effective in late pregnancyCalcium antagonistsPotential synergism with magnesium sulfate may lead to precipitous hypotension.[?]Treatment of Chronic Hypertension:Methyldopa, labetalol & nifedipine most common oral agents.AVOID: ACEI & ARBs, atenolol, thiazide diureticsWomen in active labor with uncontrolled severe chronic hypertension require treatment with intravenous labetalol or hydralazine.No other additional maternal/fetal complications = wait until >38w.Oral Antihypertensive for Control of Mild to Moderate Hypertension in Pregnancy*. Methyldopa*. A drug of first choice; Central & peripheral anti adrenergic action*. Labetalol*. A reasonable alternative; Adrenoceptor antagonist (Alpha & Beta blocker)*. Atenolol*. To be avoided*. Nifedipine*. Calcium channel blocker in late pregnancy; Calcium channel blocker*. Propranolol*. Can be used in late pregnancy*. Hydralazine*. Add on therapy to Methyldopa; Vascular smooth muscle relaxant*. ACE inhibitors*. To be avoided*. Diuretics*. Not to be used as antihypertensiveManagement of HTN disorder:Antihypertensive Therapy:Non-severe hypertension (BP:140-159/90-10gmmHg)-BP goal: w/o cormorbid - 130-155/80-105-BP goal: w/o cormorbid - 130/139/80-8gDrug of Choice: Methyldopa, labetalol, other beta blockers, CCB (nifedipine). (I-A)ACEi & ARBs should not be used. (II-2E)Atenolol & prazosin are not recommended.Level A;ACE inhibitors & angiotension receptor blockers; Contraindicated in all trimesters of pregnancy.Level B:Woman with severe HTN - require antihypertensive medication for acute | BP.Methyldopa & Labetalol; a good option for 1st line tx of chronic HTN in pregnancy - based on the overall low rate of adverse effects & good efficacy.Atenolol; not currently recommended due to IUGR.Thiazide used in women before pregnancy.No need to be discontinued during pregnancy.Antihypertensives use in Pre-Eclampsia:Have limited value in controlling blood pressure in pre-eclampsia.Indications for anti-hypertensive drugs are:-In persistent rise of blood pressure (If diastolic BP>110mmHg, & if urgent & associated with proteinuria).-In severe pre-eclampsia (to reduce BP during continued pregnancy & during period of induction of labor).

So the answer to this question is B


Instruction:
A female patient is having diarrhea and abdominal distension. Small intestinal biopsy shows villous atrophy and crypt hyperplasia. Diagnosis is ?
A. Celiac sprue
B. Tropical sprue
C. Whipples disease
D. Hirchsprung's disease

Response:
Ans. is 'a' i.e., Celiac sprueo Villous atrophy with crypt hyperplasia is characteristic of celiac disease (See previous explanations).

So the answer to this question is A


Instruction:
In Parvovirus infection what is common in adult
A. Bone marrow aplasia
B. PRCA
C. Erythema infectiosum
D. Arthropathy

Response:
Arthropathy occurs in ~50% of adults and is more common among women than among men.
The distribution of the affected joints is often symmetrical, with arthralgia affecting the small joints of the hands and occasionally the ankles, knees, and wrists.
Resolution usually occurs within a few weeks, but recurring symptoms can continue for months. Arthropathy is uncommon among children

So the answer to this question is D


Instruction:
Outer membrane action potential is maintained by influx of
A. Na+
B. Mg3+
C. K+
D. CA2+

Response:
Outer membrane action potential is maintained by influx of K+ Ref: guyton and hall textbook of medical physiology 12 edition page number:66,67,68

So the answer to this question is C


Instruction:
A patient presented with acute abdominal pain. On clinical suspicion the pt. underwent cholecystectomy. On histopathological examination the finding is normal. The gallbladder epithelium will be
A. Squamous epithelium
B. Simple columnar with brush border
C. Simple columnar
D. Simple columnar with sterocilia

Response:
Inderbir Singh&;s Human Histology Seventh edition Pg A30 The mucous membrane of gallbladder is lined with simple columnar epithelium with brush border

So the answer to this question is B


Instruction:
Myotonic dystrophy:
A. CTG trinucleotide repeats
B. Dystrophin 1
C. Dystrophin 2
D. CAG repeats

Response:
Ans. A. CTG trinucleotide repeatsExplanationMyotonic dystrophy is an autosomal dominant multisystem disorder associated with skeletal muscle weakness, cataracts, endocrinopathy, and cardiomyopathy. The disease is caused by expansions of CTG triplet repeats in the 3'-noncoding region of the myotonic dystrophy protein kinase (DMPK) gene.

So the answer to this question is A


Instruction:
True about the orphan drug is:
A. Developed for orphans
B. Drugs used very rarely
C. Drugs used for rare diseases
D. Rare drug for common diseases

Response:
Orphan Drugs are drugs or biological products for diagnosis/treatment/prevention of a rare disease or condition, or a more common disease (endemic only in resource-poor countries) for which there is no reasonable expectation that the cost of developing and marketing it will be recovered from the sales of that drug.
The list includes sodium nitrite, fomepizole, liposomal amphotericin B, ancrod, rifabutin, succimer, somatropin, digoxin immune Fab (digoxin antibody), liothyronine (T3) and many more.

So the answer to this question is C


Instruction:
Which of the following antiarrhythmic drugs mediates its effect by interfering with movement of calcium through the slow channel?
A. phenytoin
B. verapamil
C. lidocaine
D. amiodarone

Response:
The slow channel for calcium assumes considerable importance in the region of the sinus node and AV node. For verapamil, this results in both antiarrhythmic and negative inotropic effects. Different classes of calcium channel blockers have differential effects on these slow channels, explaining the different clinical properties of the various calcium channel blocking drugs.

So the answer to this question is B


Instruction:
The concept of Social medicine was first introduced by-
A. Neumann and Virchow
B. Robe Grotjahn
C. John Ryle
D. Rene sand

Response:
Ans. is 'a' i.e., Neumann and virchow The seeds that medicine is a social science were sown late in the 19th century by pioneers such as Neumann and Virchow.

So the answer to this question is A


Instruction:
Borax is: NEET 13
A. Gastrointestinal irritants
B. Genitourinary irritants
C. Ecbolics
D. Emmenagogues

Response:
Ans. Emmenagogues

So the answer to this question is D


Instruction:
Lignocaine is useful for the treatment of :
A. Atrial fibrillation
B. Paroxysmal supraventricular tachycardia
C. Digitalis induced ventricular extrasystoles
D. All of the above

Response:
(Ref: KDT 6/e p502) Lignocaine is used only for the treatment of ventricular arrhythmias, it has no role in atrial arrhythmia.

So the answer to this question is C


Instruction:
Blood is flowing through a circuit with an inflow pressure of 100 mm Hg and an outflow pressure of 10 mm Hg. Each of the parallel circuits (R1, R2, R3, R4 and R5) has a resistance of 5 mm Hg/mL/min. What is the blood flow across this circuit?
A. 3.6 ml/min
B. 45 ml/min
C. 90 ml/min
D. 135 ml/min

Response:
In electrical theory, Ohm&;s law states that the resistance, R, equals the ratio of voltage drop, E, to current flow, I.R=E/ISimilarly, in fluid mechanics, the hydraulic resistance, R, may be defined as the ratio of pressure drop. Pi - Po, to flow, Q. P and P, are the pressures at the inflow and outflow ends, respectively, of the hydraulic system.R = P-PJOFor the resistance of vessels in parallel:1/R= l/R1 + 1/R2...... 1/R5Applying equation 3 to the given blood circuit, the resistance will be 1 mm Hg/mL/min. From Ohm&;s law (Equation 2), flow (Q) in a circuit would be,Q = P - Po/R By substituting corresponding values for inflow and outflow pressures, resistance of the given blood circuit in equation 4,Q= 100- 10/1 =90 mL/min(Refer: Ganong&;s Review of Medical physiology 23 edition, pg no: 602-604)

So the answer to this question is C


Instruction:
The impoant coreceptors for HIV to bind with CD4 receptors are:
A. CCR4 and CXCR3
B. CCR5 and CXCR4
C. CCR4 and CXCR5
D. CCR4 and CXCR2

Response:
The primary cellular receptor for HIV is CD4 (Helper subset of T cells). HIV has two major coreceptors: CCR5 and CXCR4 (for fusion and entry)ALSO KNOW:Kaposi's sarcoma cannot be explained completely by the immunodeficiency caused by HIV infection. Ref: Harrison, Edition-18, Page-1519.

So the answer to this question is B


Instruction:
Which one of the following factors is labelled as cytokine in the pathogenesis of systemic inflammatory response syndrome (SIRS) ?
A. Nitric oxide
B. Complements
C. Leukotrienes
D. Tumor Necrosis factor

Response:
Ans. is 'd' i.e., Tumor Necrosis factor

So the answer to this question is D


Instruction:
Morphological stages of tooth development are explained based on:
A. Shape of enamel organ
B. Shape of tooth germ
C. Functions of enamel organ
D. Shape of dental papilla

Response:
Morphological stages of tooth development, i.e. bud, cap and bell stage are named after the shape of enamel organ.

So the answer to this question is A


Instruction:
Which of the following is treatment of choice for the treatment of a 2 month old child with C/C of watering and discharge of the eye with normal anterior and posterior chamber findings:-
A. Massage over lacrimal sac
B. Syringing and probing
C. Balloon catheter dilation
D. Dacryocystorhinostomy

Response:
Congenital Nasolacrimal Duct Obstruction Congenital NLDO- Membranous block of valve of Hasner Most open spontaneously by 4-6 weeks 90% resolve by 1st yr Management of NLDO Obstruction 0-6 months: Crigler massage (massage over lacrimal sac) 6 months - 2yrs: Syringing & Probing (can be repeated thrice) > 2 years: 3 failed probing attempts or more than 2 yr (preferably 4 years) of age you can go for DCR. Lacrimal scintigraphy -lacrimal scintigraphy mimicks "physiological" lacrimal outflow, being performed under pressure gradients

So the answer to this question is A


Instruction:
A 36 years old obese man was suffering from hypeension and snoring. Patient was a known smoker. In Sleep test, there were 5 apnea/hyperapneas episodes per hour. He was given antihypeensives and advised to quit smoking. Next line of management:
A. Uvulopalatopharyngeoplasty
B. Weight reduction and diet plan
C. Nasal CPAP
D. Mandibular repositioning sling

Response:
The primary treatments of obstructive sleep apnea are: weight loss in those who are overweight, continuous positive airway pressure, and mandibular advancement devices. There is little evidence to suppo the use of medications or surgery. Continuous positive airway pressure (CPAP) is effective for both moderate and severe disease. It is the most common treatment for obstructive sleep apnea. Adherence to CPAP is generally better than that to an MRS, and there is evidence that CPAP improves driving, whereas there are no such data on MRSs. Thus, CPAP is the current treatment of choice (for both moderate and severe disease). However, MRSs are evidence-based second-line therapy in those who fail CPAP.- Harrison 18/p2189 There is no proven evidence that pharyngel surgery, including uvulopalatopharyngoplasty (whether by scalpel, laser or thermal techniques) helps OSAHS patients.

So the answer to this question is B


Instruction:
Sublethal damage to DNA is caused by:
A. Deterministic effect
B. Stochastic effect
C. Both
D. None

Response:
Comparison of Deterministic and Stochastic effects of radiation (Very important and conceptual topic):

So the answer to this question is B


Instruction:
Choledochal cyst in intrahepatic biliary tree
A. I
B. II
C. IVa
D. IVb

Response:
Todani Modification of Alonso-Lej classification Type I - Dilation of extrahepatic biliary tree Type Ia- cystic dilation Type Ib - focal segmental dilation Type Ic- fusiform dilation Type II - Diveicular dilation of extrahepatic biliary tree Type III - Cystic dilation of intra duodenal poion of common bile ducts (choledochocele) Type IVA- Dilation of the extrahepatic and intrahepatic biliary tree Type IVB- Dilation of multiple secretion of extrahepatic bile ducts Type V - Dilation confined to intrahepatic bile ducts (caroli's disease) Type VI - Cystic dilation of cystic duct (not included in Todani's modification) Ref: Sabiston 20th edition Pgno :1510-1511

So the answer to this question is C


Instruction:
Bonney's test demonstrates:
A. Stress urinary incontinence
B. Urge incontinence
C. Overflow
D. All of the above

Response:
Ans. is a, i.e. Stress urinary incontinenceRef: Telinde 9th/ed, pl035-37Bonney's test is performed in the clinical evaluation of SUL In the Bonney's test, two fingers are placed in the vagina at the UV junction on either side of the urethra and the bladder neck is elevated.On straining or coughing, leakage of urine indicates of positive test. A positive test indicates that the SUI is due to bladder neck descent and urethral hypermobility and can be corrected by bladder neck suspension surgeries.A negative test i.e. leakage of urine-means SUI is due to intrinsic urethral sphincteric deficiency and results of performing bladder neck suspension surgery will not be good.Note: Marchetti test is same as Bonney's test, but two Allis forceps are used instead of fingers.

So the answer to this question is A


Instruction:
Sternocleidomastoid is supplied by all of the following aeries, EXCEPT:
A. Occipital
B. Posterior auricular
C. Thyrocervical trunk
D. Superior thyroid

Response:
The sternocleidomastoid muscle derives its blood supply from three separate sources: Superior-occipital aeryCentral-superior thyroid aeryInferior- thyrocervical trunkRef: Gray's anatomy: the anatomical basis of clinical practice by Henry Gray, Susan Standring, Harold Ellis, 2005, Page 536.

So the answer to this question is B


Instruction:
FIGLU excretion in the urine, is an index of the deficiency of:
A. Thiamine
B. Niacin
C. Pyridoxine
D. Folate

Response:
Folate

So the answer to this question is D


Instruction:
The thickness of thin rubber dam is:
A. 0.002 inch
B. 0.004 inch
C. 0.006 inch
D. 0.2 inch

Response:
None

So the answer to this question is C


Instruction:
Which of the following is not used in the management of thyroid storm -
A. Potassium iodide
B. Reserpine
C. Propranolol
D. Calcium channel blockers

Response:
Ans. is 'b' i.e., Reserpine Thyroid storm (thyrotoxic crisis) o It is an emergency due to decompensated hypehyroidism. o Treatment includes Non-selective b-blocker o It is the most valuable measure in thyroid storm. In thyroid storm most of the symptoms are because of adrenergic overactivity due to increased tissue sensitivity to catecholamines in hypehyroidism. This increased sensitivity is due to increased number of b-receptors. So, quick relief can be obtained by blocking b-receptors. Prophythiouracil o It is the antithyroid drug of choice for thyroid storm because it reduces hormone synthesis as well as peripheral conversion of T4 to T3. Note: Prophylthiouracil is the DOC amongst antithyroid drugs, but the DOC for thyroid storm is 13-blockers. Coicosteroid (Hydrocoisone) o It inhibits both release of thyroid hormone from the gland and peripheral conversion of T4 to T3. Iodides (Potassium iodide or ipanoic acid) o They are used to inhibit fuher hormone release from the gland. Diltiazem (a calcium channel blocker) may be added if tachycardia is not controlled by propranolol alone. Rehydration, anxiolytics, external cooling and appropriate antibiotics are the other measures.

So the answer to this question is B


Instruction:
The tricyclic antidepressant with LEAST autonomic and cardiotoxic effects: March 2004
A. Amitriptyline
B. Desipramine
C. Lofepramine
D. Protriptyline

Response:
Ans. C i.e. Lofepramine

So the answer to this question is C


Instruction:
Which is true of alveolar bone
A. Most stable of the periodontal tissues
B. It is in a constant state of flux
C. It is not regulated by systemic and local influences
D. All of the above

Response:
None

So the answer to this question is B


Instruction:
Mendelson syndrome is due to – a) Aspiration pneumonitisb) Chemical pneumonitisc) Oesophagitisd) Oesophageal spasm
A. ac
B. ab
C. ad
D. bc

Response:
Mendelson's syndrome is aspiration pneumonitis caused by aspiration of gastric fluid into the lung.
Aspiration pneumonitis is a chemical pneumonitis due to chemical reaction produced by gastric acid.

So the answer to this question is B


Instruction:
Which of the following soft tissue tumor has characteristic nuclear palisading pattern?
A. Fibrosarcoma
B. Embryonal Rhabdomyosarcoma
C. Synovial sarcoma
D. Schwannoma

Response:
Pecular alignment of nuclei into parallel rows is called nuclear palisading. The bands of palisading nuclei alternated with clear zones devoid of nuclei is together called veroccy bodies. All this characteristic histological finding is Schwannoma.

So the answer to this question is D


Instruction:
Point source epidemic tends to -
A. Continue over one incubation period
B. Produce multiple peaks in the epidemic curve
C. Be explosive
D. Tail gradually

Response:
None

So the answer to this question is C


Instruction:
Digoxin toxicity is increased by all except:
A. Renal impairment
B. Hyperkalemia
C. Hypercalcemia
D. Hypomagnesemia

Response:
Hypokalemia increases the binding of digoxin to Na-k ATPase and enhances its toxicity. Hypokalemia decreases digoxin toxicity Diuretics also interfere with the action of digoxin (REF. Essentials of medical pharmacology KD TRIPATHI 8th Edition)

So the answer to this question is B


Instruction:
Cell lining of common bile duct is ?
A. Stritified Columnar
B. Stratified squamous
C. Simple cuboidal
D. Simple columnar

Response:
Ans. is 'd' i.e., Simple columnar Gall bladder and common bile ducts are lined by simple columnar epithelium.

So the answer to this question is D


Instruction:
In an alcoholic man, Blackout is seen in
A. Alcohol abstinence
B. Hepatic encephalopathy
C. Alcohol intoxication
D. Alcohol withdrawal

Response:
Acute Intoxication After a brief period of excitation, there is a generalised central nervous system depression with alcohol use. With increasing intoxication, there is increased reaction time, slowed thinking, distractibility and poor motor control. Later, dysahria, ataxia and incoordination can occur. There is a progressive loss of self-control with frank disinhibited behaviour. The duration of intoxication depends on the amount and the rapidity of ingestion of alcohol. With blood alcohol levels of 300-450 mg%, increasing drowsiness followed by coma and respiratory depression develop. Death occurs with blood alcohol levels between 400 to 800 mg%. Occasionally a small dose of alcohol may produce acute intoxication in some persons. This is known as pathological intoxication. Another feature, sometimes seen in acute intoxication, is the development of amnesia or blackouts. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 37

So the answer to this question is C


Instruction:
Ramsay Hunt syndrome involves:
A. 7th cranial nerve
B. 5th cranial nerve
C. 12th cranial nerve
D. 10th cranial nerve

Response:
Ans: a (7th cranial nerve) Ref: Harrison, 16th ed, p. 1043; Dhingra, 4th ed, p. 95,17th ed, p. 1103Ramsay Hunt syndrome (Herpes zoster oticus)Ipsilateral facial nerve palsy with vesicular rash in external auditor)' canal and pinna.Geniculate ganglion of sensory branch of facial nerve is involvedManagement: similar to Bell's palsyMelkersson's syndrome:Idiopathic disorder consisting of triad of facial paralysis, swelling of lips and fissured tongue.It may be recurrent.Treatment is similar to Bell palsyCauses of recurrent facial palsiesBell palsyMelkersson syndromeDiabetesSarcoidosisTumoursGuillain -Barre syndromeSarcoidosisSickle cell diseaseAcute leukemiaBulbar palsyLeprosy

So the answer to this question is A


Instruction:
Drug of choice for absence seizure is ?
A. Clonezapam
B. Diazepam
C. Phenytoin
D. Valproate

Response:
Ans. is 'd' i.e., Valproate o DOC for generalized tonic clonic seizure (Grand mal), absence seizure (petit mal), Atonic seizure, mvoclonic epilepsy valproate. o DOCfOr paial seizure --) carbamazepine / oxcarbazepine DOC for status epilepticus -4 IV lorazepam o DOC forfebrile seizures Rectal Diazepam o DOC for seizure of eclampsia Magnesium sulfate. o DOC for infantile spasm --) Vigabatrin. o DOC.for myoclonic epilepsy -* Valproic acid.

So the answer to this question is D


Instruction:
All of the following are known risk factors for development of endometrial carcinoma except :
A. Obesity
B. Family History
C. Use of Hormone Replacement Therapy
D. Early Menopause

Response:
Ans. is d i.e. Early menopause Friends, this is the most frequently asked question on Endometrial cancer. Mug up predisposing factors by hea. Endometrial carcinoma occurs as a result of unopposed estrogen exposure in body. Predisposing factors are : Family Family history Has Hypeension m Obesity L Late menopause / Early menarche Diabetes A Atypical endometrial hyperplasia U Unopposed estrogen or increased estrogen in body as in : H Fibroid PCOD Feminizing ovarian Tumour N Nulliparity H/o infeility / menstrual irregularity Mnemonic : Family has OLD AUNT Oral contraceptive pills (combined addition of Progesterone to H). Smoking (as it decreases leygirtpf estrogen, decreases weight& is associated with earlier age at menopause). H Fibroid PCOD Feminizing ovarian Tumour

So the answer to this question is D


Instruction:
In a pregnant female, there is decreased requirement of the spinal anaesthetic agent because of all of the following except:
A. Exaggerated lumbar lordosis
B. Decreased volume of sub arachnoid space
C. Engorgement of epidural veins
D. Increased sensitivity of the nerves to anaesthetic agent

Response:
Ans. a. Exaggerated lumbar lordosis In a pregnant female, there is decreased requirement of the spinal anaesthetic agent because of decreased volume of sub arachnoid space, engorgement of epidural veins and increased sensitivity of the nerves to anaesthetic agent (but not due to exaggerated lumbar lordosis). Spinal Anesthesia Spinal anesthesia blocks nerve roots as they course through the subarachnoid space. The spinal subarachnoid space extends from the foramen magnum to the S2 in adults and S3 in childrendeg. Injection of local anesthetic below Ll in adults and L3 in children helps avoid direct trauma to the spinal corddeg. Spinal anesthesia is also referred to a subarachnoid block or intrathecal injection Factors affecting the Level of Spinal Anesthesia Most impoant factors Other factors Baricity of anesthetic solutionQ Age Position of the patientQ CSF volumeQ During injectionQ Curvature of the spineQ Immediately after injectionQ Drug volumeQ Drug dosageQ Intra-abdominal pressureQ Site of injectionQ Needle directionQ Patient heightQ PregnancyQ CSF volume inversely correlates with level of anesthesia. Increased intra-abdominal pressure or conditions that cause engorgement of the epidural veins, thus decreasing CSF volume, are associated with higher blocksdeg. This would include conditions such as pregnancyQ, ascites, and large abdominal tumorsQ In these clinical situations, higher levels of anesthesia are achieved with a given dose of local anesthetic than would otherwise be expected. For spinal anesthesia on a term paurient, the dosage of anesthetic can be reduced by one-third compared with a non-pregnant patientQ. Age-related decreases in CSF volume are likely responsible for the higher than expected level, paicularly with a hypobaric technique or rapid injection. During pregnancy progesterone also increases sensitivity of nerves to local anesthetics thus decreasing the doseQ.

So the answer to this question is A


Instruction:
HACEK group of organism includes all except
A. Haemophilus aphrophilus
B. Acinctobacter baumannii
C. Cardiobacterium hominis
D. Eikenella corrodens

Response:
Acinetobacter baumannii Repeat from May 2008

So the answer to this question is B


Instruction:
Physical withdrawal symptoms are not marked in patients abusing:
A. Pethidine
B. Cannabis
C. Opium
D. Alcohol

Response:
Cannabis

So the answer to this question is B


Instruction:
Which of the following indicator is used for growth monitoring at Anganwadi centre?
A. Height for age
B. Mid arm circumference
C. Weight for age
D. Height for weight

Response:
ANGANWADI CENTRE ICDS GROWTH CHA Nutritional staus of the child is assessed against Weight for age Separate chas for girls and boys 3 zones: Normal zone (grey), Under-nutrition below -2 SD (light grey), severe underweight below-3 SD (dark grey).

So the answer to this question is C


Instruction:
Which laser is used in the management of after cataracts:
A. Argon
B. Krypton
C. Nd-YAG
D. Excimer

Response:
Ans. Nd-YAG

So the answer to this question is C


Instruction:
A lady has B/L hearing loss since 4 years which worsened during pregnancy. Type of impedence auditometry graph will be :
A. Ad
B. As
C. B
D. C

Response:
Ans. is 'b' i.e. As Bilateral painless hearing loss in 25 yr old female accentuated with pregnancy is suggestive of otosclerosis or otospongiosis Tympanometry shows as curve due to ossicular stiffness. Tympanometry Is based on the principle of reflection of sound energy when sound strikes tympanic membrane, some of the sound energy is absorbed while the rest is reflected. A stiffer tympanic membrane would reflect more of sound energy than a compliant one. By changing the pressures in a sealed external auditory canal and then measuring the reflected sound energy, it is possible to find the compliance or stiffness of the tympano-ossicular system and thus find the healthy or diseased status of the middle ear. By charting the compliance of tympano-ossicular system against various pressure changes, different types of graphs called tympanograms are obtained. These tympanograms are diagnostic of certain middle ear pathologies. Types of tympanograms Type A Normal tympanogram Type As Reduced compliance at or near ambient air pressure. Seen in fixation of ossicles, eg. otosclerosis or malleus fixation. Type Ad Increased compliance at or near ambient pressure. Seen in ossicular discontinuity or thin and lax tympanic membrane. Type B Flat or dome shaped graph. Seen in middle ear fluid or thick tympanic membrane. Type C Maximum compliance at pressures more than -100 mm H20 (negative pressure in middle ear) eg. eustachian tube obs truction or early stage of serous otitis media.

So the answer to this question is B


Instruction:
True about Arboviruses is
A. Yellow fever is endemic in India
B. Dengue has only one serotype
C. KFD was first identified in West Bengal
D. Chikungunya is transmitted by Aedes aegypti

Response:
Ans is 'd' i.e. Chikungunya is transmitted by Aedes aegypti Arbovirus (arthropod borne) is a term used to refer to a group of viruses that are transmitted by arthropod vectors. Most important vectors are mosquitos and ticks.These viruses are maintained in nature principally, or to an important extent through biological transmission between susceptible vertebrate hosts by hematophagous arthropods; they multiply in the tissues of arthropods, and are passed on to new vertebrates by the bites of arthropod after a period of incubation.Although arboviruses are many, only a small number of them are known to be capable of producing disease. A high proportion of the infection is inapparent. Three clinical syndromes have been described:Febrile illness- Chikungunya, DengueHaemorrhagic fever- Dengue, Chikungunya, KFDEncephalitis- Japanese encephalitisChikungunya virus is transmitted to humans by Aedes mosquito (commonly Aedes aegypti). Yellow fever does not exist in India.Yellow fever is largely confined to Central and South America and Africa.Dengue has four serotypesFour types of dengue virus exist-DENI, DEN2, DEN3, DEN4.KFD was first identified in Karnataka.In 1957, several dead monkeys were noticed in Kyasanur forest in Karnataka along with a severe prostrating illness in some of the villagers in the area.

So the answer to this question is D


Instruction:
Milian&;s ear sign is seen in
A. Erysipelas
B. Cellulitis
C. Erysipeloid
D. None of the above

Response:
Erysipelas Erysipelas is a common infection involving the upper dermis and lymphatics, where as cellulitis involves the deeper dermis and subcutaneous fat. (1) Ear involvement is called Milian's ear sign, and it is a feature distinguishing erysipelas from cellulitis, because the pinna has no deeper dermis and subcutaneous tissue. (2) Bilateral ear erysipelas is rare, but it should be considered in the differential diagnosis when encountering patients with bilateral red ears. Ref:- Madke B, Nayak C. Eponymous signs in dermatology

So the answer to this question is A


Instruction:
Embryo proper is derived from which pa of morula:
A. Inner cell mass
B. Outer cell mass
C. Both of the above
D. None of the above

Response:
Approximately 3 days after feilization, cells of the compacted embryo divide again to form a 16-cell morula (mulberry). Inner cells of the morula constitute the inner cell mass, and surrounding cells compose the outer cell mass. The inner cell mass gives rise to tissues of the embryo proper, and the outer cell mass forms the trophoblast, which later contributes to the placenta. Ref: Langman's embryology 11th edition Chapter 3.

So the answer to this question is A


Instruction:
Most common salivary gland tumor in children:
A. Lymphoma
B. Adenoid cystic Ca
C. Pleomorphic adenoma
D. Mucoepidermoid Ca

Response:
The commonest benign tumor encountered is pleomorphic salivary adenoma accounting for approximately 30% of all pediatric salivary neoplasma. The majority occur within the parotid gland. Most common malignant tumor of salivary gland in childhood: Mucoeidermoid carcinoma, approximately 50% followed by acinic cell carcinoma (20%)

So the answer to this question is C


Instruction:
Cherry red colour postmortem appearance is seen in-
A. Cyanide poisoning
B. Phosphorus
C. Arsenic
D. Mercury

Response:
(Cyanide poisoning) (8.40-P)Hydrocyanic acid (Cyanogen or prussic acid)*Externally - is the smell of bitter almonds from the body*Postmortem staining is pink often incorrectly referred to as cherry red***Rigor mortis sets in early if there have been convulsive seizures*Internally -*The smell of bitter almonds ***The mucous membrane of the stomach may be pink*Blood stained froth may be found in the trachea and bronchi*The brain and meninges are hyperaemic and petechial hemorrhages appear in the pleura and pericardium*Gastric mucous membrane which may be of a brick red to brown colour due to the formation of alkaline haematin.

So the answer to this question is A


Instruction:
Transferrin saturation is?
A. Serum iron/TIBC x100
B. TIBC/serum iron x100
C. TIBC/serum iron
D. Serum iron/TIBC

Response:
Ans. A. Serum iron / TIBC x100Transferrin saturation =TIBCSerumiron x100Usual valuesNormal reference ranges are:a. Serum iron: 60-170mg/mlb. TIBC:240-450mg/mlc. Transferrin saturation: 15-50% (males), 12-45% (females)

So the answer to this question is A


Instruction:
Which index is used in relation to Hookworm infestation -
A. Quetelet's index
B. Chandler's index
C. Soiling index
D. Broca's index

Response:
Ans. is 'b' i.e., Chandler's index o Has been explained in previous sessions

So the answer to this question is B


Instruction:
This disease is
A. Osteochondrosis of the lunate
B. Osteochondrosis of the navicularq
C. Tuberculosis of the scaphoid
D. Syphilitic dactylitis

Response:
Osteochondrosis of the tarsal navicular (Kohler's disease) is characterised by aseptic necrosis of the Navicular bone causing a painful limp in a child usually 4-10 years of age.

So the answer to this question is B


Instruction:
which of the following is also called as milk sugar
A. mannose
B. glucose
C. galactose
D. lactose

Response:
Lactose is the milk sugar; a disaccharide made of galactose and glucose.
Reference: Vasudevan 7th  ed, pg 77

So the answer to this question is D


Instruction:
Black patch delirium is seen in
A. Dart skinned individuals
B. Patients with malignant melanoma
C. Patients with 3 degree burns
D. Post cataract surgery patient

Response:
Delirium can develop after cataract surgery in ilder patient who wear eye patches.Delirium caused by this sensory deprivation is called as "Black patch" delirium.

So the answer to this question is D


Instruction:
A 45 yrs old man presents with progressive cervical lymph nodes enlargement, since 3 months; most diagnostic investigation is -
A. Xray soft tissue
B. FNAC
C. Lymph node biopsy
D. None of the above

Response:
Ans. is 'c' i.e., Lymph node biopsy Harrison writes that in cases of lymphadenopathy, if the patient's history and physical findings are suggestive of malignancy, then a prompt lymph node biopsy (excisional biopsy) should be done. FNAC is not of much use, as it does not provide enough tissue to reach a diagnosis. ("FNAC should be reserved for thyroid nodules and for confirmation of relapse in patients whose primary diagnosis is known." - Harrison)

So the answer to this question is C


Instruction:
A patient is having a malignancy and has been suffering from severe pain. Which of the following opioid analgesics can be used as a transdermal patch for the alleviation of pain in him?
A. Morphine
B. Pentazocine
C. Fentanyl
D. Tramadol

Response:
None

So the answer to this question is C


Instruction:
C3a, C5a are called?
A. Chemotactic agent
B. Lytic complex
C. Opsonins
D. Anphylotoxins

Response:
Ans. is 'd' i.e., Anaphylotoxins * C5a, C3a 8c to a lesser extent C4a- are called anaphylotoxin because they have effects similar to those of mast cell mediators that are involved in the reaction called anaphylaxis. These effects are due to stimulation of histamine release by these anaphylotoxin. The effects are increased vascular permeability and vasodilatation.

So the answer to this question is D


Instruction:
White pupillary reflex is seen in:
A. Retinoblastoma
B. Complete retinal detachment
C. Endophthalmitis
D. All of the above

Response:
Ans. All of the above

So the answer to this question is D


Instruction:
Impact indicator for ASHA ?
A. Number of ASHA trained
B. Infant moality rate
C. % of institutional deliveries
D. % of JSY claims made to ASHA

Response:
Ans. is 'b' i.e., Infant moality rate Monitoring and Evaluation of ASHA's work Government of India has set up following indicators for monitoring ASHA (41). 1.Process Indicators a) Number of ASHAs selected by due process b) Number of ASHAs trained; and c) % of ASHAs attending review meeting after one year 2.Outcome Indicators a) % of newborn who were weighed and families counseled. b) % of children with diarrhoea who received ORS. c) % of deliveries with skilled assistance. d) % of institutional deliveries. e) % of JSY claims made to ASHA f) % of completely immunized in 12 to 23 months age group. g) % of unmet need for spacing contraception among BPL. h) % of fever cases who received chloroquine with in first week in a malaria endemic area. 3.Impact Indicators a) IMR b) Child malnutrition rates c) Number of cases of TB/leprosy detected as compared to previous year.

So the answer to this question is B


Instruction:
Meckel's diverticulum is a remnant of
A. Stenson's duct
B. Wolffian duct
C. Mullerian duct
D. Vitellointestinal duct

Response:
None

So the answer to this question is D


Instruction:
A marker of Golgi apparatus is-
A. Galactosyl transferase
B. Acetyl CoA synthetase
C. Pyruvate kinase
D. Malonyl CoA

Response:
Ans. A. Galactosyl transferaseEnzymatic Markers of Different Membranes-MembraneEnzymePlasma5'-NucleotidaseAdenylyl cyclase NA+-K+-ATPaseEndoplasmic reticulumGlucose-6-phosphataseGolgi apparatus CisGIcNAc transferase IMedialGolgi mannosidase IITransGalactosyl transferaseTrans Golgi NetworkSialyl transferaseInner mitochondrial membraneATP synthase

So the answer to this question is A


Instruction:
In the WHO recommended EPI Cluster sampling for assessing primary immunization coverage, the age group of children to be surveyed is-
A. 0-12 months
B. 6-12 months
C. 9-12 months
D. 12-23 months

Response:
None

So the answer to this question is D


Instruction:
Doc for Her 2 positive breast carcinoma is:
A. Trastuzumab
B. Tamoxifen
C. Exemestane
D. Fluvestrant

Response:
Ans. a. TrastuzumabRef: Goodman Gilman 13th E/P1209Her-2 PositiveDrug of Choice for Breast Cancer ER positiveDrug of choice: TrastuzumabDrug of choice in Trastuzumab resistance: LapatinibPremenopausal PostmenopausalDrug of Choice: Tamoxifen Drug of Choice: Aromatase Inhibitors likeExemestane

So the answer to this question is A


Instruction:
only epithelium in the body in which type4 collagen is absent in basal lamina:
A. Oral epithelium
B. Sulcular epithelium
C. Gingival epithelium
D. Junctional epithelium

Response:
None

So the answer to this question is D


Instruction:
Which of the following anti hypertensives act by decreasing heart rate only?
A. Propranolol
B. Methyl dopa
C. Prazosin
D. Nitrate

Response:
Ans: a (Propranolol) Ref: Katzung, 10th ed, p. 160Beta blockers decrease heart rate, force of contraction and cardiac output, this leads to decrease in blood pressure.Drugs used in hypertension are:1) Diuretics - Low-dose thiazide diuretics are often used as first-line agents, alone or in combination with other antihypertensive drugs e.g., hydrochlorthiazide, chlorthalidone.2) ACE-inhibitors and angiotensin receptor blockers - ACE inhibitors decrease the production of angiotensin n, increase bradykinin levels, and reduce sympathetic nervous system activity. Angiotensin II receptor blockers provide selective blockade of AT1 receptors.3) Beta Blockers - a adrenergic receptor blockers lower blood pressure by decreasing cardiac output, due to a reduction of heart rate and contractility. Other actions include renin inhibition.4) Calcium Channel Blockers - Calcium channel antagonists reduce vascular resistance through L- channel blockade, which reduces intracellular calcium and blunts vasoconstriction.5) Aldosterone Antagonists - It may be a particularly effective agent in patients with low-renin essential hypertension, resistant hypertension, and primary aldosteronism.The newer agent, eplerenone, which is a selective aldosterone antagonist have lesser side effects than spironolactone.6) a adrenergic blockers - They lower blood pressure by decreasing peripheral vascular resistance.7) Sympatholytic Agents - Centrally acting a2 agonists lower blood pressure by inhibiting sympathetic outflow and thereby decreasing peripheral resistance e.g., clonidine.8) Direct vasodilators - These agents decrease peripheral resistance.Hydralazine is a potent direct vasodilator.S/e: lupus-like syndrome.Minoxidil is another vasodilator and is most frequently used in patients with renal insufficiency that is refractory to all other drugs.S/e: hypertrichosis and pericardial effusion.9) Adrenergic neuron-blocking agents-These drugs lower blood pressure by preventing normal physiological release of norepinephrine from postganglionic sympathetic neurons.E.g. Guanethidine, reserpine

So the answer to this question is A


Instruction:
The earliest Cataract in the development of Senile Cortical Cataract is
A. Lamellar separation
B. Intumescent cataract
C. Incipient cataract
D. Mature senile cataract

Response:
The earliest Cataract in the development of Senile Cortical Cataract is Incipient cataract.

So the answer to this question is C


Instruction:
Which of the following muscle relaxant has the maximum duration of action -
A. Atracurium
B. Vecuronium
C. Rocuronium
D. Doxacurium

Response:
Ans. is 'd' i.e., Doxacurium o Amongst the given options doxacurium is longest acting (Duration of action 90-120 minutes). Rocuronium (duration of action 30-60 minutes), Atracurium (duration of action 30-60 minutes) and vecuronium (duration of action 60-90 minutes) have shoer duration of action than doxacurium.

So the answer to this question is D


Instruction:
Borchardt&;s triad of acute epigastric pain, violent retching and inability to pass a nsogastric tube is seen in patients with
A. Achalasia cardia
B. Acute gastric volvulus
C. Jejunogastric intussusception
D. Hitus hernia

Response:
A volvulus is a twisting or axial rotation of a poion of bowel about its mesentery. When complete it forms a closed loop of obstruction with resultant ischaemia secondary to vascular occlusion. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1193

So the answer to this question is B


Instruction:
Priapism occurs in: AIIMS 06; 13
A. Snake bite
B. Rati poisoning
C. Cantharide poisoning
D. Arsenic poisoning

Response:
Ans. Cantharide poisoning

So the answer to this question is C


Instruction:
Lymphoreticular system includes -
A. T- cells
B. B-cells
C. Neutrophils
D. All

Response:
Ans. is 'a' i.e., T- cells; 13' i.e., B-cells; 'c' i.e., Neutrophils Lymphoreticular system is a complex organization of cells of diverse morphology distributed widely in different organs and tissues of the body responsible for the immunity.

So the answer to this question is D


Instruction:
Imfection of all the following structures can be cause Psoas Abscess except
A. Veebrae
B. Appendix
C. Hip joint
D. Ribs

Response:
Abscess in the psoas region in the iliac fossa, is commonly due to tuberculosis of spine (T 10) and lymph nodes, retroperitoneal structures, lower intercostal region. * It can also be a pyogenic abscess. Clinical Features * Back pain, fever, spinal tenderness, para spinal spasm and restricted spine movement. ref:SRB&;S manual of surgery,ed 3,pg no 651

So the answer to this question is D


Instruction:
Giant cell (Hecht's) pneumonia is due to ?
A. CMV
B. Measles
C. Malaria
D. P. carinii

Response:
Ans. is 'b' i.e., Measles o Primary giant cell or Hecht's pneumonia is seen in case of measles. It is a complication of measles and is seen in immunocompromised and malnourished patients.

So the answer to this question is B


Instruction:
Mild hemolytic anaemia is associated with vitamin deficiency-
A. B6
B. E
C. A
D. C

Response:
Vitamin E acts as antioxidants that serve to scavenge free radicals formed in redox reactions throughout the body.
Vitamin-E deficient erythrocytes are more susceptible to oxidative stress and have a shorter half-life in the circulating blood.

So the answer to this question is B


Instruction:
False about bochdalek hernia is -
A. The defect is posterolateral
B. more common on right side
C. May lead to pulmonary hypoplasia and respiratory distress
D. Can be diagnosed prenataily

Response:
Ans. is 'b' i.e., More common on right side Congenital diaphragmatic herniao It is the herniation of abdominal contents into the thoracic cavity through the diaphragmatic defecto The defect may be# Posterolateral (Bochdalek hernia)# Retrosternal (Morgagni hernia)# At the esophageal hiatus (hiatal hernia)# Adjacent to the hiatus (paresophageal hernia)o Although all these defects are congenital, the term congenital diaphragmatic hernia is generally used for Bochdalek hernia.Bochdalek herniao Most Bochdalek hernia are on the left side (-80%) and may rarely be bilateral.o Compression of the lung results in pulmonary hypoplasia, involving both the lungs (ipsilateral > contralateral)o Pulmonary vasculature is also abnormal leading to pulmonary hypertension.o Thus the two main factors that affect morbidity and mortality are pulmonary hypoplasia and pulmonary hypertensiono The most frequent clinical presentation of CDH is respiratory distress due to severe hypoxemiao The anteroposterior diameter of the chest may be large along with a scaphoid abdomeno The diagnosis of CDH can be made prenatally by ultrasound.o The postnatal diagnosis is relatively straightforward because a plain chest radiograph demonstrates the gastric air bubbles or loops of bowel within the chest. There may also be a mediastinal shift away from the side of the hernia.o Historically, the surgical repair of a CDH was considered to be a surgical emergency because it was believed that the abdominal viscera within the chest prevented the ability to ventilate. More recently with the recognition of the role of pulmnary hypertension and pulmonary hypoplasia and the adverse effects of early operative repair on the pulmonary function has caused a policy of delayed repair. Thus most pediatric surgeons wait for a variable period (24 to 72 hrs) to allow for stabilization of the infant before doing surgical repair.

So the answer to this question is B


Instruction:
Which of the following is a mineralocoicoid antagonist ?
A. Spironolactone
B. Inamrinone
C. Nicorandil
D. Ketorolac

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

So the answer to this question is A


Instruction:
PE is a type of: September 2010
A. Network analysis
B. Input output analysis
C. System analysis
D. Cost benefit analysis

Response:
Ans. A: Network analysis The Program (or Project) Evaluation and Review Technique/ PE, is a model for project management designed to analyze and represent the tasks involved in completing a given project. It is commonly used in conjunction with the critical path method or CPM.

So the answer to this question is A


Instruction:
Under national programme for prevention of nutritional blindness, a child in the age group of 6-11 months is given a mega dose of vitamin A equal to:
A. 50,000 IU
B. 1,00,000 IU
C. 1,50,000 IU
D. 2,00,000 IU

Response:
First dose is with measles at 9 months - 1, 00,000 IU After 1 year the dose is 2, 00,000 IU Vitamin A supplement is given every 6 month after first dose till 5 year age. Ref: Park's textbook of Preventive and Social Medicine, 21st edition, page-593

So the answer to this question is B


Instruction:
Gas gangrene is
A. Caused by Clostridium perfringens.
B. Gas and smell are characteristic.
C. Antibiotic prophylaxis is essential when performing amputations to remove dead tissue.
D. All of the above

Response:
None

So the answer to this question is D


Instruction:
Stepwise mutation for drug resistance is seen with:
A. Penicillin
B. Streptomycin
C. Garamycin
D. Kanamycin

Response:
None

So the answer to this question is A


Instruction:
Innervation of lower one third of vaginal is ?
A. Pudendal nerve
B. Pelvic splanchnic nerve
C. Lumbar splanchnic nerve
D. Hypogastric nerve

Response:
The lower one-third of the vagina is pain sensitive and is supplied by the pudendal nerve through the inferior rectal and posterior labial branches of the perineal nerve. The upper two-thirds of the vagina are pain insensitive and are supplied by sympathetic L7, L2 and parasympathetic segments 52 to 54. Nerves are derived from the inferior hypogastric and uterovaginal plexuses. Sympathetic nerves are vasoconstrictor and parasympathetic nerves vasodilator. The fibres which accompany the vaginal aeries form the vaginal nerves. ref - BDC 6e vol2 pg394

So the answer to this question is A