Instruction:
Which of the following anti tubercular drug requires dose adjustment in renal failure:
A. Isoniazid
B. Rifampicin
C. Pyrazinamide
D. Ethambutol

Response:
Ref: Katzung's Pharmacology, 14th ed. pg. 846* Dose of Ethambutol: 15-25mg/kg OD dose.* About 20% drug is excreted in feces and 50% in urine in unchanged form.* Ethambutol accumulates in renal failure, and the dose should be reduced by half if creatinine clearance is less than 10mL/min.* Side effect: Most common serious adverse event is retrobulbar neuritis, resulting in loss of visual acuity and red green color blindness (Patient develop BLUE VISION).# It can also cause hyperuricemia and peripheral neuritis.* It is also Contraindicated in children as they are unable to report loss of visual acuity and red-green color discrimination.

So the answer to this question is D


Instruction:
Which of these forms the principle of stroboscopy
A. Terrier's law
B. Goldsmith law
C. Seldinger principle
D. Talbott's law

Response:
Talbot law --images on human retina linger for 0.2 seconds after exposure.Therefore, sequential images produced at intervals less than 0.2 seconds produce the illusion of a continuous image which allows for the illusion of motion when rapidly produced still images are presented Ref : Diseases of ENT by Dhingra 6th edition Pgno : 385

So the answer to this question is D


Instruction:
Vasculitis involving the Aoic arch is
A. Takayasu aeritis
B. Polyaeritis nodosa
C. Kawasaki disease
D. Churg-Strauss syndrome

Response:
Takayasu aeritis classically involves the aoic arch. This is a granulomatous vasculitis of medium and larger aeries characterized principally by ocular disturbances and marked weakening of the pulses in the upper extremities (hence the name pulseless disease). Takayasu aeritismanifests with transmural fibrous thickening of the aoa-- paicularly the aoic arch and great vessels--with severe luminal narrowing of the major branch vessels.Ref: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 11; Blood vessels; Page no: 508

So the answer to this question is A


Instruction:
Acute onset of blurred vision and absent pupillary response with rapidly progressive descending muscular weakness manifesting as quadriparesis in an afebrile 20 year old male with preserved sensorium is
A. Porphyria
B. Botulism
C. Polio
D. Diphtheria

Response:
Answer is B (Botulism): Sudden onset of blurred vision, absent pupillary reflexes (fixed /dilated pupil with lack of accomodation), symmetric descending paralysis progressing to qudriparesis and preserved sensorium suggest a diagnosis of Botulism. Cardinal Feature of Botulism Cranial Nerve Palsies with prominent bulbar palsy (4 'D's of Bulbar Palsy) (Diplopia, Dysahria, Dysphonia, Dysphagia, Ptosis, Loss of Accomodation, Fixed / Dilated pupils) Descending motor paralysis (Extent of paralysis from a few cranial nerves only to quadriperesis depends on dose of toxin) Symmetry of symptoms/signs A clear sensorium Absence of fever Lack of sensory findings

So the answer to this question is B


Instruction:
A person is diagnosed to be a diabetic on his 45th bihday. You will recommend a dilated fundoscopic examination:
A. Immediately
B. Before his 50th bihday
C. When he turns 50 years of age
D. When he complains dimness of vision

Response:
Ans. a. Immediately

So the answer to this question is A


Instruction:
A 42-year-old primigravida presents to your office for a routine OB visit at 34 weeks gestational age. She voices concern because she has noticed an increasing number of spidery veins appearing on her abdomen. She is upset with the unsightly appearance of these veins and wants to know what you recommend to get rid of them. How do you advise this patient?
A. Tell her that this is not a serious condition and give her a referral to a vascular surgeon to have the veins removed
B. Tell her that you are concerned that she may have serious liver disease and order liver function tests
C. Refer her to a dermatologist for further workup and evaluation
D. Tell her that the appearance of these blood vessels is a normal occurrence with pregnancy and will resolve spontaneously after delivery

Response:
Vascular spiders, or angiomas, are common findings during pregnancy. They form as a result of the hyperestrogenemia associated with normal pregnancies and are of no clinical significance. The presence of these angiomas does not require any additional workup or treatment, and they will resolve spontaneously after delivery Reassurance to the patient is all that is required.

So the answer to this question is D


Instruction:
Cobblestone conjunctiva is seen in?
A. Trachoma
B. Spring catarrah
C. Ophthalmia nodosa
D. Interstial keratitis

Response:
Ans. is 'b' i.e., Spring catarrh Vernal kerato conjunctivitis (spring cattarrh) Spring cattarrh is an allergic inflammation of conjunctiva which is characterized by recurrent, bilateral, interstitial, selflimiting conjunctivitis that becomes aggravated during spring and summer period. It is considered to be Type I hypersensitivity reaction (immediate type) to exogenous allergens such as grass pollens. It is more common in boys and affects age group 4-20 years. More common in summer, hence the name spring catarrh looks a misnomer. Recently it is being labeled as "Warm weather conjunctivitis". Clinical features of spring catarrh Spring catarrh is characterized by marked itching& burning, Stringy (ropy) discharge, lacrimation, photophobia and heaviness of lids. Clinically spring catarrh is divided into three types : ? Palpebral form : - It is the most common types. The upper palpebral conjunctiva shows papillae (papillary hyperophy with their characteristic appearance : - i) Lage & flat toped Cobble stone appearance (Pavement stone appearance). These papilla heal without scarring. Bulbar form : - It is characterized by Dusky red triangular congestion of bulbar conjunctiva in palpebral area; Gelatinous thickened accumulation of tissue around the limbus; Presence of discrete whitish raised dots along the limbus (Tranta's spot). Mixed form : - Both bulbar and palpebral manifestations occur together. Corneal signs (Vernal keratopathy) Punctate epithelial keratitis Ulcerative vernal keratitis : shallow transverse ulcer (Shield ulcer) Vernal corneal plaques Subepithelial scarring Pseudogerontoxon: chracterized by a classical "cupid's bow" outline.

So the answer to this question is B


Instruction:
The site of action of the furosemide is
A. Thick ascending limb of loop of Henle
B. Descending limb of loop of Henle
C. Proximal convoluted tubule
D. Distal convoluted tubule

Response:
Furosemide is a loop diuretic and this group of drugs act on thick ascending limb of loop of Henle

So the answer to this question is A


Instruction:
Which of the following antibiotic can be administered in group B B lactamase induced resistance?
A. 3rd generation cephalasporin
B. Amoxicillin
C. Monobactam
D. Oxacillin

Response:
Group B B lactamase (also called as metallo enzymes) hydrolyze all B lactam antibiotics except Monobactum.

So the answer to this question is C


Instruction:
Most common organism causing T. capitis is –
A. Trichophyton tonsurans
B. Microsporum
C. Epidermophyton
D. Candida albicans

Response:
"Ringworm of the scalp occurs in children exclusively and is mainly due to M. canis".
Following statement of Harrison creats some confusion here :-
"The predominent organism is T tonsurans".

Therefore, I had to do extensive search on this question and I collected following information :
Most common organism causing Ectothrix is M. canis, whereas most common organism causing Endothrix is T tonsurans. Ectothrix is the most common type of T. capitis, therefore M. canis would be the most common cause of T. capitis.

So the answer to this question is B


Instruction:
Volume of interstitial fluid in a normal adult
A. 5L
B. 10L
C. 15L
D. 20L

Response:
In a 70 kg man ,60%of body weight is due to water ,about 42 L .of this 10 L is present ias Interstitial fluid Ref.Textbook of physiology AK Jain 5th edition page no.24 table 1.3.2

So the answer to this question is B


Instruction:
Best radiographic view for fracture of C1, C2 veebrae is:
A. AP view
B. Odontoid view
C. Lateral view
D. Oblique view

Response:
The odontoid view (open mouth view) is the best radiographic view to vizualize C1, C2 veebra. This view is used to evaluate an area that is difficult to visualize in the cross-table lateral view because of shadow superimposition. The most impoant relationship to evaluate in this view is alignment of the lateral masses of C1 with respect to the odontoid process. Ref: Factors Associated with Spinal Cord Injury in Children after Blunt Trauma By Leonard JC , Kuppermann N, Oisen C, Babcock-CimpelloL, BrownK, Mahajan P, Pages 145-55; Fractures of The Cervical, Thoracic and Lumbar Spine By Alexander R Vaccaro, Pages 90-96

So the answer to this question is B


Instruction:
Chickenpox is caused by
A. Varicella-zoster virus
B. Epstein-barr virus
C. Pox virus
D. Herpes simplex virus

Response:
Ans. A. Varicella-zoster virus. (Ref. Harrison's medicine 17th ed. Chapter 173)Varicella-zoster virus# Varicella-zoster virus (VZV) causes two distinct clinical entities:- varicella (chickenpox) and- herpes zoster (shingles).# Chickenpox, a ubiquitous and extremely contagious infection, is usually a benign illness of childhood characterized by an exanthematous vesicular rash.# With reactivation of latent VZV (which is most common after the sixth decade of life), herpes zoster presents as a dermatomal vesicular rash, usually associated with severe pain.# Children between 5-9 yr age are most commonly affected.# Incubation period 14-17 days.# Secondary attack rate 72-90%.# Patients are infectious prior to onset of rash, during period of vesicle formation (4-5days) & until all vesicles are crusted.# Hallmark of infection is maculopapules, vesicles escabs in various stages.# Most common infectious complication of varicella is superficial bacterial infection of skin by Staph.# Most common extracutaneous site of affection by VZV is CNS.Recommendations for VZIG AdministrationExposure Criteria1. Exposure to person with chickenpox or zostera. Household: residence in the same householdb. Playmate: face-to-face indoor playc. HospitalVaricella: same 2- to 4-bed room or adjacent beds in large ward, face-to-face contact with infectious staff member or patient, visit by a person deemed contagiousZoster: intimate contact (e.g., touching or hugging) with a person deemed contagiousd. Newborn infant: onset of varicella in the mother <5 days before delivery or <48 h after delivery; VZIG not indicated if the mother has zoster2. Patient should receive VZIG as soon as possible but not >96 h after exposureCandidates (Provided They Have Significant Exposure) Include:1. Immunocompromised susceptible children without a history of varicella or varicella immunization2. Susceptible pregnant women3. Newborn infants whose mother had onset of chickenpox within 5 days before or within 48 h after delivery4. Hospitalized premature infant (>28 weeks of gestation) whose mother lacks a reliable history of chickenpox or serologic evidence of protection against varicella5. Hospitalized premature infant (<28 weeks of gestation or <1000-g birth weight), regardless of maternal history of varicella or varicella-zoster virus serologic status.

So the answer to this question is A


Instruction:
Nelson's syndrome is most likely seen after -
A. Hypophysectomy
B. Adrenalectomy
C. Thyroidectomy
D. Orchidectomy

Response:
Adrenalectomy performed by an expe surgeon effectively cures ACTH-dependent Cushing's syndrome, but in patients with pituitary-dependent Cushing's syndrome this can result in Nelson's syndrome. In Nelson's syndrome, the loss of negative feedback from endogenous coisol results in growth of the pituitary tumour, often leading to an invasive pituitary macroadenoma (which causes local mass effects) and very high ACTH levels (which cause pigmentation). The risk of Nelson's syndrome is repoed as being reduced by pituitary irradiation in some series, but not all . Ref - Davidson's medicine 23e p669

So the answer to this question is B


Instruction:
Arsenic causes all, except: WB 09
A. Raindrop pigmentation
B. Alopecia
C. Palmar hyperkeratosis
D. Blue line in gums

Response:
Ans. Blue line in gums

So the answer to this question is D


Instruction:
Which vein is found at the apex of the heart?
A. Great cardiac vein
B. Coronary Sinus
C. Anterior cardiac vein
D. Middle cardiac vein

Response:
Ans. is 'a' i.e., Great cardiac vein Great Cardiac Vein* The great cardiac vein (left coronary vein) begins at the apex of the heart and ascends along the anterior longitudinal sulcus to the base of the ventricles.* It then curves to the left in the coronary sulcus, and reaching the back of the heart, opens into the left extremity of the coronary sinus, draining from the myocardium.

So the answer to this question is A


Instruction:
Prostaglandin analogs have therapeutic utility in all the following EXCEPT:
A. Palliative treatment of patent ductus aeriosus
B. Pulmonary hypeension
C. Impotence
D. Inflammatory bowel disease

Response:
Main uses of prostaglandins are -Aboion, Induction of labor, Cervical ripening, Postpaum hemorrhage, Peptic ulcers, Glaucoma, Maintain patency of ductus aeriosis( only after surgery), Avoid platelet damage i. e pulmonary hypeension, Peripheral vascular diseases, Impotence ESSENTIALS of medical PHARMACOLOGY SEVENTH EDITION-KD TRIPATHI Page 189,190,191,188

So the answer to this question is A


Instruction:
Raised AFP's is typically seen in -
A. Hepatitis
B. Seminoma
C. HCC
D. All of the above

Response:
Harshmohan textbook of pathology 7th edition alpha feto protein is a glycoprotein synthesized normally by fetal liver cells. Their serum levels are elevated in hepatocellular carcinoma and non seminomatous germcell tumours of the testis. .

So the answer to this question is C


Instruction:
"Gottron sign" seen in
A. Polymyositis
B. Dermatomyositis
C. Polymyositis + Sjogren's syndrome
D. Polymyositis + SLE

Response:
(Dermatomyositis) (760-CMDT-10, 2696-H 17th)* "Gottron sign" - scaly patches over of the dorsum of PIP and MCP joints are highly suggestive of dermatomyositisDERMATOMYOSITIS - the characteristic rash is dusky red and may appear in a malar distribution mimicking the classic rash of SLE* Facial erythema beyond the malar distribution is also characteristic of dermatomyositis (Shawl's sign)* Periorbital edema and a purplish (heliotrope) suffusion over the eyelids are typical signs, periungual erythema, dilations of nailbed capillaries* Bilateral proximal muscle weakness*** *** Increased risk of malignancy** - in descending order of frequency are ovarian, lung, pancreatic, stomach, colorectal and NHL)* Biopsy of clinically involved muscle is the only specific diagnostic test*** A pathologic hall mark of dermatomyositis is perifascicular atrophy. In polymyositis - endomysical infiltration of the inflammatory infiltrate**** Various auto antibodies against nuclear antigens (antinuclear antibodies) and cytoplasmic antigens are found in upto 20% of patients with inflammatory myopathies* Glucocorticoids: oral prednisone is the initial treatment of choice* Myositis may also be associated with other connective tissue diseases especially - Scleroderma, lupus, mixed connective tissue disease and Sjogren syndrome, overlap syndrome* Antisvnthetase syndrome - polymyositis and dermatomyositis develops- inflammatory arthritis, Raynaud phenomenon, interstitial lung disease, auto antibodies (eg anti Jo I antibodies)* Most common myositis-specific antibody -anti Jo-I antibody** (ILD)* Anti Mi-2 associated with dermatomyositis* Anti SRP (anti- signal recognition particle) associated with polymyositisPolymyositis can occur as a complication of HIV or HTLV-1 infection and with zidovudine therapy as well**** Anti-endomysial antibody - Celiac sprue*** Anti mitochondrial antibody - Primary biliary cirrhosis*** Anti-smooth muscle antibody - Auto immune hepatitis* Anti centromere antibody - CREST syndrome (limited scleroderma)* Histidyl-t-RNA antibody - Inflammatory myopathy * Anti DNA topoisomerase antibody (Scl-70)- Systemic sclerosis * Antibodies of ribonucleoprotein antigen containing ULRNP- Mixed connective tissue disease * SSb(La)* SSb(La)}Antibodies to ribo nucleoprotein antigen- Sjogren syndrome

So the answer to this question is B


Instruction:
Hot potato voice is characteristic of -
A. Nasopharyngeal carcinoma
B. Glottic carcinoma
C. Subglottic carcinoma
D. Supraglottic carcinoma

Response:
Ans. is 'd' i.e., Supraglottic carcinoma Clinical features of supraglottic carcinomao Pain on swallowing is the most frequent initial symptom -- Devita 7th/e p. 698o Mass in neck may be the first sign.o Hoarsness is a late symptom.o Pain may be referred to ear by vagus nerve and auricular nerve of arnold.o Late symptoms include foul breath, dysphagia and aspiration.o Large tumors can cause uhot potato voice/muffled voice"o Hemoptysis, sore throat, shorteness of breath, stridor, otalgia and aspiration pneumonia may also occur.

So the answer to this question is D


Instruction:
Portal vein starts at level of?
A. L2
B. L3
C. L4
D. L5

Response:
Ans. A L2Ref: Netter's Clinical Anatomy, 3rd ed. pg. 202* Portal vein starts at level of L2 vertebra and is formed by junction of superior mesenteric vein and splenic vein. It is 8 cm long and lies behind the neck of pancreas.* Normal portal vein pressure is 5-10 mm Hg.

So the answer to this question is A


Instruction:
In determining blood pressure by auscultatory method
A. The loudest sound is the diastolic pressure
B. Systolic pressure estimation tends to be lower than those made by palpatory method
C. The first sound heard is the systolic pressure
D. The sounds that are heard are generated in heart

Response:
None

So the answer to this question is C


Instruction:
Name the effect in which severity of the response is dose dependent:
A. Deterministic effect
B. Stochastic effect
C. Both of the above
D. None of the above

Response:
None

So the answer to this question is A


Instruction:
Most common endocrine abnormality in Down's syndrome is-
A. Hypothyroidism
B. Hypoparathyroidism
C. Congenital adrenal hyperplasia
D. Cushing's disease

Response:
Ans. is 'a' i.e., Hypothyroidism o Hypothyroidism is the most common endocrine abmnormality in downs syndromeClinical features of Downs svndromeo Most striking feature in the neonate is hypotonia and although the diagnosis is usually evident at this time, it may sometimes be missed if the baby is very premature or his facial features are concealed by ventilatory apparatus.Other clinical features include:-1) GeneralMental retardation, short stature2) Cranio-facial:- Brachycephaly, epicanthic fold, protrudingtongue, small ears, upward sloping palpebral ?fissures (Mongoloid slant), strabismus, nystagmus, Brushfied spots in iris.3) Limbs :- Fifth finger clinodactyly, single palmar crease (simian crease), wide gap between first and second toes (sandle gap ).4) Congenital heart disease - Common AV canal, ostium primum/endocardial cushion defect type ASD (most common), VSD, PDA, fallot tetralogy.5) GIT Anal atresia, Duodenal atresia, Hirschsprung disease, annular pancreas.6) Increased incidence of leukemia (1 %). Leukemias common are ALL (most common), AML (M7-AML) transient myeloproliferative disorders, and Juvenil CML.7) Others : Early onset of Alzheimer's disease, Decreased immunity with recurrent infections, obesity, DM, Hypothyroidism.

So the answer to this question is A


Instruction:
Alpha methyldopa primarily used for
A. Pregnancy induced hypeension
B. Renovascular hypeension
C. First line agent in hypeension
D. Refractory hypeension

Response:
Methyldopa was primarily used in the past but is now used widely for pregnancy induced hypeension. Refer katzung 11e p173

So the answer to this question is A


Instruction:
An ideal result of endodontic treatment is deposition of which of the following at the apex:
A. Bone
B. Cementum deposition
C. Dentin
D. Periodontal ligment

Response:
None

So the answer to this question is B


Instruction:
The following enzyme activity is measured in Beriberi:
A. Decarboxylase
B. Deaminase
C. Transketolase
D. Transaminase

Response:
In thiamine deficiency transketolase activity in erythrocytes is decreased. Measures of RBC transketolase is a reliable diagnostic test for thiamine deficiency. Beriberi is caused by thiamine deficiency. Ref: Clinical Laboratory Medicine, 2nd Ed, Page 322

So the answer to this question is C


Instruction:
Most common cancer worldwide is: September 2010, March 2013
A. Breast
B. Lung
C. Cervix
D. Oral cavity

Response:
Ans. B: Lung Cancer is a leading cause of death worldwide. The main types of cancer leading to overall cancer moality each year are: Lung (1.3 million deaths/year) Stomach (803 000 deaths) Colorectal (639 000 deaths) Liver (610 000 deaths) Breast (519 000 deaths) The most frequent types of cancer worldwide (in order of the number of global deaths) are: Among men - lung, stomach, liver, colorectal, oesophagus and prostate Among women - breast, lung, stomach, colorectal and cervical.

So the answer to this question is B


Instruction:
What is epiphora?
A. Eveed upper lid following surgery
B. CSF running through nose after injury
C. Abnormal flow of tears due to obstructed lacrimal duct
D. CSF running through ears after injury

Response:
Epiphora- It is characterised by overflow of tears from the conjunctival sac. The condition may occur either due to excessive secretion of tears (hyperlacrimation) or may result from inadequate drainage (outflow) of normally secreted tears. CSF running through nose after injury(CSF Rhinorrhae)-M/C Cause -fracature of cribriform plate of ethmoid CSF running through ears (CSF otorrhea) seen due to fracture of mastoid bone

So the answer to this question is C


Instruction:
HLA typing is useful in-
A. Disputed paternity
B. Thanatology
C. Organ transplant
D. Dactylography

Response:
Reference :Robbins basic pathology 9th edition pg no 117:As a result of the polymorphism at the major HLA loci in the population, a viually in nite number of combina- tions of molecules exist, and each person expresses a unique MHC antigenic pro le on his or her cells. The com- bination of HLA alleles for each person is called the HLA haplotype. The implications of HLA polymorphism are obvious in the context of transplantation--because each person has HLA alleles that differ to some extent from every other person's, grafts from viually any donor will evoke immune responses in the recipient and be rejected (except, of course, for identical twins). In fact, HLA mole- cules were discovered in the course of early attempts at tissue transplantation.

So the answer to this question is C


Instruction:
The finding of urine sodium concentration <20 mmol/L in hypovolemic hyponatremia implies
A. Salt-wasting nephropathy
B. Diuretic therapy
C. Hypoaldosteronism
D. Trauma

Response:
Hypovolemic hyponatremia Urine sodium concentration >20 mmol/L Renal losses Diuretic excess Mineral coicoid deficiency Salt-losing deficiency Bicarbonaturia with Renal tubal acidosis and Metabolic alkalosis Ketonuria Osmotic diuresis Cerebral salt wasting syndrome Urine sodium concentration <20 mmol/L Extrarenal losses Vomiting Diarrhea Third spacing of fluids Burns Pancreatitis Trauma Ref: Harrison 19e pg: 299

So the answer to this question is D


Instruction:
Which treatment goal is not included in the control phase of caries management?
A. Eliminate active disease
B. Eliminate cause of disease
C. Manage symptoms like swelling and pain
D. Remove conditions preventing maintenance

Response:
Five phases of caries management

Urgent phase - management of pain, swelling, bleeding, infection before initiation of subsequent phases.
Control phase - eliminate active disease, remove conditions preventing maintenance, eliminate cause of the disease and begin preventive alternatives.
Reevaluation phase.
Definitive phase.
Recare and reassessment phase.

Reference- Sturdevant 6th ed pg- 107

So the answer to this question is C


Instruction:
All are of adult size at bih except:
A. Mastoid antrum
B. Ear Ossicles
C. Tyrnpanic cavity
D. Maxillary antrum

Response:
Maxillary antrum "The tympanic cavity and mastoid antrum , auditory ossicles and structures of the internal ear are all almost fully developed at bih and subsequently alter little." -Gray's Anatomy 40/e p623Maxillary antrum reaches adult size by 15 yrs of age. All paranasal sinuses except maxillary (and sometimes ethmoidal) are rudimentary or absent at bih. They enlarge appreciably during the eruption of the permanent teeth and after pubey, events that significantly alter the size and shape of the face.Some students were of the opinion that in the present question 'orbit' was the option instead of maxillary antrum. In that case the answer would be orbit. "Orbit reaches its full adult size by 15 to 16 yrs of age." Also Know:Though the mastoid antrum is well developed at bih, the mastoid air cells are not developed and are merely minute antral diveicula at this stage. The mastoid process develops in the 2"d yr and is invaded by air cells in the 6ill yr.(Ref: Grays 40/e p417)

So the answer to this question is D


Instruction:
If the seventh nerve is damaged on the right side of the face
A. the muscles of mastication would be denervated
B. the	muscles	of	facial	expression	would	be denervated
C. taste from the right anterior two thirds of the tongue would not be affected
D. sympathetic	fibre	to	salivary	gland	would	be interrupted

Response:
None

So the answer to this question is B


Instruction:
Percentage of newborn with deviation of nasal septum-
A. 60%
B. 10%
C. 20%
D. 50%

Response:
Ans- C 20% Reference- Neonatal septal deviation is quite common, being present in approximately 20% of all newborns. Greater amount of birth trauma, like in primiparas, instrumental deliveries or emergency LSCS, and high birth weight predisposes more to neonatal septal deviation and increases the incidence. Strut test being a simple, non-invasive, and fairly accurate is quite useful for diagnosis of Neonatal septal deviations. The test can be carried out by a trained nurse or ANMs at the peripheral centres and positive NSD cases can be referred for proper management

So the answer to this question is C


Instruction:
Which of the following is not true about plasma protein binding?
A. Free fraction of the drug is pharmacologically active
B. Acidic drugs generally bind to plasma albumin
C. There is no effect of nephrotic syndrome on plasma protein binding
D. Prazocin is bound to alpha 1 acidic glycoprotein

Response:
Ans. is 'c' i.e., There is no effect of nephrotic syndrome on plasma protein binding Plasma protein binding* Many natural substances circulate around the body partly free in plasma water and partly bound to plasma proteins, e.g. cortisol, thyroxine.* Similarly drugs circulate in protein bound and free states, and the significance is that the free fraction is pharmacologically active whereas the protein bound component is a reservoir of drug that is inactive because of this binding.* Acidic drugs generally bind to plasma albumin.* Basic drugs bind to al acid glycoprotein.* Binding to albumin is quantitatively more important.Drugs bound to plasma protein To albumin To a, acid glycoprotein* Barbiturates * Penicillins* b- blockers* Methadone* Benzodiazepines (Diazepam)* Sulfonamides* Bupivacaine* Prazosin* NSAIDS * Tetracyclines* Lignocaine* Quinidine* Valproate * Tolbutamide* Disopyramide* Verapamil* Phenytoin * Warfarin* Imipramine * In nephrotic syndrome and other conditions causing hypoproteinemia, protein binding will be altered.* Morphine is not a plasma protein bound drug ->> in nephrotic syndrome there is no effect on protein binding.

So the answer to this question is C


Instruction:
In which of the following disease is corticosteroids  indicated ?
A. Osteoporosis
B. Peptic ulcer
C. Collagen vascular diseases
D. Tuberculosis

Response:
None

So the answer to this question is C


Instruction:
The following diseases are associated with HLA B27 and uveitis Except
A. Bechet's syndrome
B. Reiter's syndrome
C. Psoriasis
D. Ankylosing spondylitis

Response:
Features of seronegative spondyloahroahropathiesOnset usually before 40 yearsAbsence of RA factorHLA- B27 positivePresence of uveitisExamples:- ankylosing spondylitis, Reitter's syndrome, Psoriatic ahritis, enteropathic ahritis, Reactive ahritis.(Refer: Mohindra's Fundamentals of Ohopedics, 2nd edition, pg no. 302, 426)

So the answer to this question is A


Instruction:
In Budd Chiari syndrome, the site of venous thrombosis is?
A. Infrahepatic inferior vena cava
B. Infrarenal inferior vena cava
C. Hepatic veins
D. Poal veins

Response:
Answer is C (Hepatic vein) Rudd chiari syndrome is characterized by post sinusoidal obstruction outside the liver at the level of hepatic veins.

So the answer to this question is C


Instruction:
In the composition of normal air of the atmosphere at ground level in an unpolluted area, which one among the following is found inhighest concentration ?
A. Carbon dioxide
B. Hydrogen
C. Methane
D. Nitrous oxide

Response:
The normal composition of external air by volume is nitrogen-78.1%,oxygen-20.93%, carbon dioxide- 0.03%, Argon 0.9%. Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 791

So the answer to this question is A


Instruction:
Substantia nigra is affected in -
A. Parkinson's disease
B. Huntington's disease
C. Progressive supranuclear palsy
D. Alzheimer's dementia

Response:
Ans. is 'a' i.e., Parkinson's disease Diseases of Basal gangliao Three distinct biochemical pathways in the basal ganglia normally operate in a balanced fashion: -1 ) Nigrostriatal dopaminergic system; 2) Intrastriatal cholinergic system; 3) GABAergic system which projects from the stratum to globus pallidus and substantia nigra.o When one or more of these pathways become dysfunctional, characteristic motor abnormalities occur. There may be two types of disorder : -Hyperkinetic: - There is excessive and abnormal movement, e.g., Chorea, athetosis and ballism.Hypokinetic: - There is paucity of movement, e.g., Akinesia and Bradykinesia.o The classical example of Basal ganglia disease is Parkinsonism in which there is degeneration of dopaminergic neurons in the substantia nigra pars compacta. The fibers to putamen are most severely affected. A patient with parkinsonism have both hypokinetic and hyperkinetic features : -Hypokinetic : - Bradykinesia, AkinesiaHyperkinetic : - Cogwheel rigidity, Resting tremorDiseasePart of Basal ganglia involvedo ParkinsonismSubstantia nigra pars compacta - Nigrastriatal pathwayo Huntington choreaStriatum (mainly caudate nucleus; may be putamen)o BallismSubthalamic nucleio AthetosisGlobus pallidus (mainly) and Subthalamic nucleus.Pathologic Examination in Parkinsons shows:o Gross / Macroscopically :Pallor of the substantia nigra and locus ceruleuso Microscopic Examination :Loss of catecholaminergic neurons in these regions +# gliosisLewy bodies.o Lewy Bodies : are inclusion bodies found within neurons in Parkinsons disease.Lewy bodies are single or multiple, intra-cytoplasmic, eosinophilic, round and elongated inclusions that often have a dense core surrounded by a pale halo.Ultrastructurally These are composed of fine filaments, densely packed in the core but loose at the rim.

So the answer to this question is A


Instruction:
Cholera presents with symptoms mimicking: TN 10
A. Arsenic poisoning
B. Dhatura poisoning
C. Barbiturate poisoning
D. Morphine poisoning

Response:
Ans. Arsenic poisoning

So the answer to this question is A


Instruction:
a child beats other children. after this behaviour he is made to sit in a sepeae room and not allowed to watch the TV channel he likes usually
A. punishment
B. omission
C. negative reinforcement
D. positive reinforcemnt

Response:
Behavioral therapy is learning given by BF Skinner , according to him all behaviors are learned phenomenon and thus can be unlearned Positive reinforcement a type of reinforcement when a behavior is rewarded there is more chance that the behavior is repeated Negative reinforcement is that when a behavior is done and an aversive response is removed, the behavior is repeated. When I go and meet my girlfriend, she checks my messages and picks up fight (aversive response) suddenly I delete all messages one day and that day there was no fight (no aversive response) then that behavior is repeated (delete all messages before meeting my girlfriend) Extinction is the type of reinforcement where a behavior is done and a rewarding response is removed the chance is that behavior will not be repeated A child likes to play with children( reward) but when the child fights with other children( undesirable behavior) the child will be removed from playing( removing a reward) , then the child stops fighting with other children( reduction of undesirable behaviour) Ref. kaplon and sadock synopsis, 11 th edition, pg no. 845

So the answer to this question is B


Instruction:
Metcalfe's Criteria is used for:
A. Assessing risk of maternal moality in pregnancy
B. Grading congenital valvular hea diseases in pregnancy
C. Findings suggestive of hea disease in pregnancy
D. Classifying various cardiomyopathies

Response:
Metcalfe's Criteria for Hea Disease in Pregnancy (Finding Suggestive of Hea Disease in Pregnancy) Symptoms Progressive dyspnea or ohopnea Nocturnal cough Hemoptysis Syncope Chest pain Clinical Findings Cyanosis Clubbing of fingers Persistent neck vein distention Systolic murmur grade 3/6 or greater Diastolic murmur Cardiomegaly Persistent split-second sound Criteria for pulmonary hypeension Persistent arrhythmias Atrial and ventricular premature contractions, 15deg Left Axis Detion and mild ST changes in inferior leads are considered normal during pregnancy.

So the answer to this question is C


Instruction:
Which one of the following provides hemodynamic stability and prolonged survival in congestive hea failure
A. Lisinopril
B. Furosemide
C. Digoxin
D. Milrinone

Response:
Ref-KDT 6/e p486 Lisinopril is a medication of the angiotensin-conveing enzyme inhibitor class used to treat high blood pressure, hea failure, and after hea attacks. For high blood pressure it is usually a first line treatment, although in black people calcium-channel blockers or thiazide diuretics work better.

So the answer to this question is A


Instruction:
IL-2 is produced by
A. T cells
B. B cells
C. Monocytes
D. Neutrophils

Response:
IL-2 is produced by CD4 T helper cellsIts actions are:Promotes growth and differentiation of T and B cellsPromotes cytotoxicity of T cells and NK cellsPromotes secretion of other lymphokines IL-3 is produced by T cells for hematopoiesis(ref: Harrison's 18/e p2659, table 314-7)

So the answer to this question is A


Instruction:
Pontine Stroke is associated with all except :
A. Bilateral pin point pupil
B. Pyrexia
C. Vagal palsy
D. Quadriparesis

Response:
Answer is C ( Vagal palsy) Vagal palsy is not a recognized feature of pontine stroke Features of pontine stroke Sudden onset Deep coma with quadriplegia (usually occurs over a few minutes) Pinpoint pupils (1mm pupils) that react to light. Loss of reflex eye movements and corneal responses (There is impairment of reflex horizontal eye movements evoked by head turning i.e doll's head or oculocephalic maneuver or by irrigation of the ears with ice water). Decrebrate rigidity / Posturing Hyperpnea / Hyperventilation Severe Hypeension Ocular bobbing Excessive Sweating / Hyperhidrosis Hyperpyrexia, (Neurology Secrets 4th Ed.) Hyperpyrexia and intracerebral haemorrhage ; Harrison 16th / 164 A fever of> 41.5degC (> 1067degF) is called hyperpyrexia. This extraordinary high fever can develop in patients with severe infections, but most commonly occurs in patients with central nervous system (CNS) haemorrhages.

So the answer to this question is C


Instruction:
Most specific antibody in SLE is -
A. Anti nuclear
B. Anti Sm
C. Anti Ro
D. Anti histone

Response:
Ans. is 'b' i.e., Anti Sm Auto anti bodies in Systemic Lupus Erythematosuso Antinuclear antibody-best screening test.o Anti DS DNA antibody-Specific for SLE only in high litres.o Anti Smantbody-Specific for SLE.o Anti Ro (SS - A) antibody-Predisposes to Sicca syndrome, subacute cutaneous lupus and neonatal lupus with congenital heart block.o Anti histone antibody-Associated with drug induced lupus.

So the answer to this question is B


Instruction:
Ascending UTI caused by -a) Salmonellab) T.B.c) E.colid) Chlamydiae) Klebsiella
A. abd
B. cde
C. bde
D. ade

Response:
None

So the answer to this question is B


Instruction:
Virus causing hemopoietic carcinoma are-
A. EBV
B. HTLV - I
C. HHV 8
D. CMV

Response:
The Epstein-Barr virus (EBV), also called human herpesvirus 4 (HHV-4), is one of eight known viruses in the herpes family, and is one of the most common viruses in humans. It is best known as the cause of infectious mononucleosis (glandular fever). It is also associated with paicular forms of cancer, such as Hodgkin's lymphoma, Burkitt's lymphoma, gastric cancer, nasopharyngeal carcinoma, and conditions associated with human immunodeficiency virus (HIV), such as hairy leukoplakia and central nervous system lymphomas. There is evidence that infection with EBV is associated with a higher risk of ceain autoimmune diseases,[v especially dermatomyositis, systemic lupus erythematosus, rheumatoid ahritis, Sjogren's syndrome, and multiple sclerosis. Some 200,000 cancer cases per year are thought to be attributable to EBV.

So the answer to this question is A


Instruction:
The thumb action that is totally affected in radial nerve trauma -
A. Abduction
B. Adduction
C. Extension
D. Flexion

Response:
Radial nerve injury
-        High radial nerve palsy- Injury above the spiral groove.
o   Paralysis of all muscles supplied by radial nerve.
o   Clinical features

Wrist drop, finger drop, thumb drop
Extension affected of- elbow, wrist, thumb and fingers
Sensation affected of- posterior surface of arm and forearm and lower lateral half of forearm.

-        Low radial nerve palsy- Injury below the spiral groove.
o   Type I- Injury between spiral groove and elbow.

Elbow extensors are spared- Triceps and Anconeus.
Wrist, thumb and finger extensors paralysed- wrist drop, thumb drop, finger drop.
Loss of sensation on dorsal side of first web space.

o   Type II- Injury below the elbow joint.

Elbow and wrist extensors spared
Thumb and finger extensors paralysed.(extensor digitorum, extensor digiti minimi, extensor indicis, extensor pollicis longus, extensor pollicis brevis)- Thumb drop and finger drop.
Loss of sensation on dorsal side of first web space.

So the answer to this question is C


Instruction:
Denture stability refers to resistance of a denture:
A. To move in a vertical direction away from basal seat
B. To move in a vertical dimension towards basal seat
C. To movements on its tissue foundation especially to lateral forces
D. Against any kind of movement more the 24 µm in any direction

Response:
Stability (GPT-9):

That quality of maintaining a constant character or position in the presence of forces that threaten to disturb it; the quality of being stable; to stand or endure.
The quality of a complete or removable partial denture to be firm, steady, or constant, to resist displacement by functional horizontal or rotational stresses.
Resistance to horizontal displacement of a prosthesis.

So the answer to this question is C


Instruction:
Which of the following is NOT a MAO inhibitor ?
A. Tranylcypromine
B. Isocarboxazide
C. Phenelzine
D. Maprotiline

Response:
None

So the answer to this question is D


Instruction:
Order of neurovascular bundle in the femoral triangle from medial to lateral
A. Nerve, artery, vein
B. Vein, Artery, Nerve
C. Artery, Vein, Nerve
D. Nerve, Vein, Artery

Response:
(B) Vein, Artery, Nerve # FEMORAL TRIANGLE: This is a clinically important triangular subfascial space in the superomedial one-third part of the thigh. It appears as a depression inferior to the inguinal ligament when the thigh is actively flexed at the hip joint. Its main contents are the femoral vessels and the femoral nerve.> Boundaries of the Femoral Triangle: Superiorly by the inguinal ligament. Medially by the medial border of the adductor longus muscle. Laterally by the medial border of the sartorius muscle. Muscular floor of the femoral triangle is not flat but gutter-shaped Formed from medial to lateral by the adductor longus, pectineus, and the iliopsoas. It is the juxtaposition of the iliopsoas and pectineus muscles that forms the deep gutter in the muscular floor. Roof of the femoral triangle is formed by the fascia lata, which includes the cribriform fascia.> Contents of the Femoral Triangle: This triangular space in the anterior aspect of the thigh contains Medial to Lateral: Vein-Artery-Nerve (VAN) the femoral Vein and its tributaries, the femoral Artery (femoral artery in femoral triangle) and its branches, the femoral Nerve and its branches, the lateral cutaneous nerve, the femoral branch of the genitofemoral nerve, lymphatic vessels, and some inguinal lymph nodes.

So the answer to this question is B


Instruction:
La belle indifference is seen in
A. Conversion Reaction
B. Schizophrenia
C. Mania
D. Depression

Response:
A i.e. Conversion reactionLa belle indifferenceQ is in-appropiate attitude of calm or lack of concern about one's disability. It is seen in conversion (dissociative) disorderQ (but not specific), physical illness etc.

So the answer to this question is A


Instruction:
What is the health indicator obtained by dividing body height (in centimeters) by cube root of body weight (in kilograms) -
A. Quetelet's Index
B. Broca Index
C. Ponderal Index
D. Corpulence Index

Response:
Ans-C

So the answer to this question is C


Instruction:
Which test is performed to detect stunned (reversible) myocardial ischemia?
A. Coronary angiography.
B. PET scan
C. ECG
D. Resting echocardiography

Response:
Ans. B. PET scana. PET scan is a type of nuclear scan.b. LV dysfunction can be due to non-contractile or hypercontractile segments that are viable but are chronically ischemic (Hibernating Myocardium).

So the answer to this question is B


Instruction:
Endometrial hyperplasia is seen in:
A. Endodermal sinus tumor
B. Dysgerminoma
C. PCOD
D. Ca cervix

Response:
Endometral hyperplasia specially simple hyperplasia results from circumstances in which there is prolonged, increased oestrogen production example:

Follicular cysts of ovary
PCOD
Granulosa and theca cells
HRT

So the answer to this question is C


Instruction:
Fanconi's anemia is a:
A. Constitutional anemia
B. Hemolytic anemia
C. Iron deficiency anemia
D. Auto-immune anemia

Response:
a. Constitutional anemia(Ref: Nelson's 20/e p 2390-2392, Ghai 8/e p 349-351)Constitutional pancytopenia is defined as decreased marrow production of the 3 major hematopoietic lineages on an inherited basis, resulting in anemia, neutropenia and thrombocytopenia. Important causes are:Fanconi anemiaAmegakaryocytic thrombocytopeniaShwachman-Diamond syndromeDown syndromeDyskeratosis congenitaNoonan syndrome

So the answer to this question is A


Instruction:
Drug of choice for prophylaxis of acute mountain sickness is?
A. Diltiazem
B. Digoxin
C. Dexamethasone
D. Acetazolamide

Response:
DOC for acute mountain sickness are Carbonic anhydrase inhibitors like Acetazolamide. BEST treatment is to descent down because it occurs due to decreased pO2 at high altitudes. DOC for motion sickness is Hyoscine.

So the answer to this question is D


Instruction:
Most common cause of menorrhagia in chilbearing period:
A. Fibroid
B. Dysfunctional uterine bleeding
C. Pelvic endometriosis
D. Adenomyosis

Response:
About 10-15% women experiences episodes ofDUB in the reproductive years of their life.It is common during extremes of reproductive life following pregnancy,during lactation. The endometral abnormalities may be primary or secondary to incoordination in the hypothalamo-pituatary ovarian axis. It is thus more prevalent in extremes of reproductive period. DUB is more prvalent in extremes of Reproductive period. In childbearibg period ,MC cause of menorrhagia is DUB. SHAW' S TEXTBOOK OF GYNAECOLOGY,Pg no:301,15th edition and DC Dutta' s ,page no.154, 7th edition.

So the answer to this question is B


Instruction:
Point mutation is seen in
A. Antigenic shift
B. Antigenic drift
C. Both of above
D. None of above

Response:
Antigenic shift may be due to genetic recombination, reassoment, rearrangement Sudden change in Antigenic variation occurs. Antigenic drift due to point mutation Antigenic change is Gradual over a Period of Time.

So the answer to this question is B


Instruction:
Ramesh 40 yrs male patient presenting with polyuria, pain abdomen, nausea, vomitting, altered sensorium was found to have bronchogenic carcinoma. The electrolyte abnormality seen in him would be -
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcaemia
D. Hypercalcemia

Response:
None

So the answer to this question is D


Instruction:
Knee joint pain in a deep-sea diver is due to
A. Increased O2
B. Increased CO2
C. Increased N2O
D. Increased N2

Response:
It is due to decompression sickness In case of deep sea divers ,the nitrogen gets conveed to liquid form due to high pressure When the diver comes out of the water suddenly, the nitrogen in liquid form suddenly conves into gas,producing nerve compresses etc Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:382,383,384

So the answer to this question is D


Instruction:
As a pa of space-research program , a physiologist was asked to investigate the effect of flight-induced stress on blood pressure. Accordingly, the blood pressure of the cosmonauts were to be measured twice: once before the take-off and once after the spacecraft entered the designated orbit around the eah. For a proper comparison, the preflight blood pressure should be recorded in which position?
A. The sitting position
B. The standing position
C. The lying down position
D. Any position, as long as the post-flight recording is made in the same position

Response:
In the space there is no gravity. In order to compare the blood pressure taken preflight and the one in the space, BP should be taken in a position where gravity is nullified. In lying position the gravitational force is nullified, so preflight BP measurement should be done in the lying down position. In supine position, legs are at the same level as the hea so that the gravitational forces that come into play in the upright position are diminished. When a person is lying on his back, the tricuspid valve is located at almost exactly 60% of the chest thickness in front of the back. This the zero pressure reference level. Ref: High-Yield Physiology, Pa 845, Volume 2008 By Ronald W. Dudek, Page 51; Essentials Of Medical Physiology By Khurana, Page 185.

So the answer to this question is C


Instruction:
6 years old girl with vaginal spotting. Diagnosis is –
A. Ovarian cancer
B. Foreign body
C. Sexual abuse
D. PID

Response:
A foreign body is commonly responsible for vaginal bleeding in pediatric patients.

So the answer to this question is B


Instruction:
Which of the following fluid should not be used in first 24 hrs after operation:
A. 5% dextrose.
B. Isotonic saline
C. Ringer's lactate
D. All of the above

Response:
None

So the answer to this question is B


Instruction:
Maximum cardiac output is seen during which phase of pregnancy?
A. Ist trimester
B. IInd trimester
C. Labour
D. Immediate postpaum period

Response:
Maximum cardiac output during pregnancy is seen in the immediate postpaum period. During this period blood pressure increases by 70% over the prelabour values. Cardiac output gradually increases after 5th week of pregnancy, reaches its peak 40-50% at about 30-34 weeks. Thereafter the cardiac output remains the same till term. During labour cardiac output increases to 50%. Ref: Textbook of Obstetrics By D. C Dutta, 6th Edition, Page 51-56.

So the answer to this question is D


Instruction:
Which drug is not used in SIADH -
A. Fludrocoisone
B. Demeclocycline
C. Desmopressin
D. Hypeonic saline

Response:
demeclocycline inhibit vasopression action in renal distal tubule.severe hyponatremia require treatment with hypeonic saline and fludrocoisone ( Harrison 17 pg 620)

So the answer to this question is C


Instruction:
A test has high false positive rate in a community. True is
A. High specificity
B. High sensitivity
C. High prevalence
D. Low prevalence

Response:
Ans is 'd' i.e. Low prevalence "In a population with a low prevalence of a particular disease, it is likely that most of the positive results in a screening program for that disease would be falsely positive."- Epidemiology, biostatistics, and preventive medicine By James F. Jekel, David L. Katz, Joann G. Elmore 2/e p120"In a high-prevalence population, the absolute number of false-positives is small in comparison with the absolute numbers of true positives. In a low-prevalence population, the absolute number of false-positives is large in comparison with the absolute number of true positives." -The basic science of oncology By Ian Tannock 4/e p486, 487The no. of false positive varies inversely with the prevalence of disease in population. This means that when the same test is applied to two populations with differing prevalence; false positive cases would be more in the population with low prevalence and false positive cases would be low in the population with high prevalence.Also Note:Sensitivity and specificity are characteristic of a particular test and do not depend on the prevalence of disease in the population being tested.The positive predictive value and the negative predictive value depend on characteristics of both the test (sensitivity and specificity) and the population being tested (prevalence of disease). The positive predictive value is directly proportional to the prevalence. The negative predictive value is inversely proportional to prevalence.As the prevalence of disease declines, the positive predictive value of the test declines and the negative predictive value increases.

So the answer to this question is D


Instruction:
All of the following are the contraindications for the use of progesterone-only pills except-
A. Pregnancy
B. Patient suffering from breast cancer
C. Peripheral vascular disease
D. Diabetes mellitus

Response:
Ans. is 'd' i.e., Diabetes mellitus o Contraindications for the use of progesterone-only pills are as follows:PregnancyUnexplained vaginal bleedingRecent breast cancerArterial diseaseThromboembolic disease

So the answer to this question is D


Instruction:
Drug of choice for managing asthmatic patient with hypeension: March 2009
A. Timolol
B. Propranolol
C. Metoprolol
D. Amlodipine

Response:
Ans. D: Amlodipine The management of hypeension in a patient with asthma or chronic obstructive pulmonary disease (COPD) may be made difficult by the asthma-inducing effect of some antihypeensives. As an example, beta blockers should be used with great caution or not at all in patients with chronic asthma (including chronic obstructive pulmonary disease) or acute allergic or exercise-induced bronchospasm. Calcium channel blockers are suitable as first line antihypeensive agent for: Asthma/ COPD patients. Recurrent stroke prevention Elderly with poor aerial wall compliance Isolated systolic hypeension Raynaud's/PVD patients Pregnant hypeensives Diabetes

So the answer to this question is D


Instruction:
Depigmenting agent of choice in in treatment of dermatological disorders is -
A. Hydroquinone
B. Zinc
C. Kojic acid
D. Azelaic acid

Response:
DEPIGMENTING AGENTS:- Include agents like hydroquinone(2%-5%),azelaic acid (10%-20%), glycolic acid (6%-12%) and monobenzene. They act by inhibiting tyrosinase enzyme. Hydroquinone is most commonly used.It can be combined with steroids and retinoids in the treatment of melasma. Kligmans regimen- 5% hydroquinone+0.1% tretinoin +0.1% hydrophilic ointment. Newer agents-Arbutin and kojic acid.They lighten hyperpigmented patches. Used in melasma, freckles. {Reference: IADVL textbook of dermatology, vishalakshi Vishwanath pg no.379}

So the answer to this question is A


Instruction:
A 20 years female has hepatosplenomegaly, fever, pallor and generalized lymphadenopathy. Lab test useful for diagnosis is/are -a) ESRb) Electrophoresisc) Parasite detection in aspirated) ELISAe) Routine haemogram
A. acd
B. ace
C. cde
D. ade

Response:
None

So the answer to this question is B


Instruction:
Chancroid may be caused by:
A. T. pallidium
B. G. donovani
C. Chlamydia Trachomatis
D. Herpes Hominis Virus

Response:
D i.e. Herpes virus - hominis

So the answer to this question is D


Instruction:
Amyloid (AA) originates from -
A. RBC
B. Plasma cell
C. Reticulo-endothelial cell
D. Lymphocytes

Response:
Answer is option 3 Amyloidosis: origin from fixed periodic acid-Schiff positive reticuloendothelial cells in loco and basic factors in pathogenesis. httpp://www.ncbi.nlm.nih.gov.in

So the answer to this question is C


Instruction:
Cereals and pulses are considered complementary since -
A. Cereals are dificient in methionine
B. Cereals are deficient in methionine and pulse are deficient in lysine
C. Cereals are deficient in lysine and pulses are deficient in methionine
D. Cereal proteins contain non-essential amino acids, while pulse proteins contain

Response:
- cereal protein are deficient in lysine and threonine and pulse protein in methionine. - these are known as limiting aminoacid. - when two or more of vegetarian foods are eaten together, their protein supplement one another. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:610 <\p>

So the answer to this question is C


Instruction:
Which of the following doesn't increase the risk of Ca breast?
A. Nulliparity
B. Multiparity
C. Female sex
D. Women who avoid breast feed

Response:
Family history of Ca breast in first degree relatives is also a risk factor for Ca breast. Ref: Manipal Manual of Surgery, Page 260.

So the answer to this question is B


Instruction:
Granulomatous lung disease is caused by?
A. Hypersensitivity pneumonitis
B. Sarcoma
C. Bronchogenic carcinoma
D. Bronchogenic cyst

Response:
Ans is 'a' i.e. Hypersensitivity pneumonitis* Granulomatous lung disease refers a broad group of infectious and well as non infections conditions characterized by formation of granulomas.* The spectrum includes :1) Infectiousa) Mycobacteriali) Pulmonary tuberculosisii) Pulmonary non tuberculous mycobacterial infectionb) Fungali) Pulmonary coccidioidomycosisii) Pulmonary cryptococcosisiii) Pulmonary histoplasmosisiv) Pulmonary blastomycosisv) Pulmonary aspergillus infectionsc) Parasitici) Pulmonary dirofilaria infection2) Non infectiousa) Sarcoidosisb) Wegener granulomatosisc) Churg strauss syndromed) Chronic granulomatous disease2e) Hypersensitivity pneumonitisf) Bronchocentric granulomatosisg) Pulmonary manifestations of rheumatoid arthritish) Granulomatosis secondary to substancesi) Pulmonary talc granulomatosisii) Berylliosisiii) Granulomatous pneumonitis associated with begi) Changes secondary to chronic aspiration pneumonitisj) Lymphoproliferativei) Lymphocytic interstitial pneumonitisii) Lymphomatoid granulomatosisk) Pulmonary langerhans cell histiocytosisl) Erdheim-chester diseasem) Granulomatous lung disease associated with common variable immunodeficiency

So the answer to this question is A


Instruction:
Fatty acid with even number of carbon atoms on oxidation produces:
A. Acetyl CoA
B. Succinyl CoA
C. Propionyl CoA
D. All of the above

Response:
Fatty acids with an odd number of carbon atoms are oxidized by the pathway of b-oxidation, producing acetyl-CoA, until a three-carbon (propionyl-CoA) residue remains. This compound is conveed to succinyl-CoA, a constituent of the citric acid cycle. Hence, the propionyl residue from an odd-chain fatty acid is the only pa of a fatty acid that is glucogenic Ref: Harper 28th edition, chapter 22.

So the answer to this question is A


Instruction:
Dissociative anaesthesia is produced by - (PGI 99)
A. Ketamine
B. Etomidate
C. Propofol
D. Thiopentone

Response:
Ans. is 'a' i.e., Ketamine Dissociative anaesthesia is characterized by profound analgesia, immobility, amnesia with light sleep and feeling of dissociation from once own body and the surroundings Cataleptic state. Ketamine (phencyclidine) induces dissociative anaesthesia.

So the answer to this question is A


Instruction:
You have a patient who is very health-conscious and regularly ingests a large number of vitamins in mega doses and herbal therapies on a daily basis. She is a strict vegetarian as well. She is going to attempt pregnancy and wants your advice regarding her diet and nutrition intake. Which of the following is true regarding diet recommendations in pregnancy?
A. Because herbal medications are natural, there is no reason to avoid these dietary supplements in pregnancy
B. It is recommended that in pregnancy the majority of the protein consumed be supplied from animal sources
C. Routine supplementation of vitamin A is necessary during pregnancy because dietary intake alone does not provide sufficient amounts needed during pregnancy
D. During pregnancy, vegetarians obtain sufficient amounts of vitamin B12 in their diet needed for the fetus

Response:
The use of herbal remedies is not recommended during pregnancy because such products are classified as dietary supplements and therefore are not FDA-regulated for purity, safety, and efficacy. In fact, the actual ingredients of many herbal substances are not even known. There is almost no data regarding the teratogenic potential of herbal medications in humans. It is not recommended that women assume a vegetarian diet during pregnancy because animal sources of protein such as meat, poultry, fish, and eggs contain amino acids in the most desirable combinations. In addition, strict vegetarians can give birth to infants who are low in vitamin B12 stores because vitamin B12 occurs naturally only in foods of animal origin. Pregnant women do not need to take vitamin A supplements because adequate amounts can be obtained in the diet; in addition, a very high intake of vitamin A has been associated with the type of congenital malformations seen with oral Accutane use. Adequate vitamin C levels needed for pregnancy can be provided in a reasonable diet. No known fetal anomalies have been reported with vitamin C supplementation in pregnancy.

So the answer to this question is B


Instruction:
The following structures are felt on per rectal examination except -
A. Bulb of penis
B. Ureter
C. Anorectal ring
D. Urogenital diaphragm

Response:
None

So the answer to this question is B


Instruction:
Root value of supinator jerk-
A. C3 C4
B. C4 C5
C. C5 C6
D. C8 T1

Response:
Ans. is 'c' i.e., C5 C6 ReflexRoot valueBiceps reflex (biceps jerk)C5 C6Supinator reflex (Supinator jerk)C5 C6Triceps reflex (Triceps jerk)C7 C8Knee jerkL3 L4Ankle jerkS1 s2

So the answer to this question is C


Instruction:
Fouth stage of labour i.e. observation of patient after delivery of placenta is defined as period of___________after delivery:
A. 1 hour
B. 2 hour
C. 3 hour
D. 4 hour

Response:
1 hour

So the answer to this question is A


Instruction:
Diagnosis of lung sequestration by -
A. CT
B. Angiography
C. MRI
D. X-ray

Response:
None

So the answer to this question is A


Instruction:
Oaubain acts by inhibiting
A. Adenyl cyclase
B. Ca+ chanells
C. H+K+ ATPase
D. Na+K+ATPase

Response:
Ouabain is a cardiac glycoside and in lower doses, can be used medically to treat hypotension and some arrhythmias. It acts by inhibiting the Na/K-ATPase, also known as the sodium-potassium ion pump Refer kDT 6/e p496

So the answer to this question is D


Instruction:
Sec. 377 IPC deals with: AIIMS 09
A. Rape
B. Adultery
C. Sadism
D. Sodomy

Response:
Ans. Sodomy

So the answer to this question is D


Instruction:
Passive cutaneous anaphylaxis detect:
A. Heterocytotropic ab
B. Wheal and flare reaction
C. Atopy
D. Cutaneous anaphylaxis

Response:
Ans. (a)Passive cutaneous anaphylaxis-in vivo method for detection of antibodies.Antigen injection intradermally then same antigen with a dye injected IV - after 4 to 24 hours - wheal flare reaction occurs in intradermal site.Helps to detect IgG ab which is heterocytotropic, not for IgM which is homocytotropic.

So the answer to this question is A


Instruction:
A child suffered through trauma and had to undergo splenectomy for splenic injury and blood loss. The further management includes all of the following EXCEPT
A. Continuous penicillin treatment
B. Continue aspirin to prevent coagulation
C. The parents are advised of the possible complica:ions the child is prone for
D. Repeated evaluation for potential complications

Response:
(B) Continue aspirin to prevent coagulation # Splenectomised patients are at increased risk of septicemia due to Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae & Bahesia microti.> The risk becomes even greater in Splenectomised patients treated with cytotoxic chemotherapy or radiation, & in patients who have undergone splenectomy for thalassacmia, sickle cell disease, & autoimmune anaemia or thrombocytopenia> Vaccination to be done in elective splenectomized patients> Before the age of 5 yrs should be treated with daily dose of penicillin until the age of 10 yrs> Satisfactory prophylaxis can be obtained by penicillin , erythromycin , amoxycillin , co-amoxiclav.> Suspected infections can be treated with same antibiotics & cefotaxime, cefitriaxone, or chloramphenicol

So the answer to this question is B


Instruction:
A previously healthy eight year old boy presented to the emergency depament with high grade fever, ahralgia, pruritic erythematous rash and lymphadenopathy. He has completed 8 days out of a 10 day course of cefaclor for an upper respiratory tract infection. Which of the following is the most likely diagnosis
A. Kawasaki Disease
B. Type III Hypersensitivity Reaction
C. Serum sickness Like Illness (SSLI)
D. Henoch schonlein purpura

Response:
Ans. is 'c' i.e., Serum sickness Like Illness SSLI occurs from an abnormal inflammatory reaction that occurs in response to defective metabolism of drug by products generated during pharmacotherapy. Therefore, it is also called serum sickenss like drug reaction (SSLDR). SSLDR is must commonly seen after exposure to cefclor, but other drugs including penicillins, tetracyclines, ciprofloxacin, NSAIDs, sulfonamides, barbiturates, carbamazepine, propranolol, thiouracil and allopurinol, have also been implicated.

So the answer to this question is C


Instruction:
Which of the following dietary source contains the lowest percent of linoleic acid?
A. Coconut oil
B. Mustard oil
C. Groundnut oil
D. Corn oil

Response:
<p> Essential fatty acids: Those that cannot be synthesised by humans.They can be derived from food only. The most impoant essential fatty acid is linoleic acid, which serves as the basis for production of other essential fatty acids( linolenic and arachidonic acid) . Not all PUFA are essential fatty acids. Linoleic acid:- dietary source and per cent content . Safflower oil- 73 Corn oil- 57 Sunflower oil-56 Soyabean oil-51 Sesame oil-40 Ground nut oil-39 Mustard oil -15 Palmoil- 9 Coconut oil- 2 Eichosapentanoic acid: Fish oil: 10 % present. Linolenic acid : Soyabean oil-7 {Reference: Park&;s textbook of community medicine 23 rd edition, pg no. 611}

So the answer to this question is A


Instruction:
A sexually active, long distance truck driver&;s wife comes with vaginal discharge. Under Syndromic Approach, which drug should be given?
A. Metronidazole, Azithromycin, Fluconazole
B. Metronidazole
C. Azithromycin
D. Metronidazole and Fluconazole

Response:
<p> Metronidazole,azythromycin,fluconazole. It is syndromic management of vaginal discharge for symptomatic paner. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:334. <\p>

So the answer to this question is A


Instruction:
A patient was suffering from hepatorenal syndrome. A urine sample was obtained from the patient and was examined under the microscopy. Which of the following technique is being used to make the organism visible?
A. Dark field microscopy
B. Routine microscopy with negatively stained background
C. Phase contrast microscopy
D. Compound light microscopy

Response:
Picture is showing spiral shaped bacterium ( having hooks ) suggestive of member of spirochetes Organism causing hepato-renal syndrome is Leptospira interrogans which cause ictero hemorrhagic fever/Weil's disease. Dark field microscopy- reflected light is used instead of transmitted light Dark field condenser with central circular stop illuminates the object with cone of light Light rays falling on object are reflected or scattered on to objective lens- object appears self luminous against dark background

So the answer to this question is A


Instruction:
Neutropenia is seen in all except:
A. Scurvy
B. Aplastic anemia
C. Typhoid fever
D. Chloramphenicol

Response:
Ans: A (Scurvy) Ref: Harrison's Principles of Internal Medicine, 18 ed.Explanation:Severity of neutropenia based on the absolute neutrophil count (ANC) measured in cells per microliter of blood:Mild neutropenia (1000 < ANC < 1500) minimal risk of infectionModerate neutropenia (500 < ANC < 1000) -- moderate risk of infectionSevere neutropenia (ANC < 500) -- severe risk of infection.Causes of NeutropeniaCauses can be divided into the following groups:Decreased production in the bone marrow due to:Aplastic anemiaArsenic poisoningCancer, particularly blood cancersHereditary disorders (e.g. Congenital neutropenia. cyclic neutropenia)RadiationVitamin B 12, Folate or copper deficiency.Increased destruction:Autoimmune neutropenia.Chemotherapy treatments, such as for cancer and autoimmune diseasesMarginalisation and sequestration:HemodialysisMedications:ChloramphenicolPhenytoinIndomethacinPropylthiouracilCarbimazoleChlorpromazineTrimethoprim/sulfamethoxazoleClozapineTiclodipineInfectionsTuberculosisTyphoid feverBrucellosisTularemiaMeaslesInfectious mononucleosisMalariaViral hepatitisAIDS

So the answer to this question is A


Instruction:
A 12-year-old with fever, unilateral post auricular pain and mastoid bulging with displacing the pinna forward and outwards with loss of bony trabeculae. This patient has a history of chronic persistent pus discharge from the same ear. Treatment of choice is
A. Antibiotics only
B. Incision and drainage
C. Antibiotics with incision and drainage
D. Mastoidectomy with incision and drainage and antibiotics

Response:
Swelling behind the ear displacing pinna indicate mastoiditis It is treated by mastoidectomy Aim of coical mastoidectomy is to exenterate all the mastoid air cells and remove any pockets of pus. Adequate antibiotic treatment must be continued at least for 5 days following mastoidectomy. Ref: Dhingra 7e pg 86.

So the answer to this question is D


Instruction:
Drug of choice in Acute migraine is
A. Ergotamine
B. Sumatriptan
C. Dihydroergotamine
D. Propranol

Response:
(Sumatriptan) (170-17l-KDT6th) (523-LP 3rd)Triptans (Sumatriptan, naratriptan, eletriptan, almotriptan, zolmitriptan)* "Triptans rapidly and effectively abort or markedly reduce the severity of migraine headaches in about 80% of patients"* Sumatriptan is an effective and better tolerated than ergotamine* Somatriptan is the first selective 5HT 1B/1D receptor agonist"Propranol is drug of choice for prophylaxis in migraine"

So the answer to this question is B


Instruction:
In narcolepsy, the polysomnographic recording typically shows which of the following patterns?
A. REM intrusion during inappropriate periods
B. An absence of REM sleep in midcycle
C. Spike-and-wave EEG recording
D. Extreme muscular relaxation

Response:
REM intrusion during inappropriate periods

So the answer to this question is A


Instruction:
Which of the following embryonic structures gives rise to the adrenal coex?
A. Ectoderm
B. Endoderm
C. Mesoderm
D. Mesonephros

Response:
Mesoderm

So the answer to this question is C


Instruction:
In a lady at 32 weeks pregnancy is given an injection of dexamethasone to prevent which of the following in the newborn ?
A. Respiratory Distress Syndrome
B. Neonatal convulsion
C. Neonatal jaundice
D. Cerebral palsy

Response:
The lung maturity occurs at 34 weeks of gestation and this is ceified by checking the L:S ratio which should be > 2:1 or appearance of Phosphatidyl glycerol in the amniotic fluid. Maternal administration of coicosteroid is advocated where the pregnancy is less than 34 weeks. This helps in fetal lung maturation so that the incidence of RDS, Intra Ventricular Hemorrhage , Necrotising Enterocolitis , and Patent Ductus Aeriosus are minimized. Respiratory distress of newborn often results in multiple debility in the fetus if not prevented.

So the answer to this question is A


Instruction:
Intracellular receptors are present for -
A. Estrogen
B. Vitamin D
C. Thyroxine
D. All of the above

Response:
Ans. is 'd' i.e., AH of the above TYPES OF RECEPTORSMembrane receptorso Present on the cell membrane.o Their drug/hormone binding domain is extracellular and effector domain is intracellular.These are:1. G protein coupled receptors - It may act through.Adenylvl cyclase| cAMP - TSH, FSH, LH, ACTH, glucagon, PTH, adrenaline, calcitonin, vasopressin (V2).| cAMP - PRIH (Dopamine)IP.-DAG (Ca2- and protein kinase 'c') - Vasopressin (V1), oxytocin.Channel regulation (Ca+2, K+ Na+)2. Receptor with Intrinsic ion channels - (Na+, K+, Ca+2 or Cl-)3. Enzyme linked receptorsIntrinsic enzyme receptors (tyrosine kinase receptors) - Insulin.JAK-STAT kinase binding receptors Growth hormone. Prolactin.Intracellular receptors (transcription factors)o Present inside the cell and induce synthesis of specific protein by increasing the expression of specific gene.1. Cytoplasmic - Glucocorticoids, Mineralocorticoids, Androgens, Progestins.2. Nuclear - Thyroxine, Triiodothyronine, Estrogen, retinoic acid, Vit D.

So the answer to this question is D


Instruction:
Hepatic encephalopathy is caused by an increase of -
A. Urea
B. Glutamate
C. Ammonia
D. Fattyacid

Response:
Ans. is 'c' i.e., Ammonia* Hepatic encephalopathy is characterized by altered level of consciousness, caused by liver disorder.* Liver disorder is characterized by elevation of ammonia. As liver is considered with detoxification of ammonia to form urea, in liver failure ammonia level is elevated.* Hepatic encephalopathy basically presents with manifestations of CNS depression* Pathogenesis:# Ammonia crosses Blood Brain Barrier and is taken up astrocytes. Astrocytes contribute to 30% of cells in the Central Nervous System. Within astrocytes, as pKa of ammonia is very high, it sequestrates hydrogen ions to form ammonium ions. Ammonium ions are positively charged. Additionally, ammonia reacts with glutamate to form glutamine. Glutamine is also positively charged. Both ammonium ions and glutamine, being positively charged, they attract water (Ammonium and glutamine are osmotically active). This causes astrocytes swelling. Neuronal swelling in respiratory centre causes hyperventilation and the person presents with repiratory alkalosis.# As glutamate levels are low, the neuronal activity is reduced. This explains depression, coma and EEG abnormalities (characteristic slowing of waves with high amplitude)* Hence, all features of hepatic encephalopathy are explained by hyperammonemia.

So the answer to this question is C


Instruction:
Management of typical febrile seizures include all the following except :
A. Tepid sponging
B. Paracetamol and ibuprofen
C. Intermittent diazepam
D. Prophylactic phenobarbitone

Response:
None

So the answer to this question is D


Instruction:
Bile gets concentrated in?
A. Pancreas
B. Liver
C. Gall bladder
D. Stomach

Response:
Gall bladderStorage & concentration of bileStorage of Bile:Bile is continuously secreted by liver. Released intermittently into intestine Most stored in gallbladder.Concentration of Bile:Bile is concentrated during its gallbladder storage.Gallbladder mucosa rapidly reabsorbs water & electrolytes.Calcium & potassium, bile salts, bile pigments, cholesterol, and lecithin are not reabsorbed. Hence their bile concentration increases 5 to 10 times.

So the answer to this question is C


Instruction:
In Korsakoff's Psychosis, the following in not seen
A. Memory disturbances
B. Suicidal tendencies
C. Loss of recent memory
D. Pshycosis

Response:
Suicidal tendencies

So the answer to this question is B


Instruction:
Which of the following statements about paial mole is false?
A. Usually associated with Triploidy
B. Rarely causes Persistent Gestational Trophoblastic Neoplasia
C. Usually present as Missed Aboions
D. Can be reliably diagnosed by USG in early gestation

Response:
Paial mole cannot be diagnosed by ultrasonography at a very early gestational ages, before the chorionic villi have attained vesicular pattern. Ref: Williams Gynaecology, 1st Edition, Page 758; Novak's Textbook of Gynecology, 14th Edition, Pages 1588, 1582; Obstetrics and Gynecology By Beckmann, 6th Edition, Page 360; Textbook of Obstetrics By DC Dutta, 6th Edition, Page 201.

So the answer to this question is D


Instruction:
Baby born prematurely at 29 weeks on examination at 42 weeks with ROP both eyes shows stage 2 zone I "plus' disease, how will you manage the patient?
A. Examine the patient after 1 week
B. Laser photocoagulation of both eyes
C. Laser photocoagulation of worse eye, follow up of other eye
D. Vitreoretinal surgery

Response:
. Ans. b. Laser photocoagulation of both eyes According to ETROP (early treatment for ROP cooperative group) the high risk pre threshold disease (i.e. zone / any stage plus (A)disease; or zone 1/stage 3: or zone 2, stage 2/3 plus ROP) is treated by laser photocoagulation."Retrolental fibroplasia/ Retinopathy of prematurity is a bilateral proliferative retinopathy occurring in premature infants (<32 weeks / <1.5 kg) exposed to high concentration of 0,, during the first 10 days of life. All the babies fulfilling above criteria should be screened with indirect ophthalmoscopy between 32-36 weeks post conceptionQ. The goal of treatment of threshold ROP is to prevent any retinal detachment or scarring and optimization of visual outcome. So laser photocoagulation of avascular immature retina is recommended in infants with threshold disease. According to ETROP (early treatment for ROP cooperative group) the high risk pre threshold disease (i.e. zone 1 any stage plus (+)disease; or zone 1/stage 3; or zone 2, stage 2/3 plus ROP) is treated by laser photocoagulation."Management of Retinopathy of Prematurity (ROP)Classification of ROP by Anatomic Location (Zone)* For the purpose of defining the anteroposterior (AP) location of ROP the retina is div ided into 3 concentric zones centred on optic disc.* The centre of retinal map for ROP is optic disc not the mcula as in other maps.* Since there is a direct correction between severity of disease and amount of avascular retina the location of the border between vascularized and avascular retina is an important prognostic sign.* The most anterior normal retinal vascularization is identified and is assigned a zone.Zone IMost posterior circular zone with optic disc as centre and twice the disc- fovea (or centre of macule) distance as radius.Any ROP in this zone is very severe because of large peripheral areas of avascular retina.Zone IIIt is a doughnut shaped region that extends concentrically from the anterior border of zone 1 to within 1 disc diameter of the ora serrata nasally and to anatomic equator temporallyIts radius extends from centre of disc to the nasal ora-serrata. A circle is drawn with optical disc as centre and disc to nasal ora-serrata as radius. The area between zone 1 and this boundary is zone IIZone IIIIt encompasses the residual temporal crescentshaped retina anterior to zone 2. Clinical Assessment/Classification based on Severity (Stage) of diseaseStageFeature1(1)* Demarcation line: It is appearance of a thin, flat, white (grey) tortuous line (border) at the junction of mature vascularized retina posteriorly and immature avascular retina anteriorly. * It runs roughly parallel with the ora-serrata and is more prominent in temporal periphery.* It is seen at the edge of vessels dividing the vascular from avascular retina i.e. the abnormal branching or arcading of vesseiss lead upto the line.II (2)* Ridge: Demarcation line acquires a volume to form a pink or white elevation or ridge of thickened tissue that has height, width and extends above the plane of retina.* Blood vessels enter the ridge and small isolated neovascular tufts (popcorns) may be seen posterior to it.III (3)* Extraretinai fibre vascular proliferation (vessels growth into and above the ridge) characberizes stage 3.* The fibrovascular proliferation may extend from the ridge into the overlying vitreous and cause vitreous haemorrhage.IV (4)* Partial or subtotal retinal detachment: due to traction exerted from contraction of fibrovascular proliferation.* 4A = Extra foveal (without fovea 1 involvement)* 4B = Foveal (with foveal involvement)V (5)* Total funnel shaped retinal detachment* In premature infants weighing < 1200 gm, PaO. of umbilical artery should be monitored, levels of50-100 mmHg being safe.* Premature infants should not be placed in incubator with an O, concentration of more than 30%* If minor signs of ROP are noticed, examination should be repeated at 1, 3, and 6 months and every 4 months upto the age of 4 years with the aim of diagnosing early retinal holes or retinal detachment.* Treatment involves ablation of avascular retina by laser photo coagulation {instrument of choice: and a standard of treatment in management of other vasoroliferative retinopathies associated with diabetes, sickle cell anemia and retinal vascular occlusion also).* Laser therapy has largely replaced cryotherapy because of superior visual and anatomical outcomes and induces less myopia.* Few indications for cryotherapy (over laser) include poor fundus visibility, lack of laser availability and physician's unfamiliarity with indirect laser retinoplexy procedure.* Intravitreal anti-VEGF agents as bevacizumab are also tried.Stage, ActivityManagementStage 1, 2 and 3 included in low risk (type 2) prethreshold ROP* Weekly or biweekly screeningStage 1, 2 and 3 included in high risk (type 1) prethreshold and /or Threshold ROP* Laser photocoagulatton (Treatment of choice) CryotherapyStage 4A* Laser or cryotherapy + sclera bucklingStage 4B and 5* Lens sparing pars plana vitrectomy

So the answer to this question is B


Instruction:
Post polio, a child has gastronemius power - Grade 2, peroneus longus- Grade 3, tibialis anterior - Grade 4. Deformity present is:
A. Calcaneo valgus
B. Calcaneo varus
C. Equino valgus
D. Equino varus

Response:
Ans: a (Calcaneo valgus)Ref: Textbook of Orthopaedics - Ebenezar, 4th ed.Tibialis anterior and peroneus longus which are the primedorsiflexor and evertor position the foot in calcaneo valgusdue to unequal muscle pull in the above case.Calcaneo valgus - Dorsiflexion at ankle and (eversion) at subtalar joint.Calcaneo varus - Dorsiflexion at ankle and varus (inversion) at sub talar joint.Equino valgus - Plantar flexion at ankle and valgus at subtalar jointEquino varus - Plantar flexion at ankle and varus at subtalar joint.

So the answer to this question is A


Instruction:
50 year old male with positive family history of prostate cancer has come to you for a screening test. Which is the most sensitive screening test to pickup prostate cancer ?
A. DRE
B. PSA
C. DRE + PSA
D. Endorectal Coil MPJ with T, W and T2W images

Response:
The combination of digital rectal examination and PSA levels are the most sensitive screening test to pick up prostate cancer. Diagnosis of prostate cancer is based on symptoms, an abnormal DRE, a change or an elevated serum PSA levels. Ref: Harrison's Principles Of Internal Medicine, 16th Edition, PAge 544, 545/ 18th edition chapter 95; Current Surgical Diagnosis and treatment, By Gerard M Dohey, 12th Edition, Page1045, 46

So the answer to this question is C


Instruction:
Clinical wastes in hospitals are to be disposed in which colour bags
A. Yellow
B. Black
C. Green
D. Red

Response:
None

So the answer to this question is A


Instruction:
Which is true of malaria -
A. Rods forms are seen in P. malariae
B. RBC size is more in P. vivax
C. Relapse seen in P. falciparum
D. Male and female mosquito transmit disease

Response:
RBCs shape and size malaria: P. vivex - Enlarged, Round and Bizarre form P. falciparum - Normal in size P. malariae - Normal in size P. ovale - Enlarged, Oval and Fimbriated margin Relapse: Seen in P. vivax and P. ovale Recrudescence: Seen in P. falciparum and P. malariae infections Definitive host: Female Anopheles mosquitoes (not male anopheles) Intermediate host: Man. Rod forms are seen in P. falciparm not in P. malaiae

So the answer to this question is B


Instruction:
ELISA test has sensitivity of 95% and specificity of 95%. Prevalence of HIV carries is 5%. The predictive value of positive test is-
A. 95%
B. 50%
C. 100%
D. 75%

Response:
Ref:Parks 23rd edition pg 139 Construct a 2x2 table using the above data. 4.75 4.75 0.25 9.25 PPV = TP / (TP + FP) = 4.75/(4.75+4.75)=0.5

So the answer to this question is B


Instruction:
Mallory bodies are seen in
A. Viral hepatitis
B. Toxic hepatitis
C. Alcholholic hepatitis
D. All

Response:
Refer Robbins page no 843

So the answer to this question is C


Instruction:
Coagulation factor VII is
A. Thromboplstin
B. Accalerin
C. Proconvein
D. Antihaemophilic factor

Response:
Factor VII (EC 3.4.21.21, blood-coagulation factor VIIa, activated blood coagulation factor VII, formerly known as proconvein) is one of the proteins that cause blood to clot in the coagulation cascade. It is an enzyme of the serine protease class. Ref: guyton and hall textbook of medical physiology 12 edition page number:146,147,148

So the answer to this question is C


Instruction:
In infant, bone marrow biopsy is done from ?
A. Sternum
B. Iliac crest
C. Tibia
D. All of above

Response:
Ans. is 'c' i.e., Tibia Sternum : --> Hematopoitically active Site in cooperative patient like adult Ilium : Apprehesive patient Useful in older children & adult Tibia : Useful in newborn & infant and children below 2 year of age.

So the answer to this question is C


Instruction:
Which is a fructosan
A. Pectin
B. Chitin
C. Inulin
D. Glycogen

Response:
The polysaccharide of glucose (glucosan or glucan):- starch, glycogen, cellulose, dextrin, dextran, chitin
The polysaccharide of fructose (fructosan) :- Inulin

So the answer to this question is C


Instruction:
A middle aged chronic alcoholic man complains of burning sensation in the mouth. On examination he has thickened, dry, smooth tongue with absence of the filliform papillae. MCV is 100. Which of the following should be first line of approach in the management of this patient?
A. Estimation of Vitamin B12 levels
B. Brush biopsy
C. Sta Antifungal therapy
D. Incisional biopsy

Response:
The above given scenario is likely a case of Vitamin B12 deficiency hence estimation of Vitamin B12 levels should be the first step in management. Its deficiency may cause a bilateral peripheral neuropathy or degeneration (demyelination) of the cervical and thoracic posterior and lateral (pyramidal) tracts of the spinal cord. Other clinical features include: Anorexia - weight loss Diarrhea or constipation. Glossitis Angular cheilosis Jaundice (unconjugated) Reversible melanin skin hyperpigmentation Thrombocytopenia The anemia and low leukocyte count may predispose to infections, paicularly of the respiratory and urinary tracts. Glossitis

So the answer to this question is A


Instruction:
Which of the following is not a rapidly growing atypical mycobacteria causing lung infections ?
A. M. chelonae
B. M.fouitum
C. M.abscessus
D. M.kansasii

Response:
Ans. is 'd' i.e., M.kansasii

So the answer to this question is D


Instruction:
True about Hirshprug's disease –
A. Aganglionic segment is contracted not dilated
B. Descending colon is most common site
C. Barium enema is diagnostic
D. Barium enema shows calcification

Response:
None

So the answer to this question is A


Instruction:
Diagnosis of the given condition is:
A. Episcleritis
B. Bitot spots
C. Pterygium
D. Pinguecula

Response:
ANS. CGiven image is that of pterygium.# Pinguecula Bitot's spots episceritis* Pinguecula: Degenerative condition of conjunctiva characterized by triangular yellowish white patch on the bulbar conjunctiva near limbus.* Pterygium: Growth of conjunctiva--wing-shaped fold of conjunctiva encroaching onto cornea, Stockers line.

So the answer to this question is C


Instruction:
A patient presenting with hemoptysis and renal failure with anti-basement membrane antibodies has-
A. Good pasture's
B. Wegener's
C. Churg Strauss
D. Henoch-scholein purpura

Response:
Goodpasture syndrome, the prototype disorder of this group, is an uncommon but intriguing condition characterized by a proliferative, usually rapidly progressive glomerulonephritis and hemorrhagic interstitial pneumonitis. Both the renal and the pulmonary lesions are caused by antibodies targeted against the noncollagenous domain of the a3 chain of collagen IV. These antibodies can be detected in the serum of more than 90% of persons with Goodpasture syndrome. Ref: Robbins book of pathology. 9th edition. Page 485

So the answer to this question is A


Instruction:
Appearance of which of the following correlates with high levels of hepatitis B virus replication -
A. HBsAg
B. HBeAg
C. Anti HBc
D. IgM Anti HBc

Response:
Ans. is 'b' i.e., HBeAg Serological marker and lab diagnosis* Serological markers for HBV infection are1) HBs Ag (surface antigen or Australia antigen): It is the first marker which appears in the serum. It is the epidemiological marker for HBV infection.2) HBc Ag (core antigen): It is not demonstrable in serum because it is enclosed by HBsAg coat.3) HBe Ag (envelope antigen): It is marker of active replication and high injectivity. It is qualitative marker of replication. HBs Ag carrier mothers who are HBe Ag positive almost invariably (> 90%) transmit hepatitis B infection to their offspring, where as HBs Ag carrier mothers with anti HBe rarely (10 to 15%) infect their offspring.4) Anti-HBc Ag: It is the first antibody appears in serum. IgM anti-HBc Ag is a marker of acute or recent infection. IgG anti-HBc Ag indicates remote infection.5) Anti-HBs Ag: It is protective antibody. It is the only serological marker present after vaccination. After an infection, its presence indicates recovery and end of period of communicability.6) Anti-HBe Ag: Its presence indicate stopage of replication and low infectivity.7) HBV DNA: It is quantitative marker of HBV replication.* HBe Ag - Qualitative marker of replication.* HBV DNA - Quantitative marker of replication. HBs AgAnti HBs AgHBe AgAnti HBe AgAnti HBc AgAcute HBV (high infectivity)+-+ IgMAcute HBV (low infectivity)+- +IgMChronic HBV (high infectivity)+-+ IgMChronic HBV (low infectivity)+- +IgMRecovery-+-+IgMImmunized-+-

So the answer to this question is B


Instruction:
In haemolytic glaucoma the mechanisms are all except:
A. Siderosis of trabeculae
B. Deposition of haemosiderin
C. RBC clogging the trabeculae
D. Inflammation

Response:
Ans. Inflammation

So the answer to this question is D


Instruction:
Primary Hypothyroidism is seen in all EXCEPT
A. Iodine deficiency
B. Iodine excess
C. Lithium
D. Bexarotene

Response:
(D) Bexarotene # Causes of Hypothyroidism> Secondary.* Hypopituitarism: tumors., pituitary surgery or irradiation, infiltrative disorders, Sheehan's syndrome, trauma, genetic forms of combined pituitary hormone deficiencies.* Isolated TSH deficiency or inactivity.* Bexarotene treatment.* Hypothalamic disease: tumors, trauma, infiltrative disorders, idiopathic.

So the answer to this question is D


Instruction:
Sex reassignment surgery is done in ?
A. Gender identity disorder
B. Premature ejaculation
C. Erectile dysfunction
D. Orgasmic dysfunction

Response:
Ans. A. Gender identity disorderMany persons with gender identity disorder have sought sex-reassignment surgery, that is, physical change that is constant with their cross sexual identity.

So the answer to this question is A


Instruction:
All are seen in drowning except :
A. Miosis
B. Wet heavy lungs
C. Water and weeds in stomach and lung
D. Froth from mouth

Response:
A i.e. Miosis In drowning pupils are dilatedQ Other impoant signs of drowning are -fine copious persistant leathery froth from mouth & nose, weeds in tightly clenched hands, water in stomach & intestine, diatoms in brain & bone marrow, emphysema aquosum (wet heavy lungs), cutis anserina (goose skin), washer woman hands and Paltauf's haemorrhage.Q

So the answer to this question is A


Instruction:
Which of the following will decrease the physiologic dead space?
A. Emphysema
B. Neck flexion
C. Increase in tidal volume
D. IPPV

Response:
Neck flexion decreases the volume of anatomic dead space and thus the total or physiologic dead (which includes anatomic dead space) will decrease. Physiologic dead space includes those alveoli which do not receive perfusion, making it a wasted ventilation in those alveoli. Physiologic dead space increases in emphysema. Increase in tidal volume increases anatomic dead space & thus physiologic dead space In IPPV, the positive pressure ventilation increases alveolar pressure, which in turn compresses vessels. This will decrease the blood flow to some regions of the lung.

So the answer to this question is B


Instruction:
All are macrophages except -
A. Histocytes
B. Kupffer cells
C. Osteoclasts
D. Lymphocytes

Response:
Ans. is 'd' i.e., Lymphocytes Mononuclear macrophages Blood macrophages --> Monocytes Tissue macrophages --> Histocytes Lung --> Alveolar macrophages Brain --> Microglia Liver --> Kupffer cells Bone --> Osteoclasts Kidney --> Mesangial cells Placenta --> Hofbouer cells Spleen --> Littoral cells About option 'd' Lymphocytes Lymphocytes are the major cells in both antibody mediated (humoral) and cell mediated immunity. They also have some role in nonimmune inflammation. Antigen-stimulated lymphocytes (T & B cells) use various adhesion molecules and chemokines to migrate into inflammatory sites. Lymphocytes and macrophages interact in biderectional way, and these reactions play an impoant role in chronic inflammation. Macrophages process and present antigen to T-cells and also produce IL-2 that stimulate T cells. Activated T-cells produce IFN-y, a major activator of macrophages.

So the answer to this question is D


Instruction:
Karyotyping of foetus may be done from all of the following Except
A. Lymphocyte
B. Monocyte
C. Amniocyte
D. Fibroblast

Response:
For Karyotyping, the cell needs to be arrested in the Metaphase stage for separating the chromosomes. The monocytes do not divide and therefore, they cannot be used for Karyotyping).

So the answer to this question is B


Instruction:
Absolute contra -- indication of Norplant :
A. Acute thrombophiebitis
B. Hypeension
C. Diabetes mellitus
D. Hypercholesterolemia

Response:
Acute thrombophiebitis

So the answer to this question is A


Instruction:
A man presented with fractures of 4th to 10th ribs and respiratory distress after a Road Traffic Accident (A). He is diagnosed to have flail chest and a PaO2, of
A. Tracheostomy
B. IPPV with oral intubation
C. Fixation of ribs
D. Strapping of chest

Response:
Flail chest occurs when three or more contiguous ribs are fractured in at least two locations. Paradoxical movement of this free-floating segment of chest wall may be evident in patients with spontaneous ventilation, due to the negative intrapleural pressure of inspiration. The decreased compliance and increased shunt fraction caused by the associated pulmonary contusion that is typically the source of postinjury pulmonary dysfunction. Pulmonary contusion often progresses during the first 12 hours. Resultant hypoventilation and hypoxemia may require presumptive intubation and mechanical ventilation. Ref: Cothren C., Biffl W.L., Moore E.E. (2010). Chapter 7. Trauma. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e.

So the answer to this question is B


Instruction:
Dilated pupil with coma is seen in which poisoning -
A. Opium
B. Dhatura
C. Mushroom
D. Pilocarpus

Response:
None

So the answer to this question is B


Instruction:
Commonest cause of pulmonary embolism is: CMC (Vellore) 09
A. Fat
B. Amniotic fluid
C. Thrombus
D. Air

Response:
Ans. Thrombus

So the answer to this question is C


Instruction:
Corneal transparency is due to all except:
A. Na. - K+ pump
B. Normal IOT
C. Hypercellular stroma
D. Peculiar arrangement of lamella

Response:
C i.e. Hypercellular stroma

So the answer to this question is C


Instruction:
ROME (reorientation of medical education) scheme was introduced consequent to the recommendation of: March 2011
A. Shrivastav committee
B. Chaddah committee
C. Mukerjee committee
D. Kaar Singh committee

Response:
Ans. A: Shrivastav committee Shrivastav committee was set up in 1974 to suggests steps for improving the existing medical educational processes as to provide due emphasis on the problems paicularly relevant to national requirements SHRIVASTAV COMMITTEE. 1975. This committee was set up in 1974 as "Group on Medical Education and Suppo Manpower" to determine steps needed to - Reorient medical education in accordance with national needs and priorities and - Develop a curriculum for health assistants who were to function as a link between medical officers and MPWs. It recommended immediate action for: - Creation of bonds of paraprofessional and semiprofessional health workers from within the community itself. - Establishment of 3 cadres of health workers namely - multipurpose health workers and health assistants between the community level workers and doctors at PHC. - Development of a "Refferal Services Complex" - Establishment of a Medical and Health Education Commission for planning and implementing the reforms needed in health and medical education on the lines of University Grants Commission. - Acceptance of the recommendations of the Shrivastava Committee in 1977 led to the launching of the Rural Health Service.

So the answer to this question is A


Instruction:
Which of the following virus is shed in stool ?
A. Herpangina
B. Influenza
C. Varicella
D. Small pox

Response:
Ans. is 'a' i.e., Herpangina . Amongst the given options only Herpangina is caused by enterovirus (Coxsackie group A) and the diagnosis is made by virus isolation from the lesions or from feces. . All other are respiratory viruses and are shed in respiratory secretions. Common Sites of Isolation of Picornaviruses Enteroviruses Rhinovirus Polio Coxsackie A & B Echo Entero Nose 0 0 0 0 + Throat + + + + + Lower Intestine + + + + 0

So the answer to this question is A


Instruction:
Which one of the following test is used to detect malingering?
A. Stenger test
B. Bing test
C. Weber test
D. Rinne test

Response:
(a) Stenger test(Ref. Cummings, 6th ed., 2067)Bing, Weber and Rinne tests are for the detection of conductive and SN hearing loss.

So the answer to this question is A


Instruction:
A 10 month child weighing 5 kg and 65 cm presents with cough and cold. He was found to have a respiratory rate of 48 per minute with no retractions, grunting, cyanosis. There is no history of convulsions. Which is true ?
A. No pneumonia, only cough and cold
B. Child has pneumonia
C. Severe pneumonia
D. Very severe disease

Response:
SIGNS AND SYMPTOMS CLASSIFICATION THERAPY WHERE TO TREAT cough or cold no fast breathing no chest indrawing No pneumonia home remedies home respiratory rate/min .>60 in<2 months age >50 in2-12 months >40 in1-5 years chest indrawing pneumonia cotrimoxazole home chest indrawing cyanosis severe pneumonia IV/IM Penicillin hospital Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:356,7th edition

So the answer to this question is A


Instruction:
During conversion of glycerol to pyruvic acid, the first glycolytic intermediate to form is:
A. 2 - phospho glyceric acid
B. 3 - phospho glyceric acid
C. 3 - phospho glyceraldehyde
D. Dihydroxy acetone phosphate

Response:
None

So the answer to this question is D


Instruction:
Commonest cause of post paum hemorrhage is:
A. Atonic uterus
B. Traumatic
C. Combination of atonic and traumatic
D. Blood coagulation disorders

Response:
Atonic uterus

So the answer to this question is A


Instruction:
What is the name of this skin lesion seen in Tuberous sclerosis?
A. Adenoma sebaceum
B. Ash leaf macules
C. Confetti skin lesions
D. Shagreen patches

Response:
The skin lesion shown in the picture is shagreen patch, which has orange peel like appearance. skin manifestations of Tuberous sclerosis

So the answer to this question is D


Instruction:
Following features seen are characteristic  of
A. Aplastic anemia
B. Megaloblastic anemia
C. Iron deficiency anemia
D. Leukemia

Response:
None

So the answer to this question is B


Instruction:
Which of the following sites represents the location of Bezold abscess?
A. Diagastric triangle
B. Sternocleidomastoid muscle
C. Infra temporal region
D. Sub mandibular region

Response:
Ans. (b) sternocleidomastoid muscleRef: Dhingra's ENT 6th ed/ 78* Mastoid tip is in relation to two muscles:# Sternocleidomastoid muscle# Digastric muscle (posterior belly)* If there is abscess from:# SCM muscle: Bezolds abscess# Digastric area: Citelli s abscess.Also KnowDifferent MASTOID ABSCESSESAbscessLocationWild's abscessSubperiosteal mastoid abscessBezold's abscessDeep to Sternomastoid muscleLuc's abscessUnder periosteum of the roof of bony canalCitelli's abscessDigastric triangle (along posterior belly of digastrics muscle)

So the answer to this question is B