Instruction:
What is the complication of the diuretic phase of acute renal failure?
A. Convulsion
B. Hyperkalemia
C. Increased sodium excretion in urine
D. Metabolic Alkalosis

Response:
The recovery phase of ATN is characterized by regeneration of tubular epithelial cells. Abnormal diuresis occurs, causing salt and water loss and volume depletion. The urine output gradually returns to normal, but serum creatinine and urea levels may not fall for several more days. Tubular dysfunction may persist and is manifested by sodium wasting, polyuria unresponsive to vasopressin. The mechanism of the diuresis is not completely understood, but it may in pa be due to the delayed recovery of tubular cell function in the setting of increased glomerular filtration.

So the answer to this question is C


Instruction:
All of the following are seen in asbestosis except -
A. Diffuse alveolar damage
B. Calcified pleural plaques
C. Diffuse pulmonary interstitial fibrosis
D. Mesotheliomas

Response:
Diffuse alveolar damage is a characterstic feature of ARDS. As explained in the text, asbestos inhalation is associated with pleural plaque, interstitial fibrosis, bronchogenic cancer and mesothelioma.

So the answer to this question is A


Instruction:
Commonest carcinoma in men in tropical countries -
A. Ca rectum
B. Ca oral cavity
C. Ca testis
D. Ca bladder

Response:
Oral cancer is one of the ten most common cancers in the world Mostly due to Tobacco Alcohol Precancerous state Cultural pattern Ref- Park&;s textbook of Preventive and Social Medicine 24th edition.

So the answer to this question is B


Instruction:
Mechanism of action of beta-Lactam antibiotics would be
A. Inhibition of bacterial protein synthesis by binding to subunit of bacterial ribosomes
B. Inhibition of cell wall peptidoglycan synthesis by competitive inhibition of transpeptidases
C. Reduced drug causes strand breaks in DNA.
D. Inhibition of DNA synthesis by inhibiting DNA-Dependent RNA Polymerase

Response:
None

So the answer to this question is B


Instruction:
Vital capacity is sum of
A. Inspiratory reserve volume, Tidal volume and Expiratory reserve volume
B. Tidal volume, Inspiratory reserve volume and Residual volume
C. Expiratory reserve volume, Inspiratory reserve volume and Residual volume.
D. Residual volume, Inspiratory volume, and Expiratory reserve volume.

Response:
Ans. a (Inspiratory reserve volume, Tidal volume and expiratory reserve volume) (Ref Ganong 23rd/593)Ganong 23rd/Fig. 35-7:# VC = 4700 ml = ERV + TV + IRVRespiratory volumes and capacities for an average young male.MeasurementTypicalDefinitionRespiratory volumes1Tidal volume (TV)500 mlAmount of air inhaled or exhaled in one breath during relaxed quiet breathing2Inspiratory reserve volume (IRV)3000 mlAmount of air in excess of tidal inspiration that can be inhaled with maximum effort3Expiratory reserve volume (ERV)1200 mlAmount of air in excess of tidal expiration that can be exhaled with maximum effort4Residual volume (RV)1200 mlAmount of air remaining in the lungs after maximum expiration; keeps alveoli inflated between breaths and mixes with fresh air on next inspirationRespiratory Capacities5Vital capacity (VC)4700 mlAmount of air that can be exhaled with maximum effort after maximum inspiration (ERV + TV + IRV); used to assess strength of thracic muscles as well as pulmonary function6Inspiratory capacity (1C)3500 mlMaximum amount of air that can be inhaled after a normal tidal expiration (TV + IRV)7Functional residual capacity (FRC) 2400 mlAmount of air remaining in the lungs after a normal tidal expiration (RV + ERV)8Total lung capacity (TLC)5900 mlMaximum amount of air the lungs can contain (RV + VC)Additional Educational points# In a healthy normal adult male, FVC is approximately 5.0 L, FEV, is approximately 4.0 L, and thus, the calculated FEV1/ FVC is 80%.# Obstructive disorders result in a marked decrease in both FVC and FEV1/FVC, whereas restrictive disorders result in a loss of FVC without loss in FEV1/FVC.# FEV1/FVC for obstructive (42%) versus restrictive (90%) patients defines the hallmark measurements in evaluating these two diseases.

So the answer to this question is A


Instruction:
Which of the following anti - glaucoma drug can likely cause black pigmentation on conjunctiva
A. Adrenaline
B. Latanoprost
C. Beta blockers
D. Pilocarpine

Response:
Adrenaline used in glaucoma can lead to conjunctival pigmentation because of adrenochrome.

So the answer to this question is A


Instruction:
Infant body weight is tripled by age of-
A. 5 months
B. 11 months
C. 2 years
D. 18 months

Response:
Ans. is 'b' i.e., 11 Months o The average bih weight of neonates is about 3 Kg. o During first few days after bih, the newborn loses extracellular fluid equivalent to about 10% of the body weight. o Most full term infants regain their bih weight by the age of 10 days. o Subsequently, they gain weight at a rate of approximately 25 to 30 gm per day for the first 3 months of life. o Thereafter they gain about 400 gm of weight every month for the remaining pa of first year. Age Weight Bih 3 Kg 5 months 6 Kg (2 x bih weight) 1 year 9 Kg (3 x bih weight) 2 years 12 kg (4 x bih weight) 3 years 15 kg (5 x bih weight) 5 years 18 kg (6 x bih weight) 7 years 21 kg (7 x bih weight) 10 years 30 kg (10 x bih weight) o A child gains about 2 kg every year between the age of 3 and 7 years and 3 kg per year after that till the pupeal growth spu begins.

So the answer to this question is B


Instruction:
The characteristic finding in diabetic nephropathy is-
A. Diffuse glomerulosclerosis
B. Nodular glomerulosclerosis
C. Armani -Ebstein reaction
D. Fibrin caps

Response:
Pathologically, the first changes in diabetic nephropathy coincide with the onset of microalbuminuria and include thickening of the glomerular basement membrane and accumulation of matrix material in the mesangium. Subsequently, nodular deposits (Kimmelstiel-Wilson nodule), pathognomic of diabetic kidney disease, and glomerulosclerosis develops which worsens as heavy proteinuria develops, until glomeruli are progressively lost and renal function deteriorates. Reference : page 830 Davidson's Principles and practice of Medicine 22nd edition

So the answer to this question is B


Instruction:
Which of the following muscle is derived from the 1st arch?
A. Stylopharyngeus
B. Tensor tympani
C. Platysma
D. Cricothyroid

Response:
Human embryology Tenth edition Inderbier Singh Page no 132 First arch: medial and lateral pterygoid, masseter, temporalis, tensor tympani, tensorpalati

So the answer to this question is B


Instruction:
Which isoenzyme of LDH is seen in hea
A. LDH 1
B. LDH 2
C. LDH 3
D. LDH 4

Response:
Ans. is 'a' i.e., LDH1

So the answer to this question is A


Instruction:
Urogenital Diaphragm is made up of all of the following, EXCEPT?
A. Colle's fascia
B. Sphincter urethrae
C. Perineal membrane
D. Deep transverse Perineal muscle

Response:
Urogenital diaphragm is a triangular musculofascial diaphragm situated in the anterior pa of perineum, filling in the gap of the pubic arch. It is formed by the sphincter urethrae, deep transverse perineal muscles enclosed between superior and inferior layer of fascia of urogenital diaphragm. Inferior layer of fascia is called perineal membrane.The closed space contained between the superficial and deep layers of fascia is called deep perineal pouch.

So the answer to this question is A


Instruction:
Post micturation dribbling is due to-
A. Detrusor overactivity
B. Dribbling decreases in case of urethral stricture
C. Collection of Urine in U shaped curve of bulb of penis
D. Neurogenic bladder

Response:
None

So the answer to this question is C


Instruction:
Sensory supply to diaphragm is through -
A. Phrenic nerve
B. Intercostal nerves
C. Both
D. None

Response:
Ans. is 'c' i.e., Both o Nerve supply of diaphragm is as follows -i) Motor - Phrenic nerveii) Sensory - Phrenic nerve in central portion and lower six intercostal nerves in peripheral part.

So the answer to this question is C


Instruction:
All are true about hypospadias, except:
A. Circumcision in infancy is contraindicated
B. Avoid surgery till puberty
C. No treatment required in glandular variety
D. If associated chordee is present, 2 stage operation is done

Response:
Ans. (b) Avoid surgery till puberty* Surgery ideal age- 6 months to 1 year* Chordee 2 stage operation is known as Dennis Browne operation is done. First chordee is released. In 2nd stage we correct the opening.

So the answer to this question is B


Instruction:
22.Regarding ethmoidal polyp,which of the following is true:
A. epitaxis
B. Unilateral
C. <10 years
D. Associated with Bronchial asthama

Response:
Ref: Dhingra 7e pg 195.

So the answer to this question is D


Instruction:
The recommended daily requirement of vitamin A for pregnant woman is -
A. 750 mcg
B. 900 mcg
C. 1200 mcg
D. 1500 mg

Response:
Ref: Park 25th edition Pgno : 654

So the answer to this question is A


Instruction:
Yoke muscle for right superior rectus is
A. Left superior oblique
B. Left inferior oblique
C. Left inferior rectus
D. Left superior rectus

Response:
Yoke muscles Yoke muscles (contralateral synergists) are a pair of muscles (one from each eye) which contract simultaneously during version movements. Different pairs of yoke muscles are as follows: 1) Right medial rectus and left lateral rectus 2)Right lateral rectus and left medial rectus 3)Right superior rectus and left inferior oblique 4)Right inferior rectus and left superior oblique 5)Right superior oblique and left inferior rectus 6)Right inferior oblique and left superior rectus. Reference :- A K KHURANA; pg num:- 537

So the answer to this question is B


Instruction:
According to federation dental lower left canine is designated as-
A. 32
B. 33
C. 42
D. 43

Response:
According to FDI, left lower canine is designated as 33. Ref: K.S.Narayan Reddy's synopsis of Forensic Medicine and Toxicology ,29 th edition Chapter4.page no -60

So the answer to this question is B


Instruction:
Which of the following can be oxidized by b- oxidation pathway?
A. Saturated fatty acids
B. Mono saturated fatty acids
C. Polyunsaturated fatty acids
D. All of these

Response:
Ans. D. All of theseb- oxidation is defined as the oxidation of fatty acids on the b- carbon atom. It is a characteristic feature of all the fatty acid. Even chain fatty acids are degraded to form Acetyl CoA and Odd chain fatty acids are degraded to form propionyl CoA. Due to the presence of double bonds in unsaturated fatty acids, there reactions are little bit different than saturated fatty acids. This is solved by the two additional enzymes- an isomerase and an epimerase.

So the answer to this question is D


Instruction:
Most common cataract in new born is:
A. Zonular
B. Morganian
C. Ant. Polar
D. Post. Polar

Response:
A i.e. Zonular Punctate or blue dot cataract is the most common manifestationQ, & in minute degrees, is almost universal in occurrence. It usually forms in first two decades of life. Zonular or lamellar cataract accounts for 50% (most common) of all visually significant congenital cataract. Q On the basis of Parsons' and Kanski: Cataract Feature Punctate (Blue dot) Most common Cataract congenital cataracts Lamellar or Most common Zonular Cataract visually significant congenital cataracts Now lets see what a few other books have to say about these two varieties: Cataract Khurana Neema Punctate (Blue Usually forms in the 1st 2 It is very frequent. dot) Cataract decades of life. No comment on incidence. Lamellar or It is the most common type It is the most common type of Zonular Cataract of congenital cataract developmental cataract accounting for 50% of cases. accounting for 50% of cases Despite these obvious contradictions it would be preferable to go for Punctate (Blue dot) cataract as the most common variety, as is stated in the two of the most reputed books. Bilateral & symmetrical, round, grey-white circumferential lamellar shell of opacity around the clear fetal (embryonic) nucleus, which also is surrounded by clear zone (i.e. area within and around the cataract is clear) and coical riders (radial opacities or spoke of wheels) are characteristic features of lamellar (zonular/ perinuclear) cataract. Developmental Cataract may present - At bih (Congenital Cataract) - During fuher development: Infancy to Adulthood The location of the cataract in paicular layer of the lens is an indicator of the stage of development of the cataract i.e the earliest cataracts lie in the nucleus whereas the latest ones in the superficial coex.

So the answer to this question is A


Instruction:
Name of the procedure
A. Z plasty
B. Rhomboid flap
C. V-Y advancement flap
D. Rotation flap

Response:
This is V-to-Y advancement. Commonly used for fingeips and extremities.Ref: Bailey and love, 27e, page: 641

So the answer to this question is C


Instruction:
Which of the following is true about malignant hypehermia
A. Hypernatremia
B. Hypercalcemia
C. Hyperkalemia
D. Hypothermia

Response:
C i.e. Hyperkalemia

So the answer to this question is C


Instruction:
A malignant tumor of childhood, that metastsizes to bones most often, is
A. Wilm's tumor
B. Neuroblastoma
C. Adrenal gland tumors
D. Granulosa cell tumor of ovary

Response:
In neuroblastoma,metastasis is present in 60-70% of children,usually to the skeleton(facial bones,skull),bone marrow,also to lymph nodes. Reference:Essential pediatrics-Ghai,8th edition,page no:617.

So the answer to this question is B


Instruction:
Which one of the following is considered a primary ligament of the TMJ?
A. Stylomandibular.
B. Sphenomandibular.
C. Stylohyoid.
D. Temporomandibular.

Response:
None

So the answer to this question is D


Instruction:
True about acute ITP
A. More common in female
B. Specific anti platelet antibodies detected
C. Viral infection predisposes as seen after vaccination
D. 80% cases transforms to chronic

Response:
ITP is proposed to be secondary to antibodies directed against the platelate glycoprotein 2b/3a complex. mmune thrombocytopenia (ITP) is a disorder that can lead to easy or excessive bruising and bleeding. The bleeding results from unusually low levels of platelets -- the cells that help blood clot. Formerly known as idiopathic thrombocytopenic purpura, ITPcan cause purple bruises, as well as tiny reddish-purple dots that look like a rash. Children may develop ITP after a viral infection and usually recover fully without treatment. In adults, the disorder is often long term. If you don&;t have signs of bleeding and your platelet count isn&;t too low, you may not need any treatment. If your symptoms are more severe, treatment may include medications to boost your platelet count or surgery to remove your spleen. Reference : Ghai essential of pediatrics, eighth edition, p.no:351

So the answer to this question is B


Instruction:
In Wegner's glomerulonephritis, the characteristic features seen in
A. Focal necrotizing glomerulonephritis
B. Granulomas in the vessels wall
C. Interstital granulomas
D. Nodular glomerulosclerosis

Response:
Wegener's granulomatosis is a necro-inflammatory lesion having 4 components granulomas of the upper respiratory tract, granulomas of the lungs, systemic vasculitis (page 403) and focal necrotizing glomerulonephritis. Ref: Harsh Mohan textbook of pathology 6th edition page 495.

So the answer to this question is A


Instruction:
Successful alignment of the permanent incisors to overcome the incisor liability depends upon:
A. Leeway space of Nance
B. Broadbent phenomenon
C. Increased intercanine width
D. Increased intermolar width

Response:
For incisors to erupt in normal alignment, there is an obligate space requirement in the anterior part of both the arches which is termed as incisor liability. The total sum of the mesiodistal width of four permanent incisors is larger than that of primary incisors by 7.6 mm in maxilla and 6 mm in mandible (Wayne). This obligate space is provided by:

Interdental physiologic spacing in the primary incisor region: 4 mm in maxillary arch; 3 mm in mandibular arch.
Increase in the intercanine arch width: Signiﬁcant amount of growth occurs with the eruption of incisors and canines.
Increase in the anterior length of the dental arches: Permanent incisors erupt labial to the primary incisors to obtain an added space of 2-3 mm.
Change in inclination of permanent incisors: Primary teeth are upright, but permanent teeth incline to the labial surface, thus decreasing the inter-incisal angle from about 150o in the deciduous dentition to 123o in the permanent dentition. This increases the arch perimeter.

Textbook of Orthodontics, Gurkeerat Singh, 2nd ed Page 45-46

So the answer to this question is C


Instruction:
A premature infant is more likely than a full-term infant to –
A. Suffer from jaundice of hepatic origin
B. Maintain in normal body temperature in a cold environment
C. Excrete urine with a uniform specific gravity
D. Suffer from anaemia

Response:
The liver of premature (preterm) neonate is functionally immature that leads to hypoglycemia, hyperbilirubinemia (jaundice) and poor detoxification of drugs.

Problems of preterm Premature babies

Birth asphyxia
Hypothermia
Feeding difficulties
Infections
Respiratory distress
ARDS (Hyaline membrane dis)
Hyperbilirubinemia
Apenia
Intraventricular haemorrhage
Hypocalcemia
Necrotising enterocolitis
Metabolic acidosis
Hypoglycemia
Hypoproteinemia

Note - Problems of preterm small for date babies include problems of both i.e. problems of preterm and problems of small for date.

So the answer to this question is A


Instruction:
Not true about varicocele is
A. Commmon on the right side
B. Can present as a late sign of renal cell carcinoma
C. Has a bag of worms like feeling
D. Can lead to infeility

Response:
Varicocele is seen on left side in 95% of cases Varicocele It is seen 95% of times on left side. Several anatomic features contribute to the predominance of left-sided varicoceles. The left internal spermatic vein is longer than the right; in addition, it usually joins the left renal vein at right angles. The right internal spermatic vein has a more oblique inseion into the inferior vena cava. This paicular anatomy in the standing man may cause higher venous pressures to be transmitted to the left scrotal veins and result in retrograde reflux of blood into the pampiniform plexus. Clinical picture Age - young adult Tall thin men are frequently affected* Bag of worms* like feel on palpation The veins empty in supine position (so examination is always done in standing position) Infeility: The varicocele is the most common cause of male infeility worldwide. In approximately 70% of patients with secondary infeility, a varicocele is an underlying cause. "The World Health Organization concluded that varicoceles are clearly associated with impairment of testicular function and infeility." Varicocele may be secondary to renal cell carcinoma of the left kidney. The growth from renal cell carcinoma blocks the renal vein by venous permeation. So sudden onset of varicocele (left side) in middle-aged man should arouse suspicion of a renal cell carcinoma of the left side.

So the answer to this question is A


Instruction:
A Primi mother having 3 weeks male child, which is presenting with noisy breathing sound child is afebrile, sleeping & feeding well & on clinical examination, He is normal. Management protocol include -
A. Begin IV antibiotics
B. Reassure & give saline nasal drop
C. Give recemic epinephrine
D. Order for a chest X-ray

Response:
Ans. is 'b' i.e., Reassure & give saline nasal drop o This 3 weeks male child with noisy breathing does not have chest indrawing or fast breathing (as clinical examination is normal). So, this child is having simple cough or cold, no pneumonia. o Management includes : - i) Reassurance to mother ii) Frequent breast feeding iii) Keep the baby warm iv) Clear the nose

So the answer to this question is B


Instruction:
A 35 years old female presented with acne. She was treated for her acne but after the treatment, she developed pigmentation. Which drug is responsible for hyperpigmentation?
A. Tetracycline
B. Erythromycin
C. Minocycline
D. Doxycycline

Response:
Minocycline Oral antibiotics - most widely prescribed agents in acne Dose -100-200 mg daily Indicated for severe acne, moderate facial acne not responding to topical therapies and/or extensive truncal acne. Adverse effects with minocycline include drug hypersensitivity syndrome (DHS) - within 3 months of treatment initiation characterized by fever, malaise, ahralgia and a diffuse exanthematous skin eruption. lupus?like reaction Hyperpigmentation of skin & nails Melanonychia (dark nails)

So the answer to this question is C


Instruction:
Combined oral pill reduces the risk of ?
A. Breast cancer
B. Ovarian cancer
C. Cervical cancer
D. Vaginal cancer

Response:
Ans. is 'b i.e., Ovarian cancer Functional ovarian cyst o Endometrial carcinoma o Benign breast disease (fibroadenosis) Ovarian malignancy o Urerine fibroid o Premenstural tension & dysmenorrhoea Pelvic inflammatory disease o RA o Osteoporosis Ectopic pregnancy o Colon cancer o Acne

So the answer to this question is B


Instruction:
Appendicitis like syndrome is caused by:
A. Y.pseudotuberculosis
B. Pasteurella multocida
C. Bacillus cereus
D. Y.pestis

Response:
Yersinia pseudotuberculosis causes mesentric adenitis leading to Pseudoappendicitis.

So the answer to this question is A


Instruction:
Hormone replacement therapy (HRT) all are true EXCEPT
A. Increases the risk for endometrial cancer
B. Improves the cognitive preformance in healthy women
C. May increase the risk of Alzheimer's disease
D. Decreases the risk for major coronary heart disease

Response:
(D) Decreases the risk for major coronary heart disease # HRT may actually prevent the development of heart disease and reduce the incidence of heart attack in women between 50 and 59.> Unopposed estrogen (the supplementation of endogenous estrogens without a progestagen) can also result in endometrial hyperplasia, a precursor to endometrial cancer.> The extensive use of high-dose estrogens for birth control in the 1970s is thought to have resulted in a significant increase in the incidence of this type of cancer.> Hormone therapy taken soon after menopause may help protect against dementia, even though it raises the risk of mental decline in women who do not take the drugs until they are older.> Dementia risk was 1 % in women who started HRT early, and 1.7% in women who didn't, (e.g. women who didn't take it seem to have had--on average--a 70% higher relative risk of dementia).> This is consistent with research that hormone therapy improves executive and attention processes in postmenopausal women.

So the answer to this question is D


Instruction:
Programmed cell death without caspase activation
A. Autophagy
B. Necroptosis
C. Pyroptosis
D. Gangrene

Response:
Necroptosis is a hybrid of necrosis (consider this more) and apoptosis. It is a programmed cell death without caspase (cysteine- aspaic proteases) activation

So the answer to this question is B


Instruction:
Clostridium difficile infection risk increases on use of
A. Ciprofloxacin
B. Metronidazole
C. Vancomycin
D. Teicoplanin

Response:
Ciprofloxacin increases risk of C.difficile enterocolitis.Metronidazole, vancomycin, teicoplanin are effective agaist C. difficile in cases of pseudomembranous colitis.Ref: Bailey and Love 27e pg: 56

So the answer to this question is A


Instruction:
A completely charred body was brought for autopsy. You are examining the skull and cranial cavity. You find that there is a collection of blood in the epidural space. The presence of which of the following suggest the possibility of hematoma due to trauma:
A. Carboxy hemoglobin in the hematoma
B. Dark brown friable clot
C. Radiating Fracture lines over the skull
D. Diffuse Hematoma

Response:
Epidural hematoma (EDH) due to burns and blunt force (trauma) EDH due to trauma EDH due to burns( Heat hematoma) Cause Blunt force to the head Charring of the skull due to intense heat Situation adjacent to Syln fissure Anywhere Position unilateral Usually bilateral Characteristics Disc shaped,smooth,uniform, rubbery,reddish-purple in colour honeycomb appearance; granular, friable clot; chocolate brown in color Skull fracture Fracture line radiating from a skull defect present in temporal area circular defect without radiating fracture lines, seen above the temple Crossing of suture lines Hematoma do not cross sutures It may cross suture lines

So the answer to this question is C


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

Response:
Inferior pancreatico-duodenal aery is a branch of the superior mesenteric (not celiac) aery.Celiac trunk is the aery of the foregut. It supplies all derivatives of the foregut that lie in the abdomen. Branches - 1. Left gastric aery - smallest of the three. It gives off-a. Two or three oesophageal branches at the cardiac end of the stomach. b. Numerous gastric branches along the lesser curvature of the stomach 2. Common hepatic aery - gives off-a. The gastroduodenal aery- the gastroduodenal aery runs downwards behind the first pa of duodenum and divides at its lower border into the right gastroepiploic aery and superior pancreaticoduodenal aeries. b. The right gastric aery c. The cystic aery 3. Splenic aery a. Pancreatic branches b. Sho gastric aeries c. Left gastroepiploic aeries

So the answer to this question is B


Instruction:
Mutation in Marfan's syndrome involves?
A. Collagen I
B. Collagen IV
C. Fibrillin I
D. Fibrillin II

Response:
Ans. is 'c' i.e., Fibrillin IMarfan syndrome results from inherited defect in an extracellular glycoprotein fibrillin - 1 on chromosome - 15. It has autosomal dominant inheritance.

So the answer to this question is C


Instruction:
Mechanism of action of metformin
A. Increased peripheral glucose uptake
B. Stimulate insulin release
C. Decrease glucose resorption in intestine
D. None of the above

Response:
(Refer: K. D. Tripathi's Essentials of Medical Pharmacology, 6th edition, pg no:269)
Increased peripheral glucose uptake
Oral hypoglycemic agents

Enhance insulin secretion

So the answer to this question is A


Instruction:
Abnormal excretory function of hepatocytes assessed by -
A. Increased FT
B. Increased ALT
C. Increased Alkaline Phosphatase
D. Increased gamma GT

Response:
Serum alkaline phosphatase is produced by many tissues and is excreted in the bile.Elevation occurs in case of biliary tract obstruction Reference Harsh mohan page 595

So the answer to this question is C


Instruction:
The most impoant point of reference in the use of forceps is :
A. The Plane of greatest dimension
B. Posterior sagittal diameter
C. Pelvic axis
D. Station of biparietal diameter

Response:
Station of biparietal diameter

So the answer to this question is D


Instruction:
Nitroblue tetrazolium test is used for ?
A. Phagocytosis
B. Complement
C. T cell
D. B cell

Response:
Phagocytosis In the previous discussion we have seen that with phagocytosis neutrophils gets activated and there is rapid burst of oxygen consumption and activation of hexose monophosphate shunt. The rapid burst occurs due to rapid activation of the enzyme complex NADPH oxidase which oxidizes NADPH and in the process reduces oxygen to superoxide anion (0,-). It catalyzes the reduction of oxygen to superoxide anion which is then conveed to hydrogen peroxide and other toxic oxygen products (011-) (free radicals). H.,02 then combines with myeloperoxidase and halide to form an effective antibacterial compound. (HOCC-) Chronic granulomatous disorder Chronic granulomatous disease is a disorder of phagocytes. Patients suffering from chronic granulomatous disease have leucocytes that ingest microbes normally but lack the fully functional NADPH oxidase system, required to produce the superoxide anion. In these patients there is no respiratory burst due to lack of one of the four NADPH oxidase subunits in neutrophils. Thus, these patients are not able to generate superoxide, H202 and OH- ions (free radicals). (Thus the), are not able to kill the bacterias). Leucocytes from the patients of chronic granulomatous disease fail to reduce nitroblue tetrazolium during phagocytosis. This propey has been used as a screening method for the diagnosis of chronic granulomatous disease. More on chronic granulomatous disease:- Inheritence - X linked (more common) - Autosomal recessive There is increased incidence of bacterial infection. The bacterias involved in recurrent infections are catalase positive pyogenic pathogens such as staphylococci and colifonns. Catalase negative pathogens are handled normally There is excessive inflammation with granuloma formation. Clinical features are ? - Suppurative lyrnphadenopathy - Gingivitis - Aphthous ulceration - Seborrhic dermatitis - Obstruction of gastrointestinal or genitourinary system - Autoinimune complications - Immune thrombocytopenic purpura - Juvenile rheumatoid ahritis Tests for diagnosis Nitroblue tetrazolium test Dihydrorhodamine (DHR) oxidation test Immunoblot for NADPH oxidase components

So the answer to this question is A


Instruction:
Smoking is most strongly associated with which type of lung cancer?
A. Small cell cancer
B. Squamous cell carcinoma
C. Adenocarcinoma
D. Carcinoid tumor

Response:
None

So the answer to this question is A


Instruction:
Erosion of joint is seen in all except
A. SLE
B. Osteoarthritis
C. Psoriatic arthropathy
D. Rheumatoid arthritis

Response:
None

So the answer to this question is A


Instruction:
Microspherocytosis in peripheral blood smear are seen in-
A. Congenital spherocytosis
B. Autoimmune acquired haemolytic anaemia
C. Thalassemia
D. All of the above

Response:
Spherocytosis is characterized by presence of spheroidal rather than biconcave disc shaped red cells. Spherocytes are seen in hereditary spherocytosis ,autoimmune hemolytic anaemia and in ABO hemolytic disease of newborn like Thalassemia Reference: textbook of Pathology ,7th edition Author: Harsha Mohan, page number 269

So the answer to this question is D


Instruction:
A 1-week-old neonate presents to the pediatric emergency room with fever, irritability, poor feeding, and a bulging anterior fontanelle. Lumbar puncture is performed, and the cerebrospinal fluid (CSF) grows group B Streptococcus. Which of the following is the most likely pathogenic mechanism?
A. Complement C5a, a potent chemoattractant, activates polymorphonuclear neutrophils (PMNs)
B. In the absence of a specific antibody, opsonization, phagocyte recognition, and killing do not proceed normally
C. The alternative complement pathway is activated
D. The streptococci are resistant to penicillin

Response:
There has been speculation concerning the pathogenesis of GBS. This includes failure to activate complement pathways and immobilization of polymorphonuclear leukocytes due to the inactivation of complement C5a, a potent chemoattractant.

So the answer to this question is B


Instruction:
Nucleus ambiguus is not associated with which cranial nerve: March 2010, March 2013
A. X
B. XI
C. IX
D. XII

Response:
Ans. D: XIINucleus AmbiguusFunction:Motor innervation of ipsilateral muscles of the soft palate, pharynx, larynx and upper esophagus.Pathway:Axons of motor neurons in the nucleus ambiguus course with three cranial nerves: C.N. IX (glossopharyngeal), C.N. X (vagus), C.N. XI (rostral or cranial poion of spinoaccessory) to innervate striated muscles of the soft palate, pharynx, larynx and upper esophagus.Deficits:Lesion of nucleus ambiguus results in atrophy (lower motor neuron) and paralysis of innervated muscles, producing nasal speech, dysphagia, dysphonia, and detion of the uvula toward the opposite side (strong side).No affection of the Sternocleidomastoid or Trapezius. These muscles are innervated by cells in the rostral spinal cord (caudal poion C.N. XI).

So the answer to this question is D


Instruction:
Dawbarn sign
A. Infraspinatus tendinitis
B. Subacromial bursitis
C. Achliles tendon injury
D. None of the above

Response:
Subacromial bursitis Inflammation of the bursa that separates the superior surface of the supraspinatus tendon from the overlying coracoacromial ligament, acromion, coracoid (the acromial arch) and from the deep surface of the deltoid muscle. The subacromial bursa helps the movement of the supraspinatus tendon of the rotator cuff in activities such as overhead work.Dawbarn sign - the pain of subacromial bursitis disappears when the arm is abducted.(Refer: GS Kulkarni Textbook of Ohopedics, 3rd edition, pg no. 1357)

So the answer to this question is B


Instruction:
Which are seen in endodermal sinus tumor?
A. Schiller-duval bodies
B. Reed-Sternberg cells
C. Reinke's crystals
D. Russell bodies

Response:
Ans. is a, i.e. Schiller-Duval bodiesRef: CGDT 9th/ed, p938; Shaw 13rd/ed, p362Call exner bodies are small cyst like spaces found in cases of granulosa cell tumor.FeatureAssociated tumorCall exner bodies & coffee bean nucleiGranulosa cell tumorSchiller duval bodiesEndodermal sinus tumorReinke's crystalHilus cell tumorPsammoma bodiesSerous epithelial tumorsWalthard cell nestBrenner tumorSignet ring cellKrukenberg tumorHobnail cellClear cell tumorLarge polygonal cell with lymphocyticInfiltration and fibrous septaDysgerminomaSkin, teeth, cartilageTeratoma

So the answer to this question is A


Instruction:
Heat loss at an ambient temperature of 21 degree takes place through
A. Respiration
B. Radiation
C. Sweating
D. Urine and faeces

Response:
Radiation is a process of heat transfer to or from the surroundings mediam . It doesn't require any conducter Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:863,864

So the answer to this question is B


Instruction:
Metabolic acidosis may result due to?
A. Diabetic ketoacidosis
B. Diarrhea
C. Renal failure
D. All of the above

Response:
Metabolic acidosis can occur because of an increase in endogenous acid production (such as lactate and ketoacids), loss of bicarbonate (as in diarrhea) or accumulation of endogenous acids (as in renal failure). Metabolic acidosis has profound effects on the respiratory, cardiac and nervous systems.

So the answer to this question is D


Instruction:
The following are related to face presentation except:
A. The commonest position is LMA
B. Engaging diameter is submentobregmatic
C. The diameter distending the vulval outlet is mentovertical
D. During moulding, there is elongation of occipitofrontal diameter

Response:
Face presentation:

The attitude of the fetus shows complete flexion of the limbs with extension of the spine. There is complete extension of the head so that the occiput is in contact with the back.
The denominator is mentum.
The commonest position is left mentoanterior (LMA).
Face presentation present during pregnancy (primary) is rare, while that developing after the onset of labor (secondary) is common. It occurs more frequently seen in multiparae (70%), like other malpresentations.
Most common maternal cause is platypelloid pelvis and most common fetal cause is anencephaly.
The diameter of engagement is the oblique diameter—right in LMA, left in RMA.
The engaging diameter of the head is submento-bregmatic 9.5 cm (3 3/4”) in fully extended head or submentovertical  11.5 cm (4 1/2”) in partially extended head.
Engagement is delayed because of long distance between the mentum and biparietal plane (7 cm).
The head is born by flexion: (11.5 cm).
Vaginal delivery is possible in nentoanterior positions but not in persistent mentoposterior.
In mentoposterior during early stages of labor the policy of wait and watch should be adopted, in hope of mentoposterior getting converted to mentoanterior spontanelously. Persistent mentoposterior position is an indication for doing cesarean section.

So the answer to this question is C


Instruction:
Which one of the following is the most common cause of cyanotic hea disease-
A. Dextrocardia
B. Fallot's tetralogy
C. Atrial septal defect
D. Coarctation of aoa

Response:
Ans. is 'b' i.e., Fallot's tetralogy

So the answer to this question is B


Instruction:
Trendelenburg's procedure in treatment of varicose veins is:
A. Ligation of short saphenous vein
B. Stripping of superficial varicose veins
C. Sapheno-femoral ligation
D. Ligation of perforators

Response:
Ans: C (Sapheno-femoral ligation) Ref: Bailey & Love's Short Practice of Surgery, 25th Edition, pg. 929-932 and Sab is ton Textbook of Surgery,19th Edition pg. 1805-11 Explanation: Indications for Intervention in Varicose Veins Cosmos is Symptoms refractory to conservative therapy Bleeding from a varix Superficial thrombophlebitis Li podermato sclerosis Venous stasis ulcer The Principles are to: Ligate the point of communication, the sapheno- femoral and/or saphenopopliteal junctions. Remove the major part of the incompetent trunk to prevent connections to the tributaries. Individually remove tributaries by making minor cut-downs and teasing them out from under the skin (avulsions). Management of Great Saphenous Varicosity Surgery Saphenofemoral junction ligation and greater saphenous stripping Non Operative Methods Ultrasound Guided Foam Sclerotherapy Radiofrequency ablation Endovenous laser ablation Management of Short Saphenous Vein Varicosity Saphenopopliteal junction ligation and lesser saphenous stripping Management of Minor Varicosities Injection sclerotherapy using sodium tetradecyl sulphate Management of Perforator Incompetence Subfascial endoscopic perforator surgery Also Know CEAP Classification C Clinical signs (Grade 0-6), supplemented by "A" for asymptomatic and "S" for symptomatic presentation E Classification by cause {Etiology)-- congenital, primary, secondary A Anatomic distribution--superficial, steep, or perforator, alone or in combination P Pathophysiologic dysfunction--reflux or obstruction, alone or in combination CLASS FEATURES 0 No visible or palpable signs of venous disease 1 Telangiectasia, reticular veins, malleolar flare 2 Varicose veins 3 Edema without skin changes 4 Skin changes ascribed to venous disease (e.g., pigmentation, venous eczema, lipodermatosclerosis) 5 Skin changes as defined above with healed ulceration 6 Skin changes as defined above with active ulceration

So the answer to this question is C


Instruction:
All of the following are a features of mania except -
A. Decreased need for sleep
B. Elated mood
C. Delusion of grandeur
D. Decreased motor activity

Response:
Psychomotor activity is increased in mania.

So the answer to this question is D


Instruction:
At what stage of erythropoiesis does Hemoglobin appear?
A. Reticulocyte
B. Intermediate normobalst
C. Early normoblast
D. Erythroblast

Response:
a pronormoblast, also commonly called an proerythroblast or a rubriblast. This becomes a basophilic or early normoblast, also commonly called an erythroblast, then. a polychromatophilic or intermediate normoblast, then. an ohochromatic or late normoblast. At this stage the nucleus is expelled before the cell becomes. Ref: guyton and hall textbook of medical physiology 12 edition page number: 111,112,113

So the answer to this question is B


Instruction:
First antibody to appear in intrauterine life
A. IgM
B. IgA
C. IgD
D. IgE

Response:
Ans. (a) IgM

So the answer to this question is A


Instruction:
Iron absorption is increased by which of the following?
A. Phytates
B. Tannates
C. Plant foods
D. Ascorbic acid

Response:
- Site of iron absorption - duodenum and upper jejunum (proximal small intestine). - Iron absorption is increased by Acids Ascorbic acid (Vitamin C), citric acid Amino acids containing SH-group Sugars in the diet - Phytates, Tannates (found in tea), tetracyclines & Plant foods (non-heme iron) decreases iron absorption

So the answer to this question is D


Instruction:
S1 ejection click & severe pulmonary stenosis relation is-
A. In severe pulmonary stenosis gap increases
B. In severe pulmonary stenosis gap reduces
C. In severe pulmonary'' stenosis no change
D. In severe pulmonary stenosis ejection click comes before

Response:
Ans. is 'b' i.e., In severe pulmonary stenosis gap reduceso S1 occurs due to the closure of the A. V. valveEjection click occurs due to flow of blood through the pulmonary or the Aortic valve.The ejection of the blood does not begin immediately after the closure of A- V valve.The pulmonary valve opens when the right ventricular pressure exceeds the pressure in plumonary artery. The ejection of the blood begins only after, opening of the A V valve and is preceeded by the time it takes for ventricular pressure to sufficiently exceed the Aortic and pulmonary diastolic pressure therefore there is the time interval between S1 and ejection click.o The interval between the S1 and the pulmonary ejection sound is directly related to the right ventricular isovolumic contraction time which is usually prolonged in pulmonary hypertension explaining a relative late occurrence of the ejection sound in these patients.o With increasing severity of pulmonary valve stenosis, the isovolumetric contraction shortens and the pulmonary ejection sound therefore tend to occur soon after S1.o In patient with very severe pulmonary stenosis, the ejection sound can fuse with S1 and max not he recognized.In severe pulmonary stenosis ejection click may be absent or it is very close to S1 because in severe pulmonary stenosis the increased Right ventricular pressure keeps the pulmonary' valve open before ventricular systole begins.

So the answer to this question is B


Instruction:
Stool examination in a patient reveals the following finding. What is the likely route of infection of this parasite?
A. Ingestion of food contaminated with the egg of larva
B. Insect bite
C. Improperly cooked beef
D. Swimming in dirty water pool

Response:
Ans. a. Ingestion of food contaminated with egg of larva (Ref: Paniker's Parasitology 6/e p166;Jawetz 27/e p724;Harrison 19/e p1416)Elongated, barrel-shaped eggs with a polar 'plug' at each end shown here are characteristic of Trichuris egg, which causes trichuriasis via feco-oral transmission.NematodesFecal examinationTrichinella spiralisAdult wormQTrichuris trichiuraEggs (barrel shaped) QStrongyloidesRhabditiform larvaeQAncylostoma duodenale & Necator americanusEgg which may be hatched, so rhabditiform larvae can be seenEnterobius vermicularisUsually not usefulAscaris lumbricoidesEggs & adult wormQFilariasisNo roleDracunculus medinensisNo roleTrichuris trichiura (Whipworm)Adult female whipworms are approximately 30-50 mm in length; adult male worms are smaller.Anterior end of worms is slender & posterior end is thicker, giving it a "buggy whip" appearance, hence the name whipwormQ.Life cycle:Adult Trichuris worms reside in colon & cecum, the anterior portions threaded into superficial mucosaQ.Thousands of eggs laid daily by adult female worms pass with feces and mature in the soil.After ingestion, infective eggs hatch in the duodenum, releasing larvae that mature before migrating to the large bowelQ.The entire cycle takes ~3 months, and adult worms may live for several years.Clinical Features:Most infected individuals have no symptoms or eosinophilia.Heavy infections may result in anemia, abdominal pain, anorexia & bloody or mucoid diarrhea resembling inflammatory bowel disease.Rectal prolapse can result from massive infections in children, who often suffer from malnourishment & other diarrheal illnesses.Diagnosis:Characteristic 50-20-um lemon-shaped Trichuris eggs are readily detected on stool examinationQ.Barrel shaped structure seen with lightly stained mucus plugs at each poleQEgg-shell is stained brown & encloses light yellow stained unsegmented ovumQ

So the answer to this question is A


Instruction:
All of the following are impoant clinical manifestations of hepatocellular carcinoma except:
A. Jaundice
B. Abdominal pain
C. Abdominal mass
D. Ascitis

Response:
Answer is A (Jaundice): Jaundice is rare in hepatocellular carcinoma- Harrison Clinical manifestations of hepatocellular carcinoma: Abdominal pain and Abdominal mass - The most common presenting features are abdominal pain with detection of an abdominal mass I the right upper quadrant? Ascites - Blood tinged ascites occur in about 20% of cases - Harrison 16th/534 Friction rub or brui - A friction rub or brui may be over the liver Malaise, fatigue, weight loss Uncommon / inconstant features Jaundice - Jaundice is rare, unless significant deterioration of liver function or mechanical obstruction of bile duct occurs-Harrison 16th/534 Esophageal variceal bleeding - Gastrointestinal or esophageal variceal bleeding are inconstant findings - Robbins

So the answer to this question is A


Instruction:
Which of the following is the first site of appearance of Rigor mois after death?
A. Jaws
B. Eye lid
C. Facial muscles
D. Myocardium

Response:
Rigor mois first appears in the myocardium followed by eyelids, facial muscles, neck, upper limbs and lower limbs. The small muscles of the toes and fingers are affected last. The Rigor mois passes off in the same order of appearance. Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 23, Page 128-130

So the answer to this question is D


Instruction:
In Indoor air pollution, carbon monoxide is produced by –
A. Combustion equipment
B. Stove
C. Gas heaters
D. All of the above

Response:
None

So the answer to this question is D


Instruction:
Which of the following is seen in osteoporosis:
A. Low Ca, high PO4, high alkaline phosphatase
B. Low Ca, low PO4, low alkaline phosphatase
C. Normal Ca, normal PO4, normal alkaline phosphatase
D. Low Ca, low PO4, normal alkaline phosphatase

Response:
Ans. is 'c' i.e normal Ca, P04, Alkaline phosphatase , Harrison 16/e, p 2272 (14/e, 2250)]* "Laboratory findings in metabolic bone diseases"*DiseaseSerum calciumSerum phosphorusAlkaline phosphataseParathormonei) OsteoporosisNNNNii) Osteomalacia (Rickets)DecreaseDecreaseIncreaseN (Increase)iii) Prim.HyperparathyroidismIncreaseDecreaseN (Increase)Increaseiv) Pagets diseaseNNIncreaseNv) Bone disease in renal failure with sec. Hyper parathyroidismN (Decrease)IncreaseIncreaseIncreasevi) Lytic bone neoplasm NN (Increase)N (Increase)N (Increase)N

So the answer to this question is C


Instruction:
A child comes with a circular 3cm x 3cm scaly patchy hair loss with itching in the lesions. The investigation of choice is
A. Split skin smear
B. KOH mount
C. Gram stain
D. Tzanck smear

Response:
Itchy lesions over head with hair loss likely suggestive of Tinea capitis and KOH mount of hairs is the investigation of choice.

So the answer to this question is B


Instruction:
Acanthosis means
A. Loss of intracellular connections
B. Abnormal premature keralinization
C. Diffuse epidermal hyperplasia
D. Thickening of stratum corneum

Response:
HISTOPATHOLOGIC TERMS Before describing the pathology of common skin diseases, the following pathologic terms in common use need to be defined for the understanding of Dermatopathology: Acanthosis: Thickening of the epidermis due to hyperplasia of stratum Malpighi. Acantholysis: Loss of cohesion between epidermal cells with formation of intraepidermal space containing edema fluid and detached epithelial cells. Dyskeratosis: Abnormal development of epidermal cells resulting in rounded cells devoid of their prickles and having pyknotic nuclei. Dyskeratosis is a feature of premalignant and malignant lesions and is rarely seen in benign conditions. Hyperkeratosis: Thickening of the horny layer. Parakeratosis: Abnormal keratinization of the cells so that the horny layer contains nucleated keratinocytes rather than the normal non-nucleate keratin layer. Spongiosis: Intercellular edema of the epidermis which may progress to vesicle formation in the epidermis. Pigment incontinence: Loss of melanin pigment from damaged basal cell layer so that the pigment accumulates in the melanophages in the dermis. Ref: Textbook of pathology (Harsh Mohan)6th edition, page no.769

So the answer to this question is C


Instruction:
All are associated with superior relation of uncinate process, EXCEPT:
A. Ethmoid
B. Nasal septum
C. Lamina papyracea
D. Middle turbinate

Response:
Uncinate process: The uncinate process is a superior extension of the lateral nasal wall (medial wall of the maxillary sinus). It attaches,anteriorly to the posterior edge of the lacrimal bone, and inferiorly to the superior edge of the inferior turbinate. Superior attachment of the uncinate process is highly variable, may be attached to the lamina papyracea, or the roof of the ethmoidal sinus, or sometimes to the middle turbinate. The gap between the ethmoid bulla and the free edge of the uncinate process is the hiatus semilunaris.

So the answer to this question is B


Instruction:
All are advantages of Zinc therapy for Wilson disease:
A. It is nontoxic
B. Produces positive copper balance
C. Blocks intestinal absorption of copper
D. Induces hepatic metallothionein synthesis

Response:
Zinc treatment in wilson disease: It is efficient in Wilson's disease Nontoxic Produces a negative copper balance by blocking intestinal absorption of copper It induces hepatic metallothionein synthesis, which sequesters additional toxic copper Ref: Harrison, E-18, P-3190.

So the answer to this question is B


Instruction:
In a population of pregnant female, Hb is estimated on 100 women with standard detion of lgm%. The standard error is -
A. 1
B. 0.1
C. 0.01
D. 10

Response:
Ans. is 'b' i.e., 0.1

So the answer to this question is B


Instruction:
The radiograph of a traumatized tooth is necessary to:
A. Assess the stage of root development
B. Determine the presence/absence of root fracture
C. Have a base from which comparison can be made with future radiographs
D. All of the above

Response:
None

So the answer to this question is D


Instruction:
A patient on a ventilator is having bilateral crepitations in all lung fields. CXR shows the presence of?
A. Cardiogenic pulmonary edema
B. Noncardiogenic pulmonary edema
C. Neurogenic pulmonary edema
D. Chemical pneumonitis

Response:
Cardiogenic pulmonary edema Non - cardiogenic pulmonary edema Increased CT ratio Kerley B lines Batwing configuration Normal CT ratio Diffuse bilateral infiltrates sparing costophrenic angle Absent Kerley B lines

So the answer to this question is B


Instruction:
Normal turnover time of epidermis (skin doubling time) is
A. 2 weeks
B. 4 weeks
C. 6 weeks
D. 8 weeks

Response:
B i.e. 4 weeks

So the answer to this question is B


Instruction:
Pleomorphic rash is a feature of -
A. Chicken pox
B. Small pox
C. Erythema infectiosum
D. Erythema subitum

Response:
Ans. is 'a' i.e., Chicken pox

So the answer to this question is A


Instruction:
A 29–day old child presents with features of congestive cardiac failure and left ventricular hypertrophy. Auscultation shows a short systolic murmur. Most likely diagnosis is –
A. Rheumatic fever
B. Tetralogy of Fallot
C. Transposition of great arteries
D. Ventricular septal defect

Response:
The answer is quite obvious.
TOF and TGA are cyanotic heart diseases and
Rheumatic fever can be ruled out on basis of age. (Age group of rheumatic fever is 5-15 yrs)

Clinical manifestation of VSD

The patients become symptomatic around 6 to 10 weeks of age.
At this time CHF may develop.
Frequent symptoms → Palpitation, dysnea on exertion and chest infections.

Signs

Hyperkinetic precordium with a thrill at the left sternal border.
Pansystolic murmur at left sternal border.
S1 & S2 are masked by pan-systolic murmur maximum intensity of murmur is at 3rd, 4th or 5th left interspace.
S2 can be make out at the pulmonary area (upper left sternal border) where it is not masked by pan-systolic murmur → S2 is widely split with accentuation of P2
S3 may be audible at the apex.
A delayed diastolic murmur in mitral area.
Pulmonary systolic ejection murmur in pulmonary area.

So the answer to this question is D


Instruction:
A pt presented with pulsating varicose veins of the lower limb. Most probable diagnosis is
A. Klippel Trenaunay syndrome
B. Tricuspid regurgitation
C. DVT
D. Right ventricular failure

Response:
Ans. is 'a' ie Klippel-Trenaunay Syndrome Klippel- Trenaunay Syndrome :is characterized byCongenital AV fistulasCutaneous hemangiomasVaricose veinsHyperophy of involved extremityAbsence of deep venous system (so pathological superficial veins should not be removed without evidence of an intact deep system)*Another syndrome closely associated with A-V malformations is:Kasabach-Merritt syndrome characterised by:- thrombocytopenia* and- hemorrhagic manifestation *- d/t trapping & destruction of platelets* within the AV malformations*.

So the answer to this question is A


Instruction:
About standard Normal curve all is true except
A. Area = 1
B. Mean and Median = 1
C. Bell shaped
D. S.D. = 1

Response:
None

So the answer to this question is B


Instruction:
Reverse cold chain is for-
A. Measles
B. Polio
C. Rubella
D. Peussis

Response:
Ans. is 'b' i.e., Polio "Reverse cold chain" is for transpo of ble poliovirus in stool to an investigation centre. To isolate polio virus from stool, the sample needs to be maintained at 4-8deg C or stored at - 20degC from the moment of collection, to processing in the laboratory. This process for maintaining the bility of polio virus is called 'Reverse cold chain'. o So, in reverse cold chain i) Temprature for transpoation --> + 2 to +8degC. ii) Temprature for storage --> -20degC. o Specific red vaccine carrier is used in reverse cold chain.

So the answer to this question is B


Instruction:
Saccular diveiculum of extrahepatic bile duct in choledochal cyst is classified as -
A. Type I
B. Type II
C. Type III
D. Type IV

Response:
Ans. is 'b' i.e., Type II

So the answer to this question is B


Instruction:
A factory worker presents with excessive salivation, blue line on gums, tremors, disturbed personality, insomnia and loss of appetite. Diagnosis
A. Arsenic poisoning
B. Lead poisoning
C. Mercury poisoning
D. Phosphorus poisoning

Response:
(Refer: Rajesh Bardale - Principles of Forensic medicine & Toxicology, 1st edition, pg no: 458)
Mercury poisoning:

Chronic Poisoning:  Otherwise called as ‘Hydrargyrism’.
MC poisonous salt of mercury is Chloride
Classic Triad:Gingivitis, Salivation and Tremors.
Signs & Symptoms:

Blue lines on gums
Tremors (Danbury tremors) which starts in hands and then progresses to other parts of the body. When generalized, it is called as ‘Hatter’s Shake’, glassblowers shakes
Most severe form called as ‘Concussio mercurialis’ where no activity is possible.
‘Mercurial Erethism’ which occurs in worker of mirror industry where there is development of psychological symptoms
‘Mercuria lentis’ is a peculiar eye change where brownish deposit of mercury seen on anterior lens capsule and this is due to exposure to mercury vapor. It has no effects on visual acuity
Acrodynia ( Pink disease)
Idiosyncratic hypersensitivity reaction, seen in children
Generalized erythematous, eczematous papular type of lesions mostly in hands & feet, accompanied by thickening & peeling of the skin.

Dimercaprol (BAL) is used in treatment of mercury poisoning.

So the answer to this question is C


Instruction:
Muscle relaxant associated with increased ICP is?
A. Mivacurium
B. Atracurium
C. Suxamethonium
D. Vecuronium

Response:
Ans. is 'c' i.e., Suxamethoneum * Sch causes increases in all pressures - intraocular, intracranial, BP, and intrabdominalSuccinylcholine (Suxamethonium)* SCh is a depolarising skeletal muscle relaxant.* It causes sustained partial depolarization of muscle end plate - Initially produce twitching and fasciculation followed by flaccid paralysis.* It is the shortest and fastest acting skeletal muscle relaxant.* It is the only muscle relaxant which stimulate autonomic ganglia and vagus - Bradycardia occurs due to vagal stimulation.* SCh is the most commonly used muscle relaxant for passing endotracheal tube (rapacuronium and rocuronium are alternatives).* SCh is rapidly hydrolysed by plasma cholinersterase, some patients have genetically determined abnormality or deficiency of pseudocholinesterase, in them, SCh causes phase II block (dual block).* It can cause muscle fasiculations and soreness, change in BP and HR, arrhythmia, histamine release and K+ effux from muscles.* Post-operative muscle pain (myalgia, muscle soreness) is a very common problem.* It can accentuate malignant hyperthermia caused by halothane - Succinylcholine is the most common cause of malignant hyperthermia.* Succinylcholine can cause dangerous hyperkalemia in patients with: -# Burn# Massive trauma# Crush injury# Severe intra-abdominal infection# Spinal cord injury# Hemiplegia/Paraplegia# Muscular dystrophy# GB syndrome# Rhabdomyolysis# Severe Parkinsonism# Tetanus# Polyneuropathy# Closed head injury# Stroke# Encephalitis# Mysthenia gravis* SCh causes increases in all pressures -> intraocular, intracranial, BP, and intrabdominal.* SCh can cause Trismus (masseter spasm) especially in patients susceptible for malignant hyperthermia.

So the answer to this question is C


Instruction:
Which of the following is not a cause of conductive hearing loss-
A. CSOM
B. Otosclerosis
C. Presbycusis
D. Serous otitis media

Response:
Ans. is 'c' i.e., Presbycusis Causes of conductive deafnessCongenital causeso Meatal atresiao Fixation of stapes footplateo Fixation of malleus heado Ossicular discontinuityo Congenital cholesteatomaAcquired causeso External ear:# Any obstruction in the ear canal, e.g. wax, foreign body, furuncle, acute inflammatory swelling, tumor, atresiao Middle ear :# Perforation of tympanic membrane (traumatic or infective)# Fluid in middle ear (ASOM, serous otitis media or haemotympanum)# Mass in middle ear (tumors)# Disruption of ossicles (Trauma, CSOM, cholesteatoma)# Fixation of ossicles (otosclerosis, tympanosclerosis, adhesive otitis media)# Eustachian tube blockage (retracted tympanic membrane, serous otitis media)

So the answer to this question is C


Instruction:
The commonest symptom post operatively seen is ?
A. Depression
B. Psychosis
C. Euphoria
D. None of the above

Response:
Ans. is 'd' i.e., None of the above Delirium is the commonest psychiatric problem postoperatively (1) Delirium - 20 % (2) Depression- 9% (3) Dementia- 3% (4) Functional Psychosis- 2%

So the answer to this question is D


Instruction:
Most common parasite causing myocarditis is -
A. Trichinella
B. Trypanosome
C. Ascaris
D. Plasmodium

Response:
There are 3 stages in the life cycle of trichinella spiralis stage of intestinal invasion Malaise,nausea , vomiting, diarrhoea,abdominal cramps .onset within 2-30 hours of ingestion of food. stage of muscle invasion fever, myalgia, periorbital edema ,hemorrhage in subconjuctiva, myocarditis, and encephalitis. stage of encystation:final stage All symptoms subside Ref: panickers textbook of medical parasitology 8th edition page 173.

So the answer to this question is A


Instruction:
All of the following are true about Zollinger Ellison Syndrome except -
A. It is due to the presence of a gastrinoma
B. Gastrin provocation tests are a part of diagnostic work up
C. It might be associated with ulcers in unusual locations in stomach
D. They may be associated with insulinomas

Response:
Ans. is 'd' i.e., They may be associated with insulinomas Zollinger Ellison syndromeo ZES is caused by gastrin secreting gut neuroendocrine tumors (gastrinomas), which result in hypergastrinemia and acid hypersecretion.o Clinical situations that create suspicion for ZES are -# ulcers in unusual locations# ulcers in second part of duodenum & beyond# ulcers refractory to standard medical therapy# ulcer recurrance after acid reducing surgery# ulcers presenting with frank complications (bleeding, perforation and obstruction)# ulcers in the absence of H. pylori or NS AID ingestion. - giant ulcers (> 2 cm)# multiple duodenal ulcers# ulcers associated with diarrhoea# ulcer patient with hypercalcemia or family h/o ulcers# ulcers with severe esophagitis.# ulcers associated with prominent gastric folds# ulcers with findings s/o MEN-1 (endocrinopathy, family h/o ulcers or endocrinopathy, nephrolithiasis)Diagnosis of ZES (gastrinoma)o The first step in evaluation of a patient suspected of having ZES or gastrinoma is to obtain as fasting gastrin level. All gastrinoma patients have a fasting gastrin level > 150 pg/mL.o The next step is to assess acid secretion by measuring basal acid output (BAO) which should be 15 meq/h (normal < 4 meq/h) A gastric pH of > 3.0 implies hypochlorhydria and excludes gastrinomao Gastrin Provocative tests# In a pt. with pH < 2.0 or BAO 15 meq/hr and fasting gastrin level > 1000 pg/mL, the diagnosis of ZES is confirmed.# With pH < 2.0 or BAO 15 meq/L and lower gastrin levels (150-1000 pg/mL), a secretin stimulation test is perforfmed to distinguish ZES from other causes of hypergastrinemia.# A rise of 200 pg/mL of serum gastrin level within 15 min of secretin injection, confirms ZES.

So the answer to this question is D


Instruction:
In case of Ca lung which among the following will be C/I for surgical resection -
A. Malignant pleural effusion
B. Hilar lymphadenopathy
C. Consolidation of one lobe
D. Involvement of visceral pleura.

Response:
None

So the answer to this question is A


Instruction:
Urea is formed in:
A. Brain
B. Kidney
C. Liver
D. Intestine

Response:
C & A Harper, 26th ed, p. 244 & 25,h ed, p. 319

So the answer to this question is C


Instruction:
You are examining the liver biopsy specimen of a patient and you find Mallory hyaline in it. Which of the following would you exclude from the diagnosis?
A. Alcoholic liver disease
B. Hepatocellular Ca
C. Hepatitis E
D. Wilson's syndrome

Response:
Mallory hyaline bodies are eosinophilic cytoplasmic inclusions seen in degenerating liver cells, they also contain cytokeratin intermediate filaments. Some conditions showing Mallory hyaline are given below: 1. Wilson's disease2. Hepatocellular ca3. Primary biliary cirrhosis4. Indian childhood cirrhosis5. Alcoholic liver disease Ref: Robbins Illustrated Pathology, 7th Edition, Page 905

So the answer to this question is C


Instruction:
The most common complication of clavicle fracture is
A. Injury to brachial plexus
B. Malunuion
C. Stiffness of shoulder
D. Non union

Response:
B i.e. Malunion

So the answer to this question is B


Instruction:
Regarding uterine atony after delivery, treatment includes
A. Fundal massage should be performed
B. 20 units oxytocin bolus given i.v
C. Oxytocin diluted in crystalloid solution at concentration of 200 IU / min should be given i.v
D. All the above

Response:
Vigorous fundal massage can prevent post partum hemorrhage, if uterine atony is felt per abdomen.
20 units of oxytocin in 1000mL of crystalloid solution will be effective given i.v at 10mL / min for a dose of 200 mU / min.

So the answer to this question is A


Instruction:
"3 by 5" initiative in AIDS control programme is -
A. Providing 3 million people treatment by end of 2005
B. Providing treatment to 3 out of 5 patients
C. Reducing incidence of A I DS by 3% by 2005
D. All of the above

Response:
Ans. is 'a' i.e., Providing 3 million people treatment by end of 2005 3 by 5 target o On lst December 2003, WHO and UN A IDS announced a detailed plan to reach the "3 by 5 target" of providing antiretroviral treatment (A) to three million people living with IIIIDS in the developing countries by the end of 2005. o Ultimate goal ()1 this strategy is to provide universal access to A to anyone who needs it. o It has five Pillars (focus areas of concerns) :? 1) Simptified standard tools to deliver A 2) A new service to ensure effective, reliable supply of medicines and diagnostics 3) Dissemination and application of new knowledge and successful strategy 4) Urgent, sustained suppo to countries 5) Global leadership. backed by strong panership

So the answer to this question is A


Instruction:
Pachydermia laryngitis - M/C site of involvement
A. Vestibular fold
B. Arytenoid cailage
C. Anterior 1/3 commissure
D. Posterior 1/3 and anterior 1/3 commissure

Response:
Pachyderma laryngitis affects the medial surface of arytenoid cailage, in paicular the vocal processes. Ref:- Scott&;s Brown 7th edition; pg num:- 2196

So the answer to this question is B


Instruction:
On Contrast radiography which among the following is false?
A. Ileum is featureless
B. Colon has haustrations
C. Jejunum is feathery
D. Distal part of duodenum has a cap

Response:
The first part of the duodenum has the duodenal cap or bulb and not the distal part.
The first part of the duodenum is visible as a triangular shadow on barium studies and is known as the duodenal cap.
The small intestine contains mucosal folds known as plicae circulares or valvulae conniventes that are visible on barium studies and help in the distinction between small intestine and colon. Colon instead can be identified by the presence of haustrations.
Valvulae conniventes are more prominent in the jejunum giving the 'feathery appearance' on barium. These mucosal folds are gradually reduced distally giving a 'featureless' appearance of the distal ileum.

So the answer to this question is D


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

Response:
Ans. is 'b' i.e., Vomiting Most common side-effect of Cisplatin is : Vomiting The most impoant dose dependent toxicity is renal impairment. o Amifostine is labelled for reduction of cisplatin induced nephrotoxicity.

So the answer to this question is B


Instruction:
Which of the following is a myofunctional appliance?
A. Catalan's appliance
B. Hawley's appliance
C. Expansion screw
D. Derichsweiler appliance.

Response:
Catalans or lower anterior inclined plane appliance is used to treat cross bites. The inclined plane has a 450 angulation, which forces the maxillary teeth in cross bite to a more labial position. It is teeth supported functional appliance. Expansion screw and Derichsweiler are expansion appliances.

So the answer to this question is A


Instruction:
High plasma protein binding of a drug results in:-
A. Decreased glomerular filtration
B. High volume of distribution
C. Lowers duration of action
D. Less drug interaction

Response:
* High plasma protein binding (PPB) of a drug decreases its distribution into tissue and thus lower the volume of distribution. * As only free drug can be metabolized or excreted, high PPB usually increases the duration of action. * With higher PPB, there is more chance of getting displaced by other drugs leading to more drug interactions. * Drugs with high plasma protein binding have lesser glomerular filteration as proteins cannot be filtered across the glomerulus.

So the answer to this question is A


Instruction:
Prolonged treatment with INH leads to deficiency of:
A. Pyridoxine
B. Thiamine
C. Pantothenic acid
D. Niacin

Response:
Ans. (A) Pyridoxine(Ref: Katzung 11th/e p825, KDT 8th/e p818)Isoniazid can cause peripheral neuropathy due to deficiency of pyridoxine.

So the answer to this question is A


Instruction:
Which of the following is treatment of Type I hypersensitivity -
A. Histamine
B. IgA immunoglobulin
C. Sodium cromoglycate
D. Interleukin 5

Response:
None

So the answer to this question is C


Instruction:
Early mediators of allergic rhinitis are -a) Leukotrieneb) IL-4c) IL-5d) Bradykinine) PAF
A. ab
B. bc
C. acd
D. abcde

Response:
Allergic rhinitis is Type 1 hypersensitivity reaction

So the answer to this question is D


Instruction:
The nerve that supplies the marked structure
A. Dorsal rami of CI
B. Suprascapular
C. subscapular
D. dorsal scapular

Response:
marked structure is Levator scapulae Nerve supply C5 Dorsal scapular nerve supplies Levator scapulae and Rhomboids major/ remarks : brachial plexus is repeat topic ref : GRAYS ANATOMY AND BD CHAURASIA

So the answer to this question is D


Instruction:
Commonest diameter of fetal head engagement is
A. Submentoveritcal
B. Occipito frontal
C. Suboccipito bregmatic
D. Mentoveical

Response:
The commonest diameter for fetal head engagement is suboccipitobregmatic, as it leads to veex presentation for normal vaginal delivery. Fetal skull diameters Measurements Suboccipitobregmatic Biparietal diameter Submentobregmatic 9.5 cm Suboccipitofrontal 10cm Occipitofrontal Submentoveical 11.5 cm Mentoveical 14 cm

So the answer to this question is C


Instruction:
Vitreous haemorrhage is seen in all except
A. CRAO
B. CRVO
C. Coat's disease
D. Eales' disease

Response:
VITREOUS HAEMORRHAGE Vitreous haemorrhage usually occurs from the retinal vessels and may present as pre-retinal (sub-hyaloid) or an intragel haemorrhage. Causes : Causes of vitreous haemorrhage are as follows: 1. Spontaneous vitreous haemorrhage from retinal breaks especially those associated with PVD. 2. Trauma to eye, which may be blunt or perforating (with or without retained intraocular foreign body) in nature. 3. Inflammatory diseases such as erosion of the vessels in acute chorioretinitis and periphlebitis retinae primary or secondary to uveitis. 4. Vascular disorders e.g., hypeensive retinopathy, and central retinal vein occlusion. 5. Metabolic diseases such as diabetic retinopathy. 6. Blood dyscrasias e.g., retinopathy of anaemia, leukaemias, polycythemias and sickle-cell retinopathy. 7. Bleeding disorders e.g., purpura, haemophilia and scurvy. 8. Neoplasms. Vitreous haemorrhage may occur from rupture of vessels due to acute necrosis in tumours like retinoblastoma. 9. Idiopathic. Ref:- A K KHURANA; pg num:-246

So the answer to this question is A


Instruction:
Drug of choice for NSAID induced gastric ulcer is: September 2008, March 2012
A. Miprinone
B. Misoprostol
C. Carboprost
D. Miazapine

Response:
Ans.B: Misoprostol Misoprostol is a drug that is used for the prevention of non-steroidal anti-inflammatory drug (NSAID)-induced gastric ulcers, for early aboion, to treat missed miscarriage, and to induce labor. Pharmacologically, misoprostol is a synthetic prostaglandin El (PGE1) analogue

So the answer to this question is B


Instruction:
Indication for administration of AS V (Antisnake venom) in Viper bite?
A. Renal failure
B. DIC
C. Soft tissue swelling crossing joint nearby the site of bite
D. All of the above

Response:
Ans. d (All of the above) (Ref: Pilley Textbook of Toxicolgy 7th edition, p. 450; Harrison's 17th ed., p. 2742)Use of Acetylcholinesterase Inhibitors in Neurotoxic Snake Envenomation1. Patients with clear, objective evidence of neurotoxicity after snakebite (e.g., ptosis or inability to maintain upward gaze) should receive a trial of edrophonium (if available) or neostigmine.a. Pretreat with atropine: 0.6 mg IV (children, 0.02 mg/kg; minimum of 0.1 mg)b. Follow with:Edrophonium: 10 mg IV (children, 0.25 mg/kg) orNeostigmine: 1.5-2.0 mg IM (children, 0.025-0.08 mg/kg)2. If objective improvement is evident at 5 min, continue neostigmine at a dose of 0.5 mg (children, 0.01 mg/kg) every 30 min as needed, with continued administration of atropine by continuous infusion of 0.6 mg over 8 h (children, 0.02 mg/ kg over 8 h).3. Maintain vigilance regarding aspiration risk, and secure the airway with endotracheal intubation as needed.REID'S CRITERIA FOR ADMINISTRATION OF ASV# Leukocytosis > 13,000-15,000/cu mm# Thrombocytopenia < 80,000/cu mm# Renal failure# DIC# Soft tissue swelling involving or crossing joint nearby site of bite# Systemic symptoms/signs of neuroparalytic bite (vomiting, abdominal pain, giddiness, ptosis, etc).Dose of ASVLimb Area InvolvementDose< 1/3 of Limb area50 ml1/3-1/2 Limb area100 ml>50% of Limb area150-200 mlASV should be given within 2 days preferably can be given upto 5-7 days.Comparison of Antivenoms Recently Available for Treatment of Pit Viper Bites in the U Antivenin (Crotalidae) PolyvalentCroFabAvailable since19542000OriginEquineOvineSnakes used in manufactureCrotalus adamanteusC. adamanteus C. atroxC. atrox C. durissus terrificusC. scutulatus Bothrops atroxAgkistrodon piscivorusContainsSkin testing recommended byIgG, equine albuminFab fragmentsmanufacturerYesNoPretreatment with antihistaminesYesNoDry bite-doseNoneNoneMild - dose0 or 5 vials4 vialsModerate - dose10 vials4-6 vialsSevere - dose15-20 vials6 vialsRepeat dosingAs neededRepeat starting dose if patient fails to stabilize.After stabilization, give 2 vials q6h for 3 more doses. (Alternatively, re-dose on an as needed basis with close observation for recurrence of abnormalities.)Volume of diluent1000 mL250 mLAdminister over2 h1 hIncidence of anaphyiacticoid reacn23-56%14%incidence of delayed serum sickness18-86%3%

So the answer to this question is D


Instruction:
Aminoacyl – t- RNA is required for all except ?
A. Hydroxyproline
B. Methionine
C. Cystine
D. Lysine

Response:
- Hydroxyproline is a derived amino acid and there is no t-RNA available to transport derived amino acids: hydroxyproline and hydroxylysine are two examples of derived amino acid for which there is no t-RNA available.

So the answer to this question is A


Instruction:
Conjugated hyperbilirubinemia is seen in which of the following conditions?
A. Breast milk jaundice
B. Dubin-Johnson syndrome
C. Crigler- Najjar syndrome
D. Gilbe syndrome

Response:
None

So the answer to this question is B


Instruction:
Koebner's phenomenon is characteristic of –
A. Psoriasis
B. Pemphigus vulgaris
C. Pityriasis rosea
D. Lupus vulgaris

Response:
Disorders showing koebner's phenomenon

Lichen planus           Lichen nitidus                         Darrier disease (Keratosis follicularis)
Psoriasis                   Molluscum contigiosum          DLE
Vitiligo                       Warts                                      Pityriasis rubra pilaris

Rare causes are

Erythema multiforme                                          Necrobiosis lipoidica
Hailey-bailey disease                                         Xanthoma
Leukemia & Carcinoma                                      Vasculitis
Lichen sclerosis

So the answer to this question is A


Instruction:
DPT vaccine is given -
A. Intramuscular
B. Subcutaneous
C. Intradermal
D. Intravenous

Response:
Ans. is 'a' i.e., Intramuscular DPT Vaccineo It contains components for immunization against three diseases, i.e., toxoid of diphtheria and tetanus, and killed B. pertussis. Pertussis component enhances the potency of diphtheria toxoid.o Aluminium salts (hydroxide or phosphate) are used as adjuvant to increase immunogenicity. Thiomersalis used as preservative.o Usual storage temperature for DPT vaccine in cold chain is +2 to+8degC, stored in refrigerator. It should never be stored in deep freezer (should not be frozen) and if it gets frozen accidently, vaccine should he discarded.o Exposure to sunlight should he avoided. Open vials which have not been fully used should be discarded at the end of sessiono Vaccine is given by intramuscular route in the middle third of anterolateral aspect of thigh.o Optimum age to start DPT vaccination is 6 weeks after birth.o Total three doses are given in primarly immunization with an interval of 4 weeks between three doses. First booster is given at 16-24 months with second booster at 5-6 years.DoseAgeDPT,6 weeks of ageDPT:10 weeks of ageDPT314 weeks of ageDP TBooster16-24 months of ageDPTBooster5 years of ageo Absolute valid contraindications to DPT vaccine are (i) Severe allergic reaction to previous dose, and (ii) progressive neurological deficit (i.e. active epilepsy). Epilepsy controlled on antiepileptic drugs is not a contraindication.

So the answer to this question is A


Instruction:
For Status epilepticus, treatment of choice is: September 2012
A. Ethosuximide
B. Sodium valproate
C. Lamotrigine
D. Lorazepam

Response:
Ans. D i.e. Lorazepam

So the answer to this question is D


Instruction:
Hyponatremia in multiple myeloma is
A. TRUE
B. Relative
C. Absolute
D. Pseudo

Response:
Pseudohyponatremia Patients with multiple myeloma also have a decreased anion gap because of the M component is cationic, resulting in retention of chloride This is often accompanied by hyponatremia that is felt to be aificial (pseudohyponatremia) because each volume of serum has less water as a result of the increased protein Ref: Harrison's 19th edition Pgno : 714

So the answer to this question is D


Instruction:
A woman with infertility receives an ovary transplant from her sister who is an identical twin. What type of graft it is?
A. Xenograf
B. Autograft
C. Allograft
D. Isograft

Response:
Ans. is 'd' i.e., Isograft (Ref: Ananthanarayan, 9th/e)

So the answer to this question is D


Instruction:
A young hypeensive patient has serum K+ 2.8 meq/L and Taldosterone level with Si-ed plasma rennin activity. The likely cause is:
A. Renal aery stenosis
B. Ectopic ACTH syndrome
C. Diuretic therapy
D. Conn's syndrome

Response:
Answer is D (Conn's syndrome): Increased Aldosterone levels (Hjperaldosteronism) in the presence of hypeension hypokalemia and decreased rennin activity suggests a diagnosis of Conn's syndrome.

So the answer to this question is D


Instruction:
Which one of the following statement is true regarding pathogenicity of Mycobacteria species -
A. M. tuberculosis is more pathogenic than M.bovis to the humans
B. M. Kansasii can cause a disease indistinguishable from tuberculosis
C. M.Africanum infection is acquired from the environmental source
D. M.Marinum is responsible for tubercular lymphadenopathy

Response:
“Mycobacterium kansasii produce human disease indistinguishable from tuberculosis”
M. kansasii i is the most pathogenic non tuberculous mycobacterial species affecting the lung, and the clinical features of M. kansasii disease resemble those of tuberculosis. Harrison 17/e p1030
NTM causing human infection- Refer chapter review.

About Other Options:

Option a: M.tuberculosis is equally pathogenic than M.bovis to the humans and Guinea pig. However, M.bovis but not M.tuberculosis is pathogenic to rabbit.
Option c: M. africanum belongs to the members of Mycobacterium tuberculosis complex. It is commonly found in West African countries, causing up to a quarter of cases of tuberculosis in countries such as the Gambia. ‘It is an infection of humans only and is spread by an airborne route from individuals with open cases of disease.’
Option d: ‘M. marinum causes swimming pool granuloma/fish trank granuloma/ fish fancier’s finger. Secondary lesions appear along with dermal lymphatics.’ (Sporotrichoid spread)

So the answer to this question is B


Instruction:
Definitive host is one in which the follow ing lives -
A. Larvae
B. Asexual form
C. Adult form
D. None

Response:
Ans. is 'c' i.e., Adult form Definitive host In which the parasite utilises the sexual method of reproduction. o So, definitive host harbours adult worm. Intermediate host Herbours the larval stages (asexual multiplication). Paratenic (Carrier or transpo) host Where the parasite remains ble without fuher development.

So the answer to this question is C


Instruction:
True about rash of chicken pox-
A. Deep seated
B. Centripetal
C. Affects palm & sole
D. Slow evolution

Response:
Ans. is 'b' i.e., Centripetal Differences between smallpox and chickenpoxSmallpoxChickenpox1 Incubation:About 12 days(range : 7-17 days)About 15 days(range : 7-21 days)2. Prodromol symptoms :Severe.Usually mild.3. Distribution of rash:a) Centrifugalb) Palms and soles frequently involved.c) Axilla usually freed) Rash predominant on extensor surfaces and bony prominences.a) Centripetalb) Seldom affectedc) Axilla affectedd) Rash mostly on flexor surfaces.4. Characteristics of the rash:a) Deep-seatedb) Vesicles multilocular and umbilicatedc) Only one stage of rash may be seen at one time.a) Superficialb) Unilocular; dew-drop like appearance.c) Rash pleomorphic, i.e., different stages of the rash evident at one given time, because rash appears in successive crops.d) An area of inflammation is seen around the vesicles.d) No area of inflammation is seen around the vesicles.5. Evolution of rash:a) Evolution of rash is slow, deliberate and majestic, passing through definite stages of macule, papule, vesicle and pustule.b) Scabs begin to form 10-14 days after the rash appears.a) Evolution of rash very rapid.b) Scabs begin to form 4-7 days after the rash appears.6. Fever:Fever subsides with the appearance of rash, but may rise again in the pustular stage (secondary rise of fever).Temperature rises with each fresh crop of rash.

So the answer to this question is B


Instruction:
Syndrome characterized by proteinuria, hematuria and hypeension: March 2007
A. Nephrotic syndrome
B. Acute nephritis
C. Renal cell carcinoma
D. Nephroclacinosis

Response:
Ans. B: Acute nephritis Nephritic syndrome is characterized by; Proteinuria Hematuria Hypeension Variable renal insufficiency, with; -- Azotemia (elevated blood nitrogen) Oliguria (low urine output The main features are hypeension and RBC casts. Nephritic syndrome causes are usually grouped into 'focal proliferative' and 'diffuse proliferative' on the basis of histology (obtained by a renal biopsy). Focal proliferative IgA nephropathy Chronic liver failure Celiac sprue Dermatitis herpetiformis Henoch-Schoenlein purpura Alpo syndrome SLE Diffuse proliferative Focal glomerulosclerosis Membranoproliferative glomerulonephritis (malaria, hepatitis B, hepatitis C, chronic infection, sickle-cell disease, SLE, hemolytic uremic syndrome/thrombotic thrombocytopenic purpura) Cryoglobulinemia SLE Rapidly progressing glomerulonephritis (RPGNs) - several.

So the answer to this question is B


Instruction:
In a case of hyperophic pyloric stenosis, which of the following metabolic disturbance is found?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis with paradoxical aciduria
D. Metabolic alkalosis with alkaline urine

Response:
Due to vomiting of the gastric contents, infants develop a hypochloremic, hypokalemic metabolic alkalosis. The urine pH is high initially but eventually drops because hydrogen ions are preferentially exchanged for sodium ions in the distal tubule of the kidney as the hypochloremia becomes severe. Ref: Schwaz's Principles of Surgery, 9th Edition, Chapter 39

So the answer to this question is C


Instruction:
True about asthma -a) Increasing incidence day by dayb) Allergic asthma common in older patientsc) Increase in IgE in idiosyncratic asthmad) Bronchoconstriction
A. b
B. c
C. ad
D. ab

Response:
None

So the answer to this question is C


Instruction:
Contact period of chlorination ?
A. 1 hour
B. 30 minutes
C. 1 1\/2 hour
D. 2 hours

Response:
Contact period for chlorination is one hour. The presence of free residual chlorine for a contact period of one hour is necesary to kill pathogens. The residual chlorine is 0.5 mg/L.Parks textbook of preventive and social medicine.K Park. Edition 23.Pg no: 715

So the answer to this question is A


Instruction:
The mode of inheritance of incontinentia pigment is –
A. Autosomal dominant
B. Autosomal recessive
C. X-linked dominant
D. X-linked recessive

Response:
Incontinentia pigmenti is an X-linked dominant disorder

So the answer to this question is C


Instruction:
Primordial germ cells are seen in ------ by 3rd week of development?
A. Neural crest
B. Splanchnic mesoderm
C. Genital ridge
D. Yolk sac

Response:
Primordial germ cells originate in the epiblast, migrate through the primitive streak, and by the third week reside among endoderm cells in the wall of the yolk sac close to the allantois. Germ cells do not appear in the genital ridges until the sixth week of development Ref: Langman's embryology; Chapter 16; Pg no 243

So the answer to this question is D


Instruction:
For hysteroscopy, following are/is used:a) Distilled Waterb) Airc) Glycined) CO2
A. ab
B. cd
C. bd
D. ac

Response:
None

So the answer to this question is B


Instruction:
An elderly male patient presented with fever, chest pain and dry cough. On sputum culture growth on charcol yeast extract medium was identified. The organism is likely to be which of the following?
A. H. influenza
B. Moraxella caarrhahs
C. Legionella
D. Burkholderia cepacia

Response:
An elderly patient with fever, chest pain and non-productive (dry cough) are characteristic features of legionnaires disease (pneumonia), caused by Legionella pneumophila. Legionella pneumophila grows on buffered charcoal yeast agar. Hemophilus influenzae grows on blood agar, Moraxella catarrhalis grows on nutrient agar and Burkholderia cepacia needs selective media for its growth. Ref: Textbook of Microbiology, Ananthanarayan and Paniker, 7th Edition, Chapter 45, Page 409.

So the answer to this question is C


Instruction:
Lifespan of the fetal RBC approximately is
A. 60 days
B. 100 days
C. 80 days
D. 120 days

Response:
The lifespan of fetal red cells is 80 days and Rh factor is developed by 38 days.

So the answer to this question is C


Instruction:
Stored blood as compared to fresh blood has-
A. More 2, 3 DPG
B. High extracellular K+
C. High extracellular Hb
D. Increased platelets

Response:
None

So the answer to this question is B


Instruction:
In tubercular meningitis what is not seen?
A. Low sugar
B. Lymphocytic pleocytosis
C. High protein
D. Opening pressure is low

Response:
ANSWER: (D) Opening pressure is lowREF: Chandrasoma Taylor 3rd ed p. 915CSF changes in meningitisCSF parametersBacterial meningitisTB meningitisViral meningitisOpening pressureRaisedRaisedRaisedGross appearanceTurbidClear (may clot)ClearProtein (normal - 20-50 mg/dl)HighVery highSlightly highGlucose (40-70mg/dl)Very lowLowLowChloride (116-122 micro gram/dl)LowVery lowNormalCells > 5/microliterNeutrophilsPleocytosisLymphocytosis

So the answer to this question is D


Instruction:
Trochlear nerve
A. Supplies the inferior oblique muscle of the eyeball
B. Is the only cranial nerve to emerge from the dorsal aspect of the brainstem
C. Has its nucleus of origin in the midbrain at the level of the superior colliculus
D. Enters the orbit through the middle compartment of the superior orbital fissure

Response:
(B) Is the only cranial nerve to emerge from the dorsal aspect of the brainstem # TROCHLEAR NERVE emerges from the superior medullary velum near the frenulum veli just below the inferior colliculus.> Trochlear nerve is the only cranial nerve which emerges on the dorsal aspect of the brainstem.> When the trochlear nerve is damaged, diplopia occurs on looking downwards: vision is single so long as the eyes look above the horizontal plane.

So the answer to this question is B


Instruction:
A 25 year old male is undergoing incision and drainage of abscess under general anaesthesia with spontaneous respiration. Which of the following is the most efficient anaesthetic circuit which can be used in this patient?
A. Mapleson A
B. Mapleson B
C. Mapleson C
D. Mapleson D

Response:
The most efficient anaesthetic circuit which can used in this patient undergoing general anesthesia with spontaneous respiration is Mapelson A circuit. In Mapleson A or Magill circuit, free gas flow (FGF) enters the circuit near the reservoir bag and the APL valve is placed close to the patients face. This system is very efficient during spontaneous ventilation (SV), because the FGF needs to be only 0.7 to 1.0 times the patient's minute ventilation to avoid rebreathing. Use of this circuit is less efficient in case of rapid respiratory rate as in small children, and in controlled ventilation (CV). It should not be used in children less than 20kg because of the impoant apparatus dead space. Ref: Pediatric Anesthesia By Bruno Bissonnette, Page 635 ; Fundamentals of Anaesthesia By Tim Smith, Colin Pinnock, Ted Lin, 3rd Edition, Pages 843-44

So the answer to this question is A


Instruction:
The presence of multiple cavities in the lung with hematuria is suggestive of-
A. Wegener's granulomatosis
B. Tuberculosis
C. Renal cell carcinoma
D. Systemic lupus erythematosus (SLE)

Response:
Wegener's granulomatosis is characterised by granulomatous vasculitis of the upper and lower respiratory tracts together with glomerulonephritis.Lung involvement typically appear as multiple,bilateral,nodular cavitary infiltrates and clinically expressed as cough,hemoptysis,dyspnea,and chest discomfo.Renal involvement can appear as proteinuria,hematuria,and red blood cell casts,and progressing to renal functional impairment and renal failure. Ref:Harrison's medicine-18th edition,page no:2789,2790.

So the answer to this question is A


Instruction:
Electrocogulation is used for
A. Gingivectomy
B. Flap surgeries
C. Mucogingival surgeries
D. All of the above

Response:
None

So the answer to this question is A


Instruction:
ranulomatous mastitis is caused by all except -
A. TB
B. Fungus
C. Staphylococcus
D. Antibodies to milk antigens

Response:
Ans. is 'c' i.e., Staphylococcus Granulomatous mastitis Granulomatous inflammation is present in less than I% of all breast biopsy specimens. The causes include systemic granulomatous disease (e.g., Wegener granulomatosis or sarcoidosis) that occasionally involve the breast, and granulomatous infections caused by mycobacteria or fungi. Infections of this type are most common in immunocompromised patients or adjacent to foreign objects such as breast prostheses or nipple piercings. Granulomatous lobular mastitis is an uncommon breast-limited disease that only occurs in parous women. The granulomatous inflammation is confined to the lobules, suggesting that it is caused by a hypersensitivity reaction to antigens expressed by lobular epithelium during lactation.

So the answer to this question is C


Instruction:
A 5-year-old child presents with history of fever off- and-on for past 2 weeks and petechial spots all over the body and increasing pallor for past 1 month. Examination reveals splenomegaly of 2 cm below costal margin. The most likely diagnosis is:
A. Acute leukemia
B. Idiopathic thrombocytopenic purpura
C. Hodgkin's lymphoma
D. Aplastic anemia

Response:
- Pallor (anemia), petechial spot (thrombocytopenia), fever (infection due to neutropenia) with splenomegaly suggest the diagnosis of acute leukemia. - Splenomegaly eliminates aplastic anemia - Presence of anemia and recurrent infections, go against ITP

So the answer to this question is A


Instruction:
Histamine causes
A. Hypeension
B. Vasoconstriction
C. Vasodilation
D. Tachycardia

Response:
ref Robbins 7/e p64;9/e p73 As pa of an immune response to foreign pathogens, histamine is produced by basophils and by mast cells found in nearby connective tissues. Histamine increases the permeability of the capillaries to white blood cells and some proteins, to allow them to engage pathogens in the infected tissues.

So the answer to this question is C


Instruction:
Ehrlich phenomenon is seen in:-
A. Proteus
B. Mycobacterium TB
C. Corynebacterium
D. Staphylococcus

Response:
Ehrlich phenomenon is seen in Corynebacterium. Option 1, 2, 4 Proteus, Mycobacterium species and Staphyococcus species: Do not show Ehrlich phenomenon. Proteus shows Diene's phenomenon. Option 3 Difference due to the presence of toxin preparation of varying amounts of toxoid and antitoxin to combine in varying propoions is called Ehrlich phenomenon. Minimum lethal dose (MLD) of the diphtheria toxin as the least amount of toxin required to kill a guinea pig weighing 250 g within 96 hrs after subcutaneous inoculation. One unit of antitoxin is defined as the smallest amount of antitoxin required to neutralize 100 MLD of toxin.

So the answer to this question is C


Instruction:
Best quality proteins are found in highest quantities in -
A. Rice
B. Wheat
C. Ragi
D. Bajra

Response:
Cereals include rice and wheat while Bajra and ragi are included in millets. The protein content of rice varies from 6-9%.They are richer in lysine than the other cereal proteins, and hence for this reason, rice protein is considered to be of better quality. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 579)

So the answer to this question is A


Instruction:
Anticholinergic side effect is:
A. Salivation
B. Dryness
C. GIT motility
D. Sweating

Response:
Ans. (b) DrynessRef. Katzung'a Pharamacology 10th ed. Ch 7* Anti-cholinergic agent/Muscarinic antagonists are the class of drugs which competitively inhibit the effect of acetylcholine at muscarinic receptors. Therefore decreasing secretion from glands leading to DRYNESS.* Anti-cholinergic side-effect can be remembered by this mnemonic:# Hot as hare- increased temperature# Blind as bat- mydriasis# Dry as bone- Dry mouth, dry eye, dry skin# Red as beet- Flushed face# Mad as hatter: DeliriumAlso Know'* Cholinergic agents block acetylcholine esterase enzyme, thereby increasing the acetylcholine level.* The patient therefore will present with cholinergic symptoms: (Mn: SLUDGE)* Salivation, Lacrimation, increased urination, Diarrhea, GI distress, Emesis* DOC for this poisoning: ATROPINE

So the answer to this question is B


Instruction:
M/C time for embryo transfer after IVF is:
A. 2 days
B. 3 days
C. 4 days
D. 5 days

Response:
Ans. is b, i.e. 3 daysM/C time of embryo transfer = Day 3 (8 called Blastomere stage). Best result obtained with Day 5 transfer (Blastocyst transfer)

So the answer to this question is B


Instruction:
Shoest acting synthetic opioid is
A. Fentanyl
B. Remifentanil
C. Alfentanil
D. Sufentanil

Response:
.Remifentanil is a potent, sho-acting synthetic opioid analgesic drug. It is given to patients during surgery to relieve pain and as an adjunct to an anaesthetic. Remifentanil is used for sedation as well as combined with other medications for use in general anesthesia Ref Robbins 9/e pg 345

So the answer to this question is B


Instruction:
All of the following statements about purification of water are true, EXCEPT:
A. Level of residual chlorine in water should be 0.5 mg / L
B. Presence of Clostridium spores indicates recent contamination
C. Coliforms must not be detectable in any 100 ml sample of drinking water
D. Coliforms may be detected by multiple tube method and indole production

Response:
The presence of spores of Clostridium perfringens in a natural water suggests that faecal contamination has occured, and their presence in the absence of the coliform group, suggests that faecal contamination has occured at some remote time. Its presence in filtered supplies may indicate deficiency in filtration practice. These spores are capable of surviving in water for a longer time and usually resist chlorination. Ref: Park's Textbook of Preventive and Social Medicine By K. Park, 19th Edition, Pages 58-1; Two's Water Supply By Don D. Ratnayaka, 6th Edition, Pages 241-2, 247

So the answer to this question is B


Instruction:
CVS change in pregnancy -
A. Slight right axis deviation in ECG
B. Slight left axis deviation in ECG
C. Diastolic murmur
D. Pulse rate is decreased

Response:
Ans. is 'b' i.e., Slight left axis deviation in ECG Cardiovascular systemo Anatomical changes heart is pushed upwards & outward. Apex beat is shifted in 4th intercostals space. A systolic murmur can be heard in apical or pulmonary area. Mammary' murmur is a continuous hissing murmur audible over tricuspid area in left 2nd & 3rd intercostals space. ECG shows left axis deviation. S3 and rarely S4 can be heard.o Cardiac output starts to increase from 5th week of pregnancy, reaches its peak 40-50% at about 30-34 weeks. It is lowest in sitting or supine position & highest is the right or left lateral or knee chest position. CO further increases by 50% during labour and immediately following delivery. CO returns to pre labour values by one hour following delivery and to the pre-pregnant level by another 4 weeks,o Blood pressure systemic vascular resistance (SVR) decreases. Maternal BP is decreased,o Venous pressure femoral venous pressure is raised,o Supine hypotension syndrome (postural hypotension)o Regional distribution of blood flow uterine blood flow is increased from 50 ml per minute in non-pregnant state to 750ml near term. Pulmonary blood flow is increased by 2500 ml /minrenal blood flow increases by 400ml/min. The blood flow through skin and mucous membrane increases by 500ml/min.

So the answer to this question is B


Instruction:
What is the alternative drug for epinephrine in ACLS?
A. Amiodarone infusion
B. Atropine
C. High dose vasopressin
D. Adenosine

Response:
Ans. c. High dose vasopressinADVANCED CARDIAC LIFE SUPPORT ALGORITHMS

So the answer to this question is C


Instruction:
A fisherman presents with C/O chronic diarrhea and fatigue. His physician orders a P/S, which reveals a megaloblastic anemia. Most likely cause is
A. Clonorchis sinensis
B. D. latum
C. E. granulosus
D. T. saginata

Response:
.

So the answer to this question is B


Instruction:
Reactionary hemorrhage occurs within
A. 1-2 days
B. 2-7 days
C. < 24 hours
D. After 7 days

Response:
Reactionary haemorrhage commonly occurs in the first 24 hours after surgery, It may be caused by slippage of a ligature, displacement of blood clot, cessation of vasospasm, after coughing or increased mobility Bailey and Love 26th edition pg 19

So the answer to this question is C


Instruction:
Biological value is used for assessment of –
A. Fat quality
B. Protein quality
C. Carbohydrate quality
D. None of the above

Response:
Biological value (BV)

It is the percentage of absorbed nitrogen retained by the organism.

BV = Retained nitrogen / Absorbed nitrogen x 100

So the answer to this question is B


Instruction:
Calorigenic hormone is
A. Epinephrine
B. Nor-epinephrine
C. Thyroid hormones
D. All of the above

Response:
Calorigenic hormones are hormones which producing or increasing production of heat or energy; increasing oxygen consumption.Epinephrin hormone secreted by the adrenal medulla that is released into the bloodstream in response to physical or mental stress, as from fear or injury. It initiates many bodily responses, including the stimulation of hea action and an increase in blood pressure, metabolic rate, and blood glucose concentration. Also called adrenaline.Norepinephrine hormone is secreted by the adrenal medulla and the nerve endings of the sympathetic nervous system and causes vasoconstriction and increase in hea rate, blood pressure, and the sugar level of the blood. Also called noradrenaline.Thyroid hormone, especially thyroxine or triiodothyronine, produced by the thyroid gland.Hormone produced by the thyroid glands to regulate metabolism by controlling the rate of oxidation in cells. Ref: Ganong&;s review of medical physiology,24th edition, page no:317

So the answer to this question is D


Instruction:
Fundoscopic features of papilledema include all the following except
A. Ill-defined disc margin
B. Deep physiological cup
C. Absent venous pulsation
D. Bending of blood vessels

Response:
B. i.e. Deep physiological cup Deep physiological cupQ on fundoscopy is seen in glucoma; where as in papilloedema, there is bluring of margins of optic disc (Pt sign) & reduction in size of physiological cup.Q

So the answer to this question is B