Instruction:
Iris pearls are pathognomonic for
A. Syphilis
B. Sarcoidosis
C. Herpes simplex virus
D. Leprosy

Response:
Iris pearls are seen as glistening white beads at the pupillary margin. They are compared of bacilli within histiocytes and are pathognomonic for Lepromatous uveitis.

So the answer to this question is D


Instruction:
In morbus caeruleus foramen ovole closes after
A. 6 months
B. 2 years
C. 1 year
D. Never

Response:
In few cases, foramen ovale remains patent throughout life and gives rise to cyanosis, a condition called as Morbus caeruleus.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2162)

So the answer to this question is D


Instruction:
Levothyroxine is used in:
A. Thyroid storm
B. Cretinism
C. Endemic goiter
D. Grave's disease

Response:
L-thyroxine is thyroxine analogue. It has a a more sustained and uniform action. It is used in cretinsm and in hypothyroidism it contains T4 T3 medication is liothyronine which is used very rarely -only in myxedema coma (REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 248)

So the answer to this question is B


Instruction:
A 3-week-old neonate who began vomiting 2 days after birth, usually within 30 minutes after breastfeeding. He also has abdominal distension with enlargement of liver, with jaundice. The consulting doctor did two urine dipstick test, one specific for glucose was negative, second test specific for reducing sugar was positive. What is the diagnosis?
A. Hereditary fructose intolerance
B. Classic galactosemia
C. Essential fructosuria
D. Essential pentosuria

Response:
Ans. B. Classic GalactosemiaIdentifying features* Classic galactosemia is a serious disease with onset of symptoms typically by the 2nd half of the 1st wk of life.* With jaundice, vomiting, seizures, lethargy, irritability, feeding difficulties, poor weight gain or failure to regain birth weight.* Hepatomegaly Oil drop cataracts, Hepatic failure.* Mental retardation.* Demonstrating a reducing substance in several urine specimens collected while the patient is receiving human milk, cows milk, or any other formula containing lactose.* Benedict's Test PositiveQ* Clinistix urine test results are usually negative because the test materials rely on the action of glucose oxidase, which is specific for glucose and is nonreactive with galactose (Glucose Oxidase Test is negative)

So the answer to this question is B


Instruction:
A mother brings her 10 year old son to OPD because of a history of medullary carcinoma of thyroid in his father and grandparents. There are no findings on physical examination. Which of the following tests you would perform?
A. Serum insulin level
B. Serum glucagon level
C. Urine vanillylmandelic acid (VMA) level
D. Serum somatostatin level

Response:
Most cases of medullary thyroid carcinomas (MTC) are sporadic. But 25% occur in inherited syndromes such as familial medullary thyroid cancer and MEN types 2A and 2B. These occur due to germline mutations in the RET protooncogene. MEN2A consists of Medullary thyroid cancer, Pheochromocytoma and Primary hyperparathyroidism. MEN 2B consists of MTC, Pheochromocytoma, Mucosal neuromas, Gangliomas, and aMarfan-like habitus. Any patient with MEN 2A or MEN 2B may develop medullary carcinoma at a very young age and therefore should be followed carefully for pheochromocytoma with urine VMA, for hyperparathyroidism with serum calcium, and for medullary carcinoma with serum calcitonin.

So the answer to this question is C


Instruction:
In traumatic cases, shock is most likely due to:-
A. Injury to intra-abdominal solid organ
B. Head injury
C. Septicemia
D. Cardiac failure

Response:
In traumatic cases, shock is most likely due to Injury to intra-abdominal solid organ. HYPOVOLEMIC SHOCK MC type of shockQ Causes of hypovolemic shock: Blood lossQ(Trauma, bleeding) Loss of plasma due to extravascular fluid sequestration in burnsQ Loss of body sodium & water (diarrhea & vomitingQ)

So the answer to this question is A


Instruction:
Most conservative method of root end preparation is by:
A. Round bur.
B. Sonic.
C. Ultrasonic.
D. Laser.

Response:
None

So the answer to this question is D


Instruction:
The CNS tumor present with calcification:
A. Oligodendroglioma
B. Astrocytoma
C. Medulloblastoma
D. Pheochromocytoma

Response:
Oligodendroglioma is associated with calcification. BT associated with calcification (COM):CraniopharyngiomaQ (most) > ODGQ (90%) > MeningiomaQ (20-25%)

So the answer to this question is A


Instruction:
A patient presents to the emergency department with uniocular diplopia. Examination with oblique illumination shows golden crescent while examination with coaxial illumination show a dark crescent line. Which of the following is the most likely diagnosis –
A. Lenticonus
B. Coloboma
C. Microspherophakia
D. Ectopia lentis

Response:
Presence of uniocular diplopia together with the finding of the golden crescent on oblique illumination (edge of subluxated lens) or black crecent line on coaxial illumination (edge of subluxated lens) suggests a diagnosis of `subluxation' of the crystalline lens. Ectopic lens refers to the displacement of shows lens from its normal position (subluxation, dislocation).

So the answer to this question is D


Instruction:
Comment on the histopathological specimen
A. Teratoma
B. Rhabdomyoma
C. Rhabdomyosarcoma
D. Neuroblastoma

Response:
Ref: Robbins and Cotran Atlas of Pathology, 3rd ed. pg. 356* Teratomas are made up of a variety of parenchymal cell types representing more than 1 germ layer and often all 3 germ layer.* Cells differentiate along various germ lines, essentially recapitulating any tissue of the body. Examples include hair, teeth, fat, skin, muscle, and endocrine tissue.* Arising from totipotential cells, these tumors typically are midline or paraxial.* The most common location is sacrococcygeal (57%).* Because they arise from totipotential cells, they are encountered commonly in the gonads (29%).* The most common gonadal location is the ovary, although they also occur somewhat less frequently in the testes.

So the answer to this question is A


Instruction:
All of the following statements about the differences between self-polymerizing acrylic
resins and heat—cured resins are true EXCEPT
A. The former have a lower molecular weight
B. The former have higher residual monomer content
C. The former are more porous
D. The former have greater transverse strength

Response:
None

So the answer to this question is D


Instruction:
A 30 - year - old lady complains of sudden onset breathlessness, anxiety, palpitations and feeling of impending doom. Physical examination is normal. What is the diagnosis?
A. Acute psychosis
B. Anxiety disorder
C. Conversion disorder
D. Panic attack

Response:
Panic disorder is characterised by discrete episodes of acute anxiety. The onset is usually in the early third decade with often a chronic course. The panic attacks occur recurrently every few days. They may or may not have any underlying generalised anxiety disorder.
The episode is usually sudden in onset, lasts for a few minutes and is characterised by very severe anxiety.

So the answer to this question is D


Instruction:
In B/L, abductor palsy of vocal cords following is done except:
A. Teflon paste
B. Cordectomy
C. Nerve muscle implant
D. Arytenoidectomy

Response:
Ans. is a i.e Teflon paste In Bilateral Abductor paralysis (i.e. bilateral paralysis of RLN), the cords lie in median or paramedian position due to unopposed action of cricothyroid muscle. Since, both the cords lie in median or paramedian position, the airway is inadequate causing dyspnea and stridor. Principle for managing such cases is: lateralisation of the cord and not fuher medialization of cord by injection of Teflon For more details see the proceeding text.

So the answer to this question is A


Instruction:
A previously healthy 61 - year - old woman presents with a 3 - week history of altered bowel habit and rectal bleeding. She refuses to undergo colonoscopy. Which of the following is next best investigation?
A. CT colonography
B. CT abdomen and pelvis
C. Barium enema
D. Barium meal follow through

Response:
CT colonography , CT abdomen and pelvis and barium enema are useful in this situation. But CT colonography is the most accurate of the three, enabling detection of small polyps. The conventional CT will only detect large tumours. The barium enema will only detect large polyps and frank tumours.

So the answer to this question is A


Instruction:
Host receptor for streptococcus pyogenes is?
A. CD4
B. CD21
C. CD44
D. CD46

Response:
Ans. (d) CD46(Ref: Wintrobes I2th/pg 2523)CD46 (Complement Membrane Cofactor Protein): It is a receptor to a number of pathogens, such as herpes virus 6, M protein of group A streptococci, Neisseria gonorrhoeae, and Escherichia coli.

So the answer to this question is D


Instruction:
A 14-years-old boy is not able to get good grades on 9th standard exam. But he is very sharp and intelligent. Best test to diagnose his problem:
A. Child behavior checklist
B. Bhatia's battery
C. Specific learning disability test
D. Child behavior battery

Response:
Ans. c. Specific learning disability test In the given question, as the child is sharp and intelligent but getting the poor grades, so this picture is very much suggestive of "specific" learning disability disorder which is best diagnosed by Specific learning disability test. Specific Learning Disorder Specific learning disorder refers to a child or adolescents deficit in acquiring expected skill in reading, writing, speaking, use of reasoning, listening or mathematics compared to other children of same age and intellectg. The test used for this disorder is c.alled specific learning disability testQ.

So the answer to this question is C


Instruction:
Marker of acute kidney injury all except
A. Clusterin
B. Osteopontin
C. Alanine aminopeptidase
D. Acid phosphatase

Response:
Ans. is 'd' i.e., Acid phosphatase Alanine aminopeptidase (AAP) Kidney injury molecule-1 (KIM-1) Alkaline phosphatase (AP) Clusterin utathione-S-transferase (a-GST) Neutrophil gelatinase associated lipocalin (NGAL) yglutamyl transpeptidase (TGT) Interleukin-18 (IL-18) N-acetyl-0-glucosaminidase (NAG) Cysteine-rich protein (CYR-61) 2-microglobulin Osteopontin (OPN) microglobulin o Retinol-binding protein (RBP) Fatty acid binding protein (FABP Cystatin C Sodium/hydrogen exchanger isoform (NHE3) o Microalbumin Exosomal fetuin-A

So the answer to this question is D


Instruction:
Meckel’s diverticulum is a remnant of -
A. Urachus
B. Vitellointestinal duct
C. Yolk sac
D. Allantoin

Response:
The Vitellointestinal duct or the omphalomesenteric duct is the connection between the yolk sac and the developing gut.
Normally, it gets obliterated and disappears.
But sometimes it may persist in various forms giving rise to congenital anomalies:-

Umbilical faecal fistula - due to the persistence of the entire vitellointestinal duct.
Umbilical sinus - when the duct is obliterated at the intestinal end but communicates with the umbilicus at the distal end.
Meckel’s diverticulum - when the duct is obliterated at the umbilicus but persists at it intestinal end.
Umbilical cyst or vitelline cyst - when both ends are occluded but the track in between persists.
Fibrous band - the entire track may be obliterated, but a fibrous band may persist between the ileum and the umbilicus. The fibrous band may lead to intestinal obstruction.

So the answer to this question is B


Instruction:
Epstein Barr virus causes all except -
A. Burkitt's lymphoma
B. Infectious mononucleosis
C. Nasopharyngeal carcinoma
D. Carcinoma cervix

Response:
EB virus infection leads to Infectious mononucleosis, Burkitt's lymphoma, Nasopharyngeal carcinoma in persons of Chinese origin Lymphoma in immunodeficient persons such as AIDS. REF:ANATHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 8TH EDITION PAGE NO:475

So the answer to this question is D


Instruction:
Which of the following is a risk factor for development of gastric carcinoma?
A. Blood group O
B. Intestinal metaplasia type III
C. Duodenal ulcer
D. All of the above

Response:
Blood group A, not O was considered as the risk factor for Gastric carcinoma but blood group A is also not considered as risk factor according to standard books. About duodenal ulcers standard books writes "Although once considered a premalignant conditions, it is likely that older literatures was confounded by mistakenly labeling inadequately biopsied ulcers and healing ulcers as 'benign' when in fact they were malignant to begin with". Intestinal metaplasia is a premalignant condition and among intestinal metaplasia , intestinal metaplasia type III is more likely to progress to gastric cancer. Ref: Schwaz 9/e, Page 927; Maingot's 10/e, Page 1006.

So the answer to this question is B


Instruction:
Hypeension is seen with all except-
A. Erythropoitin
B. Cyclosporine
C. NSAID
D. Levodopa

Response:
Ans. is d i.e., Levodopa Drug causing hypeension Cocaine MAO inhibitors Oral contraceptives Clonidine withdrawl Tricyclic antidepressants Cyclosporine Glucocoicoids Rofecoxib (NSAID) Erythropoietin Valdecoxib (NSAID) Sympathomimetics

So the answer to this question is D


Instruction:
C. trachomatis is a well-known cause of venereal disease. This organism is also implicated in which of the following?
A. Classic trachoma infection
B. Sexually transmitted cardiac disease in adults
C. Perinatal retinitis
D. Middle-ear infection in young children

Response:
Trachoma has been the greatest single cause of blindness in the world. Chlamydia trachomatis is the most common cause of sexually transmitted disease in the United States and is also responsible for the majority of cases of infant conjunctivitis and infant pneumonia.

So the answer to this question is A


Instruction:
A 55-year-old man is admitted to the hospital with nausea, vomiting, and hematuria. A CT scan examination reveals a neoplasm in the posterior surface of the inferior pole of the left kidney that has invaded through the renal pelvis, renal capsule, ureter, and fat. To which of the following regions will pain most likely be referred?
A. Skin of the anterior and lateral thighs and femoral triangle
B. Skin over the gluteal region, pubis, medial thigh, and scrotal areas
C. Skin over the medial, anterior, and lateral side of the thigh
D. Skin over the pubis and umbilicus

Response:
Visceral pain from the kidneys and the ureter at the point of the neoplasm is mediated via T11 and T12 spinal cord levels. Therefore, pain is referred to these dermatomes leading to pain in the upper gluteal, pubic, medial thigh, scrotal, and labial areas (from subcostal and iliohypogastric nerves, in particular). In contrast, the umbilical region, the T10 dermatome, is supplied by the T10 spinal nerve, excluding it from being the correct answer. The dermatomes that supply the anterior and lateral thighs are of upper lumbar origin and would not receive pain referred from the kidneys.

So the answer to this question is B


Instruction:
A woman is admitted with complains of low-grade fever of 6 weeks duration. Chest radiograph reveals bihilar adenopathy with clear lung fields. All of the following investigations will be useful in differential diagnosis except :
A. CD4/CD8 counts in the blood
B. Serum ACE levels
C. CECT of chest
D. Gallium scan

Response:
Answer is A (CD4/CD8 counts in the blood) : The patient in question is suffering from sarcoidosis. `While there is marked enhancement of no. of TH cells at the sites of disease the number of TH cells in the blood are normal' - Harrison `Where as TH cells in the involved organs are proliferating at an enhanced rate the T cells in other sites such as blood are quiescent' - Harrison It is the CD4 / CD8 counts in the affected organs which is an impoant ancillary aid in established the diagnosis of sarcoidosis and not the CD4 / CD8 count in the blood as specifically asked in the question. Active sarcoidosis results from an exaggerated cellular immune response resulting in accumulation of large no. of T4 cells in the affected organs, where the ratio of CD4 to CD8 cells may be as high as 10:1. Although CT of chest is also only rarely helpful, it may identify early fibrosis and active alveolitis and thus contribute to a diagnosis of sarcoidosis.

So the answer to this question is A


Instruction:
While performing external ethmoidectomy, anterior ethmoidal artery is located at frontoethmoidal suture line. Its distance from anterior lacrimal crest is:
A. 12 mm
B. 18 mm
C. 24 mm
D. 36 mm

Response:
Anterior ethmoidal artery is located approximately 24 mm posterior to anterior lacrimal crest along the frontoethmoidal suture. Posterior ethmoidal artery is situated further back, i.e. 12 mm from the anterior ethmoidal artery. Optic nerve is situated 6 mm still posterior to posterior ethmoidal artery.Relationship between anterior and posterior ethmoidal vessels and optic nerve.

So the answer to this question is C


Instruction:
Which of the following is not true about non-randomized trials?
A. Approach of comparability is high
B. Degree of comparability is high
C. The experiment can serve as its own control or can utilize a natural control
D. Several trials may be needed before evaluation is considered conclusive

Response:
Non-randomized trials ( i.e. Those depaing from strict randomization for practical purposes but in such a manner that non-randomization does not seriously affect the theoretical basis of conclusions ( refer pg 81, park 23 rd edition)

So the answer to this question is B


Instruction:
The new name for 'mental retardation' is:
A. Mental block
B. Intelligence deficit
C. Intellectual disability
D. Mental disability

Response:
The new name for 'mental retardation' is: Intellectual disability

So the answer to this question is C


Instruction:
A female undergoing treatment for infeility with IVF was given Inj. HCG, present with history of vomiting, nausea, and headache. The USG is shown as below, what is the diagnosis?
A. Ovarian Hyperstimulation Syndrome
B. PCOS
C. Theca leutin Cysts
D. Granulosa cell Tumor

Response:
USG image showing multiple cysts along with h/o undergoing IVF treatment is suggestive of Ovarian Hyperstimulation syndrome Ovarian hyperstimulation syndrome (OHSS) It is a complication of ovarian stimulation treatment (ovarian induction therapy) orin-vitrofeilisation (IVF). Rarely, it may occur in pegnancy as a spontaneous event. Ascites and pleural effusion may also be present USG findings : Bilateral symmetric enlargement of ovaries. Multiple cysts of varying sizes, giving it "spoke-wheel appearance"

So the answer to this question is A


Instruction:
All of these are fibrous joints except
A. TMJ
B. Suture
C. Gomphosis
D. Syndesmosis

Response:
None

So the answer to this question is A


Instruction:
Supraclavicular block is used for surgery of ?
A. Shoulder
B. Neck
C. Arm
D. Forearm

Response:
Ans. is `c > a, d' i.e., Arm > Shoulder, Forearm

So the answer to this question is C


Instruction:
Ventricles of brain are lined by ?
A. Ependymocytes
B. Astrocytes
C. Oligodendrocytes
D. Podocytes

Response:
Ventricles of brain are lined by ependyma (ependymocytes).Ventricles of brainThese are cavities in the brain lined by ependyma and filled with CSF.They contain choroid plexuses wich secrete CSF.These are four fluid filled intercommunicating cavities within the brain :-i) Two lateral ventricles (right and left),ii) Third ventricle, andiii) Fouh ventricle. o Lateral ventricle communicates with third ventricle by interventricular foramen (foramen of Monro).Third ventricle communicates with fouh ventricle by cerebral aqueduct (aqueduct of sylvius).Fouh ventricle communicates with subarachnoid space by a median foramen (Mangendie) and two lateral (Luschka) foramina.

So the answer to this question is A


Instruction:
Linnitis plastica is commonly seen in:
A. Carcinomas Stomach
B. Sarcoidosis
C. Lymphoma
D. Leiomyosarcoma

Response:
Linnitis plastica in carcinoma stomach leads to diffuse mural involvement by tumour and leads to decrease distensibility of stomach and complaints of early satiety.

So the answer to this question is A


Instruction:
Virus causing hepatocellular carcinoma, belongs to -
A. Hepadanviride
B. Enterovirus
C. Calci virus
D. None

Response:
Ans. is 'a' i.e., Hepadanviride o Among the hepatitis viruses, HBV (hepadanavirus) and HCV (flavivirus) can cause hepatocellular carcinoma.VirusHAV, 27 nm RNA Picomavirus (Hepatovirus)HBV, 47 nm DNA (Hepadnavirus)HCV, 30-60 nm RNA, Flavivirus (Hepacivirus)HD V, 35-37 nm Defective RNA DeltavirusHEV, 32-34 nm RNA HerpesvirusModes of infectionFecal-oralPercutaneous, Vertical, SexualPercutaneousPercutaneousFecal-oralAge affectedChildrenAny ageAdultsAny ageYoung adultsIncubation period (days)154530-18015-16030-18015-60OnsetAcuteInsidiousInsidiousInsidiousAcuteIllnessMildOccasionally severeModerateOccasionally severeMild, except in pregnancyCarrier stateNilCommonPresentNil (only with HBVNilOncogenicityNilPresent specially after neonatal infectionPresentNilNilPrevalenceWorldwideWorldwideProbably worldwideEndemic areas (Mediterranean, N Europe, Central and N America)Only developing countries (India Asia. Africa Central, America)Specific prophylaxisIg and Vaccineig and vaccineNilHBV vaccineNil

So the answer to this question is A


Instruction:
Insulin stimulated glucose transport is which type of transport-
A. Simple diffusion
B. Facilitated diffusion
C. Primary active transport
D. Secondary active transport

Response:
Ans. is 'b' i.e., Facilitated diffusion * Glucose is transported into the cells by two mechanismsi) Facilitated diffusion By glucose transporters (GLUT)ii) Secondary active transportBy sodium dependent glucose transporter (SGLT)* Insulin increases glucose uptake by increasing the GLUT4 on the cell membrane. Thus, insulin promotes facilitated diffusion i.e. diffusion along concentration gradient (not against concentration gradient). So, option b is incorrect.

So the answer to this question is B


Instruction:
Infertility issues with leiomyoma can be addressed by
A. Combined oral contraceptive pills
B. DMPA
C. GnRH agonist
D. Ulipristal

Response:
GnRH agonist treatment is approved for treating infertility associated with fibroid uterus.

So the answer to this question is C


Instruction:
Pseudouridine found in?
A. DNA
B. rRNA
C. mRNA
D. tRNA

Response:
Ans. is 'd' i.e., tRNA Modified bases found in tRNA are - Dihydrouridine (D) in which one of the double bonds of the base is reduced. Ribothymidine (T) in which methyl group is added to uracil to form thymine. Thus, tRNA is the only RNA that can contain thymine though only some times. Pseudouridine (yr) in which uracil is attached to ribose by a carbon-carbon bond rather than a nitrogen bond.

So the answer to this question is D


Instruction:
Residual bodies are -
A. Mitochondria
B. Nucleus
C. Golgi apparatus
D. Lysosomes

Response:
Ans. is 'd' i.e., Lysosomes o Lysosomes constitute an intracellular digestive system. They digest unwanted components of the cell itself as well as harmful extracellular substances entering the cell by phagocytosis or pinocytosis.o The lysosomes that pinched off from Golgi complex are called primary lysosomes.o After a primary lysosome has fused with the vacuole or vesicle containing the material to be digested, it forms thesecondary lysosome.o After the process of digestion has been completed, a secondary lysosome forms the residual body.o The residual body generally discharges its contents by exocytosis.o Sometimes, however, residual bodies containing some indigestible substances may be retained in the cell,o Such collections of residual bodies gradually increase with age, and are believed to contribute to impairment of physiological function associated with the process of aging.

So the answer to this question is D


Instruction:
What is meant by Superfecundation?
A. Feilization of two or more ova in one intercourse
B. Feilization of two or more ova in different intercourses in same menstrual cycle
C. Feilization of ova and then it's division
D. Feilization of second ovum first being implanted

Response:
* Superfecundation is the feilization of two or more ova from the same cycle by sperm from separate acts of sexual intercourse, which can lead to twin babies from two separate biological fathers. * The term superfecundation is derived from fecund, meaning the ability to produce offspring REF : DUTTA BOOK OF OBESTETRICS

So the answer to this question is B


Instruction:
ACE inhibitors are contraindicated in: March 2007
A. Hypeension
B. Myocardial infarction
C. Renal aery stenosis
D. Left ventricular dysfunction

Response:
Ans. C: Renal Aery Stenosis Renal aery stenosis is the narrowing of the renal aery, most often caused by atherosclerosis or fibromuscular dysplasia, impeding the blood flow to the target kidney. Diagnosis of renal aery stenosis: Refractory hypeension - high blood pressure that cannot be controlled adequately with antihypeensives Auscultation reveals a bruit ("rushing" sound) on affected side, inferior of the costal margin Captopril challenge test Captopril test dose effect on the differential renal function as measured by MAG3 scan. Renal aery aeriogram Deterioration in renal function may develop if both kidneys are poorly supplied, or when treatment with an ACE inhibitor is initiated. Hence ACE inhibitors are contraindicated in renal aery stenosis.

So the answer to this question is C


Instruction:
All of the following statements about Necrotizing fascitis are true, except
A. Infection of fascia and subcutaneous tissue
B. Most commonly caused by Group A beta hemolytic streptococci
C. Most common site is perineum followed by trunk and extremities
D. Surgical debridement is mandatory

Response:
Necrotizing fasciitis

Necrotizing fasciitis is a rare but life-threatening rapidly progressive bacterial infection of subcutaneous tissue and superficial fascia that is potentially fatal if appropriate treatment measures are not instituted quickly.
Usually occurring after compromised skin integrity because of infection or trauma, necrotizing fasciitis is manifested by flagrant inflammatory features at the site of infection that may be accompanied by hemorrhagic bullae, necrosis, and crepitus, often unresponsive to antibiotic therapy Systemic septic features may arise.

Most common site

Necrotizing fasciitis frequently affects the lower limbs, although any site may be involved, including the head and neck. Necrotizing fasciitis of the perineum is known as Fournier's Gangrene.

Etiological agents

Necrotizing fasciitis can be a polymicrobial infection with a mixture of Gram-positive and Gram-negative aerobes and anaerobes (Type I) or it can be monomicrobial (Type II) with group A streptococcus being the most common isolate.

Predisposing, factors

Predisposing factors include trauma (often trivial), burns, splinters, surgery, childbirth, diabetes mellitus, varicella, immunosuppression, renal failure, arteriosclerosis. odontogenic infection, malignancy, and alcoholism. Nonsteroidal and inflammatory agents may alter the immune response, causing a minor infection to become fulminant.

Clinical manifestation

Extension from a skin lesion occurs in 80% of cases. The initial lesion is often trivial, such as a minor abrasion, insect bite, injection site (drug addicts) or boil; 20% of patients have no visible skin lesion.
Initially, there is a pain, erythema, edema, cellulitis, and high fever.
The patient may be disoriented and lethargic. The local site shows cellulitis (90% of cases), edema (80%), skin discolouration or gangrene (70%), and anaesthesia of involved skin.
A wooden-hard feel of the subcutaneous tissues is characteristic.
The most consistent clinical clue is unrelenting pain out of proportion to the physical findings even if there is only mild or no fever or erythema. Typically there is diffuse swelling of an arm or leg and intense pain on palpation. About 1 or 2 days after symptom onset, the patient has a high fever, leukocytosis, edema with central patches of dusky blue discolouration, weeping blisters, and borders with cellulitis. Bullae with clear fluid rapidly turn violaceous.
Septicemia may develop secondarily and should be strongly suspected in the presence of fever, anorexia, nausea, diarrhea, confusion, and hypotension. Progression to gangrene, sometimes with myonecrosis, and an extension of the inflammatory process along fascial planes are possible.
Twenty-five percent will die of septic shock and organ failure

Treatment

Early supportive care, surgical debridement, and parenteral antibiotic administration are mandatory.
All devitalized tissue should be removed to freely bleeding edges, and repeat exploration is generally indicated within 24-36 hr to confirm that no necrotic tissue remains. The mortality rate is nearly 100% without surgical debridement.

So the answer to this question is C


Instruction:
Ringer lactate is a: March 2011
A. Isotonic crystalloid solution
B. Hypeonic crystalloid solution
C. Hypotonic crystalloid solution
D. Isotonic colloid solution

Response:
Ans. A: Isotonic crystalloid solution Lactated Ringer's solution It is a solution that is isotonic with blood and intended for intravenous administration. It is grouped with intravenous fluids that are known as "crystalloids" - which include saline and dextrose solutions (compared to the "colloids" which contain larger molecules such as dextran, hydoxyethyl starch, polyvinylpyrrolidone or gelatin polymers/ Haemaccel). It is very similar, though not identical to, Hamann's Solution which has slightly different ionic concentrations One litre of lactated Ringer's solution contains: 130 mEq of sodium ion = 130 mmol/L; 109 mEq of chloride ion = 109 mmol/ L; 28 mEq of lactate = 28 mmol/L; 4 mEq of potassium ion = 4 mmol/L; 3 mEq of calcium ion = 1.5 mmol/L Although its pH is 6.5, it is an alkalizing solution.

So the answer to this question is A


Instruction:
Amyloid stroma is seen with?
A. Papillary carcinoma Thyroid
B. Medullary carcinoma Thyroid
C. Follicular carcinoma Thyroid
D. Anaplastic carcinoma Thyroid

Response:
Ans. (b) Medullary carcinoma thyroidRef: Robbings pathology 9th ed. /1099MEDULLARY CARCINOMA THYROID* Accounts for approximately 7% of malignant tumour of thyroid* It arises from ultimo-branchial bodies (from the para- follicular C cells derived from thyroid follicles).* It contains amyloid stroma* Familial medullary carcinomas occur in 25% of patients (Marfanoid habitus, Amyloid disease also occur in patients with familial medullary cancer).* Medullary carcinoma occurs in association with (MEN) syndrome.* All patients with medullary carcinoma of thyroid should be screened for RET proto-oncogene.* Medullary Carcinoma thyroid secretes calcitonin, this does not cause hypocalcemia

So the answer to this question is B


Instruction:
The finger rest established on tooth surfaces on the opposite side of the same arch is known as:
A. Conventional finger rest
B. Opposite arch finger rest
C. Cross - arch finger rest
D. Finger - on - finger rest

Response:
None

So the answer to this question is C


Instruction:
Shedding of red tears seen in
A. Alcohol poisoning
B. Phosphorus poisoning
C. OP poisoning
D. Lead poisoning

Response:
OP poisoning Pupils will be usually constricted and will be pin point. In the eye, the ciliary muscles are constricted. So the suspensory ligaments are relaxed and the lens will bulge to the anterior chamber. So there will be blurring of vision. There may be lacrimation and in severe cases, chromo-lachryorrhoea (shedding of red tears) This is due to accumulation of porphyrin in the lacrimal glands due to inhibition of porphyrin metabolism, one of the minor actions of some organophosphates especially marathon. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 448

So the answer to this question is C


Instruction:
Which of the following is a low molecular weight heparin:
A. Hirudin
B. Enoxaparin
C. Tranexamic acid
D. Lepirudin

Response:
Ans. (b) Enoxaparin* Enoxaparin is a low molecular weight heparin.* It acts by inhibiting factor Xa.* LMWH usually doesn't need monitoring because of consistent bioavailability.* Drugs under LMWH:# Enoxaparin# Dalteparin# Tinzaparin# RabiparinAlso Know* Hirudin along with Lepirudin and Bivalirudin is an anticoagulant which is act by direct thrombin (factor IIa) inhibition.* Tranexamic acid is an anti-fibrinolytic agent.

So the answer to this question is B


Instruction:
Ceruminous glands present in the ear are -
A. Modified eccrine glands
B. Modified apocrine glands
C. Mucous gland
D. Modified holocrine glands

Response:
Sweat glands are of 2 types:

So the answer to this question is B


Instruction:
A neonate while sucking milk can respire without difficulty due to
A. Small soft palate
B. High larynx
C. Small tongue
D. Small pharynx

Response:
Q neonates have larynk at level of C2 - C3.
Q adults have larynx at level of C3,C4,C5,C6.

So the answer to this question is B


Instruction:
Mc fayden reaction seen with which organism ?
A. Clostridium perfringens
B. Clostridium botulinum
C. Bacillus cereus
D. Bacillus anthracis

Response:
Ans. is `d' i.e., Bacillus antracis Mc Fadvean's reaction When blood films containing anthrax bacilli are stained with polychrome methylene blue for a few seconds and examined under microscope, an amorphous purplish material is noticed around bacilli. This represents the capsular material and is characteristic of the anthrax bacillus.

So the answer to this question is D


Instruction:
Receptor of joint capsule and ligaments is
A. Slow adapting
B. Fast adapting
C. Different to slow and fast adapting
D. Non adapting

Response:
Receptors can be classified into rapidly adapting (phasic) receptors and slowly adapting (tonic) receptors.Rapidly adapting receptorsSlowly adapting receptorsCutaneous mechanoreceptors such as:Meissner corpuscles (respond to changes in texture and slow vibrations)Pacinian corpuscles (respond to deep pressure and fast vibration)Cutaneous mechanoreceptors such as:Merkel cells (respond to sustained pressure and touch)Ruffini endings (respond to sustained pressure)ProprioceptorsNociceptors (free nerve endings - respond to thermal, chemical and thermal noxious stimuli)(Refer: Ganong&;s Review of Medical physiology 24th edition,pg no: 158)

So the answer to this question is A


Instruction:
All true regarding fracture lateral condyle humerus except:
A. Salter Harris type IV injury
B. Most common complication of surgically treated cases is cubitus valgus deformity
C. Tardy ulnar nerve palsy occurs
D. Cubitus varus occur more commonly than valgus

Response:
B i.e. Most common complication of surgically treated cases is cubitus valgus deformity Fracture Lateral Condyle Humerus This is a transphyseal intraaicular injury usually involving immature skeleton of children & adolescent. Salter Harris classified all lateral condylar physeal injuries as type IV injuries but some authors have classifie some lateral condylar fractures (Mulch type 2 i.e. fracture line medial to trochlear groove) as salter Harris type II injury. Although these fractures may be either Salter Harris type IV & type II injury fracture treatment guidelines follow those of type IV injury :.open reduction & internal fixation of displaced intra - aicular fracturesQ with the potential for mild growth disturbance of distal humeral physis. Cubitus varus/Lateral spur formation (pseudo-varus) is the most commonlyQ repoed (-40%) complication following lateral condyle fracture. Delayed union/ nonunion is most fraquent problematic complicationQ. The most common sequela of nonunion with displacement is the development of progressive cubitus valgus deformityQ. Cubitus valgus is much less common after united lateral condylar fractures than cubitus varus. Tardy ulnar nerve palsyQ is a late complication of progressive cubitus valgus deformity occuring in lateral condylar fractures. Growth (physial) arrest, avascular necrosis & fishtail deformity are other rare complications.

So the answer to this question is B


Instruction:
Hyperkalemia is caused by ?
A. Amphotiricin B
B. Beta agonists
C. Gentamycin
D. Succinylcholine

Response:
Ans. is 'd' i.e., Succinylcholine Drugs causing hypokalemia b agonist Licorice Penicillin derivatives Amphotericin B Theophylline Steroids a Blockers Toluene abuse Gentamicin Insulin Vitamin B12 Diuretics Carbenoxalone Impoant drugs causing hyperkalemia ACE inhibitors Trimethoprim Succinylcholine K+ sparing diuretic Hep. NSAIDS Pentamidine Lithium. Cyclosporine

So the answer to this question is D


Instruction:
Memory needed for repetitive skills is
A. Declarative
B. Semantic
C. Explicit
D. Implicit

Response:
Implicit memory is subdivided into 4 types. Procedural memory includes skills and habits, which once acquired becomes unconscious and automatic. Ref: Ganong&;s review of medical physiology; 23rd edition; pg:290.

So the answer to this question is D


Instruction:
Cadaveric position of vocal cords ?
A. Midline
B. 1.5 mm from midline
C. 3.5 mm from midline
D. 7.5 mm from midline

Response:
Ans. is 'c' i.e., 3.5 mm from midline Position of vocal cords The position of the vocal cords may be described as being in various positions. These are : ? 1. Median position The vocal cords are in midline. This is the position of normal larynx during phonation and in recurrent laryngeal nerve palsy. 2. Paramedian position Just off midline (1.5 mm form midline) This position occurs in normal larynx during strong whisper. This is the resting position of vocal cords after long-term recurrent laryngeal nerve injury. 3. Cadeveric (Intermediate) position (3.5 mm from midline) It is 15-20deg from midline. This is the position of immediate total denervation of both recurrent laryngeal nerve as well as superior laryngeal paralysis, as in high vagal paralysis. 4. Gentle abduction (7 mm from midline) This position is seen during quiet respiration in normal larynx and in paralysis of adductors (very rare). 5. Abduct position (9.5 mm from midline) It is 30-45deg from midline. This is the position of maximum adduction during deep inspiration.

So the answer to this question is C


Instruction:
A 9-year-old boy with elevation in both PT and APTT. What is the diagnosis?
A. Defect in extrinsic pathway
B. Defect in intrinsic pathway
C. Platelet function defect
D. Defect in common pathway

Response:
None

So the answer to this question is D


Instruction:
Bell's palsy is
A. Hemiparesis with contralateral facial nerve palsy
B. Ipsilatera lower motor meuron lesion
C. Ipsilateral upper motor neuron lesion
D. Contralateral upper motor neuron lesions

Response:
B. i.e. (Ipsilateral LMN paralysis) (4- Dhingra 4th) (104 - Maqbool 11th)* BELL'S PALSY - Idiopathic infranuclear lesion of the facial nerve more common in diabetic (angiopathy) and pregnant women (retension of fluid)* BELL'S PHENOMENON - up and out rolling of the eyeball during forceful closure**Clinical presentation - LMN paralysis** patients is unable to close eye, saliva dribbles from the angle of mouth, face become asymmetrical, Tears flow down from the eye (epithora) stapedial reflex or loss of taste* Epiphora in bell's palsy is due to - lacrimal pump failure*** Melkersson's syndrome - Triad - Facial paralysis, swelling of lips, and fissured tongue* Recurrent facial palsy - causes - Melkersson's syndrome DM, sarcoidosis and tumoursPoor prognostic indicators - advanced age, hyperacusis, severe initial painBilateal facial paralysis - seen in GB syndrome sarcoidosis, sickle cell disease, acute leukemia, bulbar palsy, leprosy and sother systemic disorders.Supra nuclear (central) palsv primarily involves the lower part of face and emotional responses may be intact (eg- the patients not be able to show you his teeth but will smile to a Joke. Nuclear palsv affects all ipsilateral muscles of facial expression resulting in paralysis of the ipsilateral side (eg. mouth is pulled to the normal side and may droop on the affected side facial crease are effaced, eyelid may not close).

So the answer to this question is B


Instruction:
Nerve element of brachial arch are developed from
A. Ectoderm
B. Neural crest cells
C. Endoderm
D. Mesoderm

Response:
Ref. Gray’s anatomy.  41st edition. Page. 449.
Topic, Subtopic – Brachial arch, embryology
Branchial or pharyngeal arches are masses of mesoderm covered by ectoderm and lined by endoderm. Within these masses, muscular and skeletal components develop, as well as aortic arches and nerve networks. The arches are separated by grooves, visible on the surface of the embryo as pharyngeal clefts and in the interior as the pharyngeal pouches

In the human embryo, the arches are first seen during the 4th week of development.
They appear as a series of outpouchings of mesoderm on both sides of developing pharynx.

The neural crest are bilaterally paired strips of cells arising in the ectoderm at the margins of the neural tube. These cells migrate to many different locations and differentiate into many cell types within the embryo.

So the answer to this question is B


Instruction:
Uveitis with auditory and cutaneous problems occurs in
A. Vogt- Koyanagi- Harada syndrome
B. Behcets disease
C. Ankylosing spondylitis
D. Marfan's syndrome

Response:
A. i.e. (Vogt - Koyanagi - Harada syndrome)VOGT- KOYANAGI- HARADA (VKH) Syndrome* Idiopathic multisystem disorder HLA- DR4 and DW-15Clinical features1. Cutaneous lesions include - alopecia, poliosis and vitiligo2. Neurological lesions are in the form of meningism, encephalopathy, tinnitus, vertigo and deafness3. Ocular- features - are bilateral chronic granulomatous anterior uveitis, posterior uveitis and exudative retinal detachment* Uveitis with ankylosing spondyitis is characteristically an acute, recurrent, non granulomatous type of iridiocyclitis* Behcet's disease - idiopathic multi system disease characterized by recurrent non granulomatous uveitis, aphthous ulceration, genital ulceration and erythema multiforme* Persistent primary hyperplastic vitreous (PHPV) is seen in association with Trisomy 13 (Patau syndrome**) and Trisomy 22, Norries disease, walker Warburg syndrome**LDH in aqueous humor is increased in Retinoblastoma

So the answer to this question is A


Instruction:
Optic radiations arise from
A. Lateral Geniculate body
B. Medial Geniculate Body
C. Superior colliculus
D. Inferior colliculus

Response:
Answer- A. Lateral Geniculate bodyThe optic radiations (geniculocalcarine pathway) extend from the lateral geniculate body to the visual coex. Inferior fibres of optic radiations ,subserve upper visual fields and superior fibres subserve inferior visual fields.The visual pathway staing from retina consists of optic nerve, optic chiasma, optic tracts, lateral geniculate bodies, optic radiations, visual coex.

So the answer to this question is A


Instruction:
Which of the following layer of GIT is absent in esophagus ?
A. Mucosa
B. Muscularis propria
C. Submucosa
D. Serosa

Response:
Ans. is 'd' i.e., Serosa Important features in esophaguso Epithelium is stratified squamous non-keratinized epithelium.o Muscularis mucosa contains only longitudinal layer and no circular layero Mucosa is the toughest and strongest layer.o Serosa is absent.o Muscularis externa is made up of skeletal muscle fibers only in the upper third, smooth muscles only in the lower third and both types of muscle fibers in middle third. At upper end the longitudinal coat splits into two bundles and the triangular interval between them is called Laimer's tringle which is filled with circular muscle fibers.

So the answer to this question is D


Instruction:
Modified Young's operation is done for:
A. Atrophic rhinitis
B. Allergic rhinitis
C. Acute sinusitis
D. Chronic sinusitis

Response:
Ans: A (Atrophic rhinitis) Ref: Diseases of the Ear Nose and Throat by PL Dhingra. 5th edn. 2010 page 170Explantation:Young's OperationIt is done as a treatment of atrophic rhinitisIt involves closure of the nasal cavity affected with atrophic rhinitis by creating mucocutaneous flaps.These flaps are sutured together in two layers: first the mucosal layer, then the skin layer.The nasal cavity is kept closed for a period of 9 months.Re-examination is done after 9 months - if the crusts have disappeared, a revision surgery is performed and the nasal cavity is reopened.The theory behind this procedure is that the closed nasal cavity has time to heal.

So the answer to this question is A


Instruction:
This 35-year-old pet shop worker developed progressively spreading nodular lesions. He was afebrile. What is the most likely causative organism?
A. Acinetobacter baumannii
B. Erysipelothrix rhusiopathiae
C. Mycobacterium marinum
D. Pasteurella multocida

Response:
Answer C. Mycobacterium marinumNeedle aspiration of a nodule recovered thick, purulent fluid that was positive for acid-fast bacilli, identified on culture as M. marinum. The patient was treated successfully with a four-month regimen of rifampin and ethambutol. M. marinum infection is an occupational hazard for aquarium cleaners. Infection is usually limited to the skin, with the hands, elbows, and feet most commonly affected. The appearance is not typical of infection with the other listed organisms.

So the answer to this question is C


Instruction:
dihydroerigotamine differs from ergotamine in the following respect
A. It is more potent oxytocic
B. it has antimetic propey
C. it has high oral bioavailability
D. it is more potent alpha adrenergic blocker and less potent vasoconstrictor

Response:
hydrogenation of ergot alkaloids decrease their vasoconstrictor action and increase the Alpha blocking activity Ref-KDT 6/e p168

So the answer to this question is D


Instruction:
Reduced FEV 1, Normal FVC and FEV 1/FVC ratio less than 0.7 .which is reversible with bronchodilator s is consistent with
A. Bronchial Asthma
B. Hypersensitivity penumonitis
C. Sarcoidosis
D. Polyaeritis nodosa

Response:
In Asthma FEV1(forced expiratory volume in 1 second), FVC(forced vital capacity, is the total volume exhaled), FEV1/FVC decreases. To daignose Asthma: Compatible clinical history plus either : 1)FEV1>12% increase following administration of a bronchodilator or glucocoicoids. 2)FEV1>15% decrease after 6min of exercise 3)>20% diurnal variation on >3days in a weeks on PEF(peak expiratory volume). Reference : Davison, 23rd Edition, page no : 569,555

So the answer to this question is A


Instruction:
All are risk factors for preterm delivery except:
A. Absence of fetal fibronectin at <37 weeks
B. Previous history of preterm baby
C. Asymptomatic cervical dilatation
D. Chlamydial infection of genital tract

Response:
Ans. is a, i.e. Absence of fetal fibronection at <37 weeksRef. Fernando Arias 4/eRisk factors for preterm labor: have been discussed in Ans. 1Fetal fibronectinIt is a fetal glycoprotein found in the cervicovaginal discharge before 22 weeks and again after rupture of membranes.Levels of fibronectin >50mg/ml indicates preterm delivery (not absence of fibronectin).

So the answer to this question is A


Instruction:
The following are features of gunshot Exit wound, except
A. Bigger than the entry wound
B. Eveed edges
C. Protrusion of soft tissues
D. Singeing & smudging

Response:
Singeing & Smudging are the features of entry wound; not exit wound. Character Entry wound Exit wound Size Smaller than the diameter of the bullet Larger Edges Inveed Eveed` Abrasion collar and grease collar PresentQ AbsentQ Scorching, smudging & tattooing May be present Absent Bleeding Less MoreQ Fat extrusion Absent May be present Cherry red colour May be present Absent

So the answer to this question is D


Instruction:
Best range of UV light used for treatment of skin diseases:
A. 100 to 200 nm
B. 200 to 400 nm
C. 400 to 700 nm
D. More than 700

Response:
Ans. b (200 to 400 nm) (Ref. Robbins, Pathologic basis of disease, 7th/pg.321, Table 9-19)PUVA (Psoralen Ultra Voilet A) therapy has gratifying results in treatment of severe psoriasis and the range of UV light used is 200-400 nm. Initial LesionsLocation of Initial LesionsOther FindingsDiagnostic AidsTreatmentPsoriasisPink-red, silvery scale, sharply demarcatedElbows, knees, scalp, presacral areaNail dystrophy, arthritis, pustulesSkin biopsyTopical glucocorticoids, vitamin D; UV-B (narrowband); oral retinoid and/or PUVA; MTX, cyclosporine, anti-TNF agentsULTRAVIOLET RAYS# There is ample evidence from epidemiologic studies that UV rays derived from the sun induce an increased incidence of squamous cell carcinoma, BCC, and possibly malignant melanoma of the skin.# The UV portion of the solar spectrum can be divided into three wavelength ranges:- UVA (320 to 400 nm),- UVB (280 to 320 nm), and- UVC (200 to 280 nm).# UVB is believed to be responsible for the induction of cutaneous cancers.# UVC, although a potent mutagen, is not considered significant because it is filtered out by the ozone shield around the earth (hence the concern about ozone depletion).# UV rays have a number of effects on cells, including inhibition of cell division, inactivation of enzymes induction of mutations and, in sufficient dosage, death of cells.# The carcinogenicity of UVB light is attributed to its formation of pyrimidine dimers in DNA.# This type of DNA damage is repaired by the nucleotide excision repair (NER) pathway.# There are five steps in NER:- Recognition of the DNA lesion,- Incision of the damaged strand on both sites of the lesion,- Removal of the damaged nucleotide,- Synthesis of a nucleotide patch, and- Its ligation.# The importance of the NER pathway of DNA repair is most graphically illustrated by a study of patients with the hereditary disorder xeroderma pigmentosum. This autosomal recessive disorder is characterized by extreme photo- sensitivity, a 2000-fold increased risk of skin cancer in sun-exposed skin and, in some cases, neurologic abnormalities.

So the answer to this question is B


Instruction:
Dose of MgSO4 in asthma is
A. 8 g i.v. over 20 minutes
B. 2g infused over 20 minutes
C. 2g i.v. over 40 minute
D. 6 g i.V. over 40 minutes

Response:
Bronchodilators Bronchodilator therapy is central to the management of breathlessness. The inhaled route is preferred and a number of different agents delivered by a variety of devices are available. Choice should be informed by patient preference and inhaler assessment. Sho-acting bronchodilators may be used for patients with mild disease but longer-acting bronchodilators are usually more appropriate for those with moderate to severe disease. Significant improvements in breathlessness may be repoed despite minimal changes in FEV1, probably reflecting improvements in lung emptying that reduce dynamic hyperinflation and ease the work of breathing. Oral bronchodilator therapy, such as theophylline preparations, may be contemplated in patients who cannot use inhaled devices efficiently but their use may be limited by side-effects, unpredictable metabolism and drug interactions; hence the requirement to monitor plasma levels. Orally active, highly selective phosphodiesterase inhibitors remain under appraisal. Combined inhaled glucocoicoids and bronchodilators The fixed combination of an inhaled glucocoicoid and a LABA improves lung function, reduces the frequency and severity of exacerbations and improves quality of life. These advantages may be accompanied by an increased risk of pneumonia, paicularly in the elderly. LABA/inhaled glucocoicoid combinations are frequently given with a long-acting muscarinic antagonist (LAMA). LAMAs should be used with caution in patients with significant hea disease or a history of urinary retention. Oral glucocoicoids Oral glucocoicoids are useful during exacerbations but maintenance therapy contributes to osteoporosis and impaired skeletal muscle function, and should be avoided. Oral glucocoicoid trials assist in the diagnosis of asthma but do not predict response to inhaled glucocoicoids in COPD. Pulmonary rehabilitation Exercise should be encouraged at all stages and patients reassured that breathlessness, while distressing, is not dangerous. Multidisciplinary programmes that incorporate physical training, disease education and nutritional counselling reduce symptoms, improve health status and enhance confidence. Most programmes include two to three sessions per week, last between 6 and 12 weeks, and are accompanied by demonstrable and sustained improvements in exercise tolerance and health status. Oxygen therapy Long-term domiciliary oxygen therapy (LTOT) improves survival in selected patients with COPD complicated by severe hypoxaemia (aerial PaO2 < 7.3 kPa (55 mmHg)). It is most conveniently provided by an oxygen concentrator and patients should be instructed to use oxygen for a minimum of 15 hours/ day; greater benefits are seen in those who use it for more than 20 hours/day. The aim of therapy is to increase the PaO2 to at least 8 kPa (60 mmHg) or SaO2 to at least 90%. Ambulatory oxygen therapy should be considered in patients who desaturate on exercise and show objective improvement in exercise capacity and/or dyspnoea with oxygen. Oxygen flow rates should be adjusted to maintain SaO2 above 90%. Surgical intervention Bullectomy may be considered when large bullae compress surrounding normal lung tissue. Patients with predominantly upper lobe emphysema, preserved gas transfer and no evidence of pulmonary hypeension may benefit from lung volume reduction surgery (LVRS), in which peripheral emphysematous lung tissue is resected with the aim of reducing hyperinflation and decreasing the work of breathing. Both bullectomy and LVRS can be performed thorascopically, minimising morbidity. Lung transplantation may benefit carefully selected patients with advanced disease (p. 567). Other measures Patients with COPD should be offered an annual influenza vaccination and, as appropriate, pneumococcal vaccination. Obesity, poor nutrition, depression and social isolation should be identified and, if possible, improved. Mucolytic agents are occasionally used but evidence of benefit is limited. Palliative care Addressing end-of-life needs is an impoant, yet often ignored, aspect of care in advanced disease. Morphine preparations may be used for palliation of breathlessness in advanced disease and benzodiazepines in low dose may reduce anxiety. Decisions regarding resuscitation should be addressed in advance of critical illnes Magnesium sulfate is a bronchodilator. It relaxes the bronchial muscles and expands the airways, allowing more air to flow in and out of the lungs. This can relieve symptoms of asthma, such as shoness of breath. initial loading dose 2 gm over a period of 20 minutes where infused Ref Davidson edition23rd pg 577

So the answer to this question is B


Instruction:
Which of the following is not of prognostic significance to choroidal melanoma ?
A. Presence of retinal detachment
B. Size of the tumour
C. Cytology of the tumor cells
D. Presence of extraocular extension

Response:
Prognosis of choroidal melanoma depends upon :-

Cell type
Size of tumor
Location of tumor
Evidence of invasion (extrascleral or vortex vein)
Age of the patient
Cytology
Chromosomal abnormalities.

So the answer to this question is A


Instruction:
J receptors are found in which of the following-
A. Pulmonary interstitium
B. Alveolar capillaries
C. Terminal bronchiole
D. Respiratory muscles

Response:
Ans. (a) Pulmonary interstitium(Ref: Ganong, 25th ed/p.658)J receptors were discovered by an Indian physiologist A. S. PaintalThese receptors are located very close to the pulmonary capillaries (Juxtapulmonary receptors) in pulmonary interstitium

So the answer to this question is A


Instruction:
Most common cause of nephrotic range proteinuria in an adult is -
A. Diabetes Mellitus
B. Amyloidosis
C. Hypertensive nephropathy
D. Wegner's Granulomatosis

Response:
None

So the answer to this question is A


Instruction:
Complications of reflux esophagitis are all Except
A. Stricture
B. Schazki's ring
C. Barrett'a esophagus
D. Achalasia cardia

Response:
COMPLICATION OF GERD 1.Erosive oesophagitis 2.Strictures- oesophageal or peptic 3.Oesophageal shoening 4.Barretts Oesophagus 5.Adenocarcinoma of oesophagus 6.Schazki&;s ring- aetiology not clear but there is a hypothesis stating that it is a sho peptic stricture occurring as a consequence of gastroesophageal reflux disease .(REF.BAILEY AND LOVE 26TH EDITION PA 11 AND CHAPTER 62) .

So the answer to this question is D


Instruction:
Predisposing factors for gastric ca are -
A. Atrophic gastritis
B. Hyperplastic polyp
C. Adenomatous polyp
D. All

Response:
Answer 'a' i.e. Atrophic gastritis; 'b' i.e. Hyperplastic Polyp; 'c' i.e. Adenomatous Polyp Achlorhydria associated with pernicious anemia, chronic H. pylori infection, gastrectomies are assoicated with increased risk of gastric cancer probably because reduced acid secretion ours bacterial growth and perpetuation of chronic inflammation with mucosal epithelial cell proliferation and hence increased risk of genomic mutation. Bacterial growth also conves nitrates into nitrites which are a proven carcinogen.

So the answer to this question is D


Instruction:
Zero dose of polio vaccine is given at:
A. Before giving DPT
B. At bih
C. When child is having diarrhea
D. When child is having polio

Response:
- OPV zero dose: Given at bih / as early as possible within first 15 days of life. LATEST NATIONAL IMMUNIZATION SCHEDULE (NIS): 2019

So the answer to this question is B


Instruction:
Which is not true of hypocalcaemia:
A. Can occur in hypoparathyroidism
B. Latent tetany is seen
C. Prolonged QT intervala
D. Inverse relation with Me+ levels

Response:
Answer is D (Inverse relation with Mg++ levels) : Magnesium levels usually bear a direct, not an inverse, relationship with serum Ca++ levels. Severe hypo-magnesemia is associated with hypocalcemia. Intracellular magnesium deficiency results in Hypocalcemia due to : - Impaired PTH secretion - Diminished responsiveness to PTH Hypoparathyroidism is a known cause of Hypocalcemia - Harrison QT interval on ECG is prolonged in Hypocalcemia and is shoened in hypercalcemia - Harrison Tetany is a recognized feature of hypocalcemia, but it may also occur with hypomagnesemia and respiratory alkalosis - Harrison

So the answer to this question is D


Instruction:
To increase awareness of rural population towards small family norm, the best method is –
A. Film show
B. Charts Exhibitions etc
C. Role playing
D. Setting on example

Response:
The health educator should set a good example in the things he is teaching.
If he is explaining the hazards of smoking, he will not be very successful if he himself smokes.
If he is talking about the "small family norm" he will not get very far if his own family size is big.

So the answer to this question is D


Instruction:
Diagnose:-
A. Keratoconus
B. Wilson's disease
C. Glaucoma
D. Williams syndrome

Response:
Wilson's disease Kayser - Fleischer rings (KF rings) are dark rings that appear to encircle the iris of the eye. Itoccurs due to copper deposition in Descemet's membrane of cornea. In case of Wilson's disease, KF rings are present in 95% of patients with neurological symptoms, 50-60% of patients with hepatic involvement alone, and only in 10% of asymptomatic siblings. Early detection of KF ring is best possible with gonioscopy, although it is most commonly detected by slit-lamp examination.

So the answer to this question is B


Instruction:
A child was brought to the emergency depament with recurrent epistaxis. A detailed history revealed that he had a fall two days before, but he neglected because it didn't hu him. Examination shows septal hematoma. Management of septal hematoma is:
A. Incision and drainage
B. Wait and watch
C. Only pressure bandage
D. All of the above

Response:
Septal hematoma is a complication of direct nasal trauma, often associated with fracture of the nasal septum with or without concomitant nasal bone fracture. Bleeding from submucosal blood vessels leads to an accumulation of blood between the mucoperichondrium and the septal cailage, which may lead to ischemic avascular necrosis of the underlying cailage, destruction of the cailage and saddle deformity of the distal nose. Prompt incision of the hematoma and drainage through the mucosal surface is necessary.

So the answer to this question is A


Instruction:
A six month old baby girl who was normal at bih, begins to show signs of motor retardation. While she could sit up at 5 months, she can no longer do so. As time goes on, the child continues to deteriorate, and eventually becomes unresponsive to visual or auditory stimuli. Funduscopic examination reveals cherry-red macular spots in both eyes. Which of the following genetic abnormalities is most often related to the development of this disease?
A. Confined placental mosaicism
B. Expanded trinucleotide repeat
C. Frameshift mutation
D. Nondisjunction

Response:
Most cases of Tay-Sachs disease are caused by inseion of four nucleotides into the coding region of the gene for the alpha-subunit of the hexosaminidase A gene. This produces a frameshift mutation, resulting in the creation of a premature stop codon downstream from the inseed nucleotides. The disease presents as described in the question, and is more common in Ashkenazi Jews. The carrier rate in this population is 1 in 25. There is presently no effective treatment and survival beyond four years of age is rare. Confined placental mosaicism is caused by a genetic aberration (e.g., a trisomy) occurring in the trophoblast or extraembryonic progenitor cells in the inner cell mass of the embryo. This leads to abnormal placental development and intrauterine growth retardation. Expansion of tandem nucleotide repeats is thought to be etiologically involved in Fragile X syndrome and Huntington disease. Nondisjunction during meiosis is a common cause of trisomy, e.g., trisomy 21, or Down syndrome. Ref: Wyatt C., Kemp W.L., Moos P.J., Burns D.K., Brown T.G. (2008). Chapter 6. Genetic Disorders. In C. Wyatt, W.L. Kemp, P.J. Moos, D.K. Burns, T.G. Brown (Eds), Pathology: The Big Picture.

So the answer to this question is C


Instruction:
Structure passing deep to flexor retinaculum is -
A. Post tibial artery
B. Long saphenous vein
C. Tibialis anterior tendon
D. Peroneus tertius

Response:
From medial to lateral, structures passing under flexor retinaculum
-        Tibialis posterior
-        Flexor digitorum longus
-        Posterior tibial vessels
-        Tibial nerve
-        Flexor hallucis longus

So the answer to this question is A


Instruction:
In a patient P02 is 85 mmHg, PCO2 - 50mmHg, pH is 7.2 and HCO3 is 32 meq/l is suffering from :
A. Respiratory acidosis with compensatory metabolic alkalosis
B. Respiratory acidosis with compensatory metabolic acidosis
C. Metabolic acidosis
D. Metabolic alkalosis

Response:
Answer is A (Respiratory acidosis with compensatory metabolic alkalosis) Because primary respiratory component is causing acidosis and metabolic component is compensatory by producing alkaosis, the acid base disorder is Respiratory acidosis with compensatory metabolic alkalosis.

So the answer to this question is A


Instruction:
Low complement levels are seen in -
A. PSGN
B. MPGN
C. Good pasture's syndrome
D. Wegner's granulomatosis

Response:
The glomerular lesions appear to result from deposition of immune complexes in the glomeruli. The evidence cited in suppo are as under: i) There is epidemiological evidence of preceding streptococcal sore throat or skin infection about 1-2 weeks prior to the attack. ii) The latent period between streptococcal infection and onset of clinical manifestations of the disease is compatible with the period required for building up of antibodies. iii) Streptococcal infection may be identified by culture or may be inferred from elevated titers of antibodies against streptococcal antigens. These include the following: anti-streptolysin O (ASO); anti-deoxyribonuclease B (anti-DNAse B); anti-streptokinase (ASKase); anti-nicotinyl adenine dinucleotidase (anti-NADase); and anti-hyaluronidase (AHase). iv) There is usually hypocomplementaemia indicating the involvement of complement in the glomerular deposits. v) It has also been possible to identify the antigenic component of streptococci which is a cytoplasmic antigen, Endostreptosin. Ref: Textbook of pathology. Harshmohan 6thediton page 665

So the answer to this question is A


Instruction:
Palsy of right genioglossus causes-
A. Detion of tongue to right
B. Detion of tongue to left
C. Detion of soft palate to right
D. Detion of soft palate to left

Response:
A i.e. Detion of tongue to right

So the answer to this question is A


Instruction:
Russel bodies are seen in?
A. Multiple Myeloma
B. Rabies
C. Parkinsonism
D. Intracranial neoplasm

Response:
Ans. is 'a' i.e., Multiple Myeloma o Russell bodies are large homogenous eosinophilic inclusions formed by hugely distended endoplasmic reticulum of plasma cells. It is a characteristic feature of multiple myeloma,o In multiple myeloma, plasma cells can infiltrate the bone marrow diffusely or may be present in sheet like masses that completely replace normal elements. Plasma cells may be normal plasma cells but mostly they are atypical plasma cells (variants of plasma cell) produced by intracellular accumulation of intact or partially degraded immunoglobulins. These atypical plasma cells are : (i) Flame cells, and (ii) MOTT cells. Intracellular inclusions are Russel bodies cytoplasmic), Dutcher bodies (nuclear), crystalline rods and fibrils.Also remembero Electrophoresis of serum shows M band (monoclonal band) of immunoglobulin, most commonly of IgG.o Urine shows Bence-Jones protein (light chain component of Immunoglobulin).o Serum B2-microglobulin is increased and is the most important prognostic factor. There is increased serum uric acid and urea.o Monoclonal light chain may be detected both in serum and urine.

So the answer to this question is A


Instruction:
For myringoplasty, Graft material of choice is
A. Peritoneum
B. Palmar fascia
C. Temporalis fascia
D. Fascia lata

Response:
Low metabolic rate, no need for a separate incision, same thickness as that of tympanic membrane ours the use of temporalis fascia. Other graft materials also include perichondrium, dura and cadaveric tympanic membrane. Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition

So the answer to this question is C


Instruction:
An 18 year old patient presents with neck swelling which moves with deglutition . What is your diagnosis?
A. Dermoid cyst
B. Branchial cyst
C. Thyroglossal cyst
D. Cervical lymphadenopathy

Response:
Thyroglossal Cyst - Congenital - Age of presentation - 15-30 years - There is cyst in connection to thyroid and tongue. So, on protrusion of tongue, the cyst moves up - MC location - Subhyoid - Other common locations * Suprahyoid * Near thyroid cailage * Near Foramen cecum * In floor of mouth =Clinical features - Midline swelling in anterior pa of neck - Thyroglossal cyst moves with deglutination - Moves up on protrusion of tongue =Complications of Thyroglossal cyst - Infection - Abscess - if Incision and Drainage - Thyroglossal fistula (Acquired condition due to I & D of abscess of thyroglossal cyst) - Increased risk of papillary carcinoma of thyroid =Treatment - TOC - Sistrunk operation. The cyst passes body of hyoid bone - so excision is made - Enbloc removal of central pa of body of hyoid bone + cyst

So the answer to this question is C


Instruction:
Non union is a common feature of fracture of
A. Supracondylar humerus
B. Clavicle
C. Lower tibia
D. Coracoid process

Response:
C i.e. Lower tibia Fracture through the lower third of tibia. is more liable to go onto delayed union because the lower fragment becomes relatively avascular dlt poor vascularityQ.

So the answer to this question is C


Instruction:
Volume of distribution for chloroquine is :
A. 5–8 L
B. 9–15 L
C. 100–650 L
D. Above 1300 L

Response:
None

So the answer to this question is D


Instruction:
All are Narcotic drug as per NDPS (National Drug Psychotropic Substances Act) EXCEPT:
A. Marijuana
B. Ketamine
C. Cannabis
D. Heroine

Response:
ANSWER:(B)KetamineREF: Textbook Of Forensic Medicine And Toxicology: Principles And Practice By Vij 4th ed page 566, style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif; margin: 0 0 0 8px; text-indent: 0; text-align: left">The Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985 was framed taking into account India's obligations under the three UN drug Conventions as well as Article 47 of the Constitution which mandates that the 'State shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health'NARCOTIC DRUGSCoca Leaf & derivatives(a) Crude cocaine(b) Ecgonine and derivatives(c) Cocaine, that is, methyl ester of benzoyl-ecgonine and its salts(d) All preparations containing more than 0.1 per cent, of cocaineCanabis (Hemp): (AKA - Cannabis indica/ Indian hemp/Hashish in Egypt/Marijuana in America/Dagga in Africa)(a) Charas/Hashish- resinous exudates of leaves & stem- 25 to 40% THC(b) Ganja - flowering top- 25% THC(c) Any mixture, with or without any neutral material, of any of the above forms of cannabis or cannabisOpium and derivatives(a) Poppy seed: Seeds of Papaver sominiferum are called the poppy seeds while the latex which oozes out and dries is called the opium gum(b) Poppy straw: As per the NDPS Act, poppy straiv means 'all parts of the plant of opium poppy except seeds'(c) Opium derivative means: medicinal opium, phenanthrene alkaloids namely, morphine, codeine, thebaine and their salts, diacetylmorphine (Heroin), that is, the alkaloid also known as diamorphine or heroin and its salts, all preparations containing more than 0.2 per cent, of morphine or containing any diacetylmorphine and their salts, preparations, admixtures, extracts and other substances containing any of these drugs.(II) Psychotropic substances: "psychotropic substance" means any substance, natural or synthetic, or any natural material or any salt or preparation of such substance or material included in the list of psychotropic substances specified in the Schedule. E.g. Amphetamines, LSD, Barbiturates, Alprazolam, Benzodiadepines, Ergotamine, Ephedrine, Methyl ethyl ketone (MEK) etc.Note:* Essential narcotic drug means a narcotic drug notified by the Central Government for medical and scientific use (Morphine, Fentanyi and Methadone)* Bhang is a preparation made from cannabis leaves consumed in parts of India on some festivals. As it is not made from cannabis resin or from flowering tops, it is not covered under the NDPSAct, 1985.

So the answer to this question is B


Instruction:
A 34-year-old woman has a direct blow to the patella by the dashboard of the vehicle during an automobile crash. The woman is admitted to the emergency depament and radiographic examination reveals patellofemoral syndrome. This type of syndrome is characterized by lateral dislocation of the patella. Which of the following muscles requires strengthening by physical rehabilitation to prevent future dislocation of the patella?
A. Vastus lateralis
B. Vastus medialis
C. Vastus intermedius
D. Rectus femoris

Response:
During extension of knee joint their is natural tendency of patella to dislocate laterally. The vastus medialis inses upon the medial aspect of the patella and draws it medially, especially in the last quaer of extension--during which it is especially palpable in contraction. This muscle is referred to as the vastus medialis obliqus (VMO). Increasing the strength of this muscle can lessen the lateral dislocation of the patella.

So the answer to this question is B


Instruction:
In a rural clinic, a 3-year-old girl child is brought by her mother and is emaciated. Her hemoglobin was 5 g/dL. The girl also has edema over her knees and ankles with discrete rash on her knees, ankles and elbows. The most likely worm infestation causing these manifestations is:
A. Hookworm
B. Roundworm
C. Whipworm
D. Pinworm

Response:
a. Hookworm(Ref: Nelson 20/e p 1734-1735)Hookworm infestation:Leads to intestinal blood loss - iron deficiency anemia & malnutrition - growth retardationDermatitis referred to as ground itch when they penetrate human skin, manifests as vesiculation & edemaInfection with a zoonotic hookworm, especially A. braziliense cutaneous tracts of cutaneous larva migransCough occurs when larvae migrate through lungs 1 week after exposure; Eosinophilia is often seen

So the answer to this question is A


Instruction:
Antiarrhythmic drugs causing torsades de pointes are:
A. Quinidine
B. Disopyramide
C. Procainamide
D. All of these

Response:
None

So the answer to this question is D


Instruction:
A knitted Dacron aery graft
A. Is not porous
B. Is eventually dissolved by tissue reaction
C. Never gets infected
D. Can be easily incised and the opening resutured

Response:
Ans. is 'd' i.e., Can be easily incised and the opening resutured

So the answer to this question is D


Instruction:
2nd constriction in oesophagus is seen at the following site -
A. Where it crosses left main bronchus
B. Crossing of aorta
C. At pharyngoesophageal junction
D. Where it pierces the diaphragm

Response:
There are 4 esophageal constrictions. They are at 15cms, 22.5cms, 27.5cms and 37.5 to 40 cms, from the incisors. The second constriction is due to crossing of arch of aorta.

So the answer to this question is B


Instruction:
An elderly man complains of ear pain. During evaluation, the physician asks if the patient has tinnitus. What is tinnitus?
A. A subjective sensation of noise in the head
B. A complication of chronic metal ingestion
C. An audible cardiac murmur
D. Dizziness with sounds

Response:
Tinnitus is the perception of abnormal noise in the ear or head. It is usually attributed to a sensory loss; pulsatile tinnitus occurs with conductive hearing loss and is due to carotid pulsations becoming more apparent.

So the answer to this question is A


Instruction:
Lithium may produce:
A. Hypehyroidism
B. Hypothyroidism
C. Hyperparathyroidism
D. Hypoparathyroidism

Response:
Hypothyroidism

So the answer to this question is B


Instruction:
What is cutaneous Tuberculosis secondary to underlying tissue lymph node called
A. Scrofuloderma
B. Lupus vulgaris
C. Spina ventosa
D. None of the above

Response:
Cutaneous Tuberculosis Scrofuloderma:- It is a result of contiguous spread of infection to skin from underlying disease (usually cervical lymph nodes and bones); fluctuant nodules that develop sinus tracts, draining to skin, with tethered appearance. Ref:- Review of Dermatology by Alikhan; pg num:-302

So the answer to this question is A


Instruction:
A 6-year-old child presented with history of recurrent upper respiratory tract infections, mouth breathing, nasal obstruction and hearing impairment. Management will be:
A. Tonsillectomy
B. Adenoidectomy with grommet insertion
C. Myringotomy with grommet
D. Myringotomy

Response:
Symptoms of nasal obstruction, mouth breathing and hearing impairment are due to adenoids, and adenoidectomy would be required. Since the child also suffers from hearing impairment (due to otitis media with effusion), a myringotomy with grommet insertion will be required. Simply doing myringotomy (optimised) will lead to recurrence unless cause (adenoids) is removed.

So the answer to this question is B


Instruction:
Normal finding in a newborn ?
A. Length 30 cm
B. Peripheral cyanosis
C. Central cyanosis
D. Extension of body

Response:
Ans. is 'c' i.e., Central cyanosis o There is peripheral cyanosis (not central cyanosis). o Length is approximately 50 cm and the attitude of body is in flexion (not extension).

So the answer to this question is C


Instruction:
The antimullerian hormone is secreted by
A. Granulosa cells
B. Seoli cells
C. Leydig cells
D. None

Response:
The Seoli cells secrete the androgen-binding protein (ABP), inhibin, and MIS.

So the answer to this question is B


Instruction:
Pneumatocele is seen in fracture of
A. Maxillary sinus
B. Frontal sinus
C. Ethmoid sinus
D. Sphenoid sinus

Response:
Pneumatocele is a rare complication following head trauma. The pathophysiology is access of air into the cranium through a fracture involving air sinuses or middle ear roof or depressed fracture of the skull resulting in a craniodental fistula. Frontal bone fracture gives direct access to the cranium.

So the answer to this question is B


Instruction:
Most common site of subclan aery stenosis is in pa:
A. 1st
B. 2nd
C. 3rd
D. Terminal

Response:
Subclan Aery is most commonly obstructed in the proximal poion -1st pa proximal to the origin of veebral and internal thoracic aery. It is focal and is usually an extension of atherosclerotic narrowing from the aoic arch into the aery. The stenosis is more common on left side - Left subclan is involved 3 times more frequently involved than the right.

So the answer to this question is A


Instruction:
Following data was obtained from a 20 year old medical student: tidal volume = 540 mL, paial pressures of CO2 in expired air & aerial blood ~ PECO2 = 20 mm Hg, PACO2 = 30 mm Hg: respiratory rate = 15/min. The alveolar ventilation would be:-
A. 4.2 L/min
B. 4.8 L/min
C. 5.2 L/min
D. 5.4 L/min

Response:
Alveolar ventilation = (tidal volume - dead space volume) x Respiratory rate= (540 - 180) 115 = 5.4 L/min

So the answer to this question is D


Instruction:
Myofunctional appliances are
A. Active removable appliances
B. Passive appliances delivering forces from surrounding oral and periodontal tissues
C. Semi-fixed appliances
D. Fixed appliances

Response:
None

So the answer to this question is B


Instruction:
which of the following is not a side effect of amitriptyline:
A. Constipation
B. Fine tremors
C. Weight loss
D. Dry mouth

Response:
Ref: KDT 6/e p444 'Weight gain ( not weight loss) in seen with TCAs.

So the answer to this question is C


Instruction:
Algor mois is -
A. Rise of body temperature after death
B. Cooling of body
C. Persistent body spasm
D. Postmoem colouration

Response:
Algor mois is cooling of body after death. It is due to stoppage of energy and heat production after death. Dr. Narayana Reddys Synopsis of Forensic Medicine and Toxicology 27th edition pg. 75.

So the answer to this question is B


Instruction:
Which of the following is FALSE regarding the endodermal sinus turmor:
A. Malignant germ cell tumor of the ovary
B. Schiller- Duval body is the characteristic histological feature
C. Produces hCG which is a useful tumor marker
D. Surgical staging and unilateral salpingooophorectomy is generally the treatment of choice

Response:
Endodermal sinus tumor (yolk sac tumor) Unilateral & mostly observed between 15-20 yrs of age. Median age of presenation is 16 - 18 years. Its the third most common malignant germ cell tumor of the ovary (most common germ cell malignancy is Dysgerminoma) The characteristic histological feature-Schiller-duval body is seen in EST Most tumors produce Alpha feto protein and rarely Alpha1 antitrypsin. AFP is used for monitoring patient response to treatment. Treatment of choice- Surgical staging and Unilateral Salpingo-oopherectomy All patients have to be treated with adjuvant or therapeutic chemotherapy

So the answer to this question is C


Instruction:
The risk of carbamazepine induced Stevens-Johnson syndrome is increased in the presence of which of the following genes?
A. HLA-B* 5801
B. HLA-B* 1502
C. HLA-B* 5701
D. HLA-B 27

Response:
HLA DRUG DISEASE B1502 CARBAMAZEPINE STEVEN JOHNSON SYNDROME B5801 ALLOPURINOL SKIN REACTION B5701 ABACAVIR MI B53 MALARIA PROTECTION B27 ANKYLOSING SPONDYLITIS

So the answer to this question is B


Instruction:
Which of the following is not true regarding tetracycline?
A. It is not teratogenic
B. It can cause tooth discoloration
C. It can result in superinfection
D. It can lead to pseudomembranous colitis

Response:
Tetracyclines are broad spectrum antibiotics Mechanism of action The tetracyclines arc primarily bacteriostatic; inhibit protein synthesis by binding to 305 ribosomes in susceptible organism. Subsequent to such binding, attachment of aminoacyl-t-RNA to the mRNA-ribosomc complex is interferred with As a result the peptide chain fails to grow. Tetracyclines have chelating propey. Calcium-tetracycline chelate gets deposited in developing teeth and bone. Given from midpregnancy to 5 months of extrauterine life, the deciduous teeth are affected: brown discolouration, ill-formed teeth, more susceptible to caries. Tetracyclines given between 3 months and 6 years of age affect the crown of permanent anterior dentition. Repeated courses are more damaging. Given during late pregnancy or childhood, tetracyclines can cause temporary suppression of bone growth. The ultimate effect on stature is mostly insignificant, but deformities and reduction in height are a possibility with prolonged use. Tetracyclines should not be used during pregnancy, lactation and in children. Essentials of medical pharmacology K D Tripathi Sixth edition Pg no 710 to 714

So the answer to this question is A


Instruction:
Mechanism of action of d-tubocurarine is:-
A. Competitive, nondepolarizing block at the Nm cholinergic receptor
B. Non-competitive, nondepolarizing block at the Nm cholinergic receptor
C. Competitive, depolarizing block at the Nm cholinergic receptor
D. Noncompetitive, depolarizing block at the Nm cholinergic receptor

Response:
Neuro Muscular blockers Depolarising or Non-competitive Non-depolarising or competitive Succinylcholine Dexamethonium Curium Curonium Atracurium Cisatracurium Mivacurium Pancuronium Pipecuronium Vecuronium Rocuronium Rapacuronium

So the answer to this question is A


Instruction:
Techniques of delivery of after coming head in breech presentation include all except :
A. Burns-Marshall method
B. Forceps delivery
C. Modified Mauriceau Smellie Viet technique
D. Lovset's maneuver

Response:
Methods of delivery of after coming head of breech : Burns-Marshall technique Mauriceau Smellie Viet technique Piper's forceps Ref: Datta Obs 9e pg 360.

So the answer to this question is D


Instruction:
Repeat upper GI endoscopy in a patient with a gastric ulcer is performed after how many weeks of PPI therapy to assess the healing of the ulcer and confirm absence of malignancy:
A. 2 weeks
B. 4 weeks
C. 6 weeks
D. 12 weeks

Response:
Repeat upper endoscopy is done in patients with a gastric ulcer after 6 to 10 weeks of acid suppressive therapy to confirm healing of the ulcer and absence of malignancy. 2% to 4% of repeat upper endoscopies have been repoed to disclose gastric cancer. Ref: Sleisenger and Fordtran's, E-9, P-305

So the answer to this question is C


Instruction:
Most common cause of acute arterial occlusion
A. Pulmonary emboli
B. Atherosclerosis plaque
C. Emboli atrial fibrillation
D. Thrombosis of aneurysm

Response:
None

So the answer to this question is C


Instruction:
A 61-year-old alcoholic man presents with severe epigastric pain radiating to his back. His amylase and lipase are elevated, and he is diagnosed with acute pancreatitis. Over the first 48 hours, he is determined to have 6 Ranson's criteria, including a PaO2 less than 60 mm Hg. His chest x-ray reveals bilateral pulmonary infiltrates, and his wedge pressure is low. Which of the following criteria must be met to make a diagnosis of adult respiratory distress syndrome (ARDS)?
A. Hypoxemia defined as a PaO2 /FiO2 ratio of less than 200
B. Hypoxemia defined as a PaO2 of less than 60 mm Hg
C. A pulmonary capillary wedge pressure greater than 18 mm Hg
D. Lack of improvement in oxygenation with administration of a test dose of furosemide

Response:
Adult respiratory distress syndrome has been called "shock lung" or "traumatic wet lung" and occurs under a variety of circumstances. The diagnosis can be made based on bilateral pulmonary infiltrates on chest x-ray, a PaO2 /FiO2 ratio of less than 200, and pulmonary wedge pressures of less than 18 mm Hg (low filling pressures exclude the diagnosis of pulmonary edema). Three major physiologic alterations include (1) hypoxemia usually unresponsive to elevations of inspired O2 concentration; (2) decreased pulmonary compliance, as the lungs become progressively stiffer and harder to ventilate; and (3) decreased functional residual capacity. Progressive alveolar collapse occurs owing to leakage of protein-rich fluid into the interstitium and the alveolar spaces with the subsequent radiologic picture of diffuse fluffy infiltrates bilaterally. Ventilatory abnormalities develop that result in shunt formation, decreased resting lung volume, and increased dead-space ventilation.

So the answer to this question is A


Instruction:
5-year-old male brought to casualty by his mother because of episode of sudden vomiting. He has been behaving strangely according to mother. Laboratory findings showed microcytic hypochromic anemia with the above finding. The most probable poisoning is:
A. Chronic arsenic poisoning
B. Chronic lead poisoning
C. Chronic mercury poisoning
D. Chronic copper poisoning

Response:
Ans. (B). Chronic lead poisoningThe above blood picture shows basophilic stippling of RBCs.Basophilic stippling (dots in the red blood cells) is due to the inhibition of 5 pyrimidine nucleotidase enzyme resulting in aggregation of ribosomes.Other findings in blood: Microcytic hypochromic anemia, anisocytosis, poikilocytosisBasophilic stippling is also seen in megaloblastic anemia.

So the answer to this question is B


Instruction:
Which one is not the bad prognostic sign for pancreatitis? NOT RELATED-MEDICINE
A. TLC >16,000/mL
B. Calcium <8 mmol/L
C. Glucose >200 mg%
D. Prothrombin >2 times the control

Response:
.

So the answer to this question is D


Instruction:
Z score measures the bone mineral density compared to
A. Age, Race and sex matched individuals
B. Race and sex matched individuals
C. Sex matched individuals
D. None of the above

Response:
T Score and Z score are the measures of bone mineral densityZ score: measures the bone mineral density in terms of standard detion from the mean bone mineral density of age, race, and sex-matched individualsT score: measures the bone mineral density in terms of standard detion from the mean bone mineral density of race and sex-matched individuals or normal younger age group(Refer: Mohindra's Fundamentals of Ohopedics, 2nd edition, pg no. 400 - 412)

So the answer to this question is A


Instruction:
Ramla, 65 yrs old male presents with low backpain especially at L3, anaemia and fatiguability) His investigation profile reveals -Hb =7gm%, TLC-9000/cmm, DLC -N- 55%, L-30%, M-10%, E-1%, -2%,Serum proteins-8gm %, ratio-2.9/5.9, ESR-90 and serum creatinine-3.2 mg%. Likely diagnosis is -
A. Waldenstroms macroglobulinemia
B. Multiple myeloma
C. TB spine
D. Secondaries in spine

Response:
None

So the answer to this question is B


Instruction:
Thumb sign in lateral X-ray of neck seen in:
A. Epiglottitis
B. Internal hemorrhage
C. Saccular cyst
D. Ca epiglottis

Response:
In epiglottis: A plain lateral soft tissue radiograph of neck shows the following specific features Thickening of the epiglottis--the thumb sign Absence of a deep well-defined vallecula--the vallecula sign Steeple sign i.e. Narrowing of subglottic region is seen in chest X-ray of patients of laryngotracheobronchitis (i.e. croup).

So the answer to this question is A


Instruction:
Retroperitoneal fibrosis is seen with which 5HT1 and 5HT2 receptor antagonist: March 2013 (d)
A. Ketanserin
B. Cyproheptadine
C. Methysergide
D. All of the above

Response:
Ans. C i.e. Methysergide Impoant side effects of drugs Drug deposited in retina: Chloroquine Drug deposited in muscle: Digoxin Drugs causing hepatitis: Halothane, Rifampin, INH, pyrazinamide Drugs causing intrahepatic cholestasis: Phenothiazines, TCA Hepatotoxins: CC14, Paracetamol Bleomycin and pulmonary changes: Pulmonary fibrosis (stimulation of alveolar macrophages) Drugs causing pulmonary fibrosis: Bleomycin, Busulfan Cardiotoxic drugs: Doxarubicin, Daunorubicin Drugs causing osteoporosis: Glucocoicoids, Heparin Drugs with low safety margin: Lithium, Aminoglycosides, Digoxin Drugs causing hyperuricemia: Pyrazinamide, Ethambutol Drugs causing hirsutism: Minoxidil, Phenytoin Drugs causing extra-pyramidal side effects: Haloperidol, Levodopa In Glucose-6-phosphate deficiency, haemolysis is caused by: Dapsone, - Primaquine, - Sulfonamides etc.

So the answer to this question is C


Instruction:
Which action of extra-ocular muscle is spared in involvement of Occulomotor nerve :
A. Abduction
B. Depression
C. Elevation
D. Adduction

Response:
A i.e. Abduction

So the answer to this question is A


Instruction:
Age changes in periodontal ligament include which of the following?
A. Increased fibroplasia
B. Increased vascularity
C. Increased thickness
D. Decreased in number of cementicles

Response:
None

So the answer to this question is A


Instruction:
Burning epigastric pain is due to -
A. Vomiting
B. Reflux esophagitis
C. Duodenal ulcer
D. Gastric ulcer

Response:
Ans. is 'b' i.e., Reflux esophagitis

So the answer to this question is B


Instruction:
Mc Murray's osteotomy is done for
A. Malunited interochantric fracture of femur
B. Nonunion transcervical neck fracture of femur
C. Nonunion lateral condyle fracture of humerus
D. Malunited supracondylar fracture of humerus

Response:
Mc Murrary&;s osteotomy is an oblique osteotomy at the interochanteric region. The direction of osteotomy is medially upwards, beginning at the base of the greater trochanter & ending just above the lesser trochanter. Once osteotomy is made, the distal fragment is displaced medially & is abducted. The position is held by an external suppo( hip spica) or by internal fixation with plate& screws. The osteotomy conves the shearing stresses at the fracture site into compressive forces, thus enhancing fracture union. The line of weight bearing after osteotomy passes from the head to distal fragment. It, therefore, bypasses fracture site. By this osteotomy the head is suppoed by the distal fragment ( armchair effect) This helps the limb in taking weight on walking.T his operation is rarely done nowadays. Ref: Essential ohopaedics, Maheshwari, 9th edition, page no: 136

So the answer to this question is B


Instruction:
A neonate who is febrile, presents with features of encephalitis. On examination, the baby is found to have vesicular skin lesions. Most probable causative organism is:
A. HSV I
B. HSV II
C. Meningococci
D. Streptococci

Response:
- Given features suggests the diagnosis of HSV encephalitis. As the question mentions Neonate, therefore answer is option 2 i.e. HSV-II. CNS infection by Herpes Simplex: In the neonatal period, HSV II (acquired from maternal genital lesions) is an impoant cause of encephalitis. Beyond the neonatal period, HSV encephalitis is almost always caused by HSV I. HSV encephalitis usually involves (most common) temporal frontal coex and the limbic system. HSV is a cause of aseptic meningitis and is the most common cause of recurrent aseptic meningitis (Mollaret meningitis). Fever is relatively uncommon and skin vesicles occur in only 60% of cases of HSV encephalitis Herpes simplex virus (HSV) type 1 is an impoant cause of severe, sporadic encephalitis in children and adults.Severe encephalitis with diffuse brain involvement is caused by HSV type 2 in neonates who usually contract the virus from their mothers at delivery.

So the answer to this question is B


Instruction:
Following are "essential diagnostic criteria" according to
graber except
A. Case history
B. Facial photographs
C. Periapical x-rays
D. Lateral cephalograms

Response:
None

So the answer to this question is D


Instruction:
Wrong about polio patient who had paralysis
A. Can transmit It by nasal discharge
B. Sub clinical infection common
C. Most predominant polio virus during epidemic is type I
D. Can be given vaccine

Response:
None

So the answer to this question is A


Instruction:
Hypokalemia in an infant may be due to all of the following except -
A. Adrenal tumor
B. Adrenal tumor
C. Thiazide therapy
D. Diarrhea

Response:
Ans. is 'b' i.e., Acute Renal failure Hypokalemia o Hypokalemia is defined as serum potassium values of less than 3.5 meq/L. Impoant causes of hypokalemia in children Spurious Decreased intake Renal losses o Leukemia o Aorexia nervosa o Distal A Transcellular shift o External loss o Proximal A o Alkalosis o Diarrhea o Hypomagnesemia o b-agonists o Laxative use o Gitelman syndrome o Theophylline o Bater syndrome Cushing sync ,ine due to adrenal adenoma or hyperplasia Drugs : Diuretics, Cisplatin, amphotericin, Aminoglycosides.

So the answer to this question is B


Instruction:
Consider the following statements about Jacuzzi syndrome and mark the true statement .
A. It is caused by Pneumococcus .
B. It is also known as hot tub folliculitis .
C. It is progressive illness .
D. It is always a painless condition .

Response:
Jacuzzi syndrome :- It is caused by Pseudomonas aeruginosa This condition arises due to inflammation of hair follicles (haiub folliculitis). It is usually self limiting condition . It can be extremely painful or itchy condition .

So the answer to this question is B


Instruction:
Male patient with EHL weakness
A. L4-L5 slip disc
B. L5-S1 slip disc
C. S2-S3 slip disc
D. L2-L3 slip disc

Response:
(A) L4-L5 slip disc CLINICAL FEATURES OF LUMBAR DISC PROLAPSENerve Root CompressedL1L2L3L4L5S1Level of Disc ProlapseT12-L1L1-L2L2-L3L3-L4L4-L5L5-S1PainThoraco lumbar junction groin, proximal part of thighThoracolumbar junction, groin, proximal part of thighUpper lumbar spine, atnerior aspect of proximal thighLower back, hip, posterolateral thigh, anterior legSacroiliac joint, hip, lateral thigh & lateral legSacroiliac joint, hip, posteriolateral leg to heelParesthesiaOblique band proximal 3rd of thigh anteriorly just below inguinal ligamentOblique band mid 3rd of thigh anteriorlyOblique band lower part of thigh anteriorly just above the kneeMedial to shin of tibia, medial aspect of the footLateral leg, dorsum of foot, 1st web spacePosterior aspec: of thigh, back of calf lateral side & sole of footMuscle Affected MainlyIliopsoas (Hip flexion)Iliopsoas (Hip flexion), Quadriceps (Knee extension), adductor brevis, longus magnus (Hip adduction)Iliopsoas (HIP flexion), Quadriceps (knee extension), adductor brevis, longus, magnus (Hip adduction)Tibialis anterior (foot inversion), Quadriceps (knee extension), adductor brevis, longus magnus (Hip)Extensor Hallucis Longus (Dorsiflexion of great toe), Extensors brevis (Dorsiflexion of foot), GluteusPeroneus Longus & Brevis (Foot eversion), Flexor hallucis longus (Plantar flexion of great toe), Flexor digitorum longus & brevis> Extensor hallucis longus is a thin muscle, situated between Tibialis anterior and Extensor digitorum longus, functions to extend big toe and dorsiflex foot, & assists with foot eversion and inversion.> Innervation: Deep peroneal (fibular) nerve, branch of common peroneal (fibular) nerve (L4, L5, S1).

So the answer to this question is A


Instruction:
Cardiac polyp is seen in
A. Acute nephritis
B. Endocarditis
C. Septicaemia
D. Postmoem clot

Response:
Chicken fat and red current jelly seen in post moem clot

So the answer to this question is D


Instruction:
Which of the following represents the surface marking of the aoic valve ?
A. Sternal end of left 3rd costal cailage
B. Sternal end of right 3rd costal cailage
C. Besides the sternum in left 3rd intercostal space
D. Besides the sternum in right 3rd intercostals space

Response:
Surface marking of aoic valve is slightly oblique line,2.5 cm long behind left half of sternum at the level of lower border of left 3rd coastal cailage. BD CHAURASIA'S HUMAN ANATOMY.VOLUME1. 6TH EDITION.PAGE NO 291. TABLE NO 21.1 surface marking of cardiac valves

So the answer to this question is A


Instruction:
Sister mary joseph nodule is commonly seen with:
A. Ovarian CA
B. Colon CA
C. Pancreatic CA
D. Stomach CA

Response:
Ans. (d) Stomach CARef: Bailey & Love 26th ed. ch 63/1050* Tumour of the stomach may spread via the abdominal cavity to the umbilicus (Sister Josephs nodule).* The ovaries may sometimes be the sole site of transcoelomic spread (Krukenbergs tumours).

So the answer to this question is D


Instruction:
A patient admitted to an ICU is on central venous line for the last one week. He is on Ceftazidime and amikacin. After 7 days of antibiotics he develops a spike of fever and his blood culture is positive for gram positive cocci in chains which are catalase - negative. Following this vancomycin was started but the culture remained positive for same organism even after 2 weeks of therapy. The most likely organism causing infection is :
A. Staphylococci aureus
B. Viridans streptococci
C. Enterococcus faecalis
D. Coagulase negative staphylococcus

Response:
None

So the answer to this question is C


Instruction:
Gracey curettes are area specific instruments because:
A. They are used in the specific areas of the US
B. They adapt to specific areas of the tooth or root
C. They have more than one angle per cutting edge
D. They are used for root planning

Response:
None

So the answer to this question is B


Instruction:
Transection of the brain stem at the mid-pontine level with bilateral vagotomy causes ______
A. Ceasation of spontaneous respiration
B. Continuation of regular breathing
C. Irregular but rhythmic respiiration
D. Apneusis

Response:
Transection of the brainstem at the midpoint level with bilateral vagotomy causes apneusis. At mid pontine level lesion, the apneustic centre is intact while the pneumotaxic centre is seperated. Concurrent removal of vagus inputs causes this kind of abnormal pattern of breathing characterized by deep, gasping inspiration with a pause at full inspiration followed by a breif insufficient release. Effect of various Lesions and Brainstem Transection Label Level of transection Vagi intact vagi cut A Complete transection above pons Regular breathing continues Regular breathing continues but depth of inspiration increases B Mid-pontine level section Regular breathing continues Apneusis develops C Transection midway between pons and medulla Irregular but rhythmic respiration Irregular but rhythmic respiration D Complete transection below medulla Spontaneous respiration ceases Spontaneous respiration ceases Ref: Ganong&;s review of medical physiology 25th edition Pgno: 645-657

So the answer to this question is D


Instruction:
A highway truck driver has profuse rhinorrhoea and sneezing. .Which among the following drug would you prescribe him
A. Pheneramine
B. Promethazine
C. Dimenhydrine
D. Cetrizine

Response:
Is a non sedating antihistamines drugs and is preferred for the patients requiring constant attention. it does not cause sedation impairment of psychomotor function. Other Drugs listed in the question are first generation antihistamines. Refer KDT 6/e p157

So the answer to this question is D


Instruction:
Electron microscopy was introduced by:
A. Leeuwenhoek
B. Robert Koch
C. Ruska
D. Paul Ehrlich

Response:
The first prototype electron microscope, capable of four-hundred-power magnification, was developed in 1931 by the physicist Ernst Ruska and the electrical engineer Max Knoll.
The apparatus was the first practical demonstration of the principles of electron microscopy.

So the answer to this question is C