Instruction:
What are hamartomas -
A. Hemangiomas
B. Development malformations
C. Hematomas
D. Antibioma

Response:
Hamartoma

A hamartoma is a benign (noncancerous) tumor-like growth consisting of a disorganized mixture of cells and tissues normally found in the area of the body where the growth occurs.
For example, hamartoma of lung contains cartilage, blood vessels, bronchial type of structures and lymphoid tissues.

It is a development malformation that resembles a neoplasm in the tissue of origin.

But, it is not a neoplasm because it grows at the same rate as the surrounding tissues, unlike neoplasm whose growth exceeds the growth of the surrounding tissue.

Choristoma

Choristoma is the ectopic rest of normal tissue, i.e., the normal tissue is present at a different anatomical site of the body.
For example, the presence of pancreatic tissue in mucosa of the small intestine

Normally arranged tissue at a different anatomical site (ectopic site) → Choristoma.

Abnormally arranged tissue present at normal site → Hamartoma

So the answer to this question is B


Instruction:
Which of the following are true about larynx:
A. Epiglottis cailage is hyaline
B. Thyroid cailage is elastic
C. Cricoid cailage is elastic
D. Cuneiform & cornculate cailage are elastic

Response:
D i.e. Cuneiform & cornculate cailage are elastic Elastic cailage is found in sites which are concerned either with production or reception of sound eg. auricle (pinna), external acoustic meatus (lateral pa), auditory tube , epiglottis & two small laryngeal cailage (corniculate & cuneiform)

So the answer to this question is D


Instruction:
The following are related to fetal erythropoiesis except :
A. In the embryonic phase, the erythropoiesis is first demonstrated in the spleen
B. By 20th week, the liver becomes the major site of erythropoiesis
C. Near term, the bone marrow becomes the major site of erythropoiesis
D. At term 75-80% of haemoglobin is fetal type (HbF)

Response:
Primitive hematopoiesis and vasculogenesis first occur in the yolk sac followed by liver and finally bone marrow, leading to the production of blood and vessels respectively Blood islands, clusters of primitive erythrocytes surrounded by endothelial cells, arise from the extraembryonic mesoderm in the yolk sac Hematopoiesis (formation and development of various types of blood cells) begins in the liver during the sixth week The first erythrocytes released into the fetal circulation are nucleated and macrocytic Hemoglobin content of fetal blood rises to approximately 12 g/dL at midpregnancy and to 18 g/dL at term Because of their large size, fetal erythrocytes have a sho lifespan, which progressively lengthens to approximately 90 days at term Erythropoiesis is controlled primarily by fetal erythropoietin because maternal erythropoietin does not cross the placenta Fetal blood is first produced in the yolk sac, where hemoglobins Gower 1, Gower 2, and Poland are made Erythropoiesis then moves to the liver, where fetal hemoglobin F is produced When hemopoiesis finally moves to the bone marrow, adult type hemoglobin A appears in fetal red blood cells and is present in progressively greater amounts as the fetus matures The final adult version of the a chain is produced exclusively by 6 weeks. After this, there are no functional alternative versions Reference: William's Obstetrics; 24th edition; Chapter 7

So the answer to this question is A


Instruction:
The earliest hematologic manifestation of megaloblastic anemia is
A. Increase in MCV
B. Hypersegmented polymorphs
C. Thrombocytopenia
D. Leukopenia

Response:
Microcytic anemiaMacrocytic anemiaSideroblastic anemiaIron deficiency anemiaThalassemiaAnemia of chronic disease Liver disease Hypothyroidism Folic acid & vitamin B12 deficiency Cytotoxic drugs Megaloblastic anemiaTriad - Oval macrocyte , Howel Jolly bodies , Hypersegmented neutrophilsBone marrow - hypercellular bone marrow with megaloblast along with the presence of abnormal granulocytic precursors ( giant metamyelocyte & band forms ) and large megakaryocytes with bizarre multilobate nuclei Peripheral smear - pancytopenia with presence of macrocyte (MCV>100 fl) lacking central pallor ; large hypersegmented neutrophils ( >5 lobes )(Refer: Robbins & Cotran's - Pathologic Basis of Disease, SAE, 1st edition, Vol I-pg no: 643-648)

So the answer to this question is B


Instruction:
Earliest sign of Mg toxicity:
A. Falling oxygen saturation on pulse oxymetry
B. Respiratory depression
C. Cardiac arrest
D. Anuria

Response:
In case of magnesium toxicity ,there can be respirstory depression.In such cases ,infusion should be discontinued,oxygen given and 10ml of 10% calcium gluconate or calcium chloride given IV.Falling oxygen saturation in pulse oxymetry may be an early sign of magnesium toxicity TEXT BOOK OF OBSTETRICS,Sheila Balakrishnan,2nd edition,page no.269

So the answer to this question is A


Instruction:
Drug used for treatment of malignant hyperthermia is?
A. Succinylcholine
B. Dantrolene
C. Diazepam
D. Valproate

Response:
Ans. (b) DantroleneRef Lippinott 5/e, p 344, Goodman and Gillman, p 152, 11/e

So the answer to this question is B


Instruction:
Prunning of Pulmonary aeries is seen in:
A. Pulmonary hypeension
B. Chronic Bronchitis
C. Pulmonary infections
D. Pulmonary transplant

Response:
A i.e. Pulmonary hypeension Pulmonary aerial hypeension is characterized by pruning of peripheral pulmonary aeriesQ (i.e. dispropoionate increase in caliber of fibrous central aeries from sustained increase in PBF with a decrease in caliber of small muscular/peripheral aeries). Pulmonary (Aerial) Hypeension (PAH) It is defined as an elevation in mean pulmonary aerial pressure above 30mmHg during execise and above 25mmHg at rest in systole. An increase in PAH most commonly occurs as a result of intrinsic lung disease, which results in an increae in pulmonary vascular resistance and subsequent increase in PA pressure. PAP can also increase as a result of an increase in pulmonary venous pressure (which may be d/t impaired left ventricle function or obstruction to left sided cardiac flow eg MS etc). So radiological features may be slightly different depending on cause i.e. pulmonary aerial or pulmonary venous hypeension. Radiological features of PAH include. Vascular Signs - Enlargement of central pulmonary aeries (main pulmonary aery & its branches down to the segmental level)Q and tapering of peripheral aerial branches (vessels beyond segmental level)-termed pripheral pruningQ are seen - Enlargement of central main pulmonary aery may be extremely large with complete infilling of pulmonary aery/ventricular concavity of left hea border on X-ray. - Widest diameter of main pulmonary aery (MPA) 29mm measured on transverse section (CT) at level of PA bifurcation has 90% sensitivity & specificity - Diameter ratio of MPA to ascending aoa (measured at same level) >1 i.e. diameter of MPA>AA has strong correlation in - Transverse diameter of right descending pulmonary aery at midpoint >17mm (Grainger); diamete of left and right pulmonary aery >16mm (Wolfgang); maximum diameter of descending branch of pulmonary aery (measured lcm medial & 1 cm lateral to hilar points) >16mm for males & >15mm for females (Sutton) - Pulmonary aeries with in lungs are enlarged but there is rapid tapering of vessels (beyond segmental level) as they run towards the periphery. The impoant feature is discrepancy between central and peripheral vessel size, central pulmonary aeries being large or near normal sometimes and peripheral aeries dispropoionately small (pruning or tapering). - Vascular complications include sub pleural pulmonary infarct, dissection & calcified plaques of central pulmonary aeries (pathognomic, a feature not seen in nonhypeensive pulmonary aeries; is often curvilinear & egg shape calcificaiton mimicking enlarged lymph nodes, from which it is differentiated by absence of lobulation and presence of smooth border). - Pulmonary veins are small in pre capillary pulmonary hypeension whereas enlarged in post capillary causes. Mediastinal & Cardiac Signs - Cardiac enlargement (right hea i.e. RA and RV enlargement & hyperophy)Q demonstrating a large, triangular hea. - Mild pericardial thickening & effusion. - Dilatation of IVC, coronary sinus & SVC (On MRI/CT) Lung Parenchymal Signs - Mosaic perfusion without dilatation of bronchi (increase in vessel diameter in areas of hyper attenuation & tapering of peripheral vessels in areas of hypo attenuation)

So the answer to this question is A


Instruction:
Biuret test is confirmatory test for:
A. Protein
B. Fat
C. Carbohydrate
D. None of the above

Response:
None

So the answer to this question is A


Instruction:
Live part of hydatid cyst?
A. Pericyst
B. Ectocyst
C. Endocyst
D. None of the above

Response:
Ans. C. Endocyst. (Ref Bailey and Love 25th/pg. 56)Endocyst is Live part of hydatid cyst.HYDATID CYSTThe Hydatid cyst is characterised by three layers, an outer pericyst derived from compressed host organ tissues, an intermediate hyaline ectocyst which is non-infective and an inner endocyst that is the germinal membrane and contains viable parasites which can separate forming daughter cysts.A variant of the disease occurs in colder climates caused by Echinococcus multilocularis, in which the cyst spreads from the outset by actual invasion rather than expansion.

So the answer to this question is C


Instruction:
Formula to calculate minute ventilation volume
A. TV x RR
B. Fio2/PEEP
C. TV x (RR-dead space)
D. TV + (RR-dead space)

Response:
Minute respiratory volume- The minute respiratory volume I the total amount of new air moved into the respiratory passage each minute and is equal to tidal volume times the respiratory rate per minute. The normal tidal volume is about 500 milliliters, and the normal respiratory rate is about 12 breaths per minute. Therefore, the minute respiratory volume averages about 6-8L/min. A person can live for a sho period with a minute volume as low as 1.5L/min and a respiratory rate of only 2 to 4 breaths per minute. Respiratory minute vol: - (TV x RR) = 6 - 8 L / min

So the answer to this question is A


Instruction:
Mask-like appearance of face with narrowing of aperture and rigidity of the mucosa is characteristic of:
A. Progressive systemic sclerosis
B. Tetanus
C. Multiple sclerosis
D. OsteomaLacia

Response:
None

So the answer to this question is A


Instruction:
Vitamin k is required for post translational modification of
A. oxidation
B. carboxylation
C. methylation
D. Hydroxylation

Response:
The role of vitamin K is in the post-translational modification i.e, gcarboxylation of glutamic acid residues in proteins such as : Coagulation factors : Factor II, VII, IX, X Protein C and S Osteocalcin Nephrocalcin Reference: Harpers illustrated biochemistry 30th edition

So the answer to this question is B


Instruction:
Hypoglossal nucleus lies on
A. Mid brain
B. Pons
C. Medulla
D. Lower pons

Response:
Hypoglossal nucleus is an elongated column of grey matter extending throughout the length of medulla oblongata in the paramedian plane. Note: *Midbrain - nuclei of 3,4 cranial nerves *Pons - nuclei of 5,6,7,8 cranial nerves * Medulla- nuclei of 9,10,11,12 cranial nerves (Ref: Vishram Singh textbook of clinical neuroanatomy second edition pg -91, 92)

So the answer to this question is C


Instruction:
DOC for chemoprophylaxis of plague ?
A. Streptomycin
B. Erythromycin
C. Tetracycline
D. Vancomycin

Response:
Ans. is 'c' i.e., Tetracycline

So the answer to this question is C


Instruction:
All are opportunistic infection in HIV EXCEPT:
A. Toxoplasmosis
B. Malaria
C. Varicella
D. CMV

Response:
(Malaria): Ref: 1180, -CMDT-09Relationship of CD4 count to development of opportunistic infection* Varicella zoster virus (VZV) infection that occur in HIV infection, include multifocal encephalitis, ventriculitis, myeloradiculitis and arteritis VSV is the major virus associated with acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN): (1356 - 57 - CMDT)

So the answer to this question is B


Instruction:
Clue cells are seen in?
A. Bacterial vaginosis
B. Herpes virus
C. Syphilis
D. Toxoplasmosis

Response:
ANSWER: (A) Bacterial vaginosisREF: Shaw 13th ed p. 129, Novak's Gynecology 12th edition p. 192Indirect repeat from June 2010'Clue cells are seen in bacterial vaginosis"Bacterial vaginosis is diagnosed on the basis of the following findings:A fishy vaginal odour, which is particularly noticeable following coitus, and vaginal discharge are present.Vaginal secretions are gray and thinly coat the vaginal walls.The pH of these secretions is higher than 4.5 (usually 4.7 to 5.7).Microscopy of the vaginal secretions reveals an increased number of clue cells, and leukocytes are conspicuously absent. In advanced cases of BV, more than 20% of the epithelial cells are clue cells.The addition of KOH to the vaginal secretions (the "whiff" test) releases a fishy, amine-like odor.Culture of G. vaginalis is not recommended as a diagnostic tool because of its lack of specificity.

So the answer to this question is A


Instruction:
Oocyst of toxoplasma is found in -
A. Cat
B. Dog
C. Mosquito
D. Cow

Response:
Toxoplasma gondii: Oocysts is the sexual form of the parasite found in cats and felines. Definitive hosts -cat and other felines. Intermediate hosts - man and other mammals (goat, sheep) Transmission: MC mode: Ingestion of sporulated oocysts from contaminated soil, food, or water Ingestion of tissue cyst containing bradyzoites from undercooked meat Sporulated oocyst in cat's feces in saline mount . option-2- DOG-infected by echinococcus.

So the answer to this question is A


Instruction:
Commonest cause of abdominal pain in children is -
A. Porphyria
B. Worm colic
C. Lead poisoning
D. Appendicitis

Response:
Ans. :D.)Appendicitis. The most common medical cause of Acute abdominal pain in children is gastroenteritis, and the most common surgical cause is appendicitis Differential Diagnosis of Acute Abdominal Pain by Predominant Age:

So the answer to this question is D


Instruction:
Second attack rate is minimum in
A. Diphtheria
B. TB
C. Measles
D. Whooping cough

Response:
None

So the answer to this question is B


Instruction:
False about female pelvis:
A. Narrow' pelvic plane lies at the level of ischial spines
B. Plane of greatest pelvis dimension corresponds to SI & S2 vertebrae
C. Angle of inclination is 55deg
D. Plane of least pelvic dimension form plane of obstetrical outlet

Response:
Ans: B (Plane...) FEMALE PELVIS"For descriptive purpose, true pelvis is divided into inlet, cavity & outlet It is shallow in front, formed by symphysis pubis & measures 4 cm & deep posteriorly, formed by sacrum & coccyx & measures 11.5 cm"- Dutta's Obstetrics 6th/ 88"Pelvic cavity: The cavity is curved in such a way that it is first directed downwards & backwards, & then downwards & the forwards (J-shaped). It has unequal walls, measuring only about 5 cm anteriorly & 15 cm posteriorly" BDC4th/Vol. II-343"In the erect posture, the pelvis is tilted forward. As such, the plane of the inlet makes an angle of about 550 with the horizontal & is called angle of inclination"- Dutta's Obstetrics 6th/88"Plane of greatest pelvis dimension: The plane extends from the midpoint of posterior surface of symphysis pubis to the junction of the second & third sacral vertebrae"- Dutta's Obstetrics 6th/ 90"Obstetrical outlet: It is the segment of the pelvis bounded above by the plane of least pelvic dimensions & below by the anatomical outlet"- Dutta's Obstetrics 6th/ 91Plane of least pelvis dimension or narrow pelvic plane: The plane extend from the lower border of the symphysis pubis to the tip of ischial spines & posteriorly to meet the tip of fifth sacral vertebrae. It is irregularly oval & notched on each side by the ischial spine Dutta's Obstetrics 6th/ 91

So the answer to this question is B


Instruction:
In dysmenorrhoea indomethacin works by -
A. Inhibiting prostaglandin synthetase
B. Suppressing ovulation
C. Reducing inflammation
D. Relaxing smooth muscle

Response:
Ans. is 'a' i.e., Inhibiting prostaglandin synthetase Medical measures to relieve dysmenorrheao Analgesics paracetamol and piroxicam.o Antispasmodies hyoscine, camylofin, and drotaverineo Prostaglandin synthetase inhibitors inhibiting cyclo-oxygenaseMefenamic acid, indomethacin, naproxen, ibuprofen.o Smooth muscle relaxantGlyceryltrinitrateo Progestogen containing IUCDMirena and progestasert - reduce pain, provide contraception and reduce bleeding, o Cyclical oral contraceptive drugso Vitamin E

So the answer to this question is A


Instruction:
For which malignancy, Intensity Modulated Radiotherapy (IM) is the most suitable:
A. Lung
B. Prostate
C. Leukemias
D. Stomach

Response:
B i.e. Prostate

So the answer to this question is B


Instruction:
The receptor through which M-tropic HIV strains bind
A. CCR5
B. CXCR4
C. CXCR5
D. Any of the above

Response:
.

So the answer to this question is A


Instruction:
Benzopyrene change to carcinogen in animal occurs due to all except -
A. Epoxide formation
B. p53 activation
C. Cytochrome C activation
D. By inducing metabolism of cyt p450

Response:
. Cytochrome C activation

So the answer to this question is C


Instruction:
Conjunctival xerosis is seen in all of the following except: March 2008
A. Steven-Johnson syndrome
B. Keratoconjunctivitis sicca
C. Vitamin A deficiency
D. Sarcoidosis

Response:
Ans. D: Sarcoidosis Xerosis/xerophthalmia is a dry, lustreless condition of the conjunctiva due to a deficiency of mucin. It can be seen in: Local ocular disorders like trachoma, burns, pemphigoid, diphtheria, prolonged exposure due ectropion and proptosis etc. Systemic diseases like deficiency of vitamin A. Patients affected with sarcoidosis not infrequently show lesions in the conjunctiva. These lesions are typically nodular, translucent and orange in appearance. Keratoconjunctivitis sicca is a condition caused by deficiency of the aqueous component of the tears, i.e. the lacrimal secretion. Deficiency of conjunctival mucus occurs in stevens-Johnson syndrome.

So the answer to this question is D


Instruction:
The relationship between the working edge of the instrument and the tooth surface is:
A. Angulation
B. Access
C. Adaptation
D. Activation

Response:
None

So the answer to this question is C


Instruction:
Pancytopemia is caused by -
A. Aplastic anemia
B. MDS
C. Megaloblastic anaemia
D. All

Response:
Ans. is 'a' i.e., Aplastic anaemia; 'b' i.e., MDS; 'c' i.e., Megaloblastic anaemia

So the answer to this question is D


Instruction:
Koebner's phenomenon is not seen in:
A. Vitiligo
B. Psoriasis
C. Dermatitis herpertiformis
D. Lichen planus

Response:
Ref: Thappa DM. The isomorphic phenomenon of Koebner. Indian J Dermatol Venereal Leprol 2004;70:187-9.Explanation:The Koebner phenomenon is the development of isomorphic pathologic lesions in the traumatized uninvolved skin of patients who have cutaneous diseases.Koebner phenomenon signifies activity of the disease.Types of Koebner phenomenon:1. True isomorphic phenomenon:There appear to be three disease processes that display the true isomorphic response of Koebner:PsoriasisLichen planusVitiligo.2. Pseudoisomorphic phenomenon:The Koebner phenomenon also seen in infectious diseasesWartsMolluscum contagiosumBehcet's diseasePyoderma gangrenosum.3. Occasionally occurring isomorphic phenomenon:In this category, diseases occasionally localize to sites of trauma, e.g.Cancer (gastric, testicular or mammary )Darier's diseaseErythema multiformeHailey-Hailey diseaseKaposi's sarcomaKyrle's diseaseLichen sclerosus et atrophieusPellagraPerforating folliculitisReactive perforating collagenosis.Koebner response in psoriasis:The reported incidence of Koebner response in psoriasis varies from 11-75%.The latent period between injury to uninvolved skin and appearance of disease is usually 10-14 days, but it may range from 3 days to several years.The "reverse" Koebner response:The reverse Koebner reaction is seen when an area of psoriasis clears following injury.

So the answer to this question is C


Instruction:
All the following are true of DeQuervan's Thyroiditis except
A. Pain
B. Increased ESR
C. Increased radioactive iodine uptake
D. Fever

Response:
Answer is C (Increased radioactive Iodine uptake) : 'DeQuervaitt's Thyroiditis is characterized by a depressed radioactive iodine uptake'. DeQueryain's Thy roiditis, Granulomatous Thyroiditis or Subacute Thyroiditis or Giant cell Thyroiditis: Origin / * It is viral in origin.Q Symptoms usually follow an upper respiratory tract infection. * Pain over thyroid Q or pain referred to lower jaw, ear, occiput (stretching of thyroid capsule) Etiology Clinical presentation * Fever 2,malaise, asthenia * Firm, irregular enlargement of one or both thyroid lobes Characteristic * High Erythrocyte sedimentation rate (ESR) Laboratory * Depressed RAIU i.e. decreased radio iodine uptake test Finding * Early: patients may be mildly thyrotoxic due to leakage of hormone from gland: |T3 & T4 & |TSH Later : patients may be hypothyroid due to depletion of hormone from gland : |T3 & T4 & |TSH Histology * Multinucleated Giant cells Q are seen - Robbins Prognosis * Disorder may smoulder fir months but eventually subsides with return of normal function.

So the answer to this question is C


Instruction:
Drug contraindicated in uterine fibroid:
A. Danazol
B. Estrogen
C. Mifepristone
D. GnRH analogue

Response:
Ans. B Estrogen Ref.: Shaws 15th ed. 1359; Williams Gynecology Ch: 9 * Leiomyomas are benign smooth muscle neoplasms that typically originate from the myometrium. They are often referred to as uterine myomas, and are incorrectly called fibroids because the considerable amount of collagen contained in many of them creates a fibrous consistency. Estrogen has a hormonal role in the patho-physiology of formation of fibroids. * Drugs used to decrease the size of the fibroid: # GnRH analogue (Buserelin, Nafarelin, Goserelin, Triptorelin, Leuprorelin acetate) # GnRH antagonist: Cetrirelix, Ganirelix # Mifepristone (anti-progesterone) # Danazol

So the answer to this question is B


Instruction:
ck 7 negative and ck 20 negative tumor is
A. Prostate carcinoma
B. Carcinoma colon
C. Urothelial carcinoma
D. Mesothelioma

Response:
Answer- A. Prostate carcinomaCK7- 1 CK20 - carcinoma of adrenal coex, prostate

So the answer to this question is A


Instruction:
Antibody specificity is determined by the amino acid sequence within the:
A. Fc region
B. Constant region
C. Variable region
D. Fc receptors

Response:
Ans. C. Variable regionAntibody specificity is dictated by the sequence of amino acids within the variable regions of the light and heavy chains.a. The Fc region is a site for antibody docking to effector cells and does not play a role in antigen binding.b. The constant region has a similar structure in antibodies of widely divergent specificity and, therefore, does not dictate specificity.c. Fc receptors are sites on immune effector cells that interact with the Fc region of the antibody molecule and do not define an antibody's specificity.d. The J chain is a unique portion of secreted IgA molecules that allows the molecule to move from the circulation through mucous membranes.

So the answer to this question is C


Instruction:
All of the following are true regarding Haemophilus influenzae except -
A. It can be a part of the normal flora in some persons
B. The serotyping is based on the bacterial outer membrane proteins
C. It requires Haemin and NAD for growth in culture medium
D. Type b is responsible for invasive disease

Response:
None

So the answer to this question is B


Instruction:
In dentifrices, concentration of fluoride is:
A. 800 ppm
B. 2000 ppm
C. 1000 ppm
D. 600 ppm

Response:
Topical fluoride products can be divided into 2 broad categories:

Professionally applied products
	Professionally applied fluoride products are those medicaments typically dispensed by dental professionals in the dental office and usually involve the use of high fluoride concentration products, ranging from 5000 and 19000 ppm, which is equivalent to 5-19 mgF/ml.
Self-applied products
	Self-applied fluoride products are usually bought and dispensed by the individual patient, but at the recommendation of dental personnel. These products include fluoride dentifrices, mouthrinses and gels and typically are low fluoride concentration products ranging from 200 to 1000 ppm or 0.2 -1.0 mg fluoride/ml.

Essentials of preventive and community dentistry
Soben Peter
5th edition
page no. 252

So the answer to this question is C


Instruction:
A 5-year-old boy from upper socioeconomic back- ground presents with bowing of legs. On work up serum calcium was 9 mg% with serum phosphate of 1 mg% with normal SAP and normal Serum PTH. X-ray Wrist joint is given. Comment on the diagnosis?
A. Hypophosphatemic rickets
B. Barter syndrome
C. Chronic renal failure
D. Polycystic kidneys

Response:
Ans. (a) Hypophosphatemic rickets.* The X-ray wrist shows cupping and splaying of distal end of radius. However serum calcium is normal with normal SAP ruling out nutritional rickets.* However the radiological findings can be explained by low phosphate levels secondary to phosphate wasting. In hypophosphatemic rickets due to PHEX-1 gene phosphate depletion leads to depletion of hydroxyapatite in the bone which weakens the bone leading to rickets and bowing of legs. Image source. style="font-size: 1.04761904761905em; color: rgba(0, 0, 0, 1); font-family: Times New Roman, Times, serif; margin: 0 0 8pt">

So the answer to this question is A


Instruction:
Body mass index (BMI) is a ratio of body weight to ?
A. Height
B. Square root of height
C. Square of height
D. Cube of height

Response:
Ans. is 'c' i.e., Square of height Body mass index Body mass index (BMI) is a simple index of weight for height that is commonly used to classify underweight, overweight and obesity in adults. It is defined as the weight in kilograms divided by the squire of height in metres.

So the answer to this question is C


Instruction:
A 30 year old male presents to the dermatologist with silvery, scaling plaques on his elbows and knees. His mother has been afflicted with the same condition in the past. The most likely diagnosis is ?
A. Acne rosacea
B. Acne vulgaris
C. Pemphigus vulgaris
D. Psoriasis vulgaris

Response:
Psoriasis vulgaris usually appears on the nails, knees, elbows, and scalp. It does not generally affect the mucous membranes. Lesions are well-demarcated coral-colored plaques with a white or silvery scale (classic clue). Histologically, epidermal hyperplasia causing thickening and lengthening of the rete ridges is apparent, as is thinning of the epidermis over the dermal papillae. There is a recognized genetic component to this condition. Peak incidence is at age 30. Here's a point-saving strategy: It is easy to get confused on this question because of the similar looking answer choices, especially under time pressure. Be extra careful in such cases to mark the proper choice on your answer grid. Acne rosacea affects the central face. Erythema, telangiectasias, acneform lesions (papules, cysts, pustules), and rhinophyma (telangiectasias and hyperplasia of nasal soft tissue) are found in various combinations. It is common from ages 30-50. Women are affected three times more frequently than men, but the syndrome is more severe in the latter. Acne vulgaris causes comedones, papules, and cysts. It may be related to hormones, drugs, diet, irritants, and genetic factors. Allergy to Propionibacterium acnes has been found to contribute to this condition. Pemphigus vulgaris stas with small vesicles, usually on the oral or nasal mucosa, then spreads to other pas of the body. Bullae are delicate and flaccid. The condition is due to autoantibodies to intercellular junctions between keratinocytes. Nikolsky's sign (production of blistering by light stroking or rubbing of the skin) is positive. Pemphigus is most common from ages 40-60. Ref: Suurmond D. (2009). Section 3. Psoriasis. In D. Suurmond (Ed), Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, 6e.

So the answer to this question is D


Instruction:
True about obstructive lung disease is -
A. Decreased FEV1 and FEV1/FVC
B. FEV1/FVC normal or increased
C. Decreases RV
D. Decrease total lung capacity

Response:
(A) Decrease FEV, and FEV1/FVC) (2158-H 18th, (673 - Davidson 21st)* Hall mark of COPD is air flow obstruction (Reduction in FEV, and FEV1/FVC)* Lung volume may increase, resulting in an increase in total lung capacity (TLC), functional residual capacity (FRC) and residual volume (RV).* More recently it has been shown that a multifunctional index incorporating airflow obstruction - exercise performance, dyspnea, and body mass index is a better predictive of mortality rate than pulmonary function alone.Gold criteria for COPD severity1.MildFEV1 /FEV < 0.7 and FEV >80% predicted2.ModerateFEV1 /FVC < 0.7 and 50%< FEV,<80%predicted3.SevereFEV1 /FVC < 0.7 and <30% FEV,<50% predicted4.Very severeFEV1 /FVC < 0.7 and FEV, <30% predictedorFEV1 <50% predicted with respiratory failure or signs of right heart failure.* The change in pH with PCO2 is 0.08 units/lOmmHg actively and 0.03 units (lOmmHg in the chronic state.* Increase hematocrit suggests the presence of chronic hypoxemia as does the presence of signs of right ventricular hypertrophy.* CT scan is the current definitive test for establishing the presence or absence of emphysema in living subjects.* Recent guidelines have suggested testing for a a,AT deficiency in all subjects with COPD or asthma with chronic airflow obstruction.

So the answer to this question is A


Instruction:
Episiotomy posteriorly beyond perineal body injuring the structure immediately posterior to it Which structure is injured
A. External and sphincter
B. Ischiocavernosus
C. Bulbospongiosus
D. urethral sphincter

Response:
ref : DUTTA BOOK 9TH ED

So the answer to this question is A


Instruction:
Which of the following is not true regarding gluten sensitive enteropathy ?
A. Also known as celiac sprue.
B. Anti gliadin antibodies are present
C. Consumption of Barley, Rice, Oat and wheat to avoided.
D. Cryptitis doesn't occur in gluten sensitive enteropathy.

Response:
Barley, Rice, Oat and wheat to avoided. Mnemonic BROW.

So the answer to this question is C


Instruction:
Which of the following antifungal drug have a broad antifungal spectrum: March 2011
A. Posaconazole
B. Miconazole
C. Ketoconazole
D. Clotrimazole

Response:
Ans. A: Posaconazole Posaconazole is the broadest spectrum anti fungal azole, and the only one with consistent activity against the Mucorales.

So the answer to this question is A


Instruction:
Major sign for AIDS surveillance in WHO case definition ?
A. > 10% weight loss
B. Cough > 1 month
C. Generalized lymphadenopathy
D. Disseminated Herpes

Response:
Ans. is 'a' i.e., > 10% weight loss WHO case definition for AIDS surveillance For the purpose of AIDS surveillance an adult or adolescent (six years of age) is considered to have AIDS if at least 2 of the following major signs are present in combination with one minor sign. Major Signs Weight loss > 10 % of body weight Chronic diarrhoea for more than 1 month Prolonged fever for more than 1 month Minor signs Persistent cough for more than one month Generalized pruritic dermatitis History of herpes zoster Chronic progressive or disseminated herpes simplex infection Generalized lymphadenopathy Oropharyngeal Candidiasis. Expanded WHO case definition for AIDS surveillance For the purpose of surveillance on adult or adolescent (>12 years of age) is considered to have AIDS if a test for HIV antibody gives a positive result and one or more of the following conditions are present : >10% body weight loss or cachexia, with diarrhoea or fever or both, for at least 1 month, not known to be due to a condition unrelated to HIV infection.

So the answer to this question is A


Instruction:
Which of the following ECG findings is associated with acute myocardial infraction
A. Elevation of S wave
B. Prolonged QT interval
C. Tall T waves with increased amplitude
D. Prolonged PR interval

Response:
Ref Harrison 19 th ed pg 1594 ST-segment depression occurs in 20 to 25% of patients; it may be transient in patients without biomarker evidence of myocardial necrosis, but may be persistent for several days in NSTEMI. T-wave changes are common but are less specific signs of ischemia, unless they are new and deep T-wave inversions (>=0.3 mV).

So the answer to this question is C


Instruction:
In retinal aery angiogram, the dye is injected through the:
A. Peripheral veins
B. Aoa
C. Retinal aery
D. Retinal vein

Response:
Ans. Peripheral veins

So the answer to this question is A


Instruction:
A patient with chronic gastroesophageal reflux disease developed Barrett's esophagus. Microscopy of this region of esophagus shows:
A. Intestinal dysplasia
B. Gastric metaplasia
C. Squamous metaplasia
D. Columnar metaplasia

Response:
Barrett's esophagus is specialized columnar metaplasia that replaces the normal squamous mucosa of the distal esophagus in some persons with GERD. Barrett's epithelium is a major risk factor for adenocarcinoma of the esophagus and is readily detected endoscopically, due to proximal displacement of the squamocolumnar junction. Ref: Wong-Kee-Song L.M., Topazian M. (2012). Chapter 291. Gastrointestinal Endoscopy. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.

So the answer to this question is D


Instruction:
Atherosclerosis in the coronary circulation most commonly affects -
A. Left anterior descending artery
B. Left circumflex
C. Right coronary
D. All of the above

Response:
None

So the answer to this question is A


Instruction:
Blue eardrum is seen in
A. Serous otitis media
B. CSOM
C. Perforation
D. None

Response:
Serous otitis media is an insidious condition characterized by an accumulation of nonpurulent effusion in the middle ear cleft. In otoscopy, the tympanic membrane is often dull and opaque with loss of the light reflex. It may appear yellow, grey or bluish in colour. Reference: Diseases of Ear, Nose and Throat, PL Dhingra, Shruthi Dhingra,7th edition, pg no.69

So the answer to this question is A


Instruction:
Organelle involved in protein soing is
A. Golgi apparatus
B. Mitochondria
C. Ribosomes
D. Nuclear membrane

Response:
Protein soing, O glycosylation, and glycoproteins, oligosaccharide chain processing are the functions of the Golgi apparatus. Reference: Harper; 30th edition

So the answer to this question is A


Instruction:
Which of the following is not used to induce ovulation-
A. Danazol
B. Clomiphene
C. HMG
D. HCG

Response:
None

So the answer to this question is A


Instruction:
Which among the following is the earliest sign of vitamin-A deficiency in developing countries?
A. Conjunctival xerosis
B. Nyctalopia
C. Retinopathy
D. Pain

Response:
Night blindness is the earliest symptom. Dryness of the conjunctiva (xerosis) and the development of small white patches on the conjunctiva (Bitot spots) are early signs. Ulceration and necrosis of the cornea (keratomalacia), perforation, endophthalmitis, and blindness are late manifestations. Xerosis and hyperkeratinization of the skin and loss of taste may also occur. Ref: Baron R.B. (2013). Chapter 29. Nutritional Disorders. In M.A. Papadakis, S.J. McPhee, M.W. Rabow (Eds), CURRENT Medical Diagnosis & Treatment 2013.

So the answer to this question is A


Instruction:
All of the following are true about carcinoid tumors except:
A. Ileum is the commonest site in GIT
B. Commonest site for malignant carcinoid is distal ileum
C. Elevated urinary 5-HIAA is diagnostic of carcinoid syndrome
D. Commonest valvular disease in carcinoid syndrome is pulmonary stenosis

Response:
o Bronchus is the commonest site for carcinoids & in the GIT, ileum is the commonest siteo Ileum is the commonest site for malignant carcinoidso The commonest valvular lesion seen in carcinoids is tricuspid regurgitation

So the answer to this question is D


Instruction:
Cavitation of the lungs is not a feature of: March 2011
A. Lung abscess
B. Primary pulmonary tuberculosis
C. Secondary pulmonary tuberculosis
D. Bronchogenic carcinoma

Response:
Ans. B: Primary pulmonary tuberculosis Cavitation is rare in primary TB Radiological changes of secondary TB includes ill-defined opacification in one or both of the upper lobes, and as progression occurs, consolidation, collapse and cavitation develop to a varying degree Cavitation in lungs can be seen in C- Carcinoma - Squamous is most common A- Autoimmune - Wegener's granulomatosis, Rheumatoid nodules V- Vascular - Emboli (septic emboli or bland emboli) I- Infection - Lung abscess, Bacterial pneumonia, Fungal pneumonia, Tuberculosis (secondary), Pneumatocele T- Trauma - Pulmonary laceration Y- Young (congenital) - Congenital cystic adenomatoid malformation, Pulmonary sequestration, Bronchogenic cyst

So the answer to this question is B


Instruction:
Marker for pancreatic non-functional neuro endocrine tumor (PNET) is?
A. Chromogranin-A
B. CD100
C. CEA
D. PSA

Response:
Ans is 'a' i.e. Chromogranin-A o Chromogranin-A (CgA) is a glycoprotein used commonly as a tumor marker in histopathology but also has elevated circulating levels in patients with both functional and non-functional PNETs.o Other markers for PNETs - pancreatic polypeptide (PPP), pancreastatin, and neuron-specific enolase (NSE)

So the answer to this question is A


Instruction:
Human papiloma virus is a:
A. RNA virus
B. DNA virus
C. Both
D. None

Response:
Ans. (b) DNA virusRef.: Microbiology by Ananthanarayan and Paniker 8th ed. /549* Human papillomavirus (HPV) is a DNA virus from the papovavirus family that is capable of infecting humans.* Usually it causes no symptoms in most people, but some types can cause warts (verrucae), while others can in a minority of cases lead to cancers of the cervix, vulva, vagina, penis, oropharynx and anus.* HPV has been linked with an increased risk of cardiovascular disease.* In addition, HPV 16 and 18 infections are a cause of a unique type of oropharyngeal (throat) and cervix cancer.DNA and RNA virusDNA virusRNA virus# Pox virus: largest virus# Parvovirus: smallest virus# Adenovirus# Papovavirus# Hepadna virus# Herpesvirus# Rotavirus: only double stranded RNA virus# Orthomyxovirus# Reovirus# Buniya virus# Arena virus# Hepatitis A, C, D, E virus# Picorna, polio, cocksackie, echo and entero virus.

So the answer to this question is B


Instruction:
All of the following are true about bacillus anthrax except
A. Plasmid is responsible for toxin production
B. Cutaneous anthrax generally resolves spontatneously
C. Capsular polypeptide aids virulence by inhibiting phagocytosis
D. Toxin is a complex of two fractions

Response:
The anthrax toxin is encoded by a separate plasmid. It is a complex of three fractions: A)Edema factor B)Protective antigen factor and C)Lethal factor Reference: Textbook of Microbiology; Anathanarayan and panicker's; 10th edition; Page no: 249

So the answer to this question is D


Instruction:
Persistence of distal part of vitello intertimal duct is
A. Meckel's diverticulum
B. Raspberry tumour
C. Peritoneal mice
D. None of the above

Response:
Respberry tumour :

It is persistence of distal part of vitello - intestinal duct.
Also called as Umbilical adenoma.

So the answer to this question is B


Instruction:
NOT a feature of primary hyperaldosteronism is-
A. Pedal edema
B. Diastolic hypeension
C. Polyuria
D. Hypokalemia

Response:
potassium depletion responsibilite for weakness and fatigue, diastolic hypeension due to increased sodium reabsorption and extracellular volume expansion. Polyuria from impairment of urinary concentrating ability( Harrison 17 pg 2260

So the answer to this question is A


Instruction:
The most common site for myocardial infarction is :
A. Left atrium
B. Left ventricle
C. Right atrium
D. Right ventricle

Response:
Answer is B (Left ventricle) The most common site of myocardial infarction is the anterior wall of Left ventricle. Anterior wall MI 1. True Anterior Wall Occlusion of Left Anterior Descending aery (LAD) 2. Anteroseptal Infarction Occlusion of Left Anterior Descending aery (LAD) 3. Anterolateral infarction Occlusion of Left coronary aery thereby causing ischemia in region supplied by LAD aery and circumflex aery (lateral wall)

So the answer to this question is B


Instruction:
Leucocoria is seen in all except
A. Retinoblastoma
B. Congenital glaucoma
C. Persistent primary hyperplastic vitreous
D. Fungal Endophthalmities

Response:
In congenital glaucoma the cornea is white due to edema as a result of increased IOP, but Leucocoria is not seen . Refer khurana 6/e 415

So the answer to this question is B


Instruction:
Arch shaped bone loss around maxillary molars occurs in:
A. Gingivitis
B. ANUG
C. Chronic periodontitis
D. Juvenile periodontitis

Response:
None

So the answer to this question is D


Instruction:
A myocardial infarct showing early granulation tissue has most likely occurred
A. Less than 1 hours
B. Within 24 hrs
C. Within 1 week
D. Within 1 month

Response:
None

So the answer to this question is C


Instruction:
In the upper jaw, deciduous teeth erupt earlier than those in the lower jaw, except: Odisha 11
A. Lateral incisors
B. Central incisors
C. Canines
D. Second molars

Response:
Ans. Central incisors

So the answer to this question is B


Instruction:
In which of the following rigor mois is not seen?
A. Well built male
B. Well built female
C. Old patient> 80 years
D. Fetus <7 months

Response:
Rigor mois is not seen in fetus less than 7 months. It develops slowly and is marked in healthy adults. It is feeble and rapid in infants. Dr. Narayana Reddys Synopsis of Forensic Medicine & Toxicology 27 th edition pg. 80.

So the answer to this question is D


Instruction:
Normal pregnancy can be continued in
A. Primary pulmonary hypeension
B. Wolf-Parkinson-White syndrome
C. Eisenmenger syndrome
D. Marfan syndfome with dilated aoic root

Response:
Hea disease in which Termination of pregnancy is advised Pulmonary hypeension- primary or secondary Marfans syndrome with aoa involvement Eisenmenger syndrome Any hea disease which belongs to NYHA Class 3 or 4 Ejection fraction < 40% Severe aoic stenosis or Severe mitral stenosis Previous peripaum cardiomyopathy with any residual impairment of LV function ABSOLUTE INDICATIONS FOR TERMINATION OF PREGNANCY Pulmonary HTN Eisenmenger's Syndrome Pulmonary veno-occlusive disease. Reference: William's Obstetrics; 24th edition; Chapter 49 Reference: DC.Duttas textbook of OBG,9th edition,page 259

So the answer to this question is B


Instruction:
All of the following are branches from the CORDS of brachial plexus EXCEPT:
A. Suprascapular nerve
B. Upper subscapular nerve
C. Lower subscapular nerve
D. Lateral pectoral nerve

Response:
Suprascapular nerve

So the answer to this question is A


Instruction:
Granulomatous inflammation is found in:
A. Crohn's disease
B. Ulcerative colitis
C. Amoebiasis
D. Giardiasis

Response:
- Non-caseating granulomatous inflammation is seen in crohn's disease Impoant points about Crohn's disease are: S - Skip lesions ; Cobble stone appearance I - Ileum (MC affected site) S - Saccharomyces cerevisae antibody T - Transmural granulomatous inflammation E - Extra fibrosis - strincture & fistula formation; creeping fat R - Radiological sign- String sign of Kantor, Rectum is usually spared.

So the answer to this question is A


Instruction:
Virulence determinant implicated in pathogenesis of scarlet fever is
A. Hyaluronidase
B. M protein
C. Pyrogenic exotoxin
D. Streptokinase

Response:
Streptococcal Pyrogenic exotoxin ( erythrogenic, Dick, scarlatinal toxin): the toxin was named erythrogenic because it's intradermal injection into susceptible individuals produced an erythematous reaction. This test was used to identify children susceptible to scarlet fever, a type of acute pharyngitis with extensive erythematous rash, caused by Streptococcus pyogenes strains producing this toxin. The primary effect of the toxin is an induction of fever and so it was renamed streptococcal pyrogenic exotoxin. 3 types of SPE have been identified: A, B and C. Types A and C are coded for by bacteriophage genes while type B gene is chromosomal. SPE are superantigens, T cell mitogens that induce a massive release of inflammatory cytokines, causing fever, shock and tissue damage. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 213

So the answer to this question is C


Instruction:
Propranolol is useful for all of the following except:
A. Angina
B. Familial tremor
C. Hypertension
D. Partial AV block

Response:
None

So the answer to this question is D


Instruction:
All are transmitted by fecal-oral route except ?
A. Polio
B. Typhoid
C. Ascaris
D. Dracunculiasis

Response:
Ans. is 'd' i.e., Dracunculiasis

So the answer to this question is D


Instruction:
Ohngren's line extends from-
A. Lateral canthus of the eye to angle of mandible
B. Medial canthus of eye to angle of mandible
C. Medial canthus of eye to tragus
D. Tragus to angle of mandible

Response:
Ans. is 'b' i.e., Medial canthus of eye to angle of mandible Qhngren's lineo In head and neck cancer, Ohngren's line is a line that connects the medial canthus of the eye to the angle of the mandibleo The line defines a plane orthogonal to a sagittal plane that divides the maxillary sinus into (1) an anterior-inferior part, and (2) a superior-posterior part.o Tumours that arise in the anterior-inferior part, i.e. below Ohngren's line, generally have a better prognosis than those in the other groupo Addition to above a vertical line through pupil is also considered, which divides the above mentioned structures into 4 different regions. The structures at posterosuperior medial have worst prognosis and that at anteroinferior medial are least dangerous.

So the answer to this question is B


Instruction:
A 55yers old male has sudden onset of thunder clap headache following by loss of consiusness for 4 hour investigation is
A. Non contrast ct followed by angiogram
B. PET
C. MRI angiogram
D. Contrast enhanced CT

Response:
(A) (MRI angiogram) (128- H 18th) (Brad- Lee Neurology 5th)Primary thunderclap headache* Sudden onset of severe headache may occur in the absence of any known provocation* D/D-(i) Sentinel bleed of an intracranial aneurysm(ii) Cervicocephalic arterial dissection(iii) Cerebral venous thrombosis(iv) Sympathomimetic drugs or tyramine containing foods in patients who is taking MAO is or they may be a symptom of pheochromocytoma.* First presentation of any sudden onset severe headache should be vigoruously investigated with neuroimaging (CT or when possible MRI with MR angiography) and CSF examination* Nimodipine may be helpful. Although by definition the vasoconstriction of primary thunder clap headache resolves spontaneously.Red flag svmptons in headache (1157- Dividson 22nd)SymptomsPossible explanationSudden onset (Maximal immediately or with in minutes)- Subarachnoid haemorrhage- CCA- Pituitary apoplexy- MeningitisFocal neurological symptoms (other than for typically migrainous)Intracranial mass lesionsVascularNeoplasticInfectionsConstitutional symptoms* Weight loss* General malaise* Pyrexia* Meningism* Rash* Meningoencephalitis* Neoplastic (lymphoma or metastasis) Inflammatory (vasculitic)Raised intracranial pressure (worse on wakening/lying down, associated Vomiting)Intracranial mass lesionsNew onset aged > 60 yearsTemporal arteritis* Thunderclap headache is an acute and servre headache that is maximum in intensity at onset and has been likened to a clap thunder.* The term TCH was initially used by Day and Raskin in reference to the pain associated with an unruptured intracranial aneurysm.* However, multiple cause of thunderclap headache have since been described"subarachnoid hemorrhage is the most common cause of thunderclapQ".Primary Thunder Clap headache* Primary TCH is diagnosed when all other potential underlying cause have been eliminated by diagnostic testing* Primary TCH's can recur intermittently and are generally associated with benign outcomeThe international Headache society's diagnostic criteria for primary TCHA. Severe headpain fulfilling criteria B and CB. Both of the following characteristics- Sudden onset,- Reaching maximum intensity in < 1 min lasting form 1 hour to 10 daysC. Does not recur regularly over subsequent weeks or months.D. Not attributed to another disorder (normal cerebrospinal fluid and normal brain imaging are needed)Secondary causes of Thunderclap headache- Subarachnoid hemorrhage0- Sentinel headache- Cerebral venous sinus thrombosis0- Cervical artery dissection- Spontaneous intracranial hypotension- Pituitary apoplexy0- Retroclival hematoma- Ischaemic stroke- Acute hypertensive crisis- Reversible cerebral vasoconstriction syndrome- Third ventricle colloid cyst- Intracranial infection- Priamary thunderclap headache- Primary cough, sexual and exertional headache

So the answer to this question is A


Instruction:
Which of the following viral infections is transmitted by tick:
A. Japanese encephalitis
B. Dengue fever
C. Kyasanur forest disease (KFD)
D. Yellow fever

Response:
Kyasanur forest disease (KFD)

So the answer to this question is C


Instruction:
Glucagon hydrochloride is used in poisoning of:
A. Beta blocker
B. Calcium channel blocker
C. Tricyclic antidepressants
D. SSRI

Response:
Ref: Basic tPS Clinical Pharmacology by Katzung Twelfth Edition p.1033Explanation:Common Antidotes (See table below)* 5-10 mg IV bolus of glucagon may reverse hypotension and bradycardiaCommon AntidotesAntidotePoisonAcetylcysterne AtropineAcetaminophenAnticholinesteraseintoxication:OrganophosphatesCarbamatesBicarbonate sodiumMembrane - depressant cardiotoxic drugs Tricyclic antidepressants QuinidineCalciumFluorideCalcium channel blockersDesferoxamineIron saltsDigoxin antibodiesDigoxinRelated cardiac GlycosidesEsmololTheophylline Caffeine MetaproterenolEthano1Methano 1 Ethylene glycolFlumazenilBenzodiazepinesFomepizoleMethanol Ethylene glycolGlucagonP blockersHydroxocobalaminCyanideNaloxoneNarcotic drugs Other opioid DerivativesOxygenCarbon monoxidePralidoxime (2 -P AM)Orga no phosphate (0 P) cholinesterase inhibitors

So the answer to this question is A


Instruction:
Inferior rib notching is seen in all except
A. Aortic thrombosis
B. Taussing Blalock operation
C. Pulmonary atresia
D. Marfan's syndrome

Response:
Superior rib notching is seen in Marfan's syndrome.

So the answer to this question is D


Instruction:
which of the following SSRI is used only in the management of OCD
A. clomipramine
B. seraline
C. miazapine
D. fluvoxamine

Response:
SSRI * IMPOANCE Most widely prescribed antidepressant * MECHANISM Specifically acts on serotonin transpoers and increases serotonin in synapse. DRUGS FLUOXETINE FLUVOXAMINE DAPOXETINE CITALOPRAM ESCITALOPRAM ESCITALOPRAM SERALINE PAROXETINE USE FLUOXETINE=============CHILDHOOD DEPRESSION FLUVOXAMINE===========OCD DAPOXETINE==============PME ESCITALOPRAM===========HEA SAFE, PATHOLOGICAL EMOTIONS PAROXETINE=========SEDATING, PANIC DISORDER IMPULSE CONTROL DISORDERS PME PARAPHILIA Ref. kaplon and Sadock, synopsis of psychiatry, 11 th editiom, pg. 955

So the answer to this question is D


Instruction:
What is absent in breast milk ?
A. Vit K
B. Vit C
C. Lactose
D. Vit A

Response:
Ans. is 'a' i.e., Vitamin K o Milks from the mother whose diet is sufficient and properly balanced will supply all the necessary nutrients except fluoride and Vitamin D. o The iron content of human milk is low, but most normal term infants have sufficient iron stores for the first 4-6 months. Human milk iron is well absorbed. Nonetheless, by 6 months the breast-fed infant's diet should be supplemented with iron foified complementary foods. o The Vitamin K content of human milk is low and may cause hemorrhagic disease of newborn.

So the answer to this question is A


Instruction:
The energy for glycogenesis is provided by -
A. GTP
B. GDP
C. UTP
D. AMP

Response:
Ans. is 'c' i.e., UTP

So the answer to this question is C


Instruction:
Which of the following is not an indication for oxytocin -
A. Spontaneous premature labour
B. Post paum hemorrhage
C. Uterine ineia
D. Breast engorgment due to inefficient milk ejection reflex

Response:
Ans. is 'a' i.e., Spontaneous premature labour Uses of oxytocin Induction of labour 3. Post paum haemorrhage 5. Oxytocin challenge test (for uteroplacental adequacy) Uterine inteia 4. Breast engorgment

So the answer to this question is A


Instruction:
Pulmonary embolism is most commonly produced by which of the following -
A. Trauma
B. Atherosclerosis
C. Thrombosis of pelvic vessels
D. None

Response:
None

So the answer to this question is C


Instruction:
One tablet of chlorine is effective to disinfect how much quantity of water
A. 5 L
B. 20 L
C. 10 L
D. 30 L

Response:
None

So the answer to this question is B


Instruction:
Example of Dimorphic fungus -
A. Cryptococcus
B. Blastomyces
C. Cladosporum
D. T. montagrophytes

Response:
Ans. is 'b' i.e., Blastomyces Dimorphic fungio Fungi that have two growth forms, such as mold (filaments) and a yeast, which develop under different growth conditions.o In host tissues or cultures at 3 / C they occur as yeasts, while in the soil and in cultures at 22 C they appear as moulds.o Most fungi causing systemic infections are dimorphic fungi.Examples:# Coccidioides# Histoplasma# Blastomyces# Paracoccidioides# Sporothrix (Sporotrichum)# Candida albicans# Penicillium mameffiNote - Candida albicans is a dimorphic fungus, while other species of Candida are not dimorphic.

So the answer to this question is B


Instruction:
A persistent left superior vena cava usually drains into
A. Right atrium
B. Inferior vena cava
C. Coronary sinus
D. Right superior vena cava

Response:
Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly. Autopsy studies in unselected patients have shown that the frequency of PLSVC is 0.3%. This anomaly is frequently observed in patients with congenital hea disease and has occasionally been repoed in patients without evidence of other congenital abnormalities.1, 2 Persistent left superior vena cava is the result of a persistent patency of an embryological vessel (left anterior cardinal vein) that is present during the early developmental period. It usually drains into the right atrium through a dilated coronary sinus.3, 4 However, in some cases, it may drain directly into the left atrium producing a right-to-left shunt,5, 6 or directly into the right atrium. In most of these cases the right superior vena cava may be present and may or may not communicate with the left superior vena cava.7 Persistent left superior vena cava is generally discovered fouitously without clinical signs.

So the answer to this question is C


Instruction:
Indicators of active multiplication of hepatitis B virus is -
A. HbsAg
B. HbcAg
C. HbeAg
D. Anti Hbs

Response:
None

So the answer to this question is C


Instruction:
Ion exchange chromatography is based on -
A. Size
B. Charge
C. Solubility
D. Polarity

Response:
Ans. is 'b' i.e.. Charge Property of protein usedMethodProtein solubility'Salting out' or salt extraction (precipitation of protein by ammonium sulfate)Molecular sizeo Gel filtration chromatography (molecular-sieve chromatography or size exclusion chromatography)o Ultracentrifugationo SDS-PAGE (Sodium dodecvl sulphate-polyacry lamide gel electrophoresis)o DialysisMolecular charge (Ionic charge)o Ion exchange chromatographyo High performance liquid chromatography (HPLC)o Electrophoresis (simple on cellulose acetate starch gel)o Isoelectric focusing (a variant of electrophoresis)Molecular charge and molecular w eightPAGE : polyacrylamide gel electrophoresisAffinity bindingAffinity chromatographyHvdnophobidty'Hydrophobic interaction chromatography

So the answer to this question is B


Instruction:
Which of following statements about extrapyramidal effects of antipsychotic drugs is FALSE?
A. Caused by blockade of dopamine receptors
B. Less likely to be produced by clozapine than by chlorpromazine
C. Can be countered to some degree by antimuscarinic drugs
D. Haloperidol does not cause extrapyramidal syndrome

Response:
(Ref: KDT 6/e p430, 431, 432) Extrapyramidal adverse effects of antipsychotic drugs are due to blockade of dopamine receptors. These are less often seen with atypical anti-psychotics like clozapine and risperidone (and more often with classical drugs like haloperidol and chlorpromazine). These effects can be treated with central anticholinergic drugs like benztropine and trihexiphenidyl.

So the answer to this question is D


Instruction:
Organisms associated with fish consumption and also causes carcinoma Gallbladder
A. Gnathostoma
B. Anglostrongyloidosis cantonensis
C. Clonorchis sinensis
D. H.dimunata

Response:
Clonorchis sinensis Clonorchis sinensis is a liver fluke, acquired by Ingestion of raw or inadequate cooked freshwater fishes In human body, it lives within bile ducts and causes Inflammatory reaction leading to cholangiohepatitis and biliary obstruction. It is well known risk factor for cholangiocarcinoma It is a rare, but mentioned risk factor for carcinoma Gallbladder Ref: www.ncbi.nlm.gov/pubmed/3993073

So the answer to this question is C


Instruction:
Hyperglycemia Associated with
A. Multiple myeloma
B. Ewing's sarcoma
C. Osteosarcoma
D. Chondroblastoma

Response:
The clinical manifestations resulting from the production of metabolic active substance by neoplastic tissue,have been labelled paraneoplastic syndrome.adolescent patients with osteosarcoma Demonstrate abnormal growth hormone ,insulin,growth hormone response to oral glucose loading in78% of the study population No statistical association exists between any of the two or three factors There fore no primary abnormality can be identified high somatomedin levels were noted 72%of group study accompanied by Simultaneous elevation of Growth hormone Study adrenal ,gonadal, gonadotropic hormone were essentially normal thrreby ruling these out as endocrine abnormalities Hyperglycemia is also aAssociated with condrosarcoma and fibrosarcoma

So the answer to this question is C


Instruction:
All of the following are recognized effects of combined oral contraceptives except
A. Breakthrough bleeding
B. Decreased risk of endometrial cancer
C. Increased risk of ischemic stroke
D. Increased risk of colon cancer

Response:
Adverse effects of OCP- breakthrough bleeding, coronary and cerebral thrombosis resulting in MI or stroke, increased incidence of genital carcinoma-like vaginal, cervical, breast cancers. It has a protective effect against endometrial carcinoma due to progesterone (Ref.Essentials of medical pharmacology TD Tripathi 7th edition page no.325,326)

So the answer to this question is D


Instruction:
Role of liver in vitamin D metabolism
A. Catalyzes rate limiting steb
B. 1-hydroxylation
C. 25-hydroxylation
D. 24-hydroxylation

Response:
Found in the liver, this enzyme is a microsomal vitamin D hydroxylase that conves vitamin D into 25-hydroxyvitamin D (calcidiol), which is the major circulatory form of the vitamin.

So the answer to this question is C


Instruction:
Which of the following statements about High Density Lipoprotein (HDL) is false:
A. HDL increases oxidation of LDL
B. HDL reduces foam cell production by LDL
C. HDL is the best predictor of CAD
D. HDL helps to clear lipids from atheromas

Response:
HDL prevent oxidation of LDL in complex in vitro models as a result HDL function as a naturally acting antioxidant which protect vessel wall from oxidative damage and resulting atherogenesis. Ref: Current Pharmaceutical Design, Page 6.

So the answer to this question is A


Instruction:
Classical triad of symptoms of depression includes all except ?
A. Depressed mood
B. Slowed thinking
C. Distractibility
D. Psychomotor retardation

Response:
Ans. is 'c' i.e., Distractibility Clinical features of depression The classical triad of depression is depressed mood, psychomotor retardation, and slowed-down thinking. Mood : Mood is characteriztically low and sad. There is loss of interest and pleasure in almost all activities, which result in social withdrawal, avolition,occupational dysfunction. In severe cases there may be anhedonia (inability to experience pleasure). Thoughts (Thinking) : - Pesimistic thoughts conerning the patients past, present and future occur which results in Hopelessness, Helplessness, and wohlessness. Other thought problems may be guilt-feeling, Loss of self esteem, Suicidal ideas, Delusion of nihlism (World has come to an end, Intestines has been rotated away, No brain in head), Hypochondriacal delusions . Other delusions that may occur in elderly include paranoid or persecutory delusion, and delusional jealousy. Psychomotor activity : - There is psychomotor retardation --> Movements are sluggish & laboured, lack of initiative & energy, Easy fatiguability. In severe form, the patient becomes stuporous (depressive stupor). In older patient there may be agitation and restlessness. Cognition : - There is poor concentration, which may lead the patient to think (mistakenly) that the memory is also impaired (However, memory is normal). In old patients depression may present similar to dementia, i.e., Pseudodementia. Somatic symptoms & biological disturbances : - Multiple physical symptoms are common in elderly patient. Symptoms include heaviness of head, generalized ache & pain, Loss of sexual drive and amenorrhea, severe disturbance in biological function is called somatic syndrome (melancholia). Somatic syndrome (melanocholia) is characterized by :- Decrease in appetite or weight Early morning awakening, at least 2 hours before usual time. Diurnal variation, depession is worse in morning Loss of interest and loss of reactivity to pleasurable stimuli, and loss of pleasure in all activities. Psychomotor agitation or retardation. Excessive or inappropriate guilt. 6. Psychotic symptoms (Psychotic depression) : - Occur in 15-20% of patients. Symptoms include 2"a person auditory hallucinations, delusions, grossly inappropriate behavior. These symptoms may be mood congruent (e.g., nihilistic delusions, delusions of povey or guilt) which are understandable in the light of depressed mood or can be mood incongruent (e.g., delusion of control) which are not directly related to depressive mood. Psychotic depression usually occur later in life and is associated with severe depression.

So the answer to this question is C


Instruction:
An infant is diagnosed with MEN-2B trait. Which the following will be best line of management?
A. Prophylactic surgery
B. Clinical observation and follow up
C. Regular FNAC
D. All of the above

Response:
Prophylactic Thyroidectomy in RET Mutation Carriers MEN-2A Before 5 years MEN-2B Before 1 year

So the answer to this question is A


Instruction:
All the following supply blood to Auditory tube except
A. Aery of Pterygoid canal
B. Ascending Pharyngeal aery
C. Middle Meningeal aery
D. Stylomastoid aery

Response:
The auditory tube is a trumpet-shaped channel which connects the middle ear cavity with the nasopharynx. It is about 4 cm long and is directed downwards, forwards and medially.The aerial supply of the tube is derived from the ascending pharyngeal and middle meningeal aeries and the aery of the pterygoid canal. The veins drain into the pharyngeal and pterygoid plexuses of veins. Lymphatics pass to the retropharyngeal nodesReference: Chaurasia Head and Neck; 6th edition; Page no: 225

So the answer to this question is D


Instruction:
Hemoglobin unlike myoglobin showsa) Sigmoid curve of oxygen dissociationb) Positive cooperativityc) Hills coefficient of oned) None of above
A. ac
B. ab
C. ad
D. bc

Response:
Hb-O2 dissociation curve- Sigmoid shape
Co-operativity- Hb is a tetramer. If one molecule of O2 binds to the tetramer more easily if other O2 is already bound.

Hills coefficient of Hb- 2.8

So the answer to this question is B


Instruction:
Regular vein, aery and nerve CVAN') arrangement is not present in which intercostal space (not the rib):
A. First intercostal space
B. Second intercostal space
C. Third intercostal space
D. Eleventh intercostal space

Response:
Ans. a. First intercostal spaceRegular vein, aery and nerve (`VAN') arrangement is not present in first intercostal space.First RibThe first rib is supplied by the internal thoracic aery and superior intercostal aery. Venous drainage is the intercostal vein.The rib is innervated by first intercostal nerve.The first intercostal vessels and nerve pass along the lower surface between intercostal intimi and costal pleura with arrangements of nerve, aery and vein from above downwards.

So the answer to this question is A


Instruction:
The longest half-life is that of -(AIIMS 90)
A. Radon
B. Radium
C. Uranium
D. Cesium

Response:
The half-life of uranium-238 is about 4.5 billion years, uranium-235 about 700 million years, and uranium-234 about 25 thousand years. Uranium atoms decay into other atoms, or radionuclides, that are also radioactive and commonly called "decay products." Radium half life 1600 years,radon (Rn222) half life 3.8 days,Caesium-137 has a half-life of about 30.17 years

So the answer to this question is C


Instruction:
Prolactin secretion will be inhibited by ?
A. Haloperidol
B. GABA (Gama aminobutyric acid)
C. Neurophysin
D. Dopamine

Response:
Ans. is 'd' i.e., Dopamine

So the answer to this question is D


Instruction:
Cytochrome C in apoptosis acts by
A. IL 10
B. Bcl-2
C. FADD
D. Apaf 1

Response:
After releasing of cytochrome in cytosol, they binas to Apart 1 protein which leads to formation of a complex apoptosome. This complex binds to caspase-9 which is a critical initiator caspase of the mitochondrial pathway of apoptosis.
Also Know
Most critical organ for apoptosis = Mitochondrion
Most characteristic feature of apoptosis = Chromatin condensation
Marker for apoptosis = Annexin V
Molecular marker for apoptosis = CD 95

So the answer to this question is D


Instruction:
A Patient who is on antihypertensive drug develops a dry cough. Which of the following drug might be responsible for the condition:
A. Diuretics
B. ACE inhibitors
C. Calcium channel blockers
D. Beta blockers

Response:
The angiotensin-converting enzyme normally helps in conversion of angiotensin I to angiotensin II, which acts as a vasoconstrictor in case of hypovolemia.
In addition to that, ACE also helps in the breakdown of bradykinin.
When ACE inhibitors (captopril) are given, it inhibits ACE and in addition inhibits the breakdown of bradykinin also, which leads to accumulation of bradykinin level in the body.
This increased level of bradykinin presents with a Dry cough, rashes, urticaria and angioedema.

So the answer to this question is B


Instruction:
Aluminum phosphide poisoning - all true except
A. Sub-endocardial infarcts
B. Produces phosphine gas
C. Oesophageal stricture
D. Cyt. A oxidase inhibitor

Response:
Aluminum phosphide (Celphos) toxicity appears to be due to release of PHOSPHINE on contact with moisture. This phosphine gas due to noncompetitive inhibition of cytochrome oxidase system of mitochondria or damage by free radicals causes' global hypoxia. Significant inhibition of cytochrome-c oxidase activity can be found in ALP-poisoned patients. Organs with the greatest oxygen requirements appear to be especially sensitive to phosphine, including the brain, kidneys, heart, and liver. Phosphine has a characteristic odor described as "decaying fish. Cardiac dysrhythmias probably secondary to electrolyte imbalances have been described in sub-lethal acute exposures. Transient atrial fibrillation and sub-endocardial infarction, adrenocortical injury with elevated serum cortisol levels have been reported.

So the answer to this question is D


Instruction:
All are true about Abdominal aneurysm except:
A. Atherosclerosis is the commonest cause
B. Most commonly arises from above the level of renal aery
C. For asymptomatic aneurysms, repair is indicated if the diameter is >5.5 cm
D. Endovascular placement of an aoic stent is use for repair

Response:
Answer- B. Most commonly arises from above the level of renal aery90% of abdominal aoic aneurysm (AAA) of size > 4cm in diameter is due to atherosclerosis.Male are more frequently affected than female.The aneurysm most commonly arises below the level of renal aery.

So the answer to this question is B


Instruction:
A 50-yrs-old male has a severe vomiting and retching spell with 'sharp substernal pain. He comes to you 4 h later and has a chest film in which the left descending aorta is outlined by air density. Optimum strategy for care would be:
A. Immediate thoracotomy
B. Serial ECGs and CPKs to rule out MI
C. Left chest tube and spit fistula
D. Esophagogastroscopy to establish diagnosis

Response:
The presence of air in the mediastinum after an episode of vomiting and retching is virtually pathognomonic of spontaneous rupture of the esophagus (Boerhaave syndrome). The evidence is overwhelming that without prompt surgical exploration of the mediastinum by left thoracotomy, the patient has little chance for a short-term outcome of low morbidity. The aspiration of highly acidic gastric contents into the mediastinum creates havoc in the tissues exposed to it. The surgical procedure must include extensive opening of the mediastinal pleura and removal of any particulate debris that might have been aspirated into the thorax from the stomach. Closure of the esophageal laceration with reinforcement by a pleural flap and secure chest tube drainage of the pleural space are mandatory.

So the answer to this question is A


Instruction:
Following drugs are known to produce osteonecrosis EXCEPT
A. Glucocoicoids
B. Alcohol
C. Cytotoxicoids
D. NSAIDs

Response:
these NSAID's cause gastric irritation and may risk the gastric bleeding. NSAIDs are non-specific cyclo-oxygenase inhibitors. So gastric protection and platelet function are lost.NSAIDS can also precipitate attacks of bleeding ulcers. ref:SRB&;s manual of surgery,ed 3,pg no 299

So the answer to this question is D


Instruction:
Alvarado score is used for -
A. Acute cholecystitis
B. Acute appendicitis
C. Acute apncreatitis
D. Acute epidydimitis

Response:
Ans. is. 'b' i.e., Acute appendicits Scoring system for Acute Appendicitis: Alvarado Score:* The diagnosis of appendicitis is based primarily on clinical history and physical examination assisted by blood counts. A number of clinical and laboratory based scoring systems have been devised to assist diagnosis.The most widely used scoring system is Alvarado score.Alvarado scoring systemSymptomsScoreMigratory right iliac fossa pain1Nausea / Vomiting1Anorexia 1SignsTenderness in right iliac fossa2Rebound tenderness in right iliac fossa1Elevated temperature1Laboratory findingsLeucocytosis Shift to the left of neutrophils Total10* The sum of all the scores are calculated for each patient and based on the results patients can be divided into three groups.i) Aggregate score 7-10: Strongly predictive of appendicitisii) Aggregate score 5-6: Equivocaliii) Aggregate score 1-4: Appendicitis can be ruled out.* In equivocal cases CT and Ultrasound can help in making the diagnosis.

So the answer to this question is B


Instruction:
Initial fluid of choice for diarrhea in an infant is:
A. Salt water
B. Sugar water
C. ORS
D. Dextrose

Response:
Ans. c. ORS (Ref: Ghai 8/e p293 294)The cornerstone of acute diarrhea management is rehydration by using oral rehydrarion solutions (ORS). Initial fluid of choice for diarrhea in an infant is ORS.Acute Diarrhea ManagementThe cornerstone of acute diarrhea management is rehydration by using oral rehydration solutions (ORS).Principles of Acute Diarrhea Management1. Correction of dehydration, electrolytes and hypoglycemia2. Evaluation for infections using appropriate investigations and their management3. Nutritional therapyPhysiological Basis for Oral Rehydration TherapyIn most cases of acute diarrhea, sodium and chloride are actively secreted from the gut mucosa due to pathogen-induced dysfunction of several actively functioning absorption pumps.However, glucose dependent sodium pump remains intact and functional transporting one molecule of glucose and dragging along a molecule of sodium and one of water across intestinal mucosa resulting in repletion of sodium and water losses.The glucose dependent sodium and water absorption is the principle behind replacing glucose and sodium in 1:1 molar ratio in the WHO oral rehydration solution (ORS).Use of low osmolality ORS causes reduction of stool output, decrease in vomiting and decrease in the use of unscheduled IV fluids without increasing the risk of hyponatremia.For this reason, the recommendation for use of standard WHO ORS (having osmolarity of 311 mmol/l) was changed to low osmolarity WHO ORS (having osmolality of 245 mmol/l)QHome available fluids for Acute DiarrheaFluids that contain salt (preferable)* Oral rehydration solution* Salted drinks (e.g. Salted rice water or salted yoghurt drink)* Vegetable or chicken soup with saltFluids that do not contain salt (acceptabte)* Plain water, water in which a cereal has been cooked (e.g. unsalted rice water), unsalted soup, yoghurt drinks without salt, green coconut water, weak unsweetened tea, unsweetened fresh fruit juiceUnsuitable home available fluids* Commercial carbonated beverages, commercial fruit juices, sweetened teaZinc SupplementationIt is helpful in decreasing severity and duration of diarrhea and also risk of persistent diarrhea.Zinc is recommended to be supplemented as sulphate, acetate or gluconate formulation, at a dose of 20 mg of elemental zinc per day for children >6 months for a period of 14 days.Composition of WHO Recommended ORSConstituentg/lOsmole or ionmmol/lSodium chloride2.6Sodium75QGlucoser anhydrous13.5Chloride65Potassium chloride1.5Glucose, anhydrous75Trisodium citrate, dihydrate2.9Potassium20Q Citrate10Total osmolarity 245Q

So the answer to this question is C


Instruction:
Most common location of lymphoma in the G.I.T?
A. Stomach
B. Ileum
C. Mesentery
D. Colon

Response:
Ans. (a) Stomach* Primary gastric lymphoma is an uncommon condition, accounting for less than 15% of gastric malignancies and about 2% of all lymphomas. However, the stomach is a very common extranodal site for lymphomas (lymphomas originating somewhere else with metastasis to stomach).It is also the most common source of lymphomas in the gastrointestinal tract.

So the answer to this question is A


Instruction:
A 1-year-old child presented with a swelling in the left flank with episodes of flushing, diarrhea, sweating and bone pain. The diagnosis is -
A. Neuroblastoma
B. Wilm's tumor
C. Medulloblastoma
D. Pheochromocytoma

Response:
Ans. is 'a' i.e., Neuroblastoma Clinical manifestations of neuroblastoma o Because neuroblastoma arises from neural crest derivatives of sympathetic nervous system, it produces catecholamines. o So, it may cause clinical feature due to : 1. Primary tumor 2. Metastais 3. Catecholamine secretion

So the answer to this question is A


Instruction:
Posterior relation of neck of pancreas ?
A. IVC
B. Origin of postal vein
C. Aoa
D. Common bile duct

Response:
Ans. is 'b' i.e., Origin of poal vein

So the answer to this question is B


Instruction:
Subacute Sclerosing Pan Encephalitis (SSPE) is a complication of:
A. Measles
B. Mumps
C. Rubella
D. Chicken pox

Response:
Measles: Cause : RNA paramyxovirus. Incubation period: 10-14 days. Source of infection: Cases . Mode of transmission : Respiratory / air droplets. Period of communicability : 4 days before & 5 days after rash. Pathognomic clinical feature : Koplik spot . Clinical feature : Retro-auricular origin of rash. MC complication : Serous otitis media. Subacute sclerosing pan encephalitis is a rare,late complication of measles - Aka 'dawson's disease', Dawson's encephalitis. Vaccine : Live attenuated ; Edmonsten zagreb strain.

So the answer to this question is A


Instruction:
S4 is not seen in-
A. Ventricular aneurysm
B. Mitral regurgitation
C. Hyperophic cardiomyopathy
D. Hypeension

Response:
A fouh hea sound is commonlyheard due to decreased ventricular compliance. It can sometimes heard immideatly before the first sound when atrial pressure is high or the ventricle is stiff in conditions like ventricular hyperophy. Ref Harrison 20th edition pg 1557

So the answer to this question is A


Instruction:
Which of the following is the most common etiological agent in paranasal sinus mycosis?
A. Aspergillus species
B. Histoplasma
C. Conidiobolus coronatus
D. Candida albicans

Response:
(a) Aspergillus species(Ref. Cummings, 6th ed., 732)The most common etiological agent in paranasal sinus mycosis is Aspergillus fumigatus.

So the answer to this question is A


Instruction:
Schiller Duval bodies are seen in
A. Teratoma
B. Seminoma
C. Yolk sad tumor
D. Choriocarcionma

Response:
Refer Robbins page no 1031

So the answer to this question is C


Instruction:
A 10-year-old boy has multiple tan-colored patches on his skin, and freckle-like skin changes in his armpit area. The rest of clinical examination is normal. Which of the following conditions is also found in patients with this disorder as they get older?
A. bilateral eighth nerve tumors
B. irregular small pupils
C. multiple cutaneous and subcutaneous tumors
D. cataracts

Response:
The two common forms of neurofibromatosis (NF-1 and NF-2) are genetically distinct. NF-1 is the type with multiple cafe au lait spots and is associated with axillary or inguinal freckling, iris hamartomas (Lisch nodules), peripheral neurofibromas, and bony abnormalities (including kyphoscoliosis). NF-2 is associated with CNS tumors, particularly bilateral eighth nerve tumors. Skin lesions are spare or absent, and early lens opacities can occur.

So the answer to this question is C


Instruction:
Autonomous zone of sensory supply by radial nerve
A. 1st dorsal web space
B. Tip of index finger
C. Tip of thumb
D. Tip of little finger

Response:
Autonomous zone for radial nerve is 1st dorsal web space Refer Campbell 12th/e p 3100

So the answer to this question is A


Instruction:
Gangrene of intestine is seen in all the following conditions, except
A. Tricuspid Valve Endocarditis
B. Shock
C. Mesenteric Artery Thrombosis
D. Volvulus

Response:
Shock, mesenteric artery thrombosis and volvulus can lead to gangrene of intestine.

So the answer to this question is A


Instruction:
A patient with previous spells of diplopia, ataxia, dysahria, and dizziness becomes acutely comatose. The most likely cause is
A. Basilar aery thrombosis
B. Subarachnoid hemorrhage
C. Carotid occlusion
D. Cerebellar hemorrhage

Response:
Patients with basilar aery stenosis frequently have spells of ischemic brainstem dysfunction before a catastrophic stroke caused by aerial thrombosis. Timely anticoagulation and allowing a higher blood pressure can arrest the progression of this potentially fatal stroke. Acute coma can occur in association with each of the cerebrovascular accidents mentioned in the question Except carotid occlusion. Subarachnoid hemorrhage causes an acute increase in intracranial pressure that reduces blood flow to the brain. Unilateral coical infarction does not cause coma, but damage to brainstem structures infarction or compression will cause coma. Ref - Harrison's principles of internal medicine 20e pg 2073

So the answer to this question is A


Instruction:
Lost muscle in squint surgery is
A. MR
B. LR
C. SR
D. SO

Response:
Ans. (a) MRwww.cybersight.orgwww.eyewiki.aao.orgRef: , , Pubmed, PMID: 11705143)Lost or slipped muscle is usually MR. It is known as the Surgeon's Graveyard.

So the answer to this question is A


Instruction:
All of the following promote platelet aggregation except
A. Plasmin
B. Prostacyclin
C. Thrombospondin
D. Platelet activating factor

Response:
Factors inhibiting platelet aggregation are ATP, PGI2 or prostacyclin, Aspirin, coisol Factors oring platelet aggregation are Thrombospondin which helps in fixation of platelet, platelet activating factor, ADP, Thromboxane A2, Ca2+,vWF etc. Plasmin also helps in platelet aggregation. Ref: Textbook of medical physiology by N Geetha, 2nd edition, page no.102,103

So the answer to this question is B


Instruction:
A man came with his wife in psychiatric depament. She is complaining about his increased cleanliness. He keeps on washing hands in frequent intervals telling that its not clean. He wants everything in an ordered manner. He is becoming obsessive in everything and compelling everyone at home to follow him. Which of the following drug is most useful in this patient?
A. Amoxapine
B. Fluoxetine
C. Doxepin
D. Dothiepin

Response:
This patient suffering from obsessive compulsive disorder (OCD). Preferential serotonergic reuptake inhibitors (PSRIs), the medications most effective in treating OCD, mainly inhibit there uptake of serotonin into nerve cells. These medications include clomipramine, fluoxetine, seraline, paroxetine, citalopram, escitalopram, and fluvoxamine. Medications with noradrenergic reuptake inhibition produce no benefit and may counteract or diminish the efficacy of serotonergic reuptake inhibition. Ref: Hewlett W.A. (2008). Chapter 21. Obsessive-Compulsive Disorder. In M.H. Ebe, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds), CURRENT Diagnosis & Treatment: Psychiatry, 2e.

So the answer to this question is B


Instruction:
Which of the following is essentially an excisional procedure of the gingiva?
A. Modified widman flap
B. Undisplaced flap
C. Apically displaced flap
D. Papilla preservation flap

Response:
None

So the answer to this question is B


Instruction:
What do you understand by isograft?
A. Bone taken from same individual
B. Bone taken from generally similar individual
C. Bone taken from identical twin
D. None of the above

Response:
None

So the answer to this question is C


Instruction:
A 30-year-old lady develops retention of urine in the 2nd trimester. The most probable cause is:
A. Fibroid uterus
B. Bladder neck obstruction due to ovarian cyst
C. Obstruction of uterus
D. Retroverted uterus

Response:
Ans. is d, i.e. Retroverted uterusRef Dutta Obs. 7/e, p 311, 312In the question:Both fibroid and retroverted uterus can cause acute retention of urine during early pregnancy.But retroverted uterus will be the more correct option as:-It is common during pregnancyoMost common time of occurrence of urinary retention is second trimester - 12 to 16 weeks.Also Know:Other causes of retention of urine in pregnancy:Early pregnancyDuring puerperiumDue to diminished bladder toneRetroverted uterusImpacted pelvic tumor

So the answer to this question is D


Instruction:
Double apical impulse: March 2013
A. MR
B. AR
C. AS
D. MS

Response:
Ans. C i.e. AS Aoic stenosis Features: - Sustained heaving apex, - Angina, - Sudden death Degenerative calcification is a cause of AS Exercise testing is C/ I in AS

So the answer to this question is C


Instruction:
Which of the following is not seen in Corpus Cancer syndrome -
A. Diabetes mellitus
B. Hypertension
C. Obesity
D. Multiparity

Response:
Ans. is 'd' i.e., Multiparity Females with diabetes. hypertension, or taking diet rich in fat are at higher risk of endometrial cancer.This is called corpus cancer syndrome which consists of obesity, hypertension and diabetes.Risk factors for Endometrial carcinomaFactor influencing riskRelative Risk* Obesity2-5* Polycystic ovary syndrome>5* Long term use of high dose10-20menopausal estrogens * Early age of menarche1.5-2* Late age of natural menopause2-3* History of infertility2-3* Nulliparity3* Menstrual irregularities1.5* Residency in North America3-18or North Europe * Higher level of income or1.5-2education * White race2* Older age2-3* High cumulative dose of3-7tamoxifen * History of diabetes, hypertension1.3-3gallbladder * High dose of OOP's0.3-0.5* Cigarette smoking.05

So the answer to this question is D


Instruction:
A lady presented with recurrent attacks of giddiness and abdominal pain since three months. Endoscopy was normal. Her fasting blood glucose was 40 mg % and insulin levels were elevated. CT abdomen showed a well defined 8 mm enhancing lesion in the head of pancreas, with no other abnormal findings. What should be the treatment plan for this patient?
A. Whipple's operation
B. Enucleation
C. Enucleation with radiotherapy
D. Administration of streptozotocin

Response:
Based on the clinical scenario, the patient is diagnosed to have insulinoma. Surgically solitary insulinomas is best managed by simple Enucleation. Enucleation means removing the tumor along with the pseudocapsule not just the resection. Whipples's procedure (pancreaticoduodenectomy) is a major surgical operation involving the pancreas, duodenum, and other organs. This procedure is usually done for the pancreatic head tumor. Ref: Pediatric Gastrointestinal Diseases By W. Allan Walker, Volume 2, Page 1207

So the answer to this question is B


Instruction:
All of the following are nuclei of cerebellum, EXCEPT?
A. Nucleus caudate
B. Nucleus dentatus
C. Nucleus globosus
D. Nucleus fastigii

Response:
Cerebellum is the largest pa of hind brain situated in the posterior cranial fossa beneath the tentorium cerebelli. It plays an impoant role in control of muscle tone and co-ordination of muscle movement. The cerebellum controls the same side of the body (ipsilateral side). Cerebellar nuclei are present within the grey matter of the cerebellum. There are four pairs of nclei they are; Nucleus dentatus Nucleus globosus Nucleus fastigii Nucleus emboliformis

So the answer to this question is A


Instruction:
How many weeks after delivery blood volume returns to pre-pregnant levels :
A. 1 week
B. 2 weeks
C. 4 weeks
D. 6 weeks

Response:
Blood volume reaches prepregnant value by 1 week postpaum after delivery Cardiac Output reaches prepregnant value by 10days postpaum after delivery Reference: William's Textbook of Obstetrics 24th edition page no 690

So the answer to this question is B


Instruction:
Peripheral chemoreceptors responds to hyproxia by oxygen sensitive:
A. Na+ channel
B. Ca+2 channel
C. K+ channel
D. CI- channel

Response:
O2 levels are regulated almost entirely by peripheral chemoreceptors located in the carotid and aoic bodies; which in turn transmit appropriate signals to the respiratory center in the brain Carotid & aoic bodies have GLOMUS CELLS (multiple highly characteristic glandular - like cells) that synapse directly with nerve endings. Glomus cells have O2 sensitive K+ channels that are inactivated when blood Po2 decrease markedly. HYPOXIA O2 sensitive K+ channels inactivated. | Glomus cell depolarizes | Voltage gated Ca++ channel open, increase intracellular Ca++ | Neurotransmitter released, activates afferent neurons to CNS center of respiration.

So the answer to this question is C


Instruction:
The most common type of Tracheo - Oesophageal Fistula is
A. Esophageal atresia without tracheosophageal fistula
B. Esophageal atresia with proximal tracheoesophageal fistula
C. Esophageal atresia with distal tracheoesophagea fistula
D. Esophageal atresia with proximal and distal fistula

Response:
Tracheo-oesophageal fistula, associated with VACTER abnormalities.there are 5 types of which their incidences are as follows type A)atresia without fistula( 8.5%) type B)atresia with proximal TOF(1%) type C)atresia with distal TOF(85%) type D)atresia with both proximal and distal TOF(1.5%) type E)no atresia but H type TOF(4%) Ref: SRB&;s manual of surgery,5th ed, pg no 803

So the answer to this question is C


Instruction:
A 73-year-old man from a nursing home develops headache, fever, cough, sore throat, malaise, and severe myalgia during a community outbreak affecting numerous other residents at the home. The symptoms gradually resolve after 3 days, and he starts feeling better but then there is a reappearance of his fever, with cough and yellow sputum production. On examination, his temperature is 38.5degC, pulse 100/min, respiration 24/min, oxygen saturation 88% and crackles in the right lower lung base, bronchial breath sounds and dullness on percussion. CXR reveals a new infiltrate in the right lower lobe. Which of the following is the most likely causative organism?
A. primary viral pneumonia
B. an autoimmune reaction
C. Mycoplasma pneumoniae
D. Streptococcus pneumoniae

Response:
This man has a complication of viral influenza; a secondary bacterial pneumonia has developed. This usually occurs 2-3 days after the initial viral symptoms resolve. Primary viral pneumonia with influenza is not common. Spneumoniae, Staphylococcus, and H influenzae are the most common bacterial invaders in pulmonary complications of influenza. Pneumonia is the leading cause of death and may also be due to Spneumoniae and H influenzae. Mixed viral and bacterial pneumonia is common; pure viral pneumonia in influenza is uncommon (but can be very severe).

So the answer to this question is D


Instruction:
Which of the following is seen in pneumothorax
A. Over expanded chest wall
B. Reduced concentration of surfactant
C. More negative itrapleural pressure
D. Increased lung compliance

Response:
Ans. b. Reduced concentration of surfactant Pneumothorax decreases the quantity of surfactant in the collapsed lung. Over expanded chest wall is characteristically seen in conditions where the lung loses its elasticity, such as in emphysema, and the natural tendency of the chest wall to recoil towards the outside, causes an over expanded chest. In pneumothorax, intra-pleural pressure equilibrates with the ambient barometric pressure and the lung's natural recoil tendency causes it to collapse. Pneumothorax tends to cause collapse of the lungs and a decreased compliance Surfactant Produced by Type 11 alveolar epithelial cells (pneumocytes)Q Synthesis of surfactant begins at 16-18 weeks of gestation and peaks at 35 weeks of gestationQ. It is stored in alveolar cells until 26 weeks when release on the alveolar surface occurs. Secreted by exocytosis in the form of lamellar bodieswhich is conveed to tubular myelin Composed of Dipalmitophosphatidyl choline (62%)Q, phosphatidyl glycerol (5%)Q, and other phospholipids, neutra lipids, protein and carbohydrate. Function Reduces alveolar surface tensionQ Prevent alveolar collapseQ Prevent pulmonary edemaQ Deficiency occur with Occlusion of main bronchusQ Occlusion of pulmonary aeryQ Cigarette smokersQ Long term inhalation of 100% 02.Q

So the answer to this question is B


Instruction:
The presence of small sized platelets on the peripheral smear is characteristic of:
A. Idiopathic thrombocytopenic purpura
B. Bernard soulier syndrome
C. Disseminated intravascular coagulation
D. Wiskott aldrich syndrome

Response:
Wiskott aldrich syndrome is characterised by the traid of: Severe exzema Thrombocytopenia Recurrent infections( ref Robbins 7th/244,8th/235)

So the answer to this question is D


Instruction:
True about optic nerve glioma
A. Seen in old individuals
B. Painful proptosis
C. Can cause hematoma
D. Unilateral proptosis

Response:
Optic Nerve Glioma *Can cause gradual, painless, unilateral Proptosis *a/w Neurofibromatosis 1 *Mainly affect children (1-10 year) *Have characteristic fusiform enlargement of optic nerve Optic Nerve Glioma - Fusiform Enlargement of optic nerve - Nerve is not seen separately from the mass

So the answer to this question is D


Instruction:
Eruption of Deciduous Mandibular 1st molar occur at
A. 8-9 months
B. 19-21 months
C. 19-20 months
D. 12-14 months

Response:
None

So the answer to this question is D


Instruction:
The most appropriate circuit for ventilating a spontaneously breathing infant during anaesthesia is?
A. jackson Rees modification of Ayre's T piece
B. Mapleson A or Magill's circuit
C. Mapleson C or Waters to and fro canister
D. Bains circuit

Response:
Ans. is 'a' i.e., Jackson Rees modification

So the answer to this question is A


Instruction:
All are features seen in Chronic Pancreatitis except
A. Chronic persistent pain
B. Diarrhea, Steatorrhoea
C. Calcification
D. Paralytic ileus

Response:
pain due to irritation of retroperitoneal nerves or ductal dilatation and stasis or due to chronic inflammation itself Diarrhoea and steatorrhea due to exocrine dysfunction Calcifications mainly in alcoholics due to direct toxicity,necrosis,scarring,obstruction and degeneration SRB's manual of surgery 5th edition,693,694

So the answer to this question is D


Instruction:
In Pediatric age group, the most common feature of polytrauma is
A. Hypothermia
B. Hypotension
C. Hypovelomic shock
D. Hypoxemia

Response:
As the surface area to body volume ratio of children is high, thermal energy loss is higher and hypothermia is a higher risk. Due to the greater physiological capacity and ability of children to compensate for the fluid loss, hypotension is a very late and ominous sign of hypovolaemic shock.

So the answer to this question is A


Instruction:
A 20 year old male had pain in abdomen and mild fever followed by gastroenteritis. The stool examination showed presence of pus cells and RBCs on microscopy. The etiological agent responsible is most likely to be -
A. Enteroinvasive E. coli.
B. Enterotoxigenic E. coli.
C. Enteropathogenic E. coli.
D. Enteroaggregative E. coli.

Response:
None

So the answer to this question is A


Instruction:
All are true about ranula except ?
A. Retention cyst
B. Translucent swelling
C. Painless swelling
D. Arises from submandibular gland

Response:
Ans. is'd' i.e., Arises from submandibular gland Ranula Ranula, also known as mucous retention cyst, is a type of mucocle found on the floor of mouth on one side of the frenulon. It arises from sublingual salivary gland, due to obstruction of its duct and is almost always unilateral. In occurs mostly in children and young adults. Clinical features Ranula is usually asymptomatic, and only complain isfluctuant swelling with a bluish translucent colour. Swelling is painless unless it becomes secondarly infected. Overlying mucosa is intact and ranula is not fixed. Treatment Surgical excision of both the gland as well as the lesion. Ranulas are likely to recur if the sublingual gland causing them is not removed with the lesion.

So the answer to this question is D


Instruction:
All are feature(s) of sarcoidosis except:
A. High CD4: CD8 ratio
B. Hypercalciuria and hypercalcimia maybe present
C. f Serum levels of angiotensin-conveing enzyme (ACE)
D. Schauman and asteroid bodies are pathognomic

Response:
Answer- D. Schauman and asteroid bodies are pathognomicHypercalcemia and/or Hypercalciuria occurs in about 10% of sarcoidosis patients.Bronchoalveolar lavage fluid ln sarcoidosis is usually characterized by an increase in lymphocyte and a high CD4/ CD8 ratio."Schauman and asteroid bodies- although characteristic, these cells are not pathognomic of sarcoidosis because they may be encountered in other granulomatous diseases.The granuloma is the pathologic hallmark of sarcoidosis."Serum levels of anglotensin-conveing enzyme (ACE) can be helpful in the diagnosls of sarcoidosis.

So the answer to this question is D


Instruction:
The two nitrogen atoms, that are incorporated into the urea cycle. The source of the nitrogen are
A. Glutamate & Aspartate
B. Aspartate & Arginine
C. Aspartate & NH3
D. Glutamate & NH3

Response:
(Aspartate & NH3) (448 - R S 7th) (251 - Lippincott's)UREA CYCLE* One nitrogen of the urea molecule is supplied by free NH3 and other nitrogen by aspartate* Glutamate is the immediate precursor of both ammonia through oxidative deamination by glutamate dehydrogenase) and aspartate nitrogen (through transmination of oxaloacetate by aspartate aminotransferase* Urea is produced by the hydrolysis of arginine* The urea cycle is linked to the TCA cycle through the production of fumarate. Amino acid catabolism is therefore directly coupled to energy production

So the answer to this question is C


Instruction:
Which one of the following conditions may lead to exudative pleural effusion
A. Cirrhosis
B. Nephrotic syndrome
C. Congestive hea failure
D. Bronchogenic carcinoma

Response:
Answer is D (Bronchogenic Carcinoma): Malignant pleural of fissions secondary to metastatic disease are exudative in nature. The three tumors that cause approx. 75% of all malignant pleural effusions are lung carcinoma, breast carcinoma, and Lymphoma. Exudative pleural effusion Transudative pleural effusion Exudative pleural effusion occurs when local factors that influence the formation Transudative pleural effusion occurs when and absorbtion of pleural fluid are altered. systemic factors that influence the formation and absorbtion of pleural fluid are altered. Distinguishing Laboratory features : * Total serum protein > 3 gm /dL * Pleural fluid protein /Serum protein > 0.5 * Pleural fluid LDH/Serum LDH > 0.6 * Pleural fluid LDH >2/3 upper limit of serum Total serum protein < 3 gm /dL Pleural fluid protein /Serum protein < 0.5 Pleural fluid LDH/Serum LDH < 0.6 Pleural fluid LDH<2/3 upper limit of serum Causes of Exudative Pleural Effusion: Causes of Tansuda ive Pleural Effusion: * Neoplastic diseases * Gastrointestinal disease * Pulmonary embolism 1. Congestive hea failure Metastatic disease Esophageal perforation * Sarcoidosis 2. Cirrhosis Mesothelioma Pancreatic disease * Uremia 3. Pulmonary embolization * Infectious diseases Intraabdominal abscesses * Asbestos exposure 4. Hephrotic syndrome Bacterial infections Diaphragmatic hernia * Meig's syndrome 5.Peritoneal dialysis Tuberculosis After abdominal surgery * Yellow nail 6. Superior vena cava obstruction Fungal infections Endoscopy variceal syndrome 7. Myxedema Tuberculosis sclerotherapy * Trapped lung 8.Urinothorax Viral infections * After liver transplant * Radiation therapy Parasitic infections * Post-coronary aery bypass * Post-cardiac injury * Collagen-vascular surgery syndrome diseases * Drug-induced pleural disease * Hemothorax Rheumatoid pleuritis Nitrofurantoin * latrogenic injury SLE Dantrolene * Ovarian Drug-induced lupus Methylsergide hyperstimulation Sjogren's syndrome Bromocriptine syndrome Wegner's Procarbazine * Pericardial disease granulomatosis Amiodarone * Chylothorax Churg-Strauss syndrome

So the answer to this question is D


Instruction:
Intermediate host for Taenia saginata is?
A. Man
B. Snail
C. Cattle
D. Pig

Response:
Ans. is 'c' i.e., Cattlecommonly known as the beef tapeworm, is a zoonotic tapeworm.Humans are generally infected as a result of eating raw or undercooked beef which contains the infective larvae, called cysticerci.embryonated eggs, called oncospheres, are released with faeces and are transmitted to cattle through contaminated fodder.Oncospheres develop inside muscle, liver, and lungs of cattle into infective cysticerci.

So the answer to this question is C


Instruction:
Shape of normal distribution curve?
A. J shape
B. U shape
C. Bell shape
D. None

Response:
Ans. is 'c' i.e., Bell shape o Standard normal curve (Gaussian distribution) is bell shape curve.

So the answer to this question is C