Instruction:
Developmental milestone attained at 9 months of age is
A. Knows full name and gender
B. Monosyllables
C. Builds tower of 2 blocks
D. Stands with support

Response:
Developmental milestones:-
GROSS MOTOR DEVELOPMENT:
2 months: Holds head in the plane of rest of the body when held in ventral suspension. In the prone position in bed, the chin lifts momentarily.
3 months: lift head above the plane of the body. Head control starts by 3 months and fully developed by 5 months.
4 months: Remain on forearm support if put in prone position, lifting the upper part of the body off the bed.
5 months: Rolls over.
6 months: sit in a tripod fashion.
8 months: sits without support., crawling
9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months.
10 months: creeps
12 months: creeps well, walk but falls, stand without support.
15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs.
18 months: Runs, walks upstairs with one hand held. Explores drawers.
2 years: walk up and downstairs, jumps.
3 years: rides tricycle, alternate feet going upstairs.
4 years: hops on one foot, alternate feet going downstairs.
5 years: skips
FINE MOTOR DEVELOPMENT:-
2 months- eyes follow objects to 180 deg.
3 months-Grasp reflex disappears and hand is open most of the time.
4 months- Bidextrous approach( reaching out for objects with both hands).
6 months- Unidextrous approach( Reach for an object with one hand).
8 months- radial grasp start to develop. Turns to sound above the level of ear.
9 months- immature pincer grasp, probes with the forefinger.
12 months- Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together.
15 months- imitate scribbling, tower of two blocks.
18 months- scribbles, tower of 3 blocks. turn pages of a book, 2-3 at a time.
2 years- tower of 6 blocks, vertical and circular stroke.
3 years- tower of 9 blocks, dressing and undressing with some help, can do buttoning.
4 years- copies cross, bridge with blocks.
5 years- copies triangle, gate with blocks.
SOCIAL AND ADAPTIVE MILESTONES:
2 months: social smile(smile after being talked to).watches mother when spoken to and may smile.
3 months: recognizes mother, anticipates feeds.
4 months: holds rattle when placed in hand and regards it. Laughs aloud. Excited at the sight of food.
6 months: recognizes strangers, stranger anxiety. Enjoy watching own image in the mirror, shows displeasure when toy pulled off.
9 months: waves bye bye.
12 months: comes when called, plays a simple ball game. kisses the parent on request. Makes postural adjustments for dressing.
15 months: jargon, starts imitating mother.
18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three parts of the body on request.
2 years: ask for food, drink, toilet, pulls people to show toys.
3 years: shares toys, know full name and gender, dry by night.
4 years: Plays cooperatively in a group, goes to the toilet alone, washes face, brushes teeth. Role play.
5 years helps in the household task, dresses and undresses.
LANGUAGE MILESTONES:
1 month: alerts to sound.
2 month: respond to sound by startle or quietening to a smooth voice.
3 months: babbles when spoken to. Makes sounds (ahh, coos, ) laughs.
4 months: laughs aloud.
6 months: monosyllables
9 months: understands spoken words, bisyllables.
12 months: 1-2 words with meaning.
18 months: a vocabulary of 10 words. Can name one part of the body.
2 years: 3-word simple sentences.
3 years: asks questions, knows full name and gender.
4 years: says songs or poem, tells a story, knows three colors.
5 years: ask the meaning of words.

So the answer to this question is D


Instruction:
A 55 year old female presented with tingling sensation in her hands and feet & pain in her legs during night time. She had type 2 diabetes for 15 years. O/E- loss of ankle deep tendon reflex, loss of position sense of great toe, decreased pinprick sensation over ankles & wrists. Her recent HbA1c was 8.9%. She is currently managed with insulin and metformin. She is diagnosed with diabetic polyneuropathy. Which of the following medications can be used to treat pain associated with diabetic neuropathy?
A. Duloxetine
B. Topiramate
C. Piroxicam
D. Naproxen

Response:
Diabetic neuropathy can manifests as polyneuropathy, mononeuropathy, and/or autonomic neuropathy. The most common form is distal symmetric polyneuropathy- presents as distal sensory loss and pain. Management: Improved glycemic control Neurotoxins (alcohol, smoking, and vitamin deficiencies) should be avoided. Only two agents--duloxetine and pregabalin--have been approved by the U.S. FDA for the treatment of diabetic neuropathy. Other off-label agents- amitriptyline, gabapentin, valproate, and opioids.

So the answer to this question is A


Instruction:
If a patient had 28 teeth and 20% of sites has attachment loss, the number of periodontally involved sites will be
A. 112
B. 28
C. 20
D. 22

Response:
None

So the answer to this question is D


Instruction:
Meckel's diverticulum, all are true except -
A. Present in 2% population
B. Lies on the antimesenteric border
C. Consists of mucosa without muscle
D. Contains ectopic gastric tissue

Response:
Ans. is 'c' i.e., Consists of mucosa without a muscle coat Meckel's diverticulum is situated at the anti-mesenteric border of small intestine. o Meckel's diverticulum is a true diverticulum as it has all the 3 layers of the intestine, o it's the most common congenital anomaly of the gastrointestinal tract. o Male to female ratio is 3 : 2. o Approximately 60% of Meckel's diverticula contain heterotopic mucosa, of which more than 60% consists of gastric mucosa. Second most common ectopic mucosa is that of Pancreas (Pancreatic acini). Other mucosa are:- colonic mucosa, Brunner's gland, pancreatic islets, endometriosis and hepatobiliary tissue, o A useful but crude Mnemonic used traditionally for describing Meckel's diverticula is Rule of two : i.e. 2% prevalence 2 Inch in length 2 Feet proximal to ileocecal valve. Half of these who are symptomatic are younger than 2 yrs of age o Meckel's diverticula are asymptomatic. Symptoms arise only when any complication occurs, o Complications o Most common complication y In children & young adults (< 18 yrs of age) y in adults y overall - - - Bleeding Intestinal obstruction Bleeding o Following complications are noted m Meckel s diverticulum. Bleeding Bleeding in Meckel's diverticulum is usually the result of ulceration in ileal mucosa adjacent to the diverticulum caused by the acid secreted by heterotopic gastric mucosa within the diverticulum. Intestinal obstruction Intestinal obstruction associated with Meckel's diverticulum can result from several mechanisms. Volvulus of the intestine around the fibrous band attaching the diverticulum to the umbilicus. Intussusception with the diverticulum acting as the lead point. Entrapment of intestine by a mesodiverticular band (mesodiverticular band is a remnant of the left vitelline artery, it tethers the Meckel's diverticulum to the ileal mesentery;.) Stricture secondary to chronic diverticulitis. 3) Diverticulitis The clinical picture is similar to appendicitis. Diverticulitis may lead to perforation. o Littre's hernia - Rarely Meckel's diverticulum is found in inguinal or a femoral hernia. This is known as Lit (re's hernia. o Diagnostic studies Meckel's diverticulum in the absence of bleeding can be rarely diagnosed before surgical intervention. Barium meal follow through can rarely demonstrate the diverticulum. Barium enteroclysis can demonstrate the diverticula in 75% of cases but is avoided during the acute presentation of complication. If repeated episodes of lower GI bleed occur and an ectopic gastric mucosa in the Meckel's diverticulum is suspected, it can be demonstrated by Technetium"pertechnate radionuclide scan. It demonstrates the ectopic gastric mucosa and localizes the Meckel's diverticulum. Angiography can localize the site of bleeding during acute hemorrhage related to meckeiMeckel'sticula.

So the answer to this question is C


Instruction:
Visual hallucinations are least likely to be found in which of the following?
A. Alcohol withdrawal delirium
B. Central anticholinergic delirium
C. Lewy body dementia
D. Schizophrenia

Response:
Visual hallucinations are most common in organic psychiatric disorders. Though, visual hallucinations can be seen in schizophrenia, they are not as common. M/C hallucination seen in patient of schizophrenia is auditory hallucination.

So the answer to this question is D


Instruction:
Which of the following is the treatment of choice for Atrial Fibrillation in patients with WPW Syndrome who are hemodynamically unstable:
A. Procainamide
B. Digoxin
C. DC Cardioversion
D. Radiofrequency Ablation of the bypass tract

Response:
Answer is C (DC Cardioversion) DC Cardioversion is the treatment of choice to terminate Atrial Fibrillation in patients with WPW Syndrome who are hemodynamically unstable (Life threatening Situations).

So the answer to this question is C


Instruction:
Troponin-T is preferable to CPK-MB in the diagnosis of acute MI in all of the following situations except -
A. Bedside diagnosis of MI
B. After CABG
C. Reinfarction after 4 days
D. Small infarct

Response:
None

So the answer to this question is C


Instruction:
There is an increased incidence of emergence delirium with ketamine in all of the following condition except:-
A. Age >15 years
B. Female gender
C. Dose of ketamine < 1mg/kg
D. A history of personality disorders

Response:
High dose > 2 mg / kg is associated with postoperative delirium. predisposing factors for postoperative delerium seen with intravenous ketamine 1. high dose of ketamine 2. female gender 3. a history of personality disorder 4. adult 5. prior intravenous glycopyrolate

So the answer to this question is C


Instruction:
Increased AV nodal blockade leads to termination of tachycardia in all except?
A. Atrial tachycardia
B. Atrial flutter
C. AVN
D. Ohodromic AV re-entry

Response:
Tachycardia can not be terminated by increased AV nodal blockade in Atrial Flutter because it will be having separate reentry circuit which bypasses the AV node. CAVOTRICUSPID ISTHUMUS DEPENDENT ATRIAL FLUTTER

So the answer to this question is B


Instruction:
The oxygen tension of the mixed venous blood is:
A. 25 mm Hg
B. 40 mm Hg
C. 55 mm Hg
D. 70 mm Hg

Response:
None

So the answer to this question is B


Instruction:
Mechanism of action of transexaminic acid is
A. Decrease vascular permeability
B. Smooth muscle contraction
C. Activates Plasmin formation
D. Prevents fibrinolysis

Response:
Ans. is `d' i.e., Prevents fibrinolysis

So the answer to this question is D


Instruction:
Typhoid Vi polysaccharide vaccine is usually administered in children above the age of :
A. 6 months
B. 1 year
C. 2 years
D. 1 year 6 months

Response:
The Vi polysacchiride vaccine is licensed for individuals aged 2 years because it does not elicit immune response in children less than 2 years.

So the answer to this question is C


Instruction:
A 42-year-old male is diagnosed with liver and pancreatic disease as a result of alcoholism. During physical examination it is noted that he has abnormal enlargement of his mammary glands, as a secondary result of his disease process. Which of the following clinical conditions will most likely describe this case?
A. Polythelia
B. Supernumerary breast
C. Polymastia
D. Gynecomastia

Response:
Gynecomastia is the abnormal growth of mammary glands in males. Polythelia refers to supernumerary nipples. Polymastia refers to supernumerary, or extra, breasts. Amastia refers to the absence of breasts.

So the answer to this question is D


Instruction:
Characteristic radiological feature of fibrous dysplasia-
A. Thickened bone matrix
B. Coical erosion
C. Ground glass appearance
D. Bone enlargement

Response:
Fibrous Dysplasia (FD) Asymptomatic, self-limiting developmental regional alteration of bone in which the normal architecture is replaced by fibrous tissue and nonfunctional trabeculae-like osseous tissue. It is self-limiting (thus it is not a true neoplasm) * Represents a group of disorders with variety of clinical patterns * Mutation in GNAS 1 gene Clinical forms of fibrous dysplasia of the jaws * Monostotic: localized to a single bone Juvenile and aggressive juvenile Adult * Polystotic: involves several bones Craniofacial McCune-Albright syndrome Jaffe syndrome ref " maheswari 9th ed

So the answer to this question is C


Instruction:
Initial amino acid in prokaryotic protein synthesis -
A. Arginine
B. Methionine
C. Formyl-methionine
D. Alanine

Response:
Ans. is 'c- i.e., Formyl-methionine o in prokaryotes and in mitochondria, the first amino acid methionine is modified by formylation, i.e. the initiator t-RNA carries an N-formylated methionine. The formyl group is added by the enzyme transformylase (formyl- transferase). In Eukaryotes, the initiator t-RNA carries a methionine that is not formylatedDifferenceProkaryotesEukaryotesm-RNAPolycistronic i.e. have several coding regions; each with its initiation & termination codon producing a seperate polypeptideMonocistr onic with one coding regionAmino acid incorporation rate18 aa/sec6aa/sec.Initial amino acidFormylated methionine ( f-met)Methionine r (Met)Initial t-RNAt-RNA/MettRNAMetTranscription & translationTranslation starts before transcription is ended (coupled)UncoupledInitiation factors (IF)3i.e.IF1,IF2,IF3> 10 designated elFDetermination of initiatingcodon# Shine Dalgarno sequencer# Facilitated by IF-2 bound to GTPKozak consensus sequencesr Facilitated by elF-2 bound to GTP (Plus additional elF)Elongation: Del Every of aminoacyl t-RNA to A site# Facilitated by EF-Tu & EF-TsFacilitated by EF1 a and EF 1 b yNucleotide exchange factors# EF - Ts (as it exchanges its GTP for GDP on EFTu)EF 1 b g (as it exchanges its GTP forGDP on EF a)Peptidyi transferase activity catalyzing peptide bond formation23 S rRNA of 50 S ribosomal subunit (ribozyme)28 S rRNA of 60 S ribosornal subunit (ribozyme)TranslocationRequires EF-G & GTPRequires EF-2 & GTPTerminationRelease factor (RF) 1 recognizes UAA & UAG, RF2 recognizes UAA & UGARF-3 (bound to GTP) causes release ofRF-1 or RF-2 as GTP is hydrolysedeRF recognizesail 3 UAA, UAGandUGA and release nascent polypeptide chaineRF-3 (bound to GTP) function like prokaryotic RF-3 & release eRF

So the answer to this question is C


Instruction:
All are seen in ARDS, Except:
A. Pulmonary edema
B. Hypoxia
C. Hypercapnia
D. Stiff lung

Response:
Ans. is 'c' Hypercapnia (Ref. Harrison, 17/e, p 1680-1681 & 16/e, p 1592 (15/e, p. 1524)).Hypocapnia is seen in ARDS.ARDS is an acute* diffuse* alveolar injury * that is caused by variety of aetiological factors. Patients with ARDS are often seriously ill with some other diseases and the features of ARDS are superimposed on it.It is characterized by acute diffuse alveolar damage leading to necrosis and loss of type I pneumocytes*. Endothelial damage also occurs leading to exudation of protein rich fluid into alveoli and resulting in pulmonary edema and formation of hyaline membrane*. Hyaline membrane is composed of fibrin* together with coagulated cell debris*. Hyaline membrane leads to decreased compliance and stiff lung.These changes result in diffusion defects. Due to low diffusion capacity of 02 hypoxemia occurs. Hypoxemia causes increase in respiratory rate due to which C02 wash out occurs so the level of CO2 is low in ARDS.Criteria for diagnosis of ARDS are:Antecedent history of precipitating conditions.Refractory hypoxemia* - Pa02 < 60 mmHg.Radiological evidence of newly evolving bilateral pulmonary infiltrates suggestive of pulmonary edema*.A pulmonary artery occlusion pressure (PAOP) less than 15-18 mmHg in the presence of normal colloid oncotic pressure.Total thoracic compliance less than 30 ml/cm H2O.

So the answer to this question is C


Instruction:
Which one of the following pulses has the highest content of iron -
A. Bengal gram
B. Black gram
C. Red gram
D. Soyabean

Response:
Soya beans contain 10.4g of iron. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 628

So the answer to this question is D


Instruction:
Laparotomy performed in a case of ovarian tumor revealed unilateral ovarian tumor with ascites positive for malignant cells and positive pelvic lymph nodes. All other structures were free of disease. What is stage of her disease?
A. Stage II c.
B. Stage III a.
C. Stage III b.
D. Stage III c.

Response:
Since the patient has ovarian tumor with ascities positive for malignant cells and positive pelvic lymph nodes, she falls under FIGO staging, stage IIc. Ref: Textbook of Gynecology By D C Dutta, 4th Edition, Page 346

So the answer to this question is A


Instruction:
A person has been brought in casualty with history of road accident. He had lost consciousness transiently and gained consciousness but again became unconscious. Most likely, he is having brain hemorrhage of:
A. Intracerebral
B. Subarachnoid
C. Subdural
D. Extradural

Response:
Ans. (d) Extradural* History typical of Lucid interval.* Immediately he needs evacuation of the EDH.* Usually they will have no hypotension.

So the answer to this question is D


Instruction:
A 40-year-old woman was involved in a car crash. She was unconscious for 5 minutes. X-ray revealed a depressed fracture in the frontal region. Which of the following statements is true of skull fracture?
A. It always requires surgical exploration.
B. It is compound if multiple.
C. It requires burr holes if compound.
D. In the anterior cranial fossa, it may produce rhinorrhea.

Response:
Skull fractures should be explored only if they are compound, if a depressed fracture is present, or if an intracranial lesion requires exploration. Compound fracture implies that the fracture site communicates with the exterior. Rhinorrhea is caused by leakage of CSF through a fractured cribriform plate.

So the answer to this question is D


Instruction:
The volatility of an anesthetic agent is directly propoional to lowering the flow in the poal vein. Poal flow is maximally reduced by -
A. Ether
B. Halothane
C. Isoflurane
D. Enflurane

Response:
Halothane Effect of Anaesthesia on Hepatic Blood flow Hepatic blood flow usually decreases during regional and general anaesthesia. Multiple factors are probably responsible including :? - Direct and indirect effect of anaesthetic agent - The type of ventilation employed - Type of surgery being performed All anaesthetic agents indirectly reduce hepatic blood flow in propoion to any decrease in mean aerial blood pressure or cardiact output. - Decrease in cardiac output reduce hepatic blood flow reflex sympathetic activation which vasoconstricts both, the aerial and splanchnic circulation. Effect of different Anaesthetic procedures on hepatic flood flow If an adequate intravascular volume is maintained - Spinal and epidural anaesthesia decrease hepatic blood flow primarily by lowering aerial blood pressure. Where as - General anaesthesia usually decreases it through reduction in blood pressure and cardiac output and sympathetic stimulation. Effect of volatile anaesthetic agents on hepatic blood flow :? All volatile anaesthetic agents reduce poal hepatic blood flow. "This decrease is greatest with halothane and least with isoflurane". - Isoflurane appears to be the only volatile agent causing significant direct aerial vasodilation that can increase hepatic aerial blood .flow. - However even with isoflurane total hepatic blood flow decreases because the decrease in poal blood flow usually offsets any increase in hepatic aery. flow.

So the answer to this question is B


Instruction:
Buprenorphine partial agonist at which opioid receptor?
A. Mu
B. Kappa
C. Delta
D. Lambda

Response:
Ans. is 'a' i.e., Mu o Buprenorphine is partial agonist on mu receptor and antagonist at Kappa receptor.Nature of interaction of opioid ligands with the three major types of opioid receptors, along with equivalent analgesic dosesLigandm (mu)k (kappa)d (delta)Analgesic dose (mg)1. MorphineAgo. (St)Ago. (W)Ago. (W)102. NalorphineAnta. (St)Ago. (M)--3. PentazocineP. Ago., Anta. (W)Ago. ( M)-30-604. ButorphanolP. Ago. (W)Ago. (St)-1-35. BuprenorphineP. Ago.Anta. (M)-0-3-046. NaloxoneAnta. (St)Anta. (M)Anta. (W)-7. NaltrexoneAnta. (St)Anta. (M)Anta. (W)_8. Met/Leu enkephalinAgo. (M)-Ago. (St)_9. (3-EndorphinAgo. (St)-Ago. (St)_10. Dynorphin A, BAgo. (W)Ago. (St)Ago. (W)-

So the answer to this question is A


Instruction:
Fireflies produce light due to:
A. NADH
B. GTP
C. ATP
D. Phosphocreatinine

Response:
ATP Bioluminescence is light produced by a chemical reaction within an organism. It requires a combination of 4 different ingredients. The light is produced through a chemical reaction involving Luciferin, which is the substrate, Luciferase, the enzyme, ATP, and oxygen. The basic reaction sequence is: The luciferase catalyzes the oxidation of luciferin into oxyluciferin. In the process light is emitted. Since the light producing reaction is dependent on ATP, it allows researchers to determine the presence of ATP and hence the presence of life. (If ATP is present in a sample of something that is a good indication that life is occurring within that specimen). NASA has used this method to test for life on other planets. If luciferin and luciferase compounds were mixed with samples and they produced a glowing reaction this would mean the presence of ATP and hence life. This reaction is also used for antibiotic susceptibility testing. If the enzyme Luciferase is added to a cultured sample of Tuberculosis and an antibiotic is also added, the strength of the antibiotic can be tested. If the drug fails, then the bacteria will continue to thrive and glow. This research has also been employed in gene activation therapy cases, where ultraviolet cameras seek out genes treated with Luciferase. If light is visible, this means that the Luciferase gene is active. This will help researchers to know when they have made a successfully attempt at gene therapy.

So the answer to this question is C


Instruction:
A 50 yr old male presented with history of hematemesis - 500 ml of blood and on examination shows BP - 90/60, PR - 110/min and splenomegaly 5 below lower costal margin. Most probable diagnosis is
A. Mallory Weiss tear
B. Duodenal ulcer
C. Gastritis
D. Poal hypeension

Response:
Ans. is 'd' i.e. Poal hypeension

So the answer to this question is D


Instruction:
In noice induced hearing loss, audiogram shows a typical notch at
A. 1000 Hz
B. 2000 Hz
C. 3000 Hz
D. 4000 Hz

Response:
Ans. is 'd' i.e., 4000 Hz Noise induced hearing loss Exposure to loud noise can lead to permanent hearing threshold shifts. This may happen immediately with extreme exposure (nearby explosion or gunfire), but more commonly occurs slowly over time with repeated exposure to industrial or environmental noise. Patients will often have a typical 4-KHz (4000 Hz) notch (dip at 4000 Hz) in their audiogram called acoustic dip. Auditory effects of noice are :? Auditory fatigue :- at 90 d B and 4000 Hz. Hearing loss Temporary :- At 4000 - 6000 Hz Permanent :- Repeated prolonged exposure to 100 d B or single exposure to 160 d B.

So the answer to this question is D


Instruction:
Basal layer of cell in stratified squamous epithelium is -
A. Squamous
B. Transitional
C. Cuboidal - columnar
D. Pseudostratified

Response:
In stratified squamous epithelium the basal layer of cells is cuboidal to columnar that give rise to cells migrating towards the surface and becoming squamous.

So the answer to this question is C


Instruction:
Ipratropium bromide acts on which receptors and its use is?
A. M2 bronchial asthma
B. M1 Peptic ulcer
C. M3 COPD
D. Nm Asthma

Response:
Ipra and tiotropium bromide are m3 receptor blockers more selective for bronchial muscle causing bronchial dilatation, so used in bronchial asthma and COPD M3 receptors are present on bronchial smooth muscle Ref: KDT 6th ed pg 113

So the answer to this question is C


Instruction:
A term neonate presents with unconjugated hyperbilirubinemia of 18 mg/dl on 29th day. All of the following are common causes, EXCEPT:
A. Breast milk jaundice
B. Neonatal hepatitis
C. G-6PD deficiency
D. Hypothyroidism

Response:
Neonatal hepatitis can lead to conjugated hyperbilirubinemia and present at 4-6 weeks of age. Two other groups of disorders are associated with hyperbilirubinemia: (1) Unconjugated hyperbilirubinemia seen in, Breast milk jaundice Blood group incompatibility Lucey-Driscoll syndrome Congenital hypothyroidism Upper intestinal obstruction Gilbe disease Crigler-Najjar syndrome Hereditary spherocytosis Non-spherocytic hemolytic anemia Drug-induced hyperbilirubinemia (2) Conjugated hyperbilirubinemia present in, Dubin-Johnson syndrome Rotor syndrome Biliary atresia Neonatal hepatitis Ref: Sokol R.J., Narkewicz M.R. (2012). Chapter 22. Liver & Pancreas. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.

So the answer to this question is B


Instruction:
Growth spu occurs at __________
A. Just before appearance of axillary hair
B. Just before menarche
C. After 16 years
D. Before thelarche

Response:
Adolescence: Stage of transmission from childhood to adulthood. During this stage, there will be an appearance of sexual characters with changes in cognition and psychology. Adolescence refers to this entire process, pubey refers to the physical aspect. Age 10-19 year is considered as a period of adolescence and pubey marks the early half of adolescence. Pubey in girls stas with breast development( thelarche) anytime between 8-13 years. This is followed by an appearance of pubic hair (pubarche) and subsequently, menstruation ( menarche), occurring at an average of 12.6 years. Menarche occurs after 2-21/2 years of thelarche. In boys, the earliest change is an increase in testicular size( testicular volume reaching 4 ml) and this occurs between 9-14 years. This is followed by an appearance of pubic hair and lengthening of the penis. Spermarche( sperm production) stas during mid-adolescence. Laryngeal growth, manifesting as cracking of voice, begins in boys in mid-pubey, deepening of voice is complete by end of pubey. During pubey, boys gain 20-30 cm and girls 16-28 cm of height. Peak growth velocity in girls occurs before attainment of menarche. Boys have their peak growth in later stages of pubey. Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is B


Instruction:
prostacyclin agonist which is usually given oral.
A. Teleprost
B. Iloprost
C. Riociguat
D. Selexipag

Response:
* Selexipag is the only PGI2 drug which can be given oral route * Prostacyclin analogue like iloprost, treprostinil can be given i/v or s.c or inhaltional route.

So the answer to this question is D


Instruction:
Fast breathing in a 3 year old child is?
A. > 60
B. >50
C. >40
D. >30

Response:
ANSWER: (C) > 40REF: OP Ghai 7th ed p. 356According to WHO fast respiratory rate:>60/ min< 2 months> 50/min2-12 months>40/min12-60 months

So the answer to this question is C


Instruction:
Common to both acute and chronic malnutrition is -
A. Weight for age
B. Weight for height
C. Height for age
D. BMI

Response:
Weight reflects only the present health status, while height indicates the event in the past. It helps on assessing acute malnutrition and chronic malnutrition. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 501

So the answer to this question is C


Instruction:
True about Sickle cell disease are all, Except:
A. Single nucleotide change results in change of Glutamine to Valine
B. Sticky patch is generated as a result of replacement of a non polar residue with a polar residue
C. HbS confers resistance against malaria in heterozygotes
D. RFLP results from a single base change

Response:
Sticky patch is generated as a result of replacement of a non polar residue with a polar residue Repeat from May 11 Sticky patch in sickle cell disease results from replacement of a polar residue (Glutamate) with a non polar residue Glutamate is ----Polar (Mnemonic: GP i.e. General Practioner) Valine is Non Polar (Valine) at the 6th position of the beta chain.

So the answer to this question is B


Instruction:
Which of the following has the propensity to metastasize through lymph nodes?
A. Alveolar rhabdomyosarcoma
B. Osteosarcoma
C. Both
D. None

Response:
None

So the answer to this question is A


Instruction:
Gottron's papules/ spots are pathognomic of: March 2013
A. Myasthenia gravis
B. Dermatomyostis
C. Dermatitis herpetiformis
D. Atopic dermatitis

Response:
Ans. B i.e. Dermatomyositis

So the answer to this question is B


Instruction:
A 17-year-old girl was evaluated for complaints of weight gain, hair loss, constipation and weakness. Her free T4 level was low and TSH was increased. Which of the following is the most likely diagnosis?
A. Graves' disease
B. McCune-Albright syndrome
C. TSH-secreting pituitary adenoma
D. Hashimoto's thyroiditis

Response:
The patient is having symptoms of hypothyroidism and thryoid profile reveals primary hypothyroidism. Analyzing all options, Graves' disease and McCune-Albright syndrome are associated with hypehyroidism. (excludes 'a' & 'b') In pituitary adenoma/TSH-secreting pituitary tumor - increased TSH with increased T3/T4 would be seen. (option 'c' excluded) Primary hypothyroidism is d/t defect in thyroid gland itself; associated with high TSH & low free T4 levels. Hashimoto's thyroiditis is a cause of primary hypothroidism.

So the answer to this question is D


Instruction:
Kluver Bucy syndrome includes all except
A. Hyper sexuality
B. Hyper activity
C. Placidity
D. Hyper metamorphosis

Response:
Kluver bucy syndrome is produced due to bilateral lesion of medial temopral lobe including amygdaloid nucleus It includes hypersixuality,hyperorality,visual agnosia etc Ref:Guyton and Hall textbook of medical physiology 12th edition ,pag number:826,837,828

So the answer to this question is B


Instruction:
Posterior column lesion which of the following is not affected
A. Vibration
B. Temperature
C. Fine touch
D. Crude sense

Response:
Posterior column carries sensations of fine touch, tactile localization, two-point discrimination, vibration, pressure with intensity discrimination and sense of position and proprioception. Therefore, damage to this pathway will produce following effects: - sensory ataxia - loss of sensation Ref:guyton and hall textbook of medical physiology 12 edition page number :576,577,578

So the answer to this question is B


Instruction:
Contraindications to ventouse delivery include all of the following except :
A. Fetal coagulopathies
B. Extreme prematurity
C. Mento transverse position
D. Occipito transverse position

Response:
Occipito transverse position

So the answer to this question is D


Instruction:
A 27-year-old woman occasionally uses calcium carbonate (Turns) for "heartburn" symptoms after a large meal.For the above patient with an acid-peptic disorder, select the mechanism of action of the prescribed medication.
A. neutralizes gastric acid
B. works by binding to cysteine
C. inhibits gastrin release
D. irreversible H1-receptor blockade

Response:
Although doctors seldom prescribe antacids because of the availability of superior medications, patients still use them extensively. As well as neutralizing acid, calcium carbonate enhances secretion in the stomach. The release of CO2 from bicarbonate can result in belching, nausea, and abdominal distension. Belching can exacerbate gastroesophageal reflex.

So the answer to this question is A


Instruction:
Weakest poion of Dermo- epidermal junction is
A. Stratum Basale
B. Lamina Lucida
C. Lamina Densa
D. Lamina Fibroreticularis

Response:
LAMINA LUCIDA * Electron-lucent zone under hemidesmosome on EM; weakest link of BMZ (Basement membrane zone). * Comprised of anchoring filaments (laminin-332), laminin-1, fibronectin, nidogen (entactin), uncein and poion of BPAG2. Anchoring Filaments :- * Delicate filaments emanating perpendicularly from HD(hemi-desmosomes) which stretch from plasma membrane to lamina densa; product of basal keratinocytes; smaller than anchoring fibrils * Laminin-332: also known epiligrin (truncated laminin), laminin-5, kalinin, and nicein; glycoprotein serving as major component of anchoring filaments; major attachment factor for keratinocytes and binds a6b4 integrin at hemidesmosome . Ref:- Sima Jain; pg num:- 7

So the answer to this question is B


Instruction:
All are True statements regarding Okazaki fragment EXCEPT?
A. Requires DNA polymerase
B. Forms on leading strand
C. Forms on lagging strand
D. Requires helicase for opening

Response:
Ans. is 'b' i.e., Forms on leading strand DNA polymerases responsible for copying the DNA templates are only able to "read" the parental nucleotide sequence in 3' - 5' direction, and they synthesize the new DNA strands only in 5' - 3' direction. Therefore, 2 newly synthesized chains must grow in opposite directions.The DNA chain which runs in the 3' to 5' direction towards replication fork as continued strand is called leading strand. This requires only one RNA primerThe DNA chain which runs in the 5' to 3' direction away from the replication fork is called lagging strand. It is synthesized discontinuously and requires numerous RNA primers.As the replication fork moves, RNA primers are synthesized at specific intervals. These RNA primers are extended by DNA polymerase III into sho pieces of DNA called Okazaki fragments.

So the answer to this question is B


Instruction:
An afro-american kid of 6 years of age presented with abdominal pain, chronic hemolysis and abnormal RBC shape on peripheral smear. Most likely disorder responsible for this condition
A. Trinucleotide repeat
B. Point mutation
C. Antibiodise against RBC membrane
D. Genetic imprinting

Response:
Diagnosis here is sickle cell disease results from point mutation ,results in substitution of valine for glutamic acid at 6 position of beta globulin chain. Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is B


Instruction:
Smith Noguchi's media is used for -
A. Salmonella
B. Klebsiella
C. Spirochetes
D. Bacillus

Response:
Cultivation of nonpathogenic treponemes (e.g., Reiter strain of Treponema phagedenis) REF: Text book of microbiology Ananthanarayan Page no. 39

So the answer to this question is C


Instruction:
Which anticancer drug causes hypercoagulable syndrome?
A. 5-FU
B. L-asparaginase
C. Melphalan
D. Carmustine

Response:
Hypersensitivity reaction manifested by fever, chills, nausea, and vomiting, uicaria, bronchospasm, respiratory failure and hypotension; i ed risk of both clotting and bleeding as a result of alterations in various clotting factors; pancreatitis, and neurological toxicity. Ref: KD Tripathi 8th ed.

So the answer to this question is B


Instruction:
The most common cause of pulmonary infection in cystic fibrosis is
A. Pseudomonas Aeroginosa
B. Staphylococcus Aureus
C. Bukholderia cenocapacea
D. Nontuberculous mycobacteria

Response:
Answer is A (Pseudomonas Aeroginosa): The most common cause of Pulmonary infections in cystic fibrosis is Pseudomonas aeroginosa The most common pathogen in CF is Pseudomonas Aeroginosa followed by Staphylococcus' - `Pseudomonsa:Getntnu & Molecular Biology' (Harizon Scientific Press)2008/160 Pulmonary Infection in Cystic Fibrosis The most common cause of Pulmonary infection in cystic fibrosis in children is staphylococcus aureusQ The most common cause of Pulmonary infection in cytic fibrosis in adolescents and adults is Pseudomonas Aeroginosa. The two most common cause of pulmonary infection in cystic fibrosis are staphylococcus aureus and Pseudomonas Aeroginosa. Overall (all age groups) Pseudomonas Aeroginosa is marginally more common than staphylococcus aureus as a cause of pulmonary infection in cystic fibrosis. The most common organism causing chronic lung disease in patients with cystic fibrosis is pseudomonas aeroginosa

So the answer to this question is A


Instruction:
What is the functional form of anterior teeth from the mesial or the distal aspect?
A. Rhomboidal
B. Trapezoidal
C. Elliptical
D. Wedge-shaped

Response:
None

So the answer to this question is D


Instruction:
Prolactin levels:
A. Lowest in pregnancy
B. Highest during pregnancy
C. Unaffected by pregnancy and lactation
D. Variable in every pregnancy

Response:
Prolactin increases tremendously in pregnancy and this ensures lactation.

So the answer to this question is B


Instruction:
Which statement about the esophagus is TRUE? Select all that apply
A. It is a cartilaginous tube
B. It extends from the nasal cavity to the stomach.
C. It lies anterior to the trachea
D. It has upper and lower sphincters

Response:
D: Upper and lower esophageal sphincters, located at the upper and lower ends of the esophagus, respectively, regulate the movement of food into and out of the esophagus.
A: The esophagus is a muscular tube, lined with moist stratified squamous epithelium.
B: It extends from the pharynx to the stomach. It is about 25 centimeters (cm) long.
C: It lies anterior to the vertebrae and posterior to the trachea within the mediastinum.

So the answer to this question is D


Instruction:
Most common cause of rupture uterus?
A. Separation of previous caesarean scar
B. Internal version
C. Excess dosage of oxytocin
D. Complicated manual removal of placenta

Response:
Ans. a (Separation of previous caesarean scar) (Ref. Dutta obst. 6th ed460)RUPTURE UTERUSDefinition: Dissolution in the continuity of uterine wall anytime beyond 28 weeks of pregnancy.Etiology# Spontaneous rupture during pregnancy: Complete and involves upper segment of uterus. Obstructive rupture during labour: Involves lower segment.# Non-obstructive rupture during labour: Complete and involves fundus.# Incidence of scar rupture is 1-2 % in lower segment scar and 5-10 times more in classical scar.# Obstructive rupture which is an end result of obstructed labour due to neglect in intranatal care involves lower segment and usually extends through one lateral side of uterus to the upper segment. Additionally, oxytocin should not be used in women with prior classic cesarean section scars because the risk of uterine rupture is high (5%-10%).Features of Uterine rupture (during labour)a) Failure in progress of labour.b) Suprapubic pain.c) Slight bleeding PV and Hematuria.d) Alteration in fetal heart rate.e) Unexplained maternal tachycardia.f) Hypotension.g) Tenderness over scar.h) Bladder tenesmus.i) Ballooning of lower segment

So the answer to this question is A


Instruction:
The most common side effect of IUCD inseion is:
A. Bleeding.
B. Pain.
C. Pelvic infection.
D. Ectopic pregnancy.

Response:
Side effects of IUCD Bleeding Most common side effect Tranexamic acid and NSAIDS and are given for the first 3 cycles during periods Best time of Inseion of IUCD within Last days of Periods Pain( Most common reason for removal) Infection PID's (Should be Ruled out before Inseing IUCD) Perforation(Rare)

So the answer to this question is A


Instruction:
Which of the following organs putrefy last in a male?
A. Uterus
B. Prostate
C. Testes
D. Liver

Response:
Prostate is the last organ to putrefy in males. In females, non gravid uterus is the last organ to putrefy. Gravid or postpaum uterus putrefies early. The sequence of putrefaction in internal organs: Organs which putrefy early are: Brain Mucosa of trachea and larynx Stomach and intestine Spleen Liver Organs that putrefy late are: Esophagus Diaphragm Hea Lungs Kidney Urinary bladder Uterus Prostate Ref: Principles of Forensic Medicine and Toxicology By Rajesh Bardale page 155.

So the answer to this question is B


Instruction:
Occlusion of which of the following blood vessels can result in hemiplegia?
A. Anterior cerebral aery
B. Middle cerebral aery
C. Posterior cerebral aery
D. Posterior communicating aery

Response:
Middle cerebral aery occlusion results in contralateral hemiplegia, hemisensory loss and homonymous hemianopia with eyes deted to the side of the lesion. It can laso result in global aphasia when the dominant hemisphere is involved. Anterior cerebral aery involvement is associated with brachiofacial monoplegia and urinary disturbances. Reference: Current Medical Diagnosis and Treatment 2013 chapter 24.

So the answer to this question is B


Instruction:
LE cell is seen in ?
A. Lupus erythmatosus
B. Lupus vulgaris
C. HNPCC
D. Medullary carcinoma of thyroid

Response:
Ans. is 'a' i.e., Lupus erythematousus In SLE, antinuclear antibodies (AN Ps) can not penetrate intact cells. However, nuclei are exposed, ANA can bind to them. In tissues, nuclei of damaged cells react with ANAs, lose their chromatin pattern, and become homogeneous, to produce lupus - erythematous (LE) bodies or hemotoxylin bodies. When these LE bodies are engulfed by phagocytic cells (neutrophil or macrophage/monocyte), the phagocytic cells are called LE cells.

So the answer to this question is A


Instruction:
Metastatic calcification is most often seen in
A. Lymphnodes
B. Lungs
C. Spleen
D. Liver

Response:
Metastatic calcification can occur in normal tissues whenever there is hypercalcemia.Metastatic calcification can occur widely throughout the body but principally affects the interstitial tissues of the vasculature, kidneys, lungs, and gastric mucosa.( Robbins Basic Pathology, 9th edition, page 26 )

So the answer to this question is B


Instruction:
A patient needs antibiotic treatment for Aificial valve, culture positive infective entercoccal endocarditis. His medical history include several anaphylactic reaction to penicillin G during the past year. The best approach would be treatment with
A. Amoxicillin clavulanic acid
B. Aztreonam
C. Cefazolin plus gentamicin
D. Vancomycin

Response:
Ref-KDT 6/e 732 * Severe allergy to penicillins rule out the use of amoxicillin and cefazolin. * Vancomycin is highly effective against MRSA and enterococcal intections. * Drugs for VRSA and VRE (Vancomvcin Resistant enterococcus faecalis) include linezolid and daptomycin.

So the answer to this question is D


Instruction:
Which one of the following is most likely to result in contraction alkalosis?
A. Laxatives
B. Infant formula
C. Loop diuretics
D. Acetazolamide

Response:
The term "contraction alkalosis" refers to the development of metabolic alkalosis (excess plasma HCO3-) when there is a loss of extracellular fluid volume (hypovolemia). Hypovolemia evokes numerous homeostatic reflexes that act to normalize extracellular fluid volume, including stimulation of the renin-angiotensin-aldosterone system. In the kidney, elevated levels of angiotensin II and aldosterone increase Na reabsorption through processes that are ultimately coupled to hydrogen secretion. Consequently, volume regulation results in a net increase in plasma HCO3-. Correction is obtained when the lost volume is replenished through intake of water and sodium. Loop diuretics such as furosemide act primarily on the thick segment of the medullary and coical ascending limbs of Henle's loop. They inhibit the coupled transpo of Na+ and Cl- that results in the production of large volumes of relatively iso osmotic urine. Excessive use of these drugs can result in hypovolemia and contraction alkalosis. Antacid and infant formula can result in metabolic alkalosis but not as a result of hypovolemia. In patients with renal insufficiency, antacids containing calcium carbonate can increase the plasma HCO3- concentration. Infant formulas that contain sodium but very little chloride enhance Na+ reabsorption in the renal tubule and, like volume contraction, this results in an increase in urinary H+ secretion. Administration of laxatives or acetazolamide promotes metabolic acidosis. Laxatives result in the loss of intestinal fluids that are relatively alkaline and contain large amounts of HCO3-. Acetazolamide inhibits the enzyme carbonic anhydrase. As a result, acetazolamide reduces the reabsorption of HCO3- in the renal tubule. Acetazolamide is often used in combination with loop diuretics to correct the alkalosis caused by these compounds. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 35. Gas Transpo & pH. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds),Ganong's Review of Medical Physiology, 24e.

So the answer to this question is C


Instruction:
In diagnosing the carious lesions, the tooth surface is examined visually. Which of the following is not considered as visual examination?
A. Cavitations
B. Brownish black discoloration of pits and fissures
C. Opacification
D. Softness of the tooth surface

Response:
The caries can be detected by

Visual methods (Cavitation, Chalky appearance of teeth)
Tectile methods (Checking carefully by using an explorer)

So the answer to this question is D


Instruction:
Perilymph contains:
A. Na+
B. K+
C. Mg++
D. Cl-

Response:
(a) Na+(Ref. Shambaugh, 6th ed., page 79)Perilymph is the fluid which fills the bony labyrinth.Perilymph is actually an extension of CSF which enters from the subarachnoid space into the scala tympani through Cochlear aqueduct.CSF being an extracellular fluid therefore perilymph is rich in Na+.Endolymph filling the membranous labyrinth and secreted from stria vascularis is rich in K+.

So the answer to this question is A


Instruction:
A patient presents with hypotension in confused state and METABOLIC ALKALOSIS Which of the following tests will best suggest the diagnosis?
A. Urine pH
B. Urine Na+
C. Urine CI-
D. Urine K+

Response:
Metabolic alkalosis Metabolic alkalosis is characterised by an increase in the plasma bicarbonate concentration and the plasma pH (see Box 14.18). There is a compensatory rise in PCO2 due to hypoventilation but this is limited by the need to avoid hypoxia. Classical causes include primary hyperaldosteronism (Conn's syndrome, p. 674), Cushing's syndrome (p. 666) and glucocoicoid therapy (p. 670). Occasionally, overuse of antacid salts for treatment of dyspepsia produces a similar pattern. Pathophysiology Metabolic alkalosis is best classified according to the accompanying changes in ECF volume. Hypovolaemic metabolic alkalosis is the most common pattern. This can be caused by sustained vomiting, in which acid-rich fluid is lost directly from the body, or by treatment with loop diuretics or thiazides. In the case of sustained vomiting, loss of gastric acid is the immediate cause of the alkalosis, but several factors act to sustain or amplify this in the context of volume depletion (Fig. 14.11). Loss of sodium and fluid leads to hypovolaemia and secondary hyperaldosteronism, triggering proximal sodium bicarbonate reabsorption and additional acid secretion by the distal tubule. Hypokalaemia occurs due to potassium loss in the vomitus and by the kidney as the result of secondary hyperaldosteronism, and itself is a stimulus to acid secretion. Additionally, the compensatory rise in PCO2 fuher enhances tubular acid secretion. The net result is sustained metabolic alkalosis with an inappropriately acid urine, which cannot be corrected until the deficit in circulating volume has been replaced. Normovolaemic (or hypervolaemic) metabolic alkalosis occurs when bicarbonate retention and volume expansion occur simultaneously. Clinical features Clinically, apa from manifestations of the underlying cause, there may be few symptoms or signs related to alkalosis itself. When the rise in systemic pH is abrupt, however, plasma ionised calcium falls and signs of increased neuromuscular irritability, such as tetany, may develop (p. 663). Investigations The diagnosis can be confirmed by measurement of electrolytes and urine sodium and aerial blood gases. Should be done Ref Davidson 23rd edition pg 367

So the answer to this question is B


Instruction:
Which of the following is a Negative staining technique?
A. Gram stain
B. Fontana stain
C. India ink
D. ZN staining

Response:
ANSWER: (C) India inkREF: Foundations in Microbiology by Talaro Kathleen Park 6"h edition (2007 Edition) Page 83Negative StainingThis procedure involves staining the background with an acidic dye, leaving the cells contrastingly colorless. The black dye nigrosin or India ink is commonly used. This method is used for those cells or structures difficult to stain directlyThis method is useful for improving visualization of encapsulated bacteria in clinical samples such as blood, blood culture bottles, or cerebrospinal fluid.

So the answer to this question is C


Instruction:
Most common associated with high risk for carcinoma colon is ?
A. Peutz-jegher syndrome
B. Juvenile familial polyposis
C. Familial Adenomatous polyposis
D. Lynch syndrome

Response:
This autosomal dominantly inherited condition is characterised by the development of multiple rectal and colonic polyps around pubey. A colonoscopy and biopsy will confirm the diagnosis Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1228,1229

So the answer to this question is C


Instruction:
Neurofibromomatosis I is -
A. AD
B. AR
C. X linked recessive
D. X linked dominant

Response:
Ans. is 'a' i.e., AD o Neurofibromatosis (Type 1 and 2) are autosomal dominanto AD is the most common Mendelian pattern of inheritanceAutosomal dominant disordersa) Nervous system - Huntington disease, Neurofibromatosis (Type l and 2), Myotonic dystrophy, Facioscapulohumeral dystrophy Tuberous sclerosis Retinoblastomab) Urinary - Polycystic kidneyc) GIT - Familial polyposis coli, Gardner's syndrome Turcot's syndrome,Lynch syndrome, Peutz Jagher's syndrome, Juvenile polyposisd) Hematological - Heriditary sphero cytosis, Von-Willibrand diseasee) Skeletal - Marfan syndrome, EDS (some variant), Osteogenesisimperfecta, Achondroplasia Tuberous sclerosisf) Metabolic - Familial hypercholesterolemia, Acute intermittent porphyria

So the answer to this question is A


Instruction:
Mega platelets are seen in?
A. Glanzmann thrombasthenia
B. Von willebrand disease
C. Wiskot-Aldrich syndrome (WAS)
D. Bernard soulier syndrome

Response:
Ans. is 'd' i.e., Bernard souiier syndrome Bernard soulier syndromeo It is an autosomal recessive disorder due to deficiency or dysfunction of glycoprotein Ib-IX (Gp Ib/IX). Thus there is defect in platelet adhesion.o Platelet aggregation is normal in response to standard agonists like collagen, ADP or thrombin. But platelets fail to aggregate in response to ristocetin (as ristacetin facilitates binding of vWF and Gp lb- IX).o There may be thrombocytopenia with abnormally large platelets.o There is prolonged BT. vWF is normal.About other optionso Small sized platelets are characteristic of Wiskot-Aldrich syndrome (WAS)o Platelet morphology is normal in Glanzmann thrombasthenia & Von willebrand disease.

So the answer to this question is D


Instruction:
Organisms with characteristic "school of fish" appearance in stained smears is seen in:
A. Granuloma inguinale
B. Chancroid
C. Lymphogranuloma venereum
D. Herpes genitalis

Response:
Haemophilus ducreyi produce "school of fish" appearance.

So the answer to this question is B


Instruction:
The culture medium used for Entamoeba histolytica-
A. Blood agar
B. Philip's medium
C. CLED medium
D. Trypticase serum

Response:
Cultures media used for cultivation of E.histolytica are:-

Boeck and Drbohlav's medium
Philip's medium
Shaffer and Frye's medium
Jones medium
Balamuth's medium
Diamond's medium

So the answer to this question is B


Instruction:
True about transfer of electrons in electron transpo chain is ?
A. All the complexes are arranged in an increasing order of redox potential
B. The direction of transpo of electrons in Complex I ->C - Complex III Q - Complex IV
C. All the complexes are arranged in an increasing order of energy
D. 10 hydrogen ions get translocated when FADH2 electrons get into electron transpo chain

Response:
Ans. is 'a' i.e., All the complexes are arranged in an increasing order of redox potential*The complexes of electron transpo chain are arranged in an increasing order of redox potential or decreasing order of energy level.The direction of transpo of electrons from NADH is Complex I -) Q Complex III -) Complex C -> Complex IV Oxygen.The direction of transpo of electrons from FADH2 is Complexx II Q Complex III - Complex C -) Complex IV - Oxygen.

So the answer to this question is A


Instruction:
Antidepressant drug that can cause neuroleptic malignant syndrome and tardive dyskinesia is: March 2009
A. Amineptin
B. Carbamazepine
C. Amoxapine
D. Trazodone

Response:
Ans. C: Amoxapine One of major metabolites of amoxapine, 7-hydroxyamoxapine, has a dopamine receptor blocking effect, making this drug a common cause of neuroleptic malignant syndrome. Amoxapine is also associated with acute extrapyramidal symptoms and tardive dyskinesia.

So the answer to this question is C


Instruction:
All of the following are WHO notifiable diseases EXCEPT:
A. Cholera
B. Chicken pox
C. Plague
D. Yellow fever

Response:
Ans. (b) Chicken poxRef : K. Park 23rd ed. /143, 841, 21sted. 1780* The following diseases are notifiable to WHO in Geneva:# Cholera# Plague# Yellow fever* In addition to these a few others like: Louse borne typhus, relapsing fever, Polio, Influenza, malaria, rabies and salmonellosis are subject to international surveillance.

So the answer to this question is B


Instruction:
Ectopic pregnancy is most common in :
A. Previous h/o recurrent PID
B. Previous h/o Aboion
C. Previous h/o Twin pregnancy
D. Endometriosis

Response:
Previous h/o recurrent PID

So the answer to this question is A


Instruction:
In a patient with ischaemic stroke, intravenous recombinant tissue has mainly been found to be useful during the initia
A. 3 hours
B. 6 hours
C. 12 hours
D. 24 hours

Response:
Ischemic stroke occurs when a blood clot blocks or plugs an aery leading to the brain. A blood clot often forms in aeries damaged by the buildup of plaques (atherosclerosis). It can occur in the carotid aery of the neck as well as other aeries. Ref Harrison20th edition pg 1123

So the answer to this question is A


Instruction:
A 12-year-old boy is referred for evaluation of nocturnal enuresis and short stature. The blood pressure is normal. The blood urea is 112 mg/dl, creatinine 6 mg/dl, sodium 119 mEq/l, potassium 4 mEcill, calcium 7 mg/dl, phosphate 6 mg/dl and alkaline phosphatase 400 U/l. Urinalysis shows trace proteinuria with hyaline casts; no red and white cells are seen. Ultrasound shows bilateral small kidneys and the micturating cystourethrogram is normal. The most likely diagnosis is -
A. Alport's syndrome
B. Medullary sponge kidney
C. Chronic glomerulonephritis
D. Nephronophthisis

Response:
None

So the answer to this question is D


Instruction:
Most accurate method of diagnosis of pregnancy at 6 weeks: AIIMS 13; JIPMER 14
A. Hegar's sign
B. X-ray examination
C. Palpation of fetal pas
D. Fetal hea sound by USG

Response:
Ans. Fetal hea sound by USG

So the answer to this question is D


Instruction:
Vomiting centre is situated in the: September 2008
A. Hypothalamus
B. Midbarin
C. Pons
D. Medulla

Response:
Ans. D: MedullaVomiting is believed to be controlled by two distinct brain centres--the vomiting centre and the chemoreceptor trigger zone--both located in the medulla oblongata.The vomiting centre initiates and controls the act of emesis, which involves a series of contractions of the smooth muscles lining the digestive tract

So the answer to this question is D


Instruction:
Scaphocephaly is due to premature closure of the –
A. Coronal sutrue
B. Metopic suture
C. Sagittal suture
D. Lambdoid suture

Response:
None

So the answer to this question is C


Instruction:
Froment test is positive in lesion of:
A. Radial nerve
B. Ulnar nerve
C. Axillary nerve
D. Median nerve

Response:
Froment sign To perform the test, a patient is asked to hold an object, usually a flat object such as a piece of paper, between their thumb and index finger (pinch grip). The examiner then attempts to pull the object out of the subject's hands. A normal individual will be able to maintain a hold on the object without difficulty. However, with ulnar nerve palsy, the patient will experience difficulty maintaining a hold and will compensate by flexing the FPL (flexor pollicis longus) of the thumb to maintain grip pressure causing a pinching effect. Clinically, this compensation manifests as flexion of the IP joint of the thumb (rather than extension, as would occur with correct use of the adductor pollicis). The compensation of the affected hand results in a weak pinch grip with the tips of the thumb and index finger, therefore, with the thumb in obvious flexion. FPL is normally innervated by the anterior interosseous branch of the median nerve.

So the answer to this question is B


Instruction:
Two hosts are required in -a) T. soliumb) E. histolytiocac) T. saginatad) Giardiae) Toxoplasma
A. ace
B. bde
C. cde
D. ade

Response:
In case of T. solium: Definitive host: Man and intermediate—Pig and man
In Case of Entamoeba and Giardia infection: Only single host (man) required to complete life cycle.
In case of T. saginata: Definitive host: Man and intermediate—Cattle
In case of Toxoplasma: Definitive host: Cat and intermediate—Man and other mammals

So the answer to this question is A


Instruction:
IQ between 50-70 indicates -
A. Mild mental retardation
B. Moderate retardation
C. Severe retardation
D. Profound retardation

Response:
Ans. is 'a' i.e., Mild mental retardation Classification of mental retardation o A child with IQ 70 is called as mentally retarded. Degree of MR IQ Mild 51-70 Moderate 36-50 Severe 21-35 Profound 0-20 o IQ level between 71-90 is designated as borderline intelligence.

So the answer to this question is A


Instruction:
Temperature above which normal hormonal actions fails
A. 45degC
B. 35degC
C. 30degC
D. 25degC

Response:
Normal temperature for hormonal action is below 45-degree Celcius.Ref: Ganong&;s review of medical physiology; 24th edition

So the answer to this question is A


Instruction:
The appropriate size of LMA for an average adult patient weighing 50 kg is:
A. 2.5
B. 3
C. 4
D. 5

Response:
Ans. c. 4.0

So the answer to this question is C


Instruction:
Sulfation factor is
A. Somatostatin
B. Somatomedian
C. GIP
D. VIP

Response:
Insulin-like growth factor 1 (IGF-1), also called somatomedin C, is a protein that in humans is encoded by the IGF1 gene.IGF-1 has also been referred to as a "sulfation factor" and its effects were termed "nonsuppressible insulin-like activity" (NSILA).Somatostatin (also known as growth hormone-inhibiting hormone (GHIH) or somatotropin release-inhibiting factor(SRIF)Gastric inhibitory polypeptide(GIP) Gastrin inhibitory peptide hormone is produced by the pancreas, that is secreted in response to oral- but not parenteral administration ofnutrients-eg, glucose and lipids. Vasoactive intestinal polypeptide(VIP) a polypeptide hormone secreted most commonly by non-b islet cell tumors of the pancreas; VIP increases the rate of glycogenolysis and stimulates pancreatic bicarbonate secretion; excess production causes copious watery diarrhea and fecal electrolyte loss, with hypokalemia and hypochlorhydria.Ref: Ganong&;s review of medical physiology;24th edition; page no-327

So the answer to this question is B


Instruction:
Which is false about syphilis -
A. TPI gives definite diagnosis
B. TPHA is earliest to be +ve
C. VDRL is +ve 1 week after appearance of chancre
D. Serologically not different from yaws

Response:
Ans. is 'b' i.e., TPHA is earliest to be (+) ye About other options - TPI is a specific treponemal test and gives definite diagnosis. - VDRL test becomes positive 7-10 days after the appearance of primary chancre (3-5 weeks after acquiring the infection.) - All treponemal and nontreponemal serological tests may be positive in nonveneral treponematoses (eg yaws, pinta and endemic syphilis), so can not differentiate nonveneral treponematoses from syphilis.

So the answer to this question is B


Instruction:
Abdominal pain, fat malabsorption and frothy stools suggests of
A. Amoebiasis
B. Bacillary dysentry
C. Giardiasis
D. Pancreatic enzyme deficiency

Response:
Giardia lamblia is an intestinal flagellate , infection acquired by ingestion of contaminated water and food and also by ano- oral sexual practice The parasite attaches itself to the epithelial surface of duodenum and jejunum causes a disturbance of intestinal function , leading to malabsorption of fat .patient complaints of loose stool and steatorroea. Baveja textbook of parasitology , 3rd edition.

So the answer to this question is C


Instruction:
Deep vein thombosis occurs most commonly after ?
A. Total hip replacement
B. Gastrectomy
C. Prostatic operation
D. Brain surgery

Response:
Ans is 'a' ie Total hip replacement The factors which result in increased risk of venous thrombosis include advancing age and greater complexity of surgical treatment. Ohopaedic operations on the lower limbs (hip and knee replacements) are especially likely to result in venous thrombosis." - Bailey & Love

So the answer to this question is A


Instruction:
Emporiatrics deals with the health of the
A. Farmers
B. Travellers
C. Industrial workers
D. Mine workers

Response:
None

So the answer to this question is B


Instruction:
Most of the iron in the diet is in the ferric (Fe3+) form. It is actively absorbed in:
A. Stomach
B. Duodenum
C. Large intestine
D. Ileum

Response:
Gastric secretions dissolve the dietary iron and permit it to form soluble complexes with ascorbic acid and other substances that aid its reduction to the Fe2+ form. Almost all iron absorption occurs in the duodenum. Transpo of Fe2+ into the enterocytes occurs divalent metal transpoer 1 (DMT1). Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 26. Digestion, Absorption, & Nutritional Principles. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.

So the answer to this question is B


Instruction:
Feature that differentiates true from aificial bruise
A. Round shape, irregular margins
B. Irregular shape with regular margins
C. Swelling of surrounding area
D. Erythema of surrounding areas

Response:
contusion: not well defined, diffuse, and irregular margins Aificial bruise: well defined with regular margins. Ref: FORENSIC MEDICINE AND TOXICOLOGY DR PC IGNATIUS THIRD EDITION PAGE 120

So the answer to this question is B


Instruction:
Contraceptive to be avoided in epilepsy:
A. OCPs
B. Condom
C. IUCD
D. Mirena

Response:
. Ans. a. OCPs (Ref: Leon Speroff 8/e p1026]Contraceptive to be avoided in epilepsy is OCPs."Epilepsy/seizure disorder is a relative contraindication for the use of OCPs as antiepileptic drugs like phenytoin, carbamazepine and phenobarbitone induce the synthesis of liver enzyme thereby reducing the plasma levels of ethinyl estradiol in women on combined pills, thereby increasing the chances of contraceptive failure.""In epilepsy, consideration should be given to methods that neither affect antiepileptic drug metabolism nor the methods affected by drugs. These include intrauterine contraception with copper IVD, or levonorgestrel releasing IVD, long actingprogestins only, barrier methods and sterilization. Leon Speroff 8/epi026Adverse effects of Oral contraceptive pills* Nausea, vomiting, headache (migraine may be worsened)* Breakthrough bleeding or spotting, amenorrhoea* Breast discomfort (Mastalgia)* Weight gain, acne and increased body hair* Chloasma, pruritus vulvae* Carbohydrate intolerance* Mood swings, abdominal distention* Leg vein and pulmonary thrombosis0* Coronary and cerebral thrombosis - Ml, stroke.- Estrogen component is responsible for venous thromboembolism.- Both estrogen and progesterone are responsible for arterial phenomenon.* Rise in BPdeg* increased risk of cervical carcinoma0 (risk of endometrial and ovarian carcinoma is decreased)* Gall stones, benign hepatoma(r)* Estrogen increases the risk of endometrial cancer.* Progesterone component decreases this risk in OCPs.* Estrogen has favorable effect on lipid profile while progesterone has opposite effect.* Progesterone component is mainly responsible for MI.

So the answer to this question is A


Instruction:
The most common cause of Addison's disease is:~
A. Autoimmune adrenalitis
B. Meningococcal septicemia
C. Malignancy
D. Tuberculosis

Response:
. Autoimmune adrenalitis

So the answer to this question is A


Instruction:
A 10 year old boy, Pappu, died of acute rheumatic fever. All the following can be expected at autopsy except :
A. Ashoff nodules
B. Rupture of chordae tendinae
C. Mc Callum patch
D. Fibrinous pericarditis

Response:
Answer is B (Rupture of Chordae tendinae)

So the answer to this question is B


Instruction:
Erythropoietin is secreted from:
A. Juxtaglomerular cells
B. Macula densa
C. Interstitial cells
D. Glomerulus

Response:
In adults, about  85% of the erythropoietin comes from the kidneys and 15% from the liver.
Erythropoietin is produced by interstitial cells in the peritubular capillary bed of the kidneys and by perivenous hepatocytes in the liver.

So the answer to this question is C


Instruction:
Not a personality trait ?
A. Sensation seeking
B. Neuroticism
C. Open to experience
D. Problem solving

Response:
D i.e. Problem solvingAccording to five factor model (DSM-IV), there five basic personality traits are: neuroticism, extraversion (excitement/ novelty / sensation seeking), agreeableness, openness (to experience) and conscientiousnessQ.Personality Traits : Temprament & CharacterPersonality is the dynamic (constantly changing) psychobiological organization within the individual that modulate their unique adaptations to a changing internal and external environment and characterize their differences in outlook, thoughts, emotions and actions. Inflexibility in personality is an indicator of personality disorder.A person may feel and act differently on different situations (such as on a date, at work or school, in church, or with trusted friend), although his personality doesn't change. So the way a person adapts to 5 different types of situations distinguish layers of personality.Sexual situations involving reproduction & sexualityMaterial situations involving quest for material possessions & power Emotional situations involving emotions and social attachment Intellectual situations involving communication & cultureSpiritual situations involving quest for what is beyond individual human existenceTemperament and character together constitute personality. Temprearment is the innate predisposition to behave in a paicular manner. Temperamental traits are biases in emotional response that are fully developed early in life and relatively stable there after whereas, character is a configuration of habbits, a disposition, consisting in the actualized aspects acquired through learning and shaped by experience. It involves higher cognitive processes that develop in a stepwise manner over the life time to enable a person to regulate his emotions, maintain paicular values and viues and achieve ceain goalsBoth are moderately heritable but differ in pattern of learning & memory : i.e. the procedural learning of habits and skills influences the conditioning of temperament, whereas propositional learning of goals and values influences the development of character.

So the answer to this question is D


Instruction:
Proximal pa of umbilical aery gives rise to?
A. Median umbilical ligament
B. lateral umbilical ligament
C. Superior vesical aery
D. Inferior vesical aery

Response:
*Umbilical aeries - seen as continuations of the right and left dorsal aoae, before their fusion. *After fusion, they are seen as lateral branches of the single dorsal aoa *Cross the 5th lumbar intersegmental aery *pa of umbilical aery, btw the aoa and the anastomosis with internal iliac, disappears so that umbilical aery is now seen as a branch of the internal iliac *Post natal life - proximal pa of the umbilical aery becomes the superior vesical aery, while it's distal pa is obliterated to form the medial umbilical ligament (Reference : I B Singh's Embryology, 10th edition, pg 264)

So the answer to this question is C


Instruction:
Which of the following general anesthetic techniques should be used for anesthesia in oral surgery:
A. Open drop method
B. Anesthesia with nasopharyngeal airway
C. Nasoendotracheal tube with throat pack
D. I.V. anesthesia with nitrous oxide and oxygen

Response:
None

So the answer to this question is C


Instruction:
All the following are examples of cardiotoxic drugs except-
A. Cyclophosphamide
B. 5-FU
C. Adriamycin
D. Cisplatin

Response:
Ans. is 'd' i.e., Cisplatin Cisplatin is not cardiotoxic Cardiotoxicity of Adriamydn: - I ) ECG changes, arrythmias 2) Congestive hea failure 3) Cardiomyopathy Doxorubicin is also known as adriamycin. Other anticancer drugs causing cardiotoxicity: I)Daunorubicin 2) Cyclophosphamide 3) Mitoxantrone 4)5 - FU

So the answer to this question is D


Instruction:
Incised wounds on genitalia: AIIMS 09, 10
A. Homicidal
B. Suicidal
C. Accidental
D. Self-inflicted

Response:
Ans. Homicidal

So the answer to this question is A


Instruction:
Bisphosphonates are used in all EXPECT
A. Paget's disease
B. Vitamin D excess
C. Postmenopausal osteoporosis
D. Hypercalcemia of malignancy

Response:
Bishosphonates are analogue of Pyro phosphate. They are most effective as anti resorptive drugs they are used to prevent calcium resorption in osteoporosis other uses: hypercalcemia of malignanct, pagets disease . (REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 333)

So the answer to this question is B


Instruction:
Most common mental disorder as a cause of suicide
A. Mania
B. Depression
C. Alcohol dependence
D. Schizophrenia

Response:
Suicide is a model of psychiatric emergencies and is also the commonest cause of death among the psychiatric patient&;s psychiatric disorders are a major cause of suicide, for example, depression(1major depression 2depression secondary to a serious physical illness 3reactive depression), alcoholism and drug dependence and schizophrenia (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition, pg no.222)

So the answer to this question is B


Instruction:
A man taking 20 cigarettes per day, started coughing, his family suggested quitting cigarettes. He is ready to quit but thinks that quitting will make him irritable, the best health planning model followed is -
A. Cost and survival
B. Persuasion
C. Precontemplation and preparation
D. Belief

Response:
Ans. is 'c' i.e., Precontemplation and preparation Five stages of change have been conceptualized for a variety of problem behavior's .The five stages of change are: -PrecontemplationContemplationPreparationActionMaintenancePrecontemplationIt is the stage at which there is no intention to change behaviour in for the seeable future. Many individuals in this stage are unaware or under aware of their problems.ContemplationIt is the stage in which people are aware that a problem exists and are seriously thinking about overcoming it but, have not yet made a commitment to take an action.PreparationIt is a stage that combines intention and behavioural criteria.Individuals in this stage are intending to take action in the next month and have unsuccessfully taken action in the past year.ActionIt is the stage in which individuals modify their behaviour experiences or environment in order to overcome their problems.Action involves the most overt behavioural changes and require considerable commitment of time and energy.MaintenanceIt is the stage in which people work to prevent relapse and consolidate the gains attained during action.For addictive behaviour this stage extends from six months to indeterminate period past the initial action.

So the answer to this question is C


Instruction:
Sickle cell anemia is due to:
A. Addition
B. Deletion
C. None
D. Point mutation

Response:
Sickle cell disease is a hereditary hemoglobinopathy, characterized by the defective haemoglobins.
It is caused by a point mutation at the sixth position of the beta globin chain leading to substitution of valine
residue for a glutamic acid residue. In homozygous state  -100 % chains defective i.e., no HbA In heterozygous
state  -40 % chains defective i.e., HbA present HbA = α2β2 Hb A2 = α2δ2 HbF = α2γ2 • Most important factor
which affects degree of sickling is amount of Hb S and its interaction with other Hb chains  Factors favouring polymerization ■ Hypoxia -↑2,3 BPG → ↑ polymerization
■ Acidosis - ↑ acidosis → ↑ polymerization ■ Hb concentration -1 Hb concentration →↑ polymerization ■ Combination with other hemoglobins - already discussed

So the answer to this question is D


Instruction:
Which of the following mediate Lewis triple response?
A. Axon reflex
B. Histamine release from mast cells
C. Injury to endothelium
D. None of the above

Response:
Lewis triple response illustrates the effect of histamine on vascular smooth muscle, vascular endothelium and sensory nerve endings. Intradermal injection of histamine produces 3 distinct effects: Dilatation of capillaries in the immediate vicinity of injection resulting in a flush. Dilatation of aerioles resulting in an irregular red flare over an area wider than due to capillary dilatation. Wheal appearing in the area of capillary dilatation. In addition to wheal, flush and flare, transient pain and itching result from effect of histamine on sensory nerve endings.

So the answer to this question is B


Instruction:
Replacement of Mirena a progestin releasing intrauterine device should be done after how many years?
A. 1 year
B. 3 year
C. 5 year
D. 10 year

Response:
Mirena is a progestin releasing device, it releases levonorgestrel into the uterus at a rate of 20 microgm/d. It has a T-shaped radiopaque frame, with its stem wrapped with a cylinder reservoir, composed of a polydimethylsiloxane-levonorgestrel mixture. It has to be replaced every 5 years. Cu T 380A is another progestin releasing device. It has a polyethylene and barium sulfate, T-shaped frame wound with copper. It has to be replaced every 10 years. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 32. Contraception.

So the answer to this question is C


Instruction:
One of the following is not a feature of catatonic schizophrenia: UPSC 07; AP 10; MAHE 12
A. Negativism
B. Automatic obedience
C. Catalepsy
D. Cataplexy

Response:
Ans. Cataplexy

So the answer to this question is D


Instruction:
All of the following process shows features of acute inflammation except
A. Apoptosis
B. Pyroptosis
C. Necroptosis
D. Necrosis

Response:
Necrosis Plasma membrane - disrupted Cellular contents - may leak out - adjacent inflammation Pathogenesis: - Apoptosis: Hallmarks of Apoptosis Intact Plasma Membrane Shrunken cell size Chromatin condensation - Most Characteristic feature Absent inflammation Pyroptosis:- associated with bacterial infection. associated with the release of IL-1 and activation of Caspase 1 and Caspase 11. inflammation is seen Necroptosis: Caspase independent Programmed cell death. (Programmed Necrosis). it is also having inflammation

So the answer to this question is A


Instruction:
Basic function of hemoglobin is
A. Increased O2 delivery in lung and uptake at tissue
B. Increased O2 delivery at tissue and uptake in lung
C. Increased CO2 delivery at tissue and uptake in lung
D. None of the above

Response:
The red, oxygen-carrying pigment in the red blood cells of veebrates is hemoglobinEach of the four iron atoms in hemoglobin can reversibly bind one O2 moleculeIt takes up O2 from lungs due to increase in pO2 and released in tissues where pO2 is lessIn this way, 250 mL of O2 per minute is transpoed from the blood to the tissues at rest.Ref: Ganong's Review of Medical Physiology Twenty-Third Edition Page No: 610

So the answer to this question is B


Instruction:
All are to access platelet functions except-
A. Prothrombin time
B. Bleeding time
C. Clot retraction time
D. Prothrombin deactivation

Response:
ROBBINS BASIC PATHOLOGY 9THEDITION PGNO 450 Prothrombin time (PT). This test assesses the extrinsic and common coagulation pathways. It measures the time (in seconds) needed for plasma to clot after addition of tissue thromboplastin (e.g., brain extract) and Ca2+ ions. A prolonged PT can result from a deficiency of factor V, VII, or X or prothrombin or fibrinogen, or by an acquired inhibitor (typically an antibody) that interferes with the extrinsic pathway.

So the answer to this question is A


Instruction:
Characterstic of basal cell carcinoma is:
A. Keratin pearls
B. Foam cells
C. Nuclear palisading
D. Psammoma bodies

Response:
Basal cell carcinomas are composed of islands or nests of basaloid cells (i.e. cells resembling cells in the normal basal cell layer of the epidermis), with palisading of the cells at the periphery and a haphazard arrangement of those in the centers of the islands. The tumor cells have a hyperchromatic nucleus with relatively little, poorly defined cytoplasm.
Other options:
Keartin pearls- seen in squamous cell carcinoma
Foam cells- seen in Xanthoma
Psammoma bodies- seen in papillary thyroid carcinoma

So the answer to this question is C


Instruction:
Characteristic of incised wound are all except -
A. Length of wound not correlated with weapon
B. Bleeding less than laceration
C. Hesitation cuts seen
D. Clean cut edges

Response:
The synopsis of forensic medicine & toxicology ; Dr k.s narayan reddy ; 28th edition ; Pg.no. 112 As the vessels are cut cleanly, bleeding is more . spuing of blood occurs if an aery is cut .

So the answer to this question is B


Instruction:
First change in a dead body is:
A. Mummification
B. Greenish discolouration of RIF
C. Putrefaction
D. Maggot formation

Response:
Greenish discolouration of RIF

So the answer to this question is B


Instruction:
A 4 years old child suffered from a fall on outstretched hand.  X rays revealed a fracture with the fracture line at the physes with a small metaphyseal fragment.  There was no epiphyseal fracture.  What type of injury by Salter harris Classification is this?
A. I
B. II
C. III
D. IV

Response:
(Refer: Mohindra’s Fundamentals of Orthopedics, 2nd edition, pg no. 510)

Type II: the fracture involves the physis and a triangle of metaphyseal bone (Thurston Holland sign).  This is the commonest type of epiphyseal injury accounting for 73 percent of cases over 10 years of age.

So the answer to this question is B


Instruction:
All of the following are causes of granular contracted kidney except:
A. Benign nephrosclerosis
B. Chronic pylonephritis
C. Diabetes mellitus
D. Chronic glomerulonephritis

Response:
Answer is C (Diabetes Mellitus): The kidneys are typically normal or increased in size in diabetic nephropathy - Harrison 14th / 1546, 15th/1590 Most forms of chronic renal insufficiencies lead to shrinkage or decrease in size of the kidney. Notable exceptions, wherein kidney size is usually normal or increases include : Diabetic nephropathy Q Amyloidosis Q Polycystic kidney disease Q Kidney is contracted/shrunken in the remaining three conditions - Benign nephrosclerosis Q - Chronic pyelonephritis Q - Chronic glomerulonephritis Q

So the answer to this question is C


Instruction:
Which of the following does not occur in Tetralogy of
Fallot ?
A. Congestive cardiac failure
B. Polycythemia
C. Brain abscess
D. Infective Endocarditis

Response:
NOT seen in Tetralogy of Fallot

Congestive cardiac failure
Cardiomegaly
Neonatal cyanosis
Recurrent Respiratory tract infection

So the answer to this question is A


Instruction:
An infant is evaluated for paial intestinal obstruction that has been present from bih. Esophagogastroduodenal endoscopic visualization fails to demonstrate an intraluminal lesion, but does show prominent narrowing at the level of the mid duodenum. CT studies demonstrate a mass lesion surrounding that poion of the duodenum. Which type of tissue is most likely present within the lesion?
A. Gastric
B. Hepatic
C. Pancreatic
D. Renal

Response:
The lesion is an annular pancreas, which is a rare pancreatic malformation, in which the pancreatic head encircles the second pa of the duodenum, potentially causing obstruction. An increase in thickness of the muscular pa of the gastric wall can cause congenital pyloric stenosis. While the liver is near the first and second pas of the duodenum, there is no common developmental anomaly in which hepatic tissue would surround the duodenum. The kidneys are located retroperitoneally and relatively far lateral from the duodenum, and would not be expected to surround it. Ref: Molina P.E. (2013). Chapter 7. Endocrine Pancreas. In P.E. Molina (Ed),Endocrine Physiology, 4e.

So the answer to this question is C


Instruction:
A 30-year-old man presents with coughing up blood and sputum. There is no associated dyspnea, fever, or pleuritic chest pain. His past medical history is significant for recurrent pneumonias and a chronic cough productive of foul-smelling purulent sputum. The sputum production is usually worse when lying down and in the morning. He quit smoking 5 years ago and started when he was 18 years old. On physical examination, he appears chronically ill with clubbing of the fingers. Wet inspiratory crackles are heard at the lung bases posteriorly. CXR shows scaring in the right lower lobe, which on chest CT scan is identified as airway dilatation, bronchial wall thickening, and grapelike cysts. Which of the following is the most likely diagnosis?
A. bronchiectasis
B. chronic bronchitis
C. disseminated pulmonary tuberculosis
D. pulmonary neoplasm

Response:
(a) Source: (Kasper, p. 1542) Bronchiectasis is defined as a permanent abnormal dilatation of large bronchi due to destruction of the wall. It is a consequence of inflammation, usually an infection. Other causes include toxins or immune response. Persistent cough and purulent sputum production are the hallmark symptoms.

So the answer to this question is A


Instruction:
The Modern Stethoscope was invented by
A. Rene Laennec
B. Golding Bird
C. Arthur Leared
D. George Phillip Cammann

Response:
(D) George Phillip Cammann# Stethoscope was invented in France in 1816 by Rene Laennec at the Necker-Enfants Malades Hospital in Paris. It consisted of a wooden tube and was monaural.> In 1840, Golding Bird described a stethoscope he had been using with a flexible tube.> Irish physician Arthur Leared invented a binaural stethoscope.> The modern binaural Stethoscope was invented by the American physician George Philip Cammann in 1852.> George Cammann perfected the design of the instrument for commercial production, which has become the standard ever since.> Cammann also wrote a major treatise on diagnosis by auscultation, which the refined binaural stethoscope made possible.

So the answer to this question is D


Instruction:
An 18-year-old male presented with acute onset descending paralysis of 3 days duration. There is also a history of blurring of vision for the same duration. On examination, the patient has quadriparesis with areflexia. Both the pupils are non-reactive. The most probable diagnosis is
A. Poliomyelitis
B. Botulism
C. Diptheria
D. Porphyria

Response:
None

So the answer to this question is B


Instruction:
Tailing of wound suggests:
A. Direction of injury
B. Weapon used
C. Type of wound
D. Surface of weapon

Response:
Ans. (a) Direction of injuryRef: The essentials of FSM by KS Narayan Reddy 31st ed. /178* Tailing of wound is one of the characteristics of the incised wound which indicates the direction in which the cut was made.* Incised wounds are deeper at the beginning as more pressure is exerted at this point (head of wound). Towards the end of the cut the wound becomes increasingly shallow, till finally as the knife leaves the tissues, the skin alone is cut. This is known as tailing of wound.

So the answer to this question is A


Instruction:
Condyloma accminatum is caused by HPV types of
A. 18,31
B. 17,12
C. 6,11
D. 16,18

Response:
Ans. is 'c' i.e., 6,11 . High risk HPV: HPV-16, 18, 31, 33 & 45 ---> associated with cervical cancer. . Low risk HPV: HPV- 6 & 11 --> associated with precursor lesions CM and condyloma accuminatum . HPV-5 & 8 associated with squamous cell cancer in patients with epidermodysplasia verruciformis

So the answer to this question is C


Instruction:
All of the following findings would be expected hi a person with coarctation of the aoa except -
A. A systolic murmur across the anterior chest and back and a high-pitched diastolic murmur along the left sternal border
B. upper extremities may be more developed than lower extremities.
C. Inability to augment cardiac output with exercise
D. Persistent hypeension despite complete surgical repair

Response:
Most children and young adults with isolated, discrete coarctation are asymptomatic. Headache, epistaxis, cold extremities, and claudication with exercise may occur, hypeension in the upper extremities and absence, marked diminution, or delayed pulsations in the femoral aeries are detected Enlarged and pulsatile collateral vessels may be palpated in the intercostal spaces anteriorly, in the axillae, or posteriorly in the interscapular area. The upper extremities and thorax may be more developed than the lower extremities. A midsystolic murmur over the left interscapular space may become continuous if the lumen is narrowed sufficiently to result in a highvelocity jet across the lesion throughout the cardiac cycle. ( Harrison&;s principle of internal medicine,18th edition,pg no. 1925) Additional systolic and continuous murmurs over the lateral thoracic wall may reflect increased flow through dilated and touous collateral vessels. The ECG usually reveals LV hyperophy.

So the answer to this question is C


Instruction:
What is the characteristic of normal distribution?
A. Mean = Median = mode
B. Mean is 1, SD-zero
C. Curve skewed towards the left
D. Curve skewed towards the right

Response:
None

So the answer to this question is A


Instruction:
A 12 year old boy presents with chronic knee pain for 2 years/. Knee x ray is shown. Probable diagnosis:
A. Chronic osteomyelitis
B. Osteosarcoma
C. Rickets
D. Hyperparathyroidism

Response:
* The x-ray shows lower end of femur with flaring and irregular margins but the epiphysis is normal.* There is no white line in epiphysis, hence scurvy is ruled out.* Absence of lytic lesions rules out hyperparathyroidism.* Malignancy is ruled out as there is no periosteal reaction or bone growth is seen.* Rickets shows flaring of metaphysis and widening of the growth

So the answer to this question is C


Instruction:
Burns grading - Grade 2 indicates involvement of:
A. Epidermis
B. Dermis
C. Subcutaneous tissue
D. Deep fascia

Response:
Ref: Sabiston Textbook of Surgery. 19th Edition, Pg: 522.Explanation:Depths of burn injury* First degree--injury localized to the epidermisSuperficial second degree--injury to the epidermis and superficial dermisDeep second degree--injury through the epidermis and deep into the dermisThird degree--full-thickness injury through the epidermis and dermis into subcutaneous fatFourth degree--injury through the skin and subcutaneous fat into underlying muscle or boneRule of ninesEach upper limb 9% Total body surface area (TBS A)Each lower limb 18% TBS AThe torso 18% TBS A each side( anterior and posterior)The head and neck 9% TBS AGenitalia l % TBSAParkland's FormulaTotal percentage body surface area x weight (kg) x 4 = volume ( ml)Half this volume is given in the first 8 hoursSecond half is given in the next 16 hoursFigure: Rule of Nines in Adults

So the answer to this question is B


Instruction:
All are types of genetic polymorphism, except
A. Copy number variation
B. Pleiotropism
C. Single nucleotide polymorphisms
D. None

Response:
Genetic polymorphisms (variations) result when copies of a specific gene present within a population do not have identical nucleotide sequences.The term allele refers to one of a series of alternative DNA sequences for a paicular gene. In humans, there are 2 copies of every gene. An individual's genotype for a given gene is determined by the set of alleles that the individual possesses. The most common form of genetic variation involves a single base change at a given location, referred to as a single-nucleotide polymorphism (SNP). At the other end of the spectrum are copy number variations, which refer to the deletion or duplication of identical or near identical DNA sequences that may be thousands to millions of bases in size.Reference: Nelson Textbook of Paediatrics; 20th edition; Chapter 59; Pediatric Pharmacogenetics, Pharmacogenomics, and Pharmacoproteomics

So the answer to this question is B


Instruction:
NREM sleep is associated with:-
A. Basal forebrain area
B. Dorsal raphe nucleus
C. Medulla
D. All of the above

Response:
NREM sleep generation is associated with 5 anatomical sites: * Basal forebrain area Thalamus Hypothalamus Dorsal raphe nucleus Nucleus tractus solitaries of the medulla Preoptic lesions produce hyposomnia, whereas electrical and thermal stimulation of this area produces sleep changes. Thalamus (especially reticular formation) plays an active role in production of coical sleep spindles and delta waves.

So the answer to this question is D


Instruction:
A pregnant women presents for prenatal care. Her past medical history is significant for a severe illness 3 years ago characterized by fatigue, nausea, anorexia, vomiting, jaundice, joint pains, and generalized skin lesions that slowly disappeareD. She has felt well recently. Which lab test should be ordered to investigate the patient's past illness?
A. Hepatitis B surface antigen (HBsAg)
B. IgG cytomegalovirus (CMV) antibody levels
C. IgM antibody to HBsAg
D. IgM antibody to hepatitis B core antigen

Response:
The woman had acute hepatitis in the past. To determine whether it is resolved or persisted, one should test for HbsAg. Definition of chronic hepatitis is presence of HBsAg for >6months.

So the answer to this question is A


Instruction:
Dr.Christian Bernard is associated with?
A. Heart transplant
B. Renal transplantation
C. Liver transplant
D. Hair transplant

Response:
ANSWER: (A) Heart transplantREF: http://en.wikipedia. or g /wiki/Chris tiaan_BarnardChristiaan Neethling Barnard (November 8,1922 - September 2, 2001) was aSouth African cardiac surgeon who performed the world's first successful human-to-human heart transplant.

So the answer to this question is A


Instruction:
Thyroid carcinoma with pulsatile vascular skeletal metastasis is
A. Medullary
B. Anaplastic
C. Follicular
D. Papillary

Response:
Pulsatile secondaries are seen in: Follicular carcinoma Thyroid Renal cell carcinoma ref - Srb's manual of surgery 5e p481

So the answer to this question is C


Instruction:
Cotton's Fracture involves:
A. Ankle
B. Foot
C. Knee
D. Spine

Response:
ANSWER: (A) AnkleREF: http;//en.wikipedia.org/wiki/List_of_eponymous_fracturesSee APPENDIX-68 for "Alphabetical list of eponymous fractures" APPENDIX - 68Alphabetical List of Eponymous FracturesFractureDescriptionMechanism of injuryAviators fractureFracture neck of talusDorsiflexionBumper fracturecompression fracture of lateral condyle of tibial (always intra articular)Forced valgus of knee when struck from side by car bumperBoxer's fractureFracture of distal 5th metacarpalPunching solid objectBos worth fractureFracture of distal fibula with posterior dislocation of the proximal fibula behind the tibiaSevere external rotation of the footBennett's fractureIntra-articular fracture of base of first metacarpalAxial load along metacarpal in a partially flexed thumb (Abductor pollids longus pull)Barton's fractureIntra articular distal radius fracture invoking the articular surface with dislocation of the radio carpal jointFall on outstretched handBankart's fractureFracture of anterior glenoid associated with anterior shoulder dislocationExternal rotation and abduction of shoulderColies' fractureDistal radius fracture with dorsal angulation, impaction and radial driftFall on outstretched handCotton's fractureTrimalleolar fracture of ankle Clay shoveller's fractureStress avulsion fracture of Spinous process of C6, C7 or T1Forced hyper flexion of neckCh opart's fracture- dislocationFoot dislocation through talonavicular and calcaneocuboid joints with associated fractures, usually after ankle twisting. Treated in a non-weight bearing cast for 6-8 weeks Chauffeur's fractureIntra-articular fracture of radial styloidForced ulnar deviation of the wrist causing avulsion of the radial styloidChance fractureHorizontal fracture of vertebral bodyHyper flexion of spine, seen in car accidents when lap belts xvere usedDuverney fractureIsolated fracture of the iliac wingDirect traumaEssex-LoprestifractureComminuted radial head fracture xvith interosseous membrane disruption and distal radioulnar joint subluxationFall from heightGosselin fractureV-shaped distal tibia fracture extending into the tibial plafond Galeazzi fractureRadius shaft fracture with dislocation of distal radioulnar jointBlow to forearmHolds worth fractureUnstable spinal fracture-dislocation at the thoracolumbar junction Hume fractureOlecranon fracture with anterior dislocation of radial head Hill-Sachs fractureImpacted posterior humeral head fracture occurring during anterior shoulder dislocation Hangman s fractureFracture of both pedicles of C2Distraction and extension of neck (judicial hanging)Jones fractureFracture of base of 5th metatarsal extending into intermetatarsal jointInversion of ankle (pronator brevis pull)Jefferson fractureBurst fracture of 1st cervical vertebraCompression of neckLisfranc fractureFracture dislocation of midfootForced plantar flexion of foot or dropping heavy weight on footLe Forts fracture of the ankleVertical fracture of distal fibula with avulsion of medial malleolus Le Fort fracturesSeries of facial fracturesDirect trauma to faceMoores fractureDistal radius fracture with ulnar dislocation and entrapment of styloid process under annular ligament Monteggia fractureProximal ulna fracture with dislocation of radial headBlow to forearmMarch fractureStress fracture of 2n<1 /3rd metatarsal shaftHeavy or unaccustomed exerciseMalgaignesfractureVertical pelvic fracture through both pubic rami and the ilium or sacroiliac joint with vertical displacementHigh energy impact to pelvis (front to back)MaisonneuvefractureSpiral fracture of proximal fibulaExternal rotation of anklePipkin fracture- dislocationPosterior dislocation of hip with avulsion fracture of fragment of femoral head by the ligamentum teresImpact to the knee with the hip flexed (dashboard injury)Pilon fractureComminuted fracture of distal articular fracture with fibular fracture Pott's fractureBimalleolar fracture of the ankleEversion of ankleRolando fractureIntra articular T or Y shaped Comminuted fracture of base of V metacarpalAxial load along the metacarpal causing splitting of the proximal articular surfaceRunner's fractureStress fracture of distal fibula 3-8 cm above the lateral malleolusRepeated axial stress on fibulaStieda fractureAvulsion fracture of the medial femoral condyle at the origin of the medial collateral ligament Smith's fractureDistal radius fracture with volar displacementFall on outstretched hand with wrist in flexed positionShepherd s fractureFracture of the lateral tubercle of the posterior process of the talus Segond fractureLateral tibial plateau avulsion fracture with anterior cruciate ligament tear| Internal rotation of the kneeSalter-HarrisfracturesFractures involving a growth platevariousTitlaux fractureSalter-Harris III fracture of the tibiaForced lateral rotation of footToddlers fractureUndisplaced spiral fracture of distal tibia in children under 8 years oldLow-energy trauma t often rotational

So the answer to this question is A


Instruction:
Indications off steroids in SLE are all except -
A. Myocarditis
B. Endocarditis
C. Thrombocytopenia
D. Neuropsychiatric symptoms

Response:
None

So the answer to this question is B


Instruction:
Combination of trimethoprim and sulfamethoxazole is effective against which opportunistic infection in AIDS:
A. Herpes simplex
B. Cryptococcal meningitis
C. Pneumocystis jiroveci
D. Tuberculosis

Response:
Ans. C. Pneumocystis jiroveciThis combination of drug is known as cotrimoxazole. It is bactericidal in nature and plays a synergistic role. It is drug of choice for pneumonia caused by pneumocystis jiroveci in AIDS patients.

So the answer to this question is C


Instruction:
Which of the following is most likely to cause of non Megaloblastic macrocytic anemia
A. Vitamin B12 deficiency
B. Hypothyroidism
C. Thiamine deficiency
D. Folic acid deficiency

Response:
Ref Harrison 19 th ed pg 640 marrow is usually hypercellular and the anemia is based on ineffective erythropoiesis. The cause is usually a deficiency of either cobalamin (vitamin B12) or folate, but megaloblas- tic anemia may occur because of genetic or acquired abnormalities that affect the metabolism of these vitamins or because of defects in DNA synthesis not related to cobalamin or folate .

So the answer to this question is B


Instruction:
Superficial thrombophlebitis is seen in -
A. Trousseau's syndrome
B. Burger's disease
C. Raynaud's disease
D. Kawasaki syndrome

Response:
Ans. is 'a' i.e., Trousseau's syndrome * Migratory superficial thrombophlebitis is known as Trousseau's syndrome.Trousseau's Syndrome* It is characterized by recurrent episodes of thrombophlebitis in superficial veins which changes locations over time (thrombophlebitis migrans or migratory thrombophlebitis).* The clot is tender and can be felt as a nodule under the skin. It can involve uncommon sites, such as the chest wall and arms.* This syndrome is a sign of internal malignancy & is particularly associated with pancreatic, gastric and lung cancer.* Heparin therapy is recommended to prevent future clots.Also know* Trousseau sign of latent tetany is caused by hypocalcemia.

So the answer to this question is A


Instruction:
Woodruff's plexus is seen at
A. Anteroinferior pa of superior turbinate
B. Middle turbinate
C. Posterior pa of inferior turbinate
D. Anterior pa of inferior turbinate

Response:
Woodruff's Plexus - Site of posterior epistaxis in adults. Plexus of veins situated inferior to posterior end of inferior turbinate Ref: Dhingra 7e pg 197.

So the answer to this question is C


Instruction:
Kruti, 56 years old, complained of pain in abdomen, with USG showing 4 cm bilateral ovarian mass with increased vascularity. Next line of managements:
A. USG guided ovarian tapping
B. Wait and watch
C. Surgery
D. OC pills x three cycles

Response:
Ans. is c, i.e. SurgeryRef: Novak 14th/ed, p472Any ovarian mass with signs of malignancy (B/L and increased vascularity) require surgery irrespective of the size.The exact nature and extent of surgery is only decided intraoperatively, depending upon the frozen section (pathology) report.

So the answer to this question is C