Instruction:
Gold standard treatment in a patient intractable aspiration with incompetent larynx due to complete laryngeal paralysis is:
A. Type I Thyroplasty
B. Tracheostomy
C. Feeding jejunostomy
D. Tracheal division & Permanent Tracheostoma

Response:
TREATMENT OF COMPLETE LARYNGEAL PALSY: Tracheostomy Gastrostomy Epiglottopexy Vocal cord plication Total laryngectomy Diversion procedures-Laryngotracheal separation, Laryngeal closure& permanent tracheostome Bilateral medialization i.e. Type I thyroplasty for aspiration requires adduction of the entirevocal cord. The technique works in carefully selectedcases of mild aspiration as it does not prevent all aspiration and risks patients requiring a tracheostomy,

So the answer to this question is D


Instruction:
Which of the following would be expected to contain relatively high numbers of functional hematopoietic cells?
A. Adult liver
B. Umbilical cord blood
C. Adult circulating blood
D. Adult spleen

Response:
Ans. B. Umbilical cord blooda. Umbilical cord blood, derived from the circulating blood of newborn infants, possesses high levels of hematopoietic progenitors.b. Levels of circulating progenitors rapidly decrease after birth, depleting the progenitor content within the circulating blood of adults.c. The spleen of adult human's functions as a hematopoietic organ in certain disease states, such as leukemia.d. However, in other animals and in developing human fetuses, the spleen plays an important role in the hematopoietic response.e. While the liver and the thymus are important in hematopoiesis and immune reconstitution prior to birth, these organs are not involved in hematopoiesis in adult humans.

So the answer to this question is B


Instruction:
Which of the following conditions is not considered
as premalignant
A. Erosive lichen planus
B. Syphilitic glossitis
C. Leukoedema
D. Leukoplakia

Response:
None

So the answer to this question is C


Instruction:
Height to weight is a/an -
A. Association
B. Correlation
C. Propoion
D. Index

Response:
Ans. is 'a' i.e., Association First read about these two related terms :? o Association ---> Association may be defined as the concurrence of two variables more often than would be expected by chance. That mean 2 variables exist simultaneously. o Correlation --> Correlation indicates the degree (strength) of association between two variables, i.e. relationship between two quantitative variables. o Height to weight is an association and the strength of this association is indicated by correlation.

So the answer to this question is A


Instruction:
Inverse agonist of GABA receptor is
A. Benzodiazepines
B. Flumazenil
C. β- Carboline
D. None of the above

Response:
β - Carboline is the inverse agonist.
Benzodiazepines are full agonists that open chloride channels by acting on GABA receptors.
Flumazenil is antagonist for Benzodiazepines given to treat toxicity.

So the answer to this question is C


Instruction:
All of the following statements regarding amyloidosis are true except -
A. Multiple myeloma - shows AL type deposits
B. Secondary amyloidosis - shows AA type deposits
C. Renal amyloidosis - shows AA type deposits
D. Renal amyloidosis commonly presents with mild proteinuria

Response:
Ans. is 'c' i.e., Renal Amyloidosis commonly presents with Hypeension Most common presentation is proteinuria. o Hypeension may occur but it is not common, it occurs in 20-50% of the patients. "Although earlier it was thought that hypeension was an infrequent complication, more recently up to 50% of patients have been detected hypeensives".

So the answer to this question is C


Instruction:
Delayed tuberculin test response is due to-
A. B lymphocytes
B. T lymphocytes
C. Monocytes
D. Histiocytes

Response:
Tuberculin test is type IV hypersensitivity reaction. Delayed or cell mediated hypersensitivity is a cell mediated response. The antigen activates specifically sensitised CD4 & CD8 T lymphocytes leading to the secretion of lymphokines and phagocyte accumulation. Reference : Anathanarayan & paniker's 9th edition, pg no: 162 <\p>

So the answer to this question is B


Instruction:
A 31-year-old woman has had vulvar pruritus along with a thick, whitish, odorless, globular vaginal discharge for the past week. On pelvic examination, the cervix appears erythematous, but there are no erosions or masses. A Pap smear shows budding cells and pseudo hyphae. No dysplastic cells are present. Which of the following infectious agents is most likely to produce these findings?
A. Candida albicans
B. Chlamydia trachomatis
C. Neisseria gonorrhoeae
D. Trichomonas vaginalis

Response:
The presence of the budding cells with pseudo hyphae indicates a fungal infection with Candida. Candidal (monilial) vaginitis is common; this organism is present in about 5% to 10% of women. Recurrent episodes of vaginal candidiasis may be associated with non-albicans species. The inflammation tends to be superficial, and there is typically no invasion of underlying tissues. Urea plasma is a bacterial agent, as is Chlamydia, and both can produce cervicitis. Neisseria gonorrhoeae, a gram-negative diplococcus, is the causative agent of gonorrhea. Infection with Trichomonas vaginalis can produce a purulent vaginal discharge, but the organisms are protozoa and do not produce hyphae.

So the answer to this question is A


Instruction:
Most suitable method of treating 4 inch size episiotomy hematoma is by :
A. Evacuation
B. Magsulf compression
C. Cold compress
D. Marsupialisation

Response:
Evacuation

So the answer to this question is A


Instruction:
The component responsible for allergy in dental casting alloys is
A. Cobalt
B. Nickel
C. Copper
D. Titanium

Response:
Nickel is the most allergenic metal known, with an incidence of allergic reactions between 10% and 20%. Reactions to nickel are more common among women, presumably because of the chronic exposure to nickel through jewellery.
Ref: Phillip’s 12th edition page 127.

So the answer to this question is B


Instruction:
Most common site of tear in Boerhaave syndrome?
A. Lower end of Esophagus
B. At Gastroesophageal junction
C. Upper esophagus
D. Mid Esophagus

Response:
Boerhaave syndrome Sudden rise in intraluminal esophageal pressure produced during vomiting, as a result of neuromuscular incoordination causing failure of the cricopharyngeus muscle to relax. Associated with overindulgence in food and/or alcohol. At the left posterolateral wall of the lower third of the esophagus, 2-3 cm proximal to the gastro-esophageal junction, along the longitudinal wall of the esophagus. 2nd most common site of rupture is in the subdiaphragmatic or upper thoracic area Vomiting, retching, or vigorous coughing can cause transmural tear at the gastroesophageal junction known as Mallory Weiss tear. Instrument perforation(iatrogenic)typically occurs in the hypopharynx or at the gastroesophageal junction.

So the answer to this question is A


Instruction:
In poal venous system, valves are present at
A. The junction of superior mesentric aery with the splenic aery
B. Within the poal vein only
C. In the intrahepatic poion of poal vein
D. The whole system is valveless

Response:
D i.e. The whole system is valvelessLike vena Cava, the poal vein and its tributaries are without valvesQ. The normal pressure in poal vein is 3-5 mmHg and the increase in venous pressure is distributed throughout the splanchenic circulation.

So the answer to this question is D


Instruction:
Paul Bunnell test is seen in -
A. Infections mononucleosis
B. Syphilis
C. Typhoid
D. RA

Response:
Ans. is 'a' i.e., Infections mononucleosis Serological TestsTypeUse to diagnosePaul Bunnell testTube agglutinationInfectious mononucleosisWasserman reactionComplement fixation testsyphilisRose waaler testPassive hemagglutinationRheumatoid arthritisWidal testTube agglutinationTVpboidVDRLSlide precipitationSyphilisKahn s flocculation testTube precipitationSyphilisWeil Felix testHeterophile tube agglutinationationRickettsiaeLancejield testRing precipitationGroup of streptococciAscoli's testRing precipitationAnthrax

So the answer to this question is A


Instruction:
An 8-year-old boy presented with a skin tumor on his left cheek. He had always avoided exposure to sunlight because it made his skin blister. His skin had scattered areas of hyperpigmentation. He mostly have:
A. Thymidine dimers
B. Trinucleotide repeats
C. Sugar changes
D. Defective DNA repair

Response:
Xeroderma pigmentosum (XP) is a rare autosomal recessive condition in which the mechanisms for repair of DNA subsequent to damage by UV irradiation are defective. This arises because of mutations in the genes encoding components of the nucleotide excision pathway of DNA repair. Ref: Murray R.K., Grossc P.L. (2011). Chapter 57. Biochemical Case Histories. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.

So the answer to this question is D


Instruction:
Most common type of mesentric cyst is
A. Entergenous cyst
B. Chelolymphalic cyst
C. O mental cyst
D. Urogenital cyst

Response:
Chelolymphalic cyst :

It is commonest type of mesentric cyst.
It has congenital misplaced lymphatic tissue.

So the answer to this question is B


Instruction:
Local anaesthetics act on
A. Inactivated voltage gated sodium channels
B. Inactivated ligand gated potassium channels
C. Resting ligand gated potassium channels
D. Resting voltage gated sodium channels

Response:
Local anaesthetics act on open state > inactivated state > resting state, votage gated sodium channels.

So the answer to this question is A


Instruction:
Which among the following is false about case fatality rate?
A. It is a ratio
B. Not useful for acute infectious disease
C. Not useful in chronic disease
D. Related to virulence

Response:
. case fatality rate represents the killing power of a disease.it is simply the ratio of deaths to cases.the time interval is not specified.it is usually used in the case of acute infections such as food poisoning,cholera,measles etc.its usefulness to chronic diseases is limited.because the period from onset to death is long and variable.the case fatality rate for the same disease may very in epidemics.it is closely related to VIRULENCE. REF:park&;s textbook ,ed22,pg no 55

So the answer to this question is B


Instruction:
True about allosteric inhibition is-
A. Substrates of an enzyme mediate allosteric inhibition
B. Citrate and ATP inhibiting PFK-1 is a classical example
C. The allosteric inhibitor directly binds to the active site of the enzyme
D. It is only homotropic allosteric regulation

Response:
Ans. is 'b' i.e., Citrate and ATP inhibiting PFK-1 is a classical example* Allsoteric inhibition is mediated, when a regulator binds to a site, other than the catalytic site. This site is called as allosteric site, (alio means other than). Hence the allosteric regulator never binds to the active site of an enzyme.* This binding of regulator to allosteric site brings about a change in the conformation of the enzyme.* Asa result of change in conformation of the enzyme, affinity of the enzyme for the substrate in the active site is reduced.* It is a form of heterotropic allosteric regulation. Hence allosteric inhibition is not a form of homotropic allosteric regulation.* In homotropic allosteric regulation, the substrate acts as an allosteric regulator as well. Substrates always bring about allosteric stimulation, not inhibition.* Allsoteric inhibition is most commonly an exemplification of feed back inhibition or product inhibition.* Examples for allosteric inhibition are-# Citrate and ATP inhibiting Phosphofructokinase-1 (PFK-1)* PFK-1 is the rate limiting enzyme of glycolysis* ATP and citrate are products of glycolysis* Hence the products Citrate and ATP in a feed back mechanism mediate allosteric inhibition of PFK-1

So the answer to this question is B


Instruction:
Acitomycin D interferes with enzyme induction by combining with -
A. TRNA
B. DNA
C. R-RNA
D. Repressor protein

Response:
B i.e. DNA

So the answer to this question is B


Instruction:
Mechanism of action of maraviroc:
A. Cyt P 450 inhibitor
B. GP 41 inhibitor
C. CCR5 inhibitor
D. GP 120 inhibitor

Response:
Ans. (c) CCR5 inhibitorRef: Mosby drug reference for health professionals 2015 ed / 996* Maraviroc is an anti HIV drug which comes under fusion inhibitor category.* This drug binds to the receptor and inhibits the fusion stage of virus and hence inhibits their speed of replication.* There are two types of fusion inhibitors:Drugs which bind to CCR5 receptorDrugs which bind to GP 41 receptorMaraviroc: active against CCR5 tropic virus.Enfuvirtide: prevents entry of virus into host cell.Can be given orally.Can only be given in s.c. injection form.

So the answer to this question is C


Instruction:
A 35 year old athlete has height 184 cm , arm span 194 cm, pulse rate 64/min , BP 148/64 mm Hg . Chest auscultation reveals long Diastolic murmur over right 2nd intercostal space on routine examination. The probable diagnosis is
A. Aoic regurgitation
B. Atrial septal defect
C. Ebstein anomaly
D. Coarctation of aoa

Response:
Ref Harrison 19 th ed pg 1536 Arm span greater than height is suggestive of MarfansM syndrome. Aoic regurgitation is a feature associated with Marfan's as well as consistent with a diastolic murmur is second right intercostal space.

So the answer to this question is A


Instruction:
Rests of Malassez have potential to form:
A. Epithelial tubes.
B. Epithelial Diaphragm.
C. Epithelial lining of Dental Cyst.
D. All of the Above.

Response:
Surrounding connective tissue by a basal lamina, known as the epithelial cell rests of Malassez.
In adults these epithelial cell rests persist next to the root surface within the periodontal ligament. Although apparently functionless, they are the source of the epithelial lining of dental cysts that develop in reaction to inflammation of the periodontal ligament.

So the answer to this question is C


Instruction:
A 42-year-old man complains of head¬ache when he wakes up in the morning. It lasts into the afternoon and then subsides. Headache has been present for a few months. CT scan shows a frontal lobe mass with focal areas of calcification. You strongly suspect the pa¬tient has
A. An astrocytoma
B. A pinealoma
C. A meningioma
D. An oligodendroglioma

Response:
A frontal headache when waking up in the morning and a computerized tomography (CT) scan showing a frontal lobe mass with focal areas of calcification are characteristic findings in oligodendrogliomas, which commonly involve the frontal lobe. These are tumors derived from oligodendrocytes that frequently locate in the cerebral hemispheres of adults 30 to 50 years of age. Calcifications are visible on routine skull films or CT in 90% of cases. They commonly have an admixture with other types of glial tumors, such as an astrocytoma (50%). Overall, oligodendrogliomas have a good prognosis but a high recurrence rate.

So the answer to this question is D


Instruction:
Most common site of ectopic pregnancy in fallopian tube: March 2005
A. Infundibulum
B. Ampulla
C. Isthmus
D. Interstitium

Response:
Ans. B: Ampulla The vast majority of ectopic pregnancies implant in the Fallopian tube. Pregnancies can grow in the infundibulum (18% of all ectopics), the ampullary section (55%), the isthmus (25%), and the interstitial pa of the tube (20%). Moality of a tubal pregnancy at the isthmus or within the uterus (interstitial pregnancy) is higher as there is increased vascularity that may result more likely in sudden major internal hemorrhage.

So the answer to this question is B


Instruction:
True statement regarding this fetal parameter is?
A. Best parameter for dating pregnancy
B. Can be measured till 10 weeks only
C. Accuracy for gestational age estimation is (+-) 7 to 10 days
D. Fetus is measured from head to toe

Response:
Ans. A. Best parameter for dating pregnancyCRL - Crown Rump lengtha. 1st trimester CRL is the best parameter for dating pregnancy. If carefully performed it has a variance of 3 - 5 days.b. Ideal time to perform CRL is between 7 to 10 weeks but can be done up till 14 weeks (till the embryo is 85mm long)c. The fetus is measured in the mid-sagittal plane from crown to the rump.

So the answer to this question is A


Instruction:
All are true about rheumatic fever, EXCEPT :
A. Common in poor socioeconomic group
B. Develops after streptococci pharyngitis
C. Communicable disease
D. Seen in 5- 15 year of children

Response:
Ans. is 'c' Communicable disease Rheumatic feverThe incidence of rheumatic fever has declined in developed countries while in developing countries it remains a significant problem.Etiology - Rheumatic fever is associated with infection of the Pharynx and Tonsils by Group A beta hemolytic streptococcus*.Peak age of Incidence is 5-15 years. *It is not a communicable disease.Rheumatic fever occurs as a result of immunological hypersensitivity* (type II or type III) to streptococcal antigens.

So the answer to this question is C


Instruction:
A 5 yr. old male child has multiple hyperpigmented macules over the trunk. On rubbing the lesion with rounded end of pen, he developed urticarial wheal, confined to border of lesion, most likely diagnosis is:
A. Fixed drug eruption
B. Lichen planus
C. Urticaria pigmentosa
D. Urticarial vasculitis

Response:
Ans. C. Urticaria pigmentosa* It is urticaria pigmentosa.* It is cutaneous mastocytosis presenting with pigmented lesions.* On rubbing the lesions mast cells degranulate releasing histamine.* This produces the wheal and flare of the lesion. It is known as Darier's sign.Epidermal acantholysis in mid epidermis with "dilapidated or crumbling brick wall" appearance. Darier's disease is associated with ATP2A2 defect

So the answer to this question is C


Instruction:
What is the amount of fluid to be given to a 2 year child weighing 12 Kg with severe dehydration in the first half an hour of IV rehydration?
A. 120 ml
B. 240 ml
C. 360 ml
D. 840 ml

Response:
AGE First give 30 ml/ Kg in Then give 70 ml/ Kg in Infants (< 12 months) 1 hour 5 hours Older children 30 minutes 2.5 hours In the above question, amount of fluid needed = 30 ml/ Kg x12=360 ml Ref: Park 21st edition, page 204.

So the answer to this question is C


Instruction:
Nigro protocol is for management of -
A. Rectal carcinoma
B. Anal canal carcinoma
C. Gastrinoma
D. Renal cell carcinoma

Response:
Ans. is 'b' i.e., Anal canal carcinoma * Nigro protocol includes combined radiation and chemotherapy with 5FU and mitomycin C. It is commonly used in management of anal canal carcinoma.

So the answer to this question is B


Instruction:
Commonest salivary gland to get stones :
A. Parotid
B. Submandibular
C. Minor salivary gland
D. Sublingual

Response:
Ans. is 'b' ie. Submandibular Gland [Ref. Bailey & love, 25/e p755 (24/e p. 723, 23/e. p 655)) "Eighty percent of all salivary stones occur in the submandibular gland, 10% occur in parotid, 7% in the sublingual and the remainder occurs in minor salivary glands Bailey & love 23/e

So the answer to this question is B


Instruction:
Eating disorder with normal weight is?
A. Anorexia nervosa
B. Bulimia nervosa
C. Binge eating disorder
D. None of the above

Response:
Ans. B. Bulimia nervosaAnorexia nervosa - Under weightBulimia nervosa - Normal WeightBinge eating disorder - Over weight.

So the answer to this question is B


Instruction:
A 27 year old obese woman is presenting with oligomenorrhoea, infeility and hirsuitism. What is the most likely diagnosis?
A. Polycystic ovaries
B. Endometriosis
C. Pelvic inflammatory disease
D. Turner's syndrome

Response:
PCOS is a syndrome manifested by amenorrhea, hirsuitism and obesity associated with enlarged polycystic ovaries. Patients presents with obesity, hirsuitism, oligomenorrhea or amenorrhea and infeility. Investigations reveals LH:FSH >3:1, reduced level of SHBG and sex hormone binding globulin, elevated levels of androstenedione and serum insulin level, marginally elevated levels of serum testosterone and DHEAS. Transvaginal ultrasonography shows enlarged ovary with peripherally arranged cysts. Ref: Textbook of Gynecology By DC Dutta, 4th Edition, Pages 285, 405, 421-3

So the answer to this question is A


Instruction:
Which of the following drugs is known to cause granuloma in the liver -
A. Allopurinol
B. Nifedipine
C. Tetracycline
D. Methyl testosterone

Response:
Ans. is `a' i.e., Allopurinol Drugs causing granuloma in liver - o Phenylbutazone o Allopurinol o Diltiazem o Sulfonamides o Quinidine o Carbamazepine.

So the answer to this question is A


Instruction:
Most pathognomonic sign of irreversible cell injury:
A. Amorphous densities in mitochondria
B. Swelling of the cell membrane
C. Ribosomes detached from endoplasmic reticulum
D. Clumping of nuclear chromatin

Response:
. Amorphous densities in mitochondria

So the answer to this question is A


Instruction:
Which of the following autoantibody is least likely associated with SLE
A. Anti ds- DNA
B. Anti Sm
C. Anti topoisomerase
D. Anti histone

Response:
Ref Robbins 9/e p219 Anti topoisomerase is least commonly associated with SLE amongst the given options .The following is a modified table for a reference from Robbins Autoantibody (Specificity) Major Disease Association(s) Likely Role(s) in Disease Anti-dsDNA (double-stranded DNA) SLE* Formation of immune complexes Anti-Sm (ribonuclear core protein, Sm antigen) SLE* Formation of immune complexes Anti-RNP U1 (ribonuclear protein) SLE, mixed connective tissue disease Formation of immune complexes Anti-SS-A (Ro), anti-SS-B (La) (ribonucleoproteins) Sjogren syndrome, SLE Role in Sjogren syndrome not known Anti-Scl-70 (DNA topoisomerase I) Systemic sclerosis* Unknown Anti-histones (histone proteins) SLE Formation of immune complexes Anti-centromere (centromere proteins) Limited scleroderma, systemic sclerosis* Unknown Antiphospholipid (phospholipid-protein complexes involved in blood coagulation) Antiphospholipid syndrome, SLE Thrombotic episodes Anti-Jo1 (histidyl tRNA ligase) Inflammatory myopathies* Unknown Anti-mitochondrial Primary biliary cirrhosis* Unknown Anti-eTg (transglutaminase) Dermatitis herpetiformis Unknown Anti-neutrophil cytoplasmic antibody (ANCA) (proteins in neutrophil cytoplasm) Various vasculitides* Formation of immune complexes? Neutrophil degranulation? Anti-smooth muscle Chronic autoimmune hepatitis Unknown

So the answer to this question is C


Instruction:
Kleptomania means -
A. Irresistable desire to set fire
B. Irresistable desire to steal things
C. Compulsive hair pulling
D. Pathological gambling

Response:
Ans. is 'b' i.e., Irresistabie desire to steal thing impulse control disordero These disorders are characterized by failure to resist an impulsive behavior that may be harmful to self or others.There may be a feeling of release of tension by doing the act and a feeling of guilt after the act is over. Important impulse control disorder are : -i) Pyromania (Pathological fire setting)Kleptomania (Pathological stealing)Trichotillomania (Compulsive hair pulling)Pathological gamblingIntermittent explosive disorderImpulse control disorder not otherwise specifiedOniomania (Compulsion to shop/buying)Internet compulsion (Internet addiction)Cellular or Mobile phone compulsionCompulsive sexual behavior (sexual addiction).

So the answer to this question is B


Instruction:
Grievous hurt include the following except
A. Emasculation
B. Permanent privation of hearing
C. Privation of any member/joint
D. Disability to follow one's ordinary1 pursuits for a period of a week

Response:
Ans. is 'd' i.e., Disability to follow' one's ordinary pursuits for a period of a w eek o Grievous injuries areEmasculation (cutting of the penis, castration; or causing loss of power of erection due to spinal injury ).Permanent privation of the sight of either eye.Permanent privation of the hearing of either ear.Privation of any member (part, organ, limb) or joint.Destruction or permanent impairing of powers of any member or joint.Permanent disfiguration of head or face.Fracture or dislocation of a bone or a tooth.Any hurt which endangerous life or which causes the sufferer to be, during the space of twenty days in severe bodily pain, or unable to follow his daily routine.

So the answer to this question is D


Instruction:
A 35-year-old HIV positive patient comes with intractable diarrhea, crampy, abdominal pain and vomiting. Biopsy of small intestine was taken which shows cyst <10 um as given below. What is the appropriate diagnosis?
A. CMV
B. Isospora belli
C. Cryptosporidium parvum
D. Giardia lamblia

Response:
- Kinyoun stain positive and clinical features like diarrhea in a immunocompromised individual highly suggestive of organism - Cryptosporidium parvum. - Its oocyst is of size 2-6 micron and it is pink coloured. - Cryptosporidium, microsporidia, and Isospora belli are the most common oppounistic protozoa that infect the GI tract and cause diarrhoea in HIV-infected patients. - Diarrhoea is accompanied by crampy abdominal pain, nausea and/or vomiting. - Diagnosis- stool Cryptosporidium examination or biopsy of the small intestine. - Diarrhoea is noninflammatory, and the characteristic finding is the presence of oocysts that stain with acid-fast dyes. - Treatment: - 2000 mg/d of nitazoxanide (NTZ)

So the answer to this question is C


Instruction:
Which is the enzyme responsible for adipocere formation?
A. Collagenase
B. Catalase
C. Lecithinase
D. Coagulase

Response:
Lecithinase enzyme produced by clostridium welchi is the main enzyme responsible for adipocere formation.

So the answer to this question is C


Instruction:
A Normal anion gap metabolic acidosis occurs in patients with?
A. Diabetic ketoacidosis
B. Methyl alcohol poisoning
C. Diarrhea
D. Acute kidney injury

Response:
Diarrhea and Renal tubular acidosis (A) are two impoant causes of normal anion gap metabolic acidosis.

So the answer to this question is C


Instruction:
'Bear-Claw' appearance on CECT abdomen is seen in:
A. Hepatic laceration
B. Pancreatic laceration
C. HCC
D. RCC

Response:
HEPATIC INJURY MC organ injured in blunt abdominal trauma: Spleen> liver. Most liver injury bleeding is venous, and therefore low pressure, tamponade is readily performed. Diagnosis Unstable patient explored for the finding of free fluid on FAST examination. Stable patient - CECT abdomen. Bear claw laceration: Multiple Linear laceration of liver on CECT .

So the answer to this question is A


Instruction:
Antihypeensive which can be used in gout, with diabetes mellitus is -
A. Thiazide
B. Enalapril
C. Propranolol
D. Diazoxide

Response:
Ans. is 'b' i.e., Enalapril o ACE inhibitors (enalapril) are the most appropriate antihypeensive in patients having DM and gout.

So the answer to this question is B


Instruction:
Resistance to isoniazid, the likely mechanism for resistance is
A. b-Lactamase
B. Mutations in the katG gene
C. Alterations in the rpoB gene
D. Mutations in the DNA gyrase gene

Response:
Strains of M. tuberculosis resistant to individual drugs arise by spontaneous point mutations in the mycobacterial genome that occur at low but predictable rates (10-7-10-10for the key drugs). Resistance to rifampin is associated with mutations in the rpoB gene in 95% of cases; That to isoniazid with mutations mainly in the katG (50-95% of cases) and inhA (up to 45%) genes; That to pyrazinamide in the pncAgene (up to 98%); That to ethambutol in the embB gene (50-65%). Because there is no cross-resistance among the commonly used drugs, the probability that a strain will be resistant to two drugs is the product of the probabilities of resistance to each drug and thus is low.

So the answer to this question is B


Instruction:
Which of the following is the presenting symptom of fallopian tube carcinoma :
A. Watery discharge per vaginum
B. Haemorrhage
C. Pain
D. Sepsis

Response:
Fallopian tube carcinoma: The tumour occurs in menopausal women, 50% of them are nulliparous. The early symptom is a watery discharge per vaginum, which may at times be amber-coloured. Sooner or later, postmenopausal bleeding develops. A lump may be too small to be felt on clinical examination. Pain is a late symptom Reference : Shaw's Textbook of Gynaecology 16th edition page no 519

So the answer to this question is A


Instruction:
MC gene involved in endometrial carcinoma
A. PTEN
B. BRAF
C. KRAS
D. Mismatch repair genes

Response:
PTEN - Phosphatase & tensin homologue Cowden syndrome - AD disorder with tumours of skin appendages & increased incidence of Breast, Endometrium, Prostate & thyroid cancer Acts as TSG by serving as a break in the pro-growth PI3K/AKT pathway (MCly mutated p/w in human ca) By phosphorylating a number of substrates like BAD and MDM2, AKT enhances cell survival.

So the answer to this question is A


Instruction:
Amyloidosis mostly affects
A. Liver
B. Tounge
C. Colon
D. Hea

Response:
Hea. Amyloidosis of the hea may occur either as iso- lated organ involvement or as pa of a systemic distribution. When accompanied by systemic involvement, it is usually of the AL form. The isolated form (senile amyloidosis) usually is confined to older persons. The deposits may not be evident on gross examination, or they may cause minimal to moder- ate cardiac enlargement. The most characteristic gross find- ings are gray-pink, dewdrop-like subendocardial elevations, paicularly evident in the atrial chambers. On histologic examination, deposits typically are found throughout the myocardium, beginning between myocardial fibers and eventually causing their pressure atrophy Ref Robbins 9/e pg 157

So the answer to this question is D


Instruction:
Which MRI sequence is best suited for this lesion?
A. T2W
B. Chemical shift imaging MRI
C. DWI
D. D STIR

Response:
Ans. B. Chemical shift Imaging MRI* This is a post contrast axial CT scan of the upper abdomen which shows a mildly enhancing lesion in right adrenal.* This lesion could be an adenoma; however, the other differentials include serious entities like metastases or carcinomas.* Differentiating between them is vital and more emphasis is on imaging as adrenals are small retroperitoneal organs which are surrounded by vascular structure thus obtaining an image guided biopsy becomes difficult.* There are various techniques used to differentiate between them, one of which is in and out phase imaging which is based on the premise that adrenal adenomas are rich in their lipid contents whereas other lesions like carcinoma and metastases are lipid poor.* The characterization of a lesion as an adenoma relies on the ratio of a decreased relative signal intensity from in phase to opposed phase images and the ratio of adrenal mass and various organs on T2-weighted and chemical shift images. Sometimes at the interface of water and fat the adenoma can give rise to dark bands - India ink artefacts.* Other commonly used indices include the relative and absolute washout values of CT scan which used HU values of CT of same area in unenhanced, enhanced and delayed scans.

So the answer to this question is B


Instruction:
In pelvis fracture, the amount of blood loss is around?
A. 1-4 units
B. 2-4 units
C. 2-6 units
D. 4-8 units

Response:
In pelvic fracture intrapelvic haemorrhage is by far, the most serious complication. Haemorrhage frequently results from fracture surfaces and small vessels in the retroperitoneum. Amount of blood loss is around 4-8 units. It must be emphasised, however, that these cases may need transfusion of very large quantities of blood. It is not uncommon for the amount of blood transfused to be in excess of the patient's total blood volume. In case of hemodynamic instability, an external fixator should be applied immediately to decrease motion at fracture sites as well as to decrease pelvic volume and generate tamponade of the pelvic venous plexus. Ref: Rockwood & Green's fracture in Adults 6/e, Page 1600-04; Watson Jones: Fracture & Joint Injuries 6/e, Page 866; Campbell's Operative Ohopedics 10/e, Page 2962-63.

So the answer to this question is D


Instruction:
The pharyngeal diverticulum is a protustion of mucosa between-
A. The two parts of inferior constrictor musice of the pharynx
B. The two parts of middle constrictor musice of the pharynx
C. The two parts of the superior constrictor muscle of the pharynx
D. Cricopharyngeal and posterior part o suprahyoid membrane

Response:
None

So the answer to this question is A


Instruction:
Action of cholecystokinin include all of the following except:
A. Contraction of gall bladder
B. Secretion of pancreatic juice rich in enzymes
C. Increases the secretion of enterokinase
D. Stimulated gastric emptying

Response:
Ans. D. Stimulated gastric emptying(1) Distribution: -a. CCK8 and CCK12 - secreted by duodenum and duodenum.b. CCK-4 - by enteric nerves and pancreatic nervesc. CCK58 and CCK8 - found in brain ~ especially in cerebral cortex, where involved in the regulation of food intake, anxiety and analgesia.(2) Function of CCK: -a. Contraction of gall bladderb. Secretion of the pancreatic juice rich in enzymec. Augments the action of secretin producing secretion an alkaline pancreatic juice.d. Inhibits gastric emptyinge. Exerts a trophic effect on the pancreas,f. Increases the secretion of enterokinaseg. Enhance the motility of the small intestine.h. Augments the contraction of pyloric sphincteri. CCK and gastrin - stimulate glucagon secretion.3) Secretion of CCK is increased by: -a. Contact of the intestinal mucosa with the products of digestion particularly peptides, and amino acidsb. By the presence of fatty acids containing more than 10 carbon atoms in duodenum.

So the answer to this question is D


Instruction:
Treatment of congenital ptosis with poor elevation is
A. Levator resection
B. Frontalis sling
C. FS operation
D. None of the

Response:
Ans. is 'b' i.e., Frontalis sling Surgeries for ptosis Depending upon the LPS action, three main types of techniques are available. If levator action is good :- LPS is shoened, i.e, resection of LPS. The operations are Blaskovics operation, Everbusch operation and Fasanella - servat operation. Fasanella - servat operation is indicated in Homer syndrome. If LPS is paralysed Superior rectus muscle is used to lift the lid. The operation is called Motais operation. If both LPS and superior rectus are paralysed Frontalis sling/suspension operation (Hess's operation) is done. It is indicated in Marcus Gunn jaw winking syndrome, blepharophimosis syndrome, total 3rd nerve palsy, Aberrant regeneration of Yd nerve.

So the answer to this question is B


Instruction:
All of the following may be causes of precocious puberty in girls except –
A. Hypothalamic harnartoma
B. Mc Cuone Albright syndrome
C. Granulosa cell tumor of human ovary
D. Congential 21–α hydroxylase deficiency

Response:
Congenital 21 hydroxylase deficiency causes precocious puberty in male due to excess of androgens.
In female, it results in virilization.

So the answer to this question is D


Instruction:
Laser Endometrial ablation is done in abnormal uterine bleeding in all cases except
A. Women not preferring surgery
B. Small uterine fibroids
C. Women preferring reproductive function
D. Failed medical treatment

Response:
Females who desire future pregnancy should not be offered endometrial ablation for AUB.

So the answer to this question is C


Instruction:
The "gp 120" in HIV helps in:
A. Virus attachment
B. Virus replication
C. Virus penetration
D. Virus dissemination

Response:
Virus attachment

So the answer to this question is A


Instruction:
Most definitive diagnosis of sinusitis is by
A. X- ray PNS
B. Proof puncture
C. Sinuscopy
D. Transillumination test

Response:
Sinuscopy is a method of Endoscopic sinus observation or surgery using Nose telescope. It involves the evaluation of nasal and sinus passages using the endoscope called Sinuscope. The Sinuscope has a narrow tube with a built-in camera so that the physician can see the internal details of the sinuses. By observing the sinus, it is possible to diagnose the problems and treat properly.

So the answer to this question is C


Instruction:
A 40 year old patient it comes with right upper quadrant pain from last 48 hours. Ultrasound reveals calculous cholecystitis. What is the preferred treatment
A. cholecystectomy
B. Antibiotics alone
C. Antibiotics and interval cholecystectomy
D. Analgesics

Response:
If symptomatic cholecystitis patients comes within 72 hours emergency cholecystectomy is preferred.
If patient comes late then interval cholecystectomy is done after 6 weeks.

So the answer to this question is A


Instruction:
All are true about Menetrier's disease except:
A. Protein loss
B. Hyperchlorhydria
C. Cobblestone appearance of mucosa
D. Associated with CMV and H. pylori

Response:
Ans. (b) HyperchlorhydriaRef: Sabiston 19th Edition, Page 1222Infections causing Menetrier's Disease:* CMV in children* H. pylori in adults

So the answer to this question is B


Instruction:
Fasciculations are seen in:
A. Motor neuron disease
B. Duchenne's muscular dystrophy
C. Polymyositis
D. None of the above

Response:
Answer is A (Motor neuron disease): Fasciculation is a visible or palpable twitch within a single muscle due to spontaneous discharge of one motor unit. Disease of motor neurons are associated with fasciculations' - Harrison's

So the answer to this question is A


Instruction:
Renshaw inhibition
A. Feedback facilitation
B. Feed forward inhibition
C. Feed forward facilitation
D. Feedback inhibition

Response:
The feedback inhibition, also known as Renshaw cell inhibition, is known to occur in spinal alpha motor neurons through an inhibitory inter-neuron. In feedback inhibition, a neuron inhibits that very neuron (s) that excite it. In this way, firing of an action potential by a motor neuron of the spinal cord is followed by a phase of hyperpolarization (inhibition) of not only the same motor neuron but also many others in the neighborhood. The feedback inhibition is thus basically a post-synaptic inhibition but is classified separately because the inhibitor Renshaw cells are activated by collateral of the ventral horn cell rather an afferent neuron. This type of feedback inhibition is also seen in other pas of CNS as well. It serves to limit the excitability of the motor neurons. Ref: guyton and hall textbook of medical physiology 12 edition page number: 677,678,679

So the answer to this question is D


Instruction:
Brown macular pigmentation in the malar area in a pregnant female is due to -
A. Acne rosacea
B. Chloasma
C. Acanthosis nigricans
D. Urticaria pigmentosa

Response:
Ans. is 'b' i.e., Chloasma Chloasma (Melasma) o Melasma (Chlosma) is the most common cause for facial pigmentation in Indian patients. There is Brown macular pigmentation on the malar area of face, forehead and sometimes chin. It usually affects young and middle-aged women. When melasma results from pregnancy it is referred as chloasma. o Two major etiological factors are : - Hormonal (estrogen) - Appears in pregnancy or in person on OCPs. Sun exposure - Especially UVB. o For treatment - Combination of topical hydroquinone (2-4%), retinoic acid and topical corticosteroids. Other drugs are - Glycolic acid (4-10%), Azelaic acid, topical vitamin C.

So the answer to this question is B


Instruction:
What procedure was most recently performed on this patient?
A. Mitral-valve repair
B. Pancreatectomy
C. Roux-en-Y gastric bypass
D. Thyroidectomy

Response:
Answer A. Mitral-valve repairThe peripheral-blood smear showed schistocytes, spherocytes, and polychromasia suggestive of hemolytic anemia. Following mitral-valve repair, some patterns of the regurgitant flow disturbances associated with high shear stress are responsible for the hemolysis. Transesophageal echocardiography in this patient showed a jet of mild transvalvular mitral regurgitation. The hemolysis resolved after mitral-valve replacement.

So the answer to this question is A


Instruction:
Which of the following is not an incision in autopsy?
A. I - shaped incision
B. Y - shaped incision
C. Modified Y - shaped incision
D. J - shaped incision

Response:
Ans. is 'd' i.e., J - shaped incision * Types of primary skin incisions of autopsy are1) I-shaped incision : Extending from the chin straight down to symphysis, passing to the side the umbilicus.2) Y-shaped incision: Begins close to acromion process and then extends down below the breast across to xiphoid process from where it is carried downwards to the symplysis pubis.3) Modified Y-shaped incision rlncision is made from suprasternal notch to symphysis pubis. The incision extendsfrom suprasternal notch over the clavicle to its center on both sides and then passes upwards over the neck behind the ear.

So the answer to this question is D


Instruction:
Which of the following drug is used for reversal of cerebral vasospasm and infarct following subarachnoid hemorrhage?
A. Nimodipine
B. Amlodipine
C. Diltiazem
D. Verapamil

Response:
Calcium Channel Blockers (CCBs) These are the drugs that block L-type of voltage gated calcium channels present in blood vessels and hea. Three groups of CCBs include phenylalkylamines (verapamil, nor-verapamil), benzothiazepines (diltiazem) dihydropyridines (nifedipine, nicardipine, nimodipine, nisoldipine, nitrendipine, isradipine, lacidipine, felodipine and amlodipine). By inhibiting the calcium channels, these agents result in vasodilation and decreased activity of the hea (decrease hea rate, AV conduction and contractility). Dihydropyridine (DHP) group has little direct cardiac activity and acts mainly on blood vessels, therefore are also called peripherally acting CCBs. Verapamil and diltiazem have strong direct cardiodepressant (verapamil > diltiazem) activity. CCBs tend to cause reflex tachycardia (because of their vasodilatory action), which is nullified by the direct depressant action on the hea (except DHPs). Nicardipine is longest acting parenteral calcium channel blocker and is drug of choice for hypeensive emergencies. It is combined with beta blockers to avoid tachycardia. Nimodipine is a relatively cerebro-selective vasodilator, thus used to reverse the compensatory vasoconstriction after sub-arachnoid hemorrhage. Verapamil has maximum depressant action on the hea and it causes vasodilation by causing blockade of calcium channel. It is indicated for the treatment of angina, PSVT, hypeension and hyperophic obstructive cardiomyopathy (HOCM). Diltiazem has lesser effect on the hea than verapamil and is also indicated for these conditions. CCBs are especially suitable for elderly patients, patients with low renin hypeension, patients with diseases like asthma, migraine or peripheral vascular disease and in cases of isolated systolic hypeension. DHPs are safe in pregnancy. CCBs (verapamil and diltiazem) should be avoided in conditions involving decreased conductivity of the hea like sick sinus syndrome, CHF and along with beta blockers (both cause myocardial depression). Clevidipine is an ultrasho acting DHP, recently approved for hypeensive emergencies.

So the answer to this question is A


Instruction:
All of the following factors fascilitate non union except:
A. Haematoma formation
B. Periosteal injuries
C. Absence of nerve supply
D. Chronic infection

Response:
A i.e. Hematoma formation Fracture healing process passes through several stages. In which the, first is stage of hematoma formationQ and the last is stage of remodelingQ Fracture Healing Bone is a unique tissue because it heals by the formation of normal bone, as opposed to scar tissue. Infact it is considered a nonunion when a bone heals by fibroblastic response. The majority of fractures heal by secondary (callus) healing through a combination of intramembranous - ossification (hard callus formation) & endochondral ossificaion (soft callus formation). Bone healing can be divided into following phases depending on the biological events. * There are two sources of repair tissues (callus), medullary & periosteal. The former is most marked in cancellous hone, while the later predominates in diaphyseal fracture. Periosteal callus may be of two types - primary callus (from DOPC) & external bridging callus (from IOPC), its appearance is inhibited by rigid fixation as plate and is predominant form of healing in cast immobilization &intramedullary nailing. (i.e. micromovements present) * Late medullary callus is more dependent on intramedullary vascularity (not on external soft trissue) and is impoant in fractures immobilized by rigid plating (i.e. no micrmovements)* Phenomenon of Creeping Substitution occurs in cancellous bone (i.e. blood vessels invading the trabeculae of bone directly causing bone apposition)* The modification of previously undifferentiated soft tissue cells in to osteogenic cells (IOPC) is termed bone induction.

So the answer to this question is A


Instruction:
Which one of the following conditions is associated with an exudative pleural effusion?
A. Cirrhosis
B. Nephrotic syndrome
C. Congestive hea failure
D. Bronchogenic carcinoma

Response:
Among the options given bronchogenic carcinoma is associated with exudative effusion. Exudative pleural effusions are distinguished from transudative by measuring the lactate dehydrogenase (LDH) and protein levels in the pleural fluid. Exudative pleural effusion is diagnosed by the presence of one or more of the following criteria: 1. Pleural fluid protein/serum protein >0.5 2. Pleural fluid LDH/serum LDH >0.6 3. Pleural fluid LDH more than two-thirds normal upper limit for serum Ref: Harrison's Internal Medicine, 18th Edition, Chapter 263

So the answer to this question is D


Instruction:
A 30 year old male presented with insidious onset of diarrhea, steatorrhea, abdominal pain, weight loss, migratory large joint ahropathy, fever and dementia. The most probable diagnosis is:
A. Chronic calcific pancreatitis
B. Whipple's disease
C. Tropical sprue
D. Celiac sprue

Response:
Whipple's disease is a chronic multisystem disease caused by tropheryma whipplei bacteria. Dementia is a late symptom. Diagnosed by PAS positive macrophages in small intestinal biopsy. DOC is double strength trimethoprim / sulfamethoxazole. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2479

So the answer to this question is B


Instruction:
All about warfarin are true EXCEPT?
A. Half-life is 36 hours
B. Crosses placenta
C. Contraindicated in hepatic failure
D. Inhibits all vitamin K dependent clotting factors

Response:
Ans. is 'c' i.e., Contraindicated in hepatic failure o Liver disease requires dose reduction, but is not a contraindication. Effect of liver disease on warfarin o In liver diseases the dose of oral anticoagulats needs to be decreased because in liver disease the hepatic synthesis of clotting factors is reduced. o Thus there is already a deficiency of clotting factors (i.e. there is preexisting anticoagulant state). o Administration of warfarin is this state increases the risk of bleeding. About other options o Warfarin is an indirectly acting anticoagulant, i.e. it inhibits vitamin K which in turn inhibits coagulation factors. o T1/2 of warfarin is 36 hrs. o Warfarin can cross placenta and cause fetal warfarin syndrome. Therefore it is contraindicated pregnancy. Patient is switched to heparin from warfarin during pregnancy.

So the answer to this question is C


Instruction:
Most common cause of hyponatremia in surgical practice
A. Small intestinal obstruction
B. Duodenal fistula
C. Pancreatic fistula
D. Intussuception

Response:
Ans. a (Small intestinal obstruction) (Ref. Bailey and Love Short textbook of surgery 24th ed., p 56)The most frequent cause of sodium depletion in surgical practice is obstruction of the small intestine.SODIUM BALANCE# Sodium is the principal cation content of the extracellular fluid.# On average it is 1 mmol/kg sodium chloride or 500 mL of isotonic 0.9 % saline solution. An equivalent amount is excreted daily, mainly in the urine and some in the faeces.Sodium Depletion (syn.Hyponatremia)Etiology# Small intestinal obstruction (most frequent cause in surgical practice).# Duodenal, total biliary, pancreatic and high intestinal external fistulae.# Severe diarrhea will cause hyponatremia with acidosis.# Hyponatremia with elevated potassium would suggest adrenocortical insufficiency.# SIADH.Potassium Depletion# It occurs most frequently in diabetic coma treated by insulin and prolonged infusion of saline solution.# Diuretics.# The diarrhoea from ulcerative colitis, villous tumours of the rectum and the loss from external fistulae of the alimentary tract are also common causes (e.g., duodenal fistula, ileostomy);Clinical features# risk of cardiac arrhythmias.# Symptoms of severe hypokalemia include listlessness and slurred speech, muscular hypotonia, depressed reflexes and abdominal distension as a result of a paralytic ileus.# ECG:Prolonged QT interval, depression of ST segment and flattening or inversion of the T-wave.Rx# Oral potassium. Potassium can be given in the form of milk, meat extracts, fruit juices and honey. However, in hospital practice, effervescent tablets of potassium chloride 2 g can be given by mouth 6-hourly.# IV potassium. Rapid IV supplementation (especially when renal function is impaired) carries the risk of dysrhythmias and cardiac arrest if the serum concentration rises to a dangerous level.# When there is no associated alkalosis, potassium deficit can be restored by adding 40 mmol KCL to each litre of 5% glucose, glucose-saline or 0.9 % saline solution, given 6-8-hrly.Sodium Excess (syn. Hypernatremia)Etiology# excessive amount of 0.9% saline solution given intravenously during the early postoperative period.Clinical Features# Slight puffiness of the face is the only early sign.POTASSIUM BALANCE# Potassium is almost entirely intracellular.# No less than 98% is intracellular, and only 2% is present in the extracellular fluid.# Three-quarters of the total body potassium (approximately 3500 mmol) is found in skeletal muscles.

So the answer to this question is A


Instruction:
In which of the following patient, there is 10-20 fold increased risk of leukemia during infancy?
A. Pierre Robin syndrome
B. Fragile X syndrome
C. Down syndrome
D. None

Response:
Children suffering from Down Syndrome

These children (10%) are mentally retarded moderate to severe and require appropriate treatment.
Incidence of cardiac disease associated with Down syndrome is 40% and will require adequate prophylaxis.
Increased incidence of leukemia and acute and chronic infections of the upper respiratory tract can also alter treatment.
Children are generally affectionate and cooperative and present no special problems during management.
Nitrous oxide analgesia or TSD in mildly apprehensive patients can be used; general anesthesia in severe resistance to dental treatment.
Preventive procedures along with chlorhexidine mouthwash may be beneficial.
Pulp treatment in deciduous teeth are contraindicated in patients with cardiac problems because of the risk of bacteremia, whereas in permanent teeth, it can be considered if an adequate apical seal can be obtained.

Key Concept

Increased incidence of leukemia and acute and chronic infections of the upper respiratory tract can also alter treatment.
There are 10-20 times increased risk of leukemia in infants suffering from Down syndrome.

Pediatric Dentistry / Shobha Tandon - 2nd Ed  P: 541

So the answer to this question is C


Instruction:
Which is the stage of sleep in which we spend maximum time?
A. Stage N1
B. Stage N2
C. Stage N3
D. REM

Response:
Ans. B. Stage N2Sleep is scored in epochs of 30 seconds, with stages of sleep defined by visual scoring of 3 parameters: electroencephalogram (EEG), electrooculogram (EOG) & electromyogram (EMG) recorded beneath chin.1. NREM:* Stage 1: 1st stage, light sleep, loss of alpha waves (eyes closed but awake) and predominant theta waves* Stage 2: maximum time spent. Findings in EEG include- Sleep spindles: bursts of waves of frequency of 11-16Hz- K-complexes: high voltage spikes, negative sharp waves followed by positive waves* Stage 3: Deepening of sleep, appearance of delta waves.* Stage 4: Deep sleep characterized by delta waves- New NREM stages: N1 (stage 1), N2 (stage 2), N3 (stage 3+4)2. REM sleep: (aka paradoxical sleep)* EEG: beta wave (similar to awake state), alpha wave

So the answer to this question is B


Instruction:
Drug of choice for prophylaxis of Mania is
A. Diazepam
B. Lithium
C. Haloperidol
D. Fluoxetin

Response:
B i.e. Lithium Condition Drug of choice Acute mania Prophylaxis of bipolar disorder Lithium (Li)Q LiQ Rapid cyclers ValproateQ or Li & L-T3 > Carbamazepine

So the answer to this question is B


Instruction:
Gastrin is produced by
A. Greater sac
B. Lesser sac
C. First part of the duodenum
D. Pyloric antrum

Response:
D. i.e. (Pyloric antrum) (443-Ganong 23rd) (484 - Ganong 22nd)* GASTRIN - is produced by cells called G-cells in the lateral walls of the glands in the antral portion of the gastric mucosa. It is polypeptide** containing* G-14, G-17 or G-34 amino acids. Found in pituitary gland, hypothalamus, medulla oblongata, vagus and sciatic nerves* SECRETIN is produced by S. cells of mucus membrane in duodenum and jejunum Stimuli that Increases gastrin secretion (a) luminal peptides and amino acids, Distension (b) Neural- increased vagal discharge via GRD (c) blood borne - calcium, Epinephrine Stimuli that inhibit gastrin secretion (a) Luminal acid, somatostatin** (b) Blood borne - secretin** GIP,VIP Glucagon**, Calcitonin* GASTRINOMA are gastrin producing tumours which can occur in stomach or duodenum or pancreatic tumour of d cells (Zollinger- Ellision Syndrome). These tumours secrete large amounts of gastrin which causes excessive secretion of HC1 and predisposes to peptic ulcer.

So the answer to this question is D


Instruction:
Patient is diagnosed with BPH. Which of the following drug provides symptomatic relief?
A. Terazosin
B. Desmopressin
C. Finasteride
D. Sildenafil

Response:
Ans. A. TerazosinSelective Alpha 1 blocker provide symptomatic relief but do not effect the disease .5 alpha reductase like finasteride slow the disease progression.

So the answer to this question is A


Instruction:
Thanatology is the science that deals with :
A. Death in all its aspects
B. Solving paternity of the child
C. Identification of the living
D. Detection of lie

Response:
Ans. is 'a' ie death in all its aspects. Reddy writes- "Thanatology deals with death in all its aspects"

So the answer to this question is A


Instruction:
Carcinoma of buccal mucosa commonly drain to the following lymph nodes sites -
A. Submental
B. Submandibular
C. Supraclavicular
D. Cervical

Response:
Nodal involvement occurs in 50% cases of tumors of buccal mucosa.
Most common lymph node involved : Submandibular lymph nodes.

So the answer to this question is B


Instruction:
Which of the following is seen in Addison's disease: September 2007
A. Hypernatremia
B. Hypokalemia
C. Hyperglycemia
D. Hypercalcemia

Response:
Ans. D: Hypercalcemia Routine investigations in Addison disease may show: Hypercalcemia Hypoglycemia, low blood sugar (worse in children due to loss of glucocoicoid's glucogenic effects) Hyponatraemia due to loss of production of the hormone aldosterone Hyperkalemia due to loss of production of the hormone aldosterone Eosinophilia and lymphocytosis Metabolic acidosis (increased blood acidity), also due to loss of the hormone aldosterone because sodium reabsorption in the distal tubule is linked with acid/hydrogen ion (H+) secretion. Low levels of aldosterone stimulation of the renal distal tubule leads to sodium wasting in the urine and H+ retention in the serum. In suspected cases of Addison's disease, one needs to demonstrate that adrenal hormone levels are low even after appropriate stimulation (called the ACTH stimulation test) with synthetic pituitary ACTH hormone tetracosactide .

So the answer to this question is D


Instruction:
Puerperal sepsis/infection occurs up to?
A. 1 week
B. 2 week
C. 3 week
D. 4 week

Response:
Ans- B 2 week PUERPERAL SEPSIS DEFINITION Puerperal sepsis is any bacterial infection of the genital tract which occurs after the birth of a baby. It is usually more than 24 hours after delivery before the symptoms and signs appear. Some of the most common bacteria are: streptococci staphylococci escherichia coli (E.coli) clostridium tetani clostridium welchii chlamydia gonococci SYMPTOMS AND SIGNS are fever (temperature of 38degC or more) chills and general malaise lower abdominal pain tender uterus subinvolution of the uterus purulent, foul-smelling lochia. light vaginal bleeding shock. RISK FACTORS Some women are more vulnerable to puerperal sepsis, including anaemia and/or malnourished, protracted labour, prolonged rupture of the membranes, frequent vaginal examinations, a traumatic delivery, caesarean section and retained placental fragments, PPH, diabetes all predispose to puerperal infection. SITES The most common site of infection in puerperal sepsis is the placental site. Other sites of infection are abdominal and perineal wounds following surgery and lacerations of the genital tract, e.g. cervix, vagina and perineum. Following delivery, puerperal sepsis may be localized in the perineum, vagina, cervix or uterus. Infection of the uterus can spread rapidly if due to virulent organisms, or if the mother's resistance is impaired. It can extend beyond the uterus to involve the fallopian tubes and ovaries, to the pelvic cellular tissue causing parametritis , to the pelvic peritoneum, causing peritonitis , and into the blood stream causing septicaemia DIFFERENTIAL DIAGNOSIS Fever in the puerperium can also be caused by: urinary tract infection (acute pyelonephritis) wound infection (e.g. scar of caesarean section) mastitis or breast abscess thrombo-embolic disorders, e.g. thrombophlebitis or deep vein thrombosis respiratory tract infections

So the answer to this question is B


Instruction:
100% recurrence of disease in Down's syndrome
A. Translocation of 15 + 21 chromsome
B. Mosaic pattern
C. Trisomy - (21, 21 translocation)
D. Non Dysjunction

Response:
100% recurrence of disease in Down's syndrome is due to balanced translocation (21 : 21).

So the answer to this question is C


Instruction:
Kviem siltzbach test is used in the diagnosis of
A. Tuberculosis
B. Sarcoidosis
C. Histoplasmosis
D. Leishmaniasis

Response:
Ans. is'b'i.e., Sarcoidosis Kveim-Siltzbath skin test It is a useful intradermal diagnostic test The antigen is prepared from involved lymph node or spleen is injected intradermally In a positive test, nodular lesions appears in 3-6 weeks at the inoculation site, which on microscopic examination shows presence of noncaseating granulomas (sarcoidosis like lesions) The kviem siltzbath material is no longer available and with the use of transbronchial biopsy to obtain lung parenchvm for diagnostic purposes, the kviem siltzbath test is only of historic interest. Laboratory anomalies Common abnormalities in the blood include Lymphocytopenia, mild eosinophilia Increased E.S.R., hyperglobulinemia Elevated level of ACE False positive tests for rheumatoid factor or ANA's Hypercalccmia or an elevated 24 hr urine calcium level The lung function abriormalties of sarcoidosis are typical for interstitial Lung diseaseQ and include decreased lung volumes with and diffusing capacity with a normal or supernormal ratio of the forced expiratory volume in is to the forced vital capacity. Also know Sarcoidosis of the lung is primarily an interstitial lung disease in which the inflammatory process involves the alveoli, small bronchi and small blood vessesls. Pleura is involved in 1-5% of cases almost always manifesting as unilateral pleural effitsionso. The effusions usually clear within a few week. Pneumothorax of hydropneumothorax is observed in sarcoidosis but is very rare.

So the answer to this question is B


Instruction:
In antral lavage, approach is through
A. Medial wall
B. Roof
C. Posterior wall
D. Canine fossa

Response:
This procedure involves puncturing the medial wall of maxillary sinus in the region of inferior meatus and irrigating the sinus. Antral Puncture- Ref- Dhingra, 6th edition, page 408.

So the answer to this question is A


Instruction:
Koplik spots are pathognomic of ?
A. Measles
B. Diphtheria
C. Donovanosis
D. Gonorrhoea

Response:
Ans. is 'a' i.e., Measles Koplik spots Koplik spots, the pathognomonic enanthem of measles, begin as small, bright red macules that have a 1-2-mm blue- white speck within them. They are typically seen on the buccal mucosa near the second molars in 1-2 days before and lasting 2 days after the onset of the rash.

So the answer to this question is A


Instruction:
Which among the following is considered as a hallmark of the fibrogenic repair:
A. Granulation tissue
B. Neovascularization
C. Neutrophilic infiltration
D. All of the above

Response:
Granulation tissue is the hallmark of the fibrogenic repair.

So the answer to this question is A


Instruction:
In-situ DNA nick end labeling can quantitate
A. Fraction of cells in apoptotic pathways
B. Fraction of cells in S phase
C. p53 gene product
D. bcr/abl gene

Response:
In situ DNA nick end – labeling is an in-situ method for detecting areas of DNA which are nicked during apoptosis.
Terminal deoxynucleotidyl transferase mediated dUTP–biotin nick end labeling (TUNEL) is a method for detecting apoptotic cells that exhibit DNA fragmentation.

So the answer to this question is A


Instruction:
Tachypnea in a 4-month-old child is respiratory rate more than
A. 30/min
B. 40/min
C. 50/min
D. 60/min

Response:
Ans, c (50/min). (Ref Nelson, 17th ed., 280) AgeHR (per min)BP (mm Hg)RR (per min)1Premature120-17055-75/35-4540-7020-3 months100-15065-85/45-5535-5533-6 months90-12070-90/50-6530-4546-12 months80-12080-100/55-6525-4051-3 years70-11090-105/55-7020-3063-6 years65-11095-110/60-7520-2576-12 years60-95100-120/60-7514-22812 years55-85110-135/65-8512-10

So the answer to this question is C


Instruction:
Natural killer cell is:
A. MHC restricted
B. Antibody dependent
C. Null cells
D. B-lymphocytes

Response:
Ans. c. Null cells

So the answer to this question is C


Instruction:
The dual cure cements should not be used with light transmitting prostheses thicker than:
A. 1.0 mm
B. 1.5 mm
C. 2.0 mm
D. 2.5 mm

Response:
Dual-cure cements require mixing similar to that for the chemical-cure systems. Static mixing and trituration of capsules have largely replaced the need for hand mixing.
Curing proceeds slowly until the cement is exposed to the curing light, at which point the cement hardens rapidly. These dual-cure cements should not be used with light-transmitting prostheses thicker than 2.5 mm; anything thicker than 2.5 mm should be bonded with chemical-cure cement.
Removal of excess cement may be performed after seating or after waiting for a specific period as indicated in the manufacturer’s directions for use.

Ref: Phillip’s 12th edition page 330

So the answer to this question is D


Instruction:
Classical Meig syndrome is associated with which of the following ovarian tumour :
A. Fibroma
B. Serous cystadenoma
C. Thecoma
D. Endometroid tumour

Response:
Fibroma

So the answer to this question is A


Instruction:
Chronic Burrowing ulcer is caused by
A. Microaerophilic streptococci
B. Peptostreptococcus
C. Streptococcus viridans
D. Streptococcus pyogenes

Response:
Microaerophilic streptococci (Burrowing ulcer / Maleny's ulcer is caused by synergistic infection of microaerophilic non hemolytic streptococci and aerobic hemolytic streptococci)

So the answer to this question is A


Instruction:
In case of malpractice punishment is given by :
A. State medical council
B. MCI
C. IMA
D. High cou

Response:
D i.e. High cou

So the answer to this question is D


Instruction:
Mechanism of action Tianeptin in the brain is -
A. Selective scrotonin reuptake inhibition
B. Selective norepinephrine reuptake inhibition
C. Selective serotonin reuptake enchancer
D. Selective dopamine reuptake inhibition

Response:
Ans. is 'c' i.e., Selective serotonin reuptake enhancer o Tianeptine is an atypical antidepressant. o It increases the uptake of serotonin (Action opposite to SSRI).

So the answer to this question is C


Instruction:
A women is diagnosed to have breast carcinoma, the other breast requires-
A. Random FNAC
B. No investigation
C. Mammography
D. Clinical breast examination

Response:
Ans. is 'c' i.e., Mammography o Annual screening mammography is recommended for patients writh personal H o DCIS or invasive cancer in one breast irrespective of age.

So the answer to this question is C


Instruction:
Second most common malignancy in a patient with retinoblastoma is:
A. Nephroblastoma
B. Osteosarcoma
C. Neuroblastoma
D. Craniopharyngioma

Response:
Retinoblastoma: It is the most common primary intraocular malignancy of childhood. The mutation occurs in the retinoblastoma gene (Rb) at chromosome 13q14. This is a tumor suppressor gene. One mutated copy may be inherited in an autosomal dominant fashion (germline mutation). If a second mutation spontaneously occurs in any cell, tumorigenesis is likely. Individuals with a germinal mutation are at risk for the development of tumors other than retinoblastoma (pineal tumors, osteosarcoma, and other soft tissue sarcomas). Ref: Braverman R.S. (2012). Chapter 16. Eye. 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:
Which of the following pa of the ear is most commonly involved in otosclerosis?
A. Oval window
B. Round window
C. Tympanic membrane
D. Malleus

Response:
While otosclerosis may potentially involve any pa of the bony labyrinth, it carries a distinct predilection for the region near the anterior border of the oval window (fissula ante fenestram).

So the answer to this question is A


Instruction:
Pasteurized milk is most commonly tested by
A. Phosphatase test
B. Standard plate count
C. Coliform Count
D. Holder method

Response:
Phosphatase test - widely used test.

So the answer to this question is A


Instruction:
Pugilistic attitude is most common in woman dying with -a) Antemortem burnsb) Post mortem burnsc) Asphyxiad) Carbon monoxide poisoning
A. ac
B. ab
C. ad
D. bc

Response:
None

So the answer to this question is B


Instruction:
Disease under international surveillance by WHO-
A. Measles
B. Relapsing fever
C. Typhoid
D. Rubella

Response:
Ans. is 'b' i.e., Relapsing fever * At the international level, the following diseases are notifiable to WHO in Geneva under International health regulation -i) Choleraii) Plagueiii) Yellow fever} -These are notifiable diseases as well as under surveillance* Few other diseases are also subjected to international surveillance -i) Lause - born typhus feveriii) Poliov) Malariavn) Salmonellosisii) Relapsing feveriv) Influenzavi) Rabies

So the answer to this question is B


Instruction:
Statutory body (shown in symbol) has been established under the act passed in
A. 2000
B. 2002
C. 2006
D. 2013

Response:
2006

So the answer to this question is C


Instruction:
Anti Snake Venin (ASV) should be given in all these situations with further lab investigations in a child presenting at 4 am except :
A. Severe pain abdomen but no fang marks
B. Local swelling with fang marks
C. External opthalmoplegia
D. Ptosis with head flexed without bite marks

Response:
Ans: B (Local swelling with fang marks) Ref: The Pediatric Management of Snakebite: The National Protocol, Indian Pediatrics; 43: 173-6 and Snake Site: Indian Guidelines and Protocol. The Association of Physicians of India Chapter 24 Pg 423 and Clinical Profile of Snake Bite in Children in Rural India. Iran J Pediatr, 2013 Dec; 23(6): 632-636. and Achar Textbook of Pediatrics, 4th edition, Pg: 127Explanation:"Among the neuroparalytic bites 60% patients presented with abdominal pain which was the main presenting complaint."Ref: Clinical Profile of Snake Bite in Children in Rural IndiaAnti-Snake VenomAnti-snake venom (ASV) is the mainstay of treatment.in India, polyvalent ASV, i.e. effective against all the four common species:o Russell's vipero Common Cobrao Common Kraito Saw-scaled ViperIndications for ASV administrationEvidence of systemic envenomationProlonged 20 min whole blood clotting time { >20 WBCT).Signs of spontaneous bleeding.Thrombocytopenia (Platelets < 1 lakh/cumm.Neurological symptomso Ptosiso Opthalmoplegiao Respiratory paralysiso Bulbar paralysiso Cardiac signsRenal problemso Oliguriao UremiaHemoglobinuriaMyoglobinuriaSevere Local SymptomsSwelling rapidly crossing joint.Swelling involving half of bitten limb.Swelling increasing rapidly after removal of tourniquet.Development of Enlarged tender regional lymph node.Features of Krait bite:Unique clinical presentation.Movements are mainly nocturnal.Abdominal pain - Most common initial symptom.Often No Pain.No fang mark.No local swelling.Neurological Symptomso Progressive paralysiso Ptosiso Respiratory muscle failure.Note:ASV should NOT be used without evidence of systemic envenomation or severe local swelling.Purely local swelling is Not an Indication for administering ASV.

So the answer to this question is B


Instruction:
Iv glucose tolerance is done in -
A. Children
B. Pregnancy
C. Gastrectomy
D. Old age

Response:
The IV Glucose Tolerance Blood Test helps determine glucose levels in blood, after intravenous administration of a 50% solution of glucose. It is used to diagnose diabetes, cancers, and metabolic disordersThis test is more sensitive than the oral glucose tolerance blood test because the glucose sample does not have to go through the digestive system. It also allows for individuals who cannot eat or tolerate glucose to measure their glucose tolerance . Following are the clinical indications for performing the IV Glucose Tolerance Blood Test: Monitoring glucose levels of individuals with diabetes Inability to eat or tolerate glucose (else, the oral glucose tolerance blood test may be performed) Family history of diabetes Extensive surgery or injury Frequent urination Increased thirst Fatigue Blurry vision Rapid weight loss Tingling and numbing in the extremities Giving bih to a baby over 9 pounds Obesity History of cardiovascular disease It is done in gastrectomy paitents as they are unable to consume glucose orally and not able to undergo OGTT. Ref -<a href="

So the answer to this question is C


Instruction:
Blood agar is an example of ?
A. Enriched media
B. Indicator media
C. Enrichment media
D. Selective media

Response:
Ans. is 'a' i.e., Enriched media

So the answer to this question is A


Instruction:
Which of the following adverse effects of levodopa is not minimized even after combining it with carbidopa?
A. Involuntary movements
B. Nausea and vomiting
C. Cardiac arrhythmia
D. 'On-off' effect

Response:
(Ref: KDT 6/e p419) Carbidopa can decrease all the adverse effects of levodopa except Involuntary movements Behavioural effects

So the answer to this question is A


Instruction:
Which one of following is Polysaccharide vaccine:-
A. Peussis
B. Hepatitis B
C. Meningococcal
D. Yellow fever

Response:
Polysaccharide vaccines are: Typhim-Vi Pneumococcal vaccine Meningococcal vaccine Hib.

So the answer to this question is C


Instruction:
CBD microliths are diagnosed by
A. ERCP
B. EUS
C. HIDA
D. CT

Response:
CBD stones IOC is MRCP
Micro stones are detected by EUS.

So the answer to this question is B


Instruction:
A patient delivers a twin gestation in which one infant has blood group O and one has blood group B. The patient and her husband are both type O. Discordant blood types is explained by
A. It involves fertilization of one ovum that splits into two during the same menstrual cycle.
B. It involves fertilization of two ova within same menstrual cycle, but not at the same coitus.
C. It involves fertilization of two ova separated in time by an interval as long as or longer than a menstrual cycle.
D. This does not occur spontaneously in humans.

Response:
The clinical Scenario describes suferfecundation.

So the answer to this question is B


Instruction:
Light-bulb sign in X-ray shoulder is seen in:
A. Fracture of neck of humerus with glenoid
B. Anterior dislocation of shoulder
C. Posterior dislocation of shoulder
D. Fracture of scapula

Response:
Ans-CKef: Apleys System of Orthopaedics and Fractures, 9th editionExplanation:Eight-bulb appearance - Seen due to internal rotation of the humeral head in posterior dislocation of the shoulder.Anterior dislocation of shoulder occurs from the excessive external rotation of the shoulder (especially in abduction).Risk factors of posterior shoulder dislocation of the shoulder occur from:o Excessive internal rotationo Following seizure episodeo Following electrocutiono In both seizure and electrocution, excessive contraction of the stronger muscles of the upper back causes pull of the humeral head backward causing dislocation.* Normal appearance of the shoulder in X-ray.Eight-bulb appearance of the humeral head in X-ray due to internal rotation of the humeral head in posterior dislocation.NOTE associated with anterior shoulder dislocation - Fracture of the greater tuberosity. associated with posterior shoulder dislocation - Fracture of the lesser tuberosity.

So the answer to this question is C


Instruction:
Severe ptosis in a new born should be operated at the age of:
A. 1 year
B. 3 years
C. 5 years
D. Earliest possible

Response:
Ans. Earliest possible

So the answer to this question is D


Instruction:
Antiepileptic drug implicated in causing toxic epidermal necrolysis is :
A. Felbamate
B. Gabapentin
C. Lamotrigine
D. Vigabatrin

Response:
None

So the answer to this question is C


Instruction:
All statements are true regarding non-ST elevation acute coronary syndromes (NSTE-ACS) and ST elevation myocardial infarctions (STEMI) except ?
A. The relative incidence of NSTEMI is rising due to the increasing burden of diabetes and chronic kidney disease in an aging population.
B. Pump failure is now the primary cause of in-hospital death from STEMI
C. Infarction of >=60% of the left ventricle usually results in cardiogenic shock
D. PCI is the treatment of choice for patients with acute coronary syndromes

Response:
Epidemiologic studies indicate there is a shift in the pattern of AMI over the last 15 years with more patients with NSTEMI than STEMI.The relative incidence of NSTEMI is rising due to the increasing burden of diabetes and chronic kidney disease in an aging population, while STEMI is declining due to greater use of aspirin, statins, and less smoking. Among patients with NSTE-ACS, the propoion with NSTEMI is rising while that with UA is falling because of the wider use of troponin assays with higher sensitivity to detect myocyte necrosis, thereby reclassifying UA as NSTEMI. Infarction of >=40% of the left ventricle usually results in cardiogenic shock. Pump failure is now the primary cause of in-hospital death from STEMI PCI is the treatment of choice for patients with acute coronary syndromes

So the answer to this question is C


Instruction:
4 drugs in AKT used because -
A. Decrease in resistance by mutation
B. Decrease in resistance by conjugation
C. To cure disease early
D. None

Response:
<p> 4 drugs used in AKT because of decrease in resistance by mutation. Park&;s textbook of preventive and social medicine,K.Park,22nd edition,page no:173. <\p>

So the answer to this question is A


Instruction:
Rape is defined under: TN 09; FMGE 10; NEET 14
A. Sec. 320 IPC
B. Sec. 375 IPC
C. Sec. 376 IPC
D. Sec. 351 IPC

Response:
Ans. Sec. 375 IPC

So the answer to this question is B


Instruction:
A patient on cisplatin therapy develops intractable vomiting on the third day of treatment. The agent of choice for controlling this vomiting is :
A. Aprepitant
B. Ondansetron
C. Metoclopramide
D. Prochlorperazine

Response:
Cisplatin-induced vomiting has two phases.

EarlyPhase: It occurs within the first 24 hours. 5 HT3 antagonists like ondansetron are the agents of choice for this condition.
Delayed Phase: Vomiting occurring after 24 hours is less responsive to ondansetron and other drugs. It is best controlled by substance P antagonist like aprepitant.

So the answer to this question is A


Instruction:
Bleomycin toxicity affects which type of cells: (REPEAT)
A. Type-I pneumocytes
B. Type-II pneumocytes
C. Endothelial cells
D. Pulmonary alveolar macrophages

Response:
Bleomycin :This is a mixture of closely related glycopeptide antibiotics having potent antitumour activity. It chelates copper or iron, produces superoxide ions and intercalates between DNA strands-causes chain scission and inhibits repair . It is highly effective in testicular tumour and squamous cell carcinoma of skin, oral cavity, head and neck, genitourinary tract and esophagus; also useful in Hodgkin&;s lymphoma. Mucocutaneous toxicity and pulmonary fibrosis, but little myelosuppression are the special features. Bleomycin-induced lung injury typically occurs insidiously during the first 6 months after staing treatment, but the potential for high-inspired fractions of oxygen to provoke pulmonary toxicity remains a life-long risk. The main abnormalities in bleomycin-induced pulmonary toxicity occur in endothelial and epithelial cells. Destruction and desquamation of type I pneumocytes occur, as does the proliferation of type II pneumocytes. Mononuclear cell infiltration, fibroblast proliferation, and fibrosis are common findings. Bronchoalveolar lavage studies in patients with bleomycin-induced pneumonitis have shown the presence of polymorphonuclear alveolitis. REFERENCE: www.medscape.com, essentials of medical pharmacology(k.d.tripathi,sixth edition,page no:826,827)

So the answer to this question is A


Instruction:
A lesion in the paracentral lobule causes:
A. Contralateral foot weakness
B. Memory impairment
C. Brocas aphasia
D. Cognitive loss

Response:
Answer is A (Contralateral foot weakness): The paracentral lobule is located on the medial frontal lobe and is involved in anterior cerebral aery occlusion. The involvement of paracentral lobule leads to contralateral lower limb (foot) weakness and urinary incontinence.

So the answer to this question is A


Instruction:
Most common ocular feature in Reiter
Syndrome is
A. Anterior Uveitis
B. Pars planitis
C. Conjunctivitis
D. Chorioretinitis

Response:
Reiter syndrome is characterised by

Urethritis
Arthritis
Conjunctivitis>>> Urethritis

So the answer to this question is C


Instruction:
Which of the following is not a hydrophobic secondary messenger?
A. DAG
B. IP3
C. Phosphatidyl inositol
D. cAMP

Response:
None

So the answer to this question is D


Instruction:
Primary healing of a mandibular fracture is seen following fixation with:
A. Gunning splints
B. Compression plates
C. Trans-osseous wires
D. Clampy plates

Response:
None

So the answer to this question is B


Instruction:
A 60-year-old male with angina comes to the emergency with severe chest pain unresponsive to sublingual nitroglycerin. An ECG shows ST segment elevation in the anterolateral leads, and thrombolytic therapy is initiated. If streptokinase is given to this patient, it may produce thrombolysis after binding to which of the following proteins?
A. Antithrombin III
B. Fibrin
C. Plasminogen
D. Protein C

Response:
The fibrinolytic activity of streptokinase is due to its ability to bind and cleave plasminogen, producing plasmin. Plasmin directly cleaves fibrin, both between and within the fibrin polymers, thus breaking up thrombi and potentially restoring blood flow to ischemic cardiac muscle. This same mechanism of fibrinolysis is shared by urokinase and tissue-plasminogen activator (tPA). Antithrombin III is a coagulation inhibitor that binds to and inactivates thrombin. Antithrombin III is anticoagulant, not fibrinolytic. Fibrin is not directly acted upon by streptokinase. It is indirectly cleaved through the action of plasmin. Protein C is a glycoprotein that modulates coagulation by inhibiting the procoagulant activities of factors V/Va and VIII/VIIIa. Protein C has no inherent fibrinolytic activity.

So the answer to this question is C


Instruction:
What is not true about mitral valve prolapse?
A. Mitral valve leaflets have myxomatous degeneration
B. Associaed marfans syndrome is present in many patients
C. Most of the patients are asympatomatic
D. Diastolic mumrmur is present on auscultation

Response:
Ans. is 'd' i.e., Diastolic mumrmur is present on auscultationMitral valve prolapse syndrome or myxomatous degeneration of mitral valve* In mitral valve prolapse one or both mitral leaflets are floppy and prolapse or balloon back into the left atria during systole with or without mitral regurgitation.* It is one of the most common valvular disease in the industrialized world and it is estimated to affect 3% or more of adults in United States, most often young women.Pathology* In mitral valve prolapse the leaflets demonstrate myxomatous degeneration.* The basis for this change within the valve is unknown.* It is believed that some underlying devlopmental defect of connective tissue is associated with mitral valve prolapse.* Thus marfan's syndrome, a connective tissue disorder is seen in many patients with mitral valve prolapse.* Even in the absence of some well defined connective tissue disorder, in some individuals with mitral valve syndrome, there are some hints of systemic structural abnormality in connective tttissue such as scoliosis, straight back and high arched palate.Clinical features* Most patients with mitral valve prolapse are asymptomatic and the condition is discovered only on routine examination by the presence of a midsystolic click as an incidental finding on clinical examination.* In those cases where mitral regurgitaion occurs, there is a late, Systolic or sometimes holosystolic murmur.* Although the great majority of patients with mitral valve prolapse have no untoward effects approximately 3% develop one of the four serious complications.# Infective endocarditis# Mitral insufficiency (mitral regurgitation)# Stroke or other systemic infarct resulting from embolism of leaflet thrombi# Arrhythmias

So the answer to this question is D


Instruction:
Which of the following is not an application of screw feed technique
A. 80% volume reduction
B. Pathological wastes are removed
C. Weight is decreased by 20-30%
D. Based on non-burn thermal treatment

Response:
SCREW-FEED Technology:

Principle: Non-burn dry thermal process
Process:

- Shredding of waste
-  Heating in a rotating auger

Reduction in waste:

- Reduction in weight: 20-35%
- Reduction in volume: 80%

Useful for wastes:

- Infectious waste
- Sharps

Not useful for wastes:

- Pathological waste
- Cytotoxic waste
- Radioactive waste

So the answer to this question is B


Instruction:
Neutrophil secretes
A. Superoxide dismutase
B. Myeloperoxidase
C. Lysosomal enzyme
D. Catalase

Response:
ref Robbins 7/e p73 Cathepsin G also secreted by neutrophil

So the answer to this question is B


Instruction:
Acute hyponatremia become symptomatic at:
A. <135 mEq
B. <125 mEq
C. <120 mEq
D. <110 meq

Response:
Hyponatremia is commonly defined as a serum sodium <135 mmol/L (<135 mEq/L). In patient with hyponatremia that develops over hours, life-threatening seizures and cerebral edema may occur at values as high as 125 mmol/L. In contrast some patients with more chronic hyponatremia that has slowly developed over months to years may be asymptomatic even with serum levels <110 mmol

So the answer to this question is B


Instruction:
The greatest incidence of bronchopleural fistula is follwing -
A. Segmental resection
B. Lobectomies
C. Pneumonectomies
D. Thorocotomy

Response:
None

So the answer to this question is B


Instruction:
Route of approach of glossopharyngeal neurectomy:
A. Tonsillectomy approach
B. Transpalatal approach
C. Transmandibular approach
D. Transpharyngeal approach

Response:
Tonsillecotmy is done as a pa of the following operations: Palatopharyngoplasty which is done for sleep apnea syndrome Glossopharyngal neurectomy--tonsil is removed first and then IX nerve is severed in the bed of tonsil Removal of styloid process.

So the answer to this question is A


Instruction:
Cystoid macular edema develops commonly after: March 2013 (a, d)
A. Extracapsular lens extraction
B. Intracapsular lens exraction
C. Proliferative diabetic retinopathy
D. Uveitis

Response:
B i.e. IntracaPsular lens extraction

So the answer to this question is B


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

Response:
Presence of uniocular diplopia together with finding of golden crescent on oblique illumination (edge of subluxated lens) or black crecent line on coaxial illumination (edge of subluxated lens) suggests a diagnosis of 'subluxation' of the crystalline lens. Ectopic lentis refers to displacement of lens from its normal position (subluxation, dislocation). (Ref: Ophthalmology by khurana 7th/e p.222 & (2005)/e p.24; Clinical Examination in by Mukherjee 2006/e p.166; Neema 6th/e p.285, 286)

So the answer to this question is D


Instruction:
Severe muscular exercise causes
A. Lactic acidosis
B. Ketoacidosis
C. Hypothermia
D. | CPK levels

Response:
Intense Exercise. When you exercise, your body uses oxygen to break down glucose for energy. During intense exercise, there may not be enough oxygen available to complete the process, so a substance called lactate is made. Your body can conve this lactate to energy without using oxygen. But this lactate or <a href=" acid can build up in your bloodstream faster than you can burn it off. The point when lactic acid stas to build up is called the "lactate threshold."Inhibition of Pyruvate MetabolismLeads to Lactic AcidosisArsenite and mercuric ions react with the 'SH groups of lipoic acid and inhibit pyruvate dehydrogenase, as does a dietary deficiency of thiamin (see Chapter 44), allowing pyruvate to accumulate. Many alcoholics are thiamin deficient (both because of a poor diet and also because alcohol inhibits thiamin absorption), and may develop potentially fatal pyruvic and lactic acidosis. Patients with inherited pyruvate dehydrogenasedeficiency, which can be the result of defects in one or more of the components of the enzyme complex, also present with lactic acidosis, paicularly after a glucose load. Because of the dependence of the brain on glucose as a fuel, these metabolic defects commonly cause neurological disturbances. Inherited aldolase A deficiency and pyruvate kinase deficiency in erythrocytes cause hemolytic anaemia. The exercisecapacity of patients with muscle phosphofructokinase deficiency is low, paicularly if they are on high-carbohydrate diets. By providing lipid as an alternative fuel, for example, during starvation, when blood free fatty acid and ketone bodies are increased, work capacity is improvedReference: Harper biochemistry page no 174

So the answer to this question is A


Instruction:
Prostaglandins are derived from :
A. Coicosteroids
B. Oleic acid
C. Linoleic acid
D. Arachidonic acid

Response:
Prostaglandins are derived from arachidonic acid through the cyclooxygenase (COX) pathway.Two isoforms of COX have been recognized.COX-1 is expressed constitutively, whereas COX-2 is induced by growth factors, tumor promoters, and proinflammatory cytokines.COX catalyzes oxidative cyclization of arachidonic acid to prostaglandin endoperoxide, which is the immediate precursor of prostaglandins, thromoboxane, and prostacyclin

So the answer to this question is D


Instruction:
The capsule of the crystalline lens is thinnest at –
A. Anterior pole
B. Posterior pole
C. Equator
D. None

Response:
Capsule is thickest at → Pre-equator regions.
Capsule is thinnest at →Posterior pole.

So the answer to this question is B


Instruction:
Dose of radiation during whole body exposure that leads to haematological syndrome is:
A. 2 Gy
B. 10 Gy
C. 100 Gy
D. 200 Gy

Response:
A i.e. 2 Gy Total (whole) body irradiation dose > 1 to 2.5 Gy predominatly leads to hematopoietic syndromeQ; dose 5 to 8 Gy predominantly leads to gastrointestinal syndromeQ and doses 20 to 50Gy predominantly leads to cardiovascular syndromeQ.

So the answer to this question is A


Instruction:
Which of the following non depolarizing neuromuscular blocker does not release histamine:-
A. Vecuronium
B. d-tubocurarine
C. Atracurium
D. Mivacurium

Response:
Aminosteroid group of non-depolarizing neuromuscular blocker does not release histamine Benzylisoquinoline release histamine in following sequence d-tubocurare >>> atracurium = mivacurium > doxacurium Erythema, flushing, and hypotension are manifestations of histamine release.

So the answer to this question is A


Instruction:
Which of the drug's main action is increasing uveo-scleral outflow
A. Apraclonidine
B. Latanoprost
C. Timolol
D. Brinzolamide

Response:
Ref: HL Sharma 3rd ed pg no:140 DOC for chronic glaucoma is latanoprost- PGF2 alpha analog It acts by increasing uveoscleral outflow of aqueous humor

So the answer to this question is B


Instruction:
Rapid change of presbyopic glass is a feature of –
A. Senile cataract
B. Retinal detatchment
C. Intumescent cataract
D. Open angle glaucoma

Response:
Clinical features of POAG :- Headache, eyeache, frequent changes in presbyopic correction, scotoma (visual field defect), difficulty in dark adaptation.

So the answer to this question is D


Instruction:
Which of the following is required in the formation of the structure of Haemoglobin?
A. Copper
B. Tyrosine
C. Histidine
D. Leucine

Response:
The Beta-chain of Hb begins with valine and histidine. Both these amino acids are impoant in the synthesis and structure of heamoglobin. Alignment according to helical designation makes homology evident: Residue F8 is the proximal heme-linked histidine, and the histidine on the distal side of the heme is E7. The iron atom is linked by a coordinate bond to the imidazole nitrogen (N) of histidine F8. The E7 distal histidine, on the other side of the heme plane, is not bonded to the iron atom but is very close to the ligand-binding site. Ref: Natarajan K., Townes T.M., Kutlar A. (2010). Chapter 48. Disorders of Hemoglobin Structure: Sickle Cell Anemia and Related Abnormalities. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds), Williams Hematology, 8e

So the answer to this question is C


Instruction:
Safest antimalarial drug during pregnancy is ?
A. Mefloquine
B. Pyrimethamine
C. Proguanil
D. All

Response:
Ans. is 'c' i.e., Proguanil "Antimalarial medicines considered safe in the first trimester of pregnancy are quinine, chloroquine, clindamycin and proguanil" -- WHO guidelines

So the answer to this question is C


Instruction:
Which radionuclide is best suited for measurement of GFR?
A. DTPA
B. DMSA
C. Ohoiodohippurate
D. EDTA

Response:
Ans. DTPA

So the answer to this question is A


Instruction:
Linitis plastica is seen in
A. Carcinoma of liver
B. Carcinoma stomach
C. Carcinoma lung
D. Carcinoma esophagus

Response:
(Carcinoma stomach) (557-Harsh Mohan 6th ,786-Robbin-Pathologic-Basis of disease 8th)Leather bottle appearance termed linitis plastica seen in gastric adenocarcinoma. Breast and lung cancers that metastasize to the stomach may also creat a linitis plastica- like appearanceSCIRRHOUS CARCINOMA (Linitis plastica) - the stomach wall is thickened due to extensive desmoplasia giving the appearance as 'leather-bottle stomach' or 'linitis plastica, The lumen of the stomach is reduced. There are no ulcer but rugae are prominent (mother-of-pearl in appearance)* Gastric carcinoma is most commonly located into region of gastric canal (prepyloric region)**_* Ulcerative carcinoma*** is the most common pattern* Most common complication of gastric cancer is haemorrhage (haematemesis or melaena)* Pre malignant changes in gastric mucosa(i) Hypo or achlorhydria in atrophic gastritis of gastric mucosa with intestinal metaplasia***(ii) Adenomatous (neoplastic) polyp of the stomach(iii) Chronic gastric ulcer (Ulcer-cancer) and its association with achlorhydria(iv) Stump carcinoma in patients who have undergone partial gastrectomy* Superficial spreading or 'early' gastric cancer-confined to the mucosa or sub mucosa (with or without lymph node metastasis) are associated with an excellent prognosis* Trossier's si2n - The metastasis through lymphatic spread presents as left supraclavicular lymphnode enlargement* The depth of invasion and the extent of nodal and distant metastasis at the time of diagnosis remain the most powerful prognostic indicators for gastric cancers (786- Robbins- Basis of disease 8th)* Most common cause of gastric outlet obstruction in India is - Carcinoma stomach*** Sister Mary Joseph nodule (Metastatic involvement of the para umbilical nodes*** is most commonly seen with stomach carcinoma)* Early gastric cancer. Defined as a primary lesion confined to the mucosa and submucosa with or without lymph node metastasis*** There is one dictum that "Anterior ulcer perforates & posterior ulcer bleeds"* Stomach reveal fat-laden cells in post gastrectomy**** Watermelon stomach is seen in Scleroderma* Blood group A is associated with(i) Carcinoma stomach, cervix, salivary gland & pancreas(ii) Pernicious anemia(iii) Thrombosis in OCP users

So the answer to this question is B


Instruction:
Which of the following is high energy phosphate bond (produce ATP on hydrolysis)a) F-6-phosphateb) Creatine phosphatec) Carbamoyl phosphated) Glucose-1 -phosphatee) Glucose-6-phosphate
A. bc
B. c
C. ac
D. ad

Response:
High energy compounds are:-

Phosphate compounds:- Nucleotides (ATP, GTP, UTP, UDP-glucose), creatinine phosphate, arginine phosphate, 1, 3-bisphosphoglycerate, phosphoenolpyruvate, inorganic pyrophosphate, carbamoyl phosphate, aminoacyl adenylate (aminoacyl AMP).
Sulfur  compounds :- CoA derivatives (acetyl CoA, succinyl CoA, fatty acyl CoA, HMG CoA), S-adenosyl methionine (SAM), adenosine phosphosulfate.

So the answer to this question is A


Instruction:
The most important source of reducing equivalents for fatty acid synthesis in the liver is
A. Glycolysis
B. TCA cycle
C. Uronic acid pathway
D. HMP pathway

Response:
HMP pathway

The main source of NADPH for lipogenesis is the pentose phosphate pathway: PPP (also called the hexose monophosphate pathway: HMP).

So the answer to this question is D


Instruction:
Most common site for carcinoma stomach is:
A. Antrum
B. Fundus
C. Lesser curvature
D. Greater curvature

Response:
Answer is A (Antrum): The most common site of gastric adenocarcinoma is antrum '40% tumors are in the antrum, predominantly on the lesser curvature, 30% arise in the body and fimdus, 25% at the cardia and 5% involve the whole organ'- CSDT

So the answer to this question is A


Instruction:
Pilocarpine causes all EXCEPT
A. Salivation
B. Miosis
C. Sweating
D. Cycloplegia

Response:
Ans. d (Cycloplegia). (Ref. KD Tripathi, 6th/98, Basak, Ophthalmology, 2nd /44)PILOCARPINE# Pilocarpine is a local parasympathomimetic ocular hypotensive drug# Its miotic effect is useful in the management of angle closure glaucoma. It is a third-line drug in open angle glaucoma.# It is not a cycloplegic drug.# However, its systemic effects include- increased sweating,- increased salivation,- bronchospasm &- abdominal cramps.# Contraindications to pilocarpine:- Inflammatory glaucoma- Malignant glaucoma- AllergyEducational point:# Sympathomimetic mydriatics like atropine (strongest cycloplegic), homatropine, cyclopentolate, tropicamide are cycloplegic, but phenylephrine is not.

So the answer to this question is D


Instruction:
Lower end of femur is ossified from how many ossification centers :?
A. 1
B. 2
C. 3
D. 4

Response:
Ans. is 'a' i.e., 1

So the answer to this question is A


Instruction:
Increased gonadal production of estrogen is characteristic of:
A. Testicular feminization
B. Polycycstic ovarian disease
C. Congenital adrenal hyperplasia
D. Third trimester of pregnancy

Response:
In persons with testicular feminization, estradiol secretion by the testes is markedly increased (but not to the level produced by normal ovaries); the mechanism is lack of suppression of LH by testosterone and consequently increased stimulation of gonadal testosterone and estradiol secretion. Ovaries containing follicle cysts may be a source of increased estrogen production, particularly during the postmenopausal years, when gonadotropin levels are very high. The increase in estrogen production that is characteristic of PCOD is the consequence of peripheral conversion of androstenedione to estrogen, not of direct gonadal production. During the third trimester of pregnancy estrogen production is increased because of the formation of estrogen by the placenta rather than by the ovary. Arrhenoblastoma is a virilizing ovarian tumor and does not secrete estrogen. Congenital adrenal hyperplasia causes virilization due to increased adrenal output of androgens.

So the answer to this question is A


Instruction:
Which of the following is Chemical stomach poison for mosquito?
A. DDT
B. Malathion
C. Paris green
D. Pyrethrum

Response:
Chemical measures for mosquito control:- Stomach poison: Paris green (anti-larval measure). It is copper acetoarsenite. Sodium fluoride is also a stomach poison of mosquito Nerve / contact poison: DDT, Pyrethrum, Malathion (Anti-adult measures). Act by inhibiting acetylcholinesterase enzyme.

So the answer to this question is C


Instruction:
Both breasts are affected in which type of breast carcinoma: September 2009
A. Inflammatory
B. Infiltrative
C. Ductall
D. Lobular

Response:
Ans. D: Lobular Carcinoma of the breast is a histologically heterogeneous disease. Invasive lobular carcinoma (ILC) accounts for 8-14% of all breast cancers. The morphologic features of lobular carcinoma differ from those of ductal carcinoma. ILC is characterized by small, round cells that are bland in appearance and have scant cytoplasm, which infiltrate the stroma in single file and surround benign breast tissues in a targeted manner. Infiltration typically does not destroy anatomic structures or incite a substantial connective tissue response. By viue of their distinctive growth pattern and biology, lobular carcinomas often fail to form distinct masses that can easily be diagnosed by palpation or mammography. This can make early diagnosis challenging and breast conservation approaches more difficult. Lobular carcinomas may have a substantially increased propensity for multifocal and multicentric distribution and for bilaterality.

So the answer to this question is D


Instruction:
Most common movemnet force involved in fractures of the spine is which of the following?
A. Flexion
B. Extension
C. C Rotation
D. Compression

Response:
Flexion injury is the commonest spinal injury. Ref: Essential ohopedics by Maheshwari 3rd Edition, Page 144,259,260.

So the answer to this question is A