Instruction:
Which of the following disorders would more likely be associated with Staphylococcus saprophyticus rather than Staphylococcus aureus?
A. Osteomyelitis
B. Tension pneumothorax
C. Burns
D. Acute cystitis

Response:
Ans:D.)Acute Cystitis. Staphylococcus Aureus. Skin infections are the most common form of S. aureus infection. This can manifest in various ways, including small benign boils, folliculitis, impetigo, cellulitis, and more severe, invasive soft-tissue infections. Also responsible for food poisoning. Most common bacteria associated with conjunctivitis Can cause Toxic shock syndrome. S. aureus is the bacterium that is commonly responsible for all major bone and joint infections. This manifests in one of three forms: osteomyelitis, septic ahritis and infection from a replacement joint surgery. Most common pathogen isolated in sputum of children with cystic fibrosis during the first decade. One of the most common causes of bacteremia and infective endocarditis.Prosthetic valve endocarditis is most commonly caused by Staphylococcus aureus. Impoant pathogen causing pneumonia in a patient with bronchiectasis. Coagulase negative Staphylococci* Staph epidermidis - MC pathogen infecting IV catheters, shunts, prosthetic valves, grafts, CSF shunts, dialyzer. Can form glycocalyx or slime layer, that protects bacteria from antibiotics* S. saphrophyticus - UTI in sexually active young women.

So the answer to this question is D


Instruction:
Regarding hepatitis E, it is true that -
A. Occurs with Hepatitis B
B. Is single stranded DNA virus
C. Occurs along with HIV
D. Increases moality in pregnancy

Response:
Clinical severity and high case fatality rate of 20-40 %in pregnant women (in last trimester) REF:ANANTHANARYANAN TTEXTBOOKOF MICROBIOLOGY 9EDITION PGNO.550

So the answer to this question is D


Instruction:
Regarding Hartmann’s solution, false is
A. Contains potassium ions
B. Equilibrates with extracellular fluid
C. Has a pH of 8
D. Is miscible with insulin

Response:
Hartmann’s solution has pH of 6-7

So the answer to this question is C


Instruction:
Not true about thalidomide :
A. Causes phocomelia
B. Not tested in pregnant animals before introduction
C. Still has restricted clinical use
D. Has no antiangiogenesis action against tumour

Response:
Thalidomide was banned in 1960 because of its teratogenic effect of phocomelia (seal-like limbs). It has anxiolytic, adjuvant analgesic/antipyretic properties and has been found to counteract cancer-associated cachexia.
Its mechanism of action is by suppressing TNF and or by modulating IL-2.
Recently it has been reintroduced as an antineoplastic drug due to its anti-angiogenesis action.

So the answer to this question is D


Instruction:
All are true about hyperopic obstructive cardiomyopathy except-
A. Assymmetric septal hyperophy
B. Dilatation of atria
C. Dilatation of ventricles
D. Outflow obstruction

Response:
Ans. is 'c' i.e., Dilatation of ventricles Hyperophic cardiomyopathy (HOCM) o HOCM also known as hyperophic subaoic stenosis or hyperophic obustructive cardiomyopathy. o It is characterized by massive myocardial hyperophy without ventricular dilatation. o Because of hyperophy ventricular filling during diastole is impaired ---> Diastolic dysfunction. Systolic function is usually preserved. HOCM has following features Massive myocardial hyperophy without ventricular dilatation, i.e. there is increase in transverse diameter (width) of myocytes, but length remains same. The classical pattern of hyperophy is dispropoionate thickening of ventricular septum as compared with the free wall of the ventricle frequetly termed as assymetrical septal hyperophy. On cross section, the ventricular cavity loses its usual round to avoid shape and may be compressed into "banana-like" configration. Septal hyperophy is most prominent in the subaoic region, ie. at the outflow area of left ventricle --) Obustruction in the systolic ejection. There is thickening of anterior mitral leaflet which move anteriorly during systole fuher increase in obustruction. The most impoant histological finding is disruption of the normal alignment of myocytes --> myocardial disarray.

So the answer to this question is C


Instruction:
Pericoronitis is seen in relation to
A. Impacted third molars only
B. Around incompletely erupted crown
C. Completely erupted crowns only
D. None of the above

Response:
None

So the answer to this question is B


Instruction:
What is the duration of multibacillary leprosy treatment?
A. 24 months
B. 18 months
C. 12 months
D. 6 months

Response:
Ans. C. 12 monthsAs per the WHO multidrug therapy regimen for treatment of leprosy, the duration of treatment for multibacillary leprosy is 12 monthsWHO proposed Multi Drug Therapy (MDT) for the treatment of LeprosyAge groupDrugDuration of TreatmentAdultRifampicin 600mg once a month+Clofazimine 300mg once a month and 50mg daily+Dapsone 100mg daily12 months(Multibacillary)6 months(Pauci bacillary)Children (10-14 years)Rifampicin 450mg once a month+Clofazimine 150mg once a month, 50mg daily+Dapsone 50mg daily12 months(Multibacillary)6 months(Pauci bacillary)Children <10 years old or <40 kgRifampicin 10mg/kg once a month+Clofazimine 6mg/kg once a month, 1mg/kg daily+Dapsone 2mg/kg daily12 months(Multibacillary)6 months(Pauci bacillary)

So the answer to this question is C


Instruction:
The contraindication to internal fixation -
A. Physeal injury
B. Active infection
C. Intraarticular fracture
D. Fracture dislocation

Response:
Ans. is 'b' i.e., Active infection o Contraindications to internal fixation include active or suspected infection, compramised soft tissues overlying the fracture, medical or surgical conditions that contraindicate aneshthesia (e.g. recent Ml) and sever, irreparable neurovascular injury (amputation is better).

So the answer to this question is B


Instruction:
True about ascending limb of loop of Henle ?
A. Recieves hypeonic saline
B. Maximum absorption of fluid
C. Respond to ADH
D. None of these

Response:
Ans. is 'a' i.e., Recieves hypeonic saline Fluid leaving the descending limb of loop of Henle and entering the ascending limb of loop of Henle is very hypeonic. Renal reabsorption and secretion The Glomerular filtrate enters the renal tubules and flows through the successive pas of the tubule (i.e. the proximal tubule, loop of Henle, distal tubule and finally collecting ducts) before it is excreted as urine. Along its course, the tubular cells may selectively secrete some substances from the blood into the tubular lumen (tubular secretion), or may selectively remove some substances (tubular reabsorption) from the tubular filtrate, or may do both. When the Glomerular filtrate is initially formed, its osmolarity is about the same as that of plasma i.e. 300mOsm/L. Its osmolalilty changes depending on the absorption of water and solutes in the segment. Proximal convoluted tubule The PCT reabsorbs- sodium, chloride, bicarbonate, phosphate, potassium, glucose and amino acids. The PCT secretes- H+, organic acids and bases (such as bile salts, oxalate, urate and catecholamines) The PCT is highly permeable to water. In PCT solutes and water are reabsorbed in equal propoions, thus little change in the osmolarity occurs i.e. the tubular fluid in the PCT is isotonic to the plasma. Loop of Henle: Descending limb The thin descending segment is highly permeable to water and moderately permeable to most solutes, including urea and sodium. No active reabsorption or secretion takes place. The water is reabsorbed as the tubular fluid passes down the descending limb and the filtrate becomes concentrated, in equilibrium with the surrounding interstitial fluid of the renal medulla, which is very hypeonic. Thus fluid leaving Descending limb of loop of Henle is very hypeonic. Loop of Henle: Ascending limb The thick ascending limb reabsorbs - sodium, chloride, and potassium, calcium, bicarbonate, and magnesium. o This segment also secretes- hydrogen ions into the tubular lumen. The thin segment of the ascending limb has a much lower reabsorptive capacity than the thick segment, and the thin descending limb does not reabsorb significant amounts of any of these solutes. The ascending limb, including both the thin and the thick poions, is completely impermeable to water, even in the presence ofADH. Since other solutes are being reabsorbed, the tubular fluid becomes hypotonic. Thus the fluid leaving the ascending limb of loop is hypotonic, with an osmolarity of only about one third the osmolarity of plasma i.e. 100 mOsm/L. Early distal tubule Early distal tubule has propeies similar to those of the thick ascending limb of the loop, that is, it avidly reabsorbs most of the ions, including sodium, potassium, and chloride, but is viually impermeable to water so there is fuher dilution of the tubular fluid. The late distal tubules and coical collecting tubules The late distal tubules and coical collecting tubules are composed of two distinct cell types, the principal cells and the intercalated cells. The principal cells reabsorb sodium from the lumen and secrete potassium ions into the lumen. The intercalated cells reabsorb potassium and bicarbonate ions from the lumen and secrete hydrogenions into the lumen. The reabsorption of water from this tubular segment is controlled by the concentration of antidiuretic hormone. Medullary Collecting Duct The medullary collecting ducts actively reabsorb sodium and secrete hydrogen ions and are permeable to urea, which is reabsorbed in these tubular segments. The reabsorption of water in medullary collecting ducts is controlled by the concentration of antidiuretic hormone. In late distal tubule, coical collecting tubules and medullary collection tubules the tubular fluid osmolarity depends on the presence or absence ofADH. In presence of high levels of ADH these tubules are highly permeable to water and significant amounts of water are reabsorbed and the tubular fluid becomes hypeonic, up to 1200 mOsm/L (equal to osmolarity of the surrounding medullary interstitium). In the absence of ADH, these segments are almost impermeable to water; therefore osmolarity decreases even fuher because of continued active reabsorption of ions from these segments-tubular fluid thus becomes hypotonic with osmolarity as low as 50mOsm/L.

So the answer to this question is A


Instruction:
Which of the following syndromes in relation to obesity are associated with hypogonadism in males but not in the females?
A. Prader Willi syndrome
B. Laurence Moon Biedl syndrome
C. AHLSTROM'S syndrome
D. COHEN'S syndrome

Response:
AHLSTROM'S SYNDROME is autosomal recessive disorder associated with obesity, hypogonadism in males but not in females . Ref Harrison 20th edi page no 2842, tab 394-2

So the answer to this question is C


Instruction:
A 38 year old nullipara is on treatment for infeility. Inhibin B levels are tested to assess ovarian reserve. Inhibin B level is best measured which day of menstruation:
A. Day 2 of menstruation
B. Day 3 of menstruation
C. Day 4 of menstruation
D. Day 5 of menstruation

Response:
Inhibins are produced by Seoli cells in males and by granulosa cells in females. Serum inhibin levels vary widely across the menstrual cycle. During the early follicular phase, FSH stimulates the secretion of inhibin B by the granulosa cells. However, increasing levels of circulating inhibin B blunt FSH secretion later in the follicular phase. A low level of inhibin B on day 3 may indicate a declining ovarian reserve which is helpful for assessing reproductive ageing and ovarian reserve. During the luteal phase, regulation of inhibin production comes under the control of LH and switches from inhibin B to inhibin A. Inhibin B levels peak during the midluteal phase, decrease with the loss of luteal function, and remain low during the luteal-follicular transition and early follicular phase. The inverse relationship between circulating inhibin levels and FSH secretion is consistent with a negative-feedback role for inhibin in regulating FSH secretion. Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 15. Reproductive Endocrinology. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.

So the answer to this question is B


Instruction:
Globus pallidus and putamen are present in?
A. Pons
B. Thalamus
C. Cerebellum
D. Basal ganglia

Response:
Ans. (d) Basal gangliaRef: Ganong 25th ed. / 244

So the answer to this question is D


Instruction:
Ventilation-perfusion ratio is maximum at
A. Apex of lung
B. Base of lung
C. Posterior lobe of lung
D. Middle of the lung

Response:
Apical alveoli have low ventilation and perfusion per unit volume of the lung, whereas the basal alveoli have high ventilation and perfusion.
Ventilation-perfusion ratio and the PaO2 is maximum at the apex. PCO2 is maximum at the base.

So the answer to this question is A


Instruction:
True about cytokines is -
A. It is always a polypeptide
B. It acts on protein targets
C. It takes pa in intrinsic enzymatic reactions
D. Chemotactic

Response:
They are a broad and loose category of small proteins (~5-20 kDa) that are impoant in cell signaling. They act on receptors Ref: Ananathanarayanan & Panikers textbook of microbiology 9th edition pg: 152

So the answer to this question is A


Instruction:
Sweat chloride in cystic fibrosis ?
A. Decreased
B. Increased
C. No change
D. May increase or decrease

Response:
Ans. is 'b' i.e., Increased CYSTIC FIBROSIS Cystic fibrosis is an inherited disease of the mucus and sweat glands. Cystic fibrosis follows on autosomal recessive transmission. There is a defect in ion transpo of epithelial cells that affects fluid secretion in Exocrine glands (pancreas) Epithelial lining of respiratory, gastrointestinal and reproductive tract. Pathophysiologv In normal duct epithelia, chloride is transpoed by plasma membrane channels (chloride channels) The primary defect in cystic fibrosis results from abnormal function of an epithelial chloride channel protein encoded by the cystic fibrosis transmembrane conductance regulator (CFTR) gene on chromosome 7q 31.2. Protein encoded by CFTR is a chloride channel through which chloride passes In cystic fibrosis activity of chloride channel is decreased. Along with chloride channel, CFTR can regulate other channel also, for example epithelial sodium channels (ENaC). ENaC is inhibited by normally functioning CFTR; hence, in cystic fibrosis, ENaC activity increases, markedly augmenting sodium uptake across the apical membrane (especially in respiratory and gastrointestinal system). Normal CFTR gene product Defective (mutated) Crl R gene product in cystic fibrosis Induce Cl- conductance through itself (chloride channel) Reduced or lost Cl conductance Inhibits Na+ conductance through Augmented sodium uptake across apical membrane ENaC Clinical features of CF Functions of CFTR are tissue specific, i.e. its functions signify whether the epithelium is secretory (secrete Cl- into lumen) or absorptive (reabsorb Cl- from lumen). Therefore clinical features are tissue specific: Respiratory tract Respiratory epithelium is secretory, i.e. there is active secretion of C1-. CFTR mutation in cystic fibrosis results in loss or reduction of chloride secretion in lumen. Active luminal sodium absorption is also increased (due to loss of inhibition of ENaC activity) Both these decreased Cl secretion and increased Na+ absorption from lumen) lead to increased passive water reabsorption (As you all know diffusion of water occurs from high osmolar to low osmolar concentration area). This results in accumulation of dehydraded hyperconcentrated viscid secretion in respiratory lumen and defective mucociliary clearance obstruction and recurrent respiratory tract infection; and bronchiectasis. 1.Intestine Similar to respiratory epithelium, intestinal epithelium is secretory and in CF there is defective Cl- secretion andenhanced Na+ absorption from lumen - Increased passive reabsorption of water from lumen. This results in accumulation of dehydrated desciated intraluminal contents obstruction of small and largeintestine. Pancreas The absence of CFTR Cl channel in the apical membrane of pancreatic ductal epithelium limits the function of an apical membrane Ct -HCHD3 exchanger to secrete bicarbonate and Na+ (by a passive process) into the duct. The failure to secrete bicarbonate and Na+ leads to retention of enzyme in the pancreas and ultimately destruction of all pancreatic tissues due to pancreatitis. Hepatobiliary system Similar to respiratory and intestinal epithelium, defective biliar Cl- and water secretion causes thickened biliary secretions-biliary cirrhosis, cholecystitis, cholelithiasis. Sweat glands In contrast to respiratory and intestinal epithelium, sweat gland duct epithelium is absorptive, i.e. function of normal CFTR in the sweat gland ducts is to reabsorb Cl- ions and Na' from lumen. Therefore, in the sweat ducts, loss of CFTR function leads to decreased reabsorption of NaC1- Hypeonic sweat with increased Na+ and Ct in sweat.

So the answer to this question is B


Instruction:
An avulsed tooth before replantation should be treated with?
A. Doxycycline
B. Dexamethasone
C. Ampicillin
D. Ibuprofen

Response:
None

So the answer to this question is A


Instruction:
Epinephrine:
A. Reduces aqueous production
B. Reduces outflow facility
C. Reduces aqueous production and increases outflow facility
D. Increases aqueous production and reduces outflow facility

Response:
Ans. Reduces aqueous production and increases outflow facility

So the answer to this question is C


Instruction:
A patient presents with serum bilirubin values of >40mg% and obstructive jaundice. This indicates?
A. Carcinoma of gallbladder
B. Concomitant renal failure
C. Acute cholecystitis
D. Complete obstruction of bile duct

Response:
In patients of obstructive jaundice the value of serum bilirubin plateaus around 25-30 mg% since the water soluble bilirubin is excreted the urine. However in concomitant renal failure, loss of conjugated bilirubin the kidney fails and leads to extremely high values. Another reason can be a simultaneous overproduction of unconjugated bilirubin due to haemolysis, sepsis and sickle cell anaemia.

So the answer to this question is B


Instruction:
Which is true of torphozoites of E. histolytica?
A. Has eccentric karyosome
B. Nuclear membrane without chromatin
C. Shows erythrophagocytosis
D. Presence of bacteria inside cell

Response:
Ans. c. Shows

So the answer to this question is C


Instruction:
Which of the following disorder is classified under defects in metabolic pathways?
A. Cherubism
B. Robinow syndrome
C. Severe infantile osteopetrosis
D. Pycnodysostosis

Response:
None

So the answer to this question is C


Instruction:
The ridge that descends from the cuspal tip towards the central part of the occlusal surface in a maxillary molar is
A. Triangular ridge
B. Marginal ridge
C. Transverse ridge
D. Oblique ridge

Response:
None

So the answer to this question is A


Instruction:
The commonest gastric polyp is ?
A. Hyperplastic polyp
B. Inflammatory polyp
C. Adenomatous polyp
D. Pa of familial polyposis

Response:
Ans. is 'a' i.e., Hyperplastic polyp

So the answer to this question is A


Instruction:
All are true about Inverted papilloma except
A. Pre malignant
B. Arise from medial wall of nose
C. Common in females
D. Causes epistaxis

Response:
None

So the answer to this question is B


Instruction:
Hypercalciuria is seen in:
A. Hyperparathyroidism
B. Vit. D intoxication
C. Sarcoidosis
D. All

Response:
Answer is D (All of the above): Hypercakiuria may be associated with Vitamin D intoxication (hypervitaminosis D), Sarcoidosis and hyperparathyroidism. Causes of Hypercalciuria-associated Nephrolithiasis in Children and Adults Idiopathic hypercalciuria Increased intestinal calcium absorption - Granulomatous disease e.g. sarcoidosis - Hypervitaminosis D - Milk alkali syndrome Increased bone resorption Immobilization e.g. paraplegia and quadriplegia High animal protein diet Systemic acidosis e.g. distal renal tubular acidosis - Adrenocoicotrophic hormone or coisol excess - Primary hyperparathyroidism Decreased renal calcium reabsorption - Barret's syndrome - Chronic loop diuretic administration - X-linked hypercalciuria nephrolithiasis - Familial hypocalcemic hypercalciuria Systemic disease associated with chronic hypercalcemia - Williams syndrome - Primary hyperparathyroidism

So the answer to this question is D


Instruction:
All are true about bulimia nervosa, except
A. Binge eating
B. Self-induced vomiting
C. Weight loss
D. Purgative abuse

Response:
Bulimia NervosaBulimia nervosa is an eating disorder characterised by the following clinical features:1. Bulimia nervosa usually has an onset in early teens or adolescence.2. There is an intense fear of becoming obese. There may be an earlier history of anorexia nervosa.3. There is usually body-image disturbance and the person is unable to perceive own body size accurately.4. There is a persistent preoccupation with eating and an irresistible craving for food. There are episodes of overeating in which large amounts of food are consumed within sho periods of time (eating binges).5. There are attempts to 'counteract' the effects of overeating by one or more of the following: self-induced vomiting, purgative abuse, periods of starvation, and/or use of drugs such as appetitesuppressants.6. No known medical illness is present which can account for the disorder.7. An absence of any other primary psychiatric disorder. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.144

So the answer to this question is C


Instruction:
Population covered by CHC
A. 5000
B. 20,000
C. 30,000
D. 100,000

Response:
Ans. (d) 100,000Ref : K. Park 23rd ed. / 907* CHC is community health Centre. It covers 120,000 population in plain areas and 80,000 population in hilly areas.* Since, 120,000 is not in option, 100,000 is the closest and best answer.Also Know* PHC is considered as Primary level of health care is. It is considered as 1st level of contact.* CHC is considered as secondary level of health care and first referral unit.* Tertiary level of health care is delivered through medical colleges and hospitals.Health Care UnitPopulation coveredPlainHilly/Tribal/BackwardCHC120,00080,000PHC30,00020,000MPW50003000AWW400-800300-800ASHA/VHG/TBA1000

So the answer to this question is D


Instruction:
Legionnaire disease is caused by?
A. Motile gram positive
B. Motile gram negative
C. Non-motile gram positive
D. Non-motile gram negative

Response:
Ans. is 'b' i.e., Motile gram negative . Legionnaire disease is caused by legionella pneumophila, which is a gram-negative motile coccobacilli.

So the answer to this question is B


Instruction:
After incision and drainage of an abscess the infectious process has failed to regress inspite of the patient being on high doses of an antibiotic. It would be wise to:
A. Insert a large drain
B. Repeat culture and sensitivity tests
C. Debride and irrigate the area with a fibrinolytic agent
D. Begin the parenteral administration of proteolytic enzymes to augment the antibiotics

Response:
None

So the answer to this question is B


Instruction:
A patient is suffering from pneumonia. Laboratory study shows acid-fast filamentous bacterium. The causative organism is ?
A. M. tuberculosis
B. Actinomyces
C. Nocardia
D. Mycobacterium Avium intracellulare

Response:
Ans. is 'c' i.e., Nocardia Symptoms of pneumonia by a filamentous acid fast bacterium suggest the diagnosis of Nocardia.

So the answer to this question is C


Instruction:
A patient present painful vesicles in ear, and tongue. He is also complaining of facial weakness and hearing loss. Dignosis is ?
A. Fungal infection
B. Chicken pox
C. Ramsay hunt syndrome
D. None

Response:
Ans. is 'c' i.e., Ramsay hunt syndrome Ramsay hunt syndrome It is lower motor neuron type official palsy due to Varicella (herpes) zoster. Pain is often a prominent feature and vesicles are seen in the ipsilateral ear, on the hard palate and/or on anterior two third of tongue. It may involve other cranial nerves-V, VIII, IX and X and cervical branches (C2, C3 & C4) that have anastomotic communications with facial nerve. This results in features like : Anaesthesia of face Giddiness Hearing impairment along with VII nerve palsy. The mechanism of disease is reactivation of the latent varicella zoster virus in the geniculate ganglion. The onset of palsy is preceeded by pain which may persist & become excruciating. When the rash is absent it is known as zoster sine herpete. The prognosis of Ramsay Hunt syndromr is worse than Bells palsy. Persistent weakness is observed in 30-50% of patients and only 10% recover completely after complete loss offunction without treatment. Treatment recommended is prednisone (steroid) combined with acyclvir

So the answer to this question is C


Instruction:
In wood lamp examination, tinea versicolor looks like ----- fluorescence?
A. Green
B. Red
C. Yellow
D. Blue

Response:
Tinea versicolorCaused by fungus Malassezia furfurHypo or Hyperpigmented macular lesion seen in above 4 years of ageWood lamp examination show yellowish gold fluorescenceTreatment is topical antifungal agents(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 3213)

So the answer to this question is C


Instruction:
A 49 year old female with shoness of breath is found to have hilar lymphadenopathy on chest x-ray. Biopsy of one of the lymph nodes reveals granulomas, and is highly suggestive of sarcoidosis. Which of the following histological findings must have been present in the biopsy material to suppo the diagnosis of granulomatous inflammation?
A. Asteroid bodies
B. Caseous necrosis
C. Epithelioid histiocytes
D. Fibroblast proliferation

Response:
A granuloma is defined as a focus of chronic inflammatory reaction in which the predominant cell type is the epithelioid macrophage or histiocyte. Epithelioid histiocytes are recognized on standard H&E preparation by their pale pink cytoplasm and indistinct cell boundaries. Granulomas are generally surrounded by a ring of lymphocytes and infrequent plasma cells. The granulomas of sarcoidosis usually contain many multinucleated giant cells, and frequently these giant cells contain stellate inclusions called asteroid bodies Caseous necrosis describes the gross appearance of cheesy, necrotic debris filling a nodule of active tuberculosis, but also has come to describe its characteristic amorphous and eosinophilic appearance on H&E sections. Caseous necrosis is suggestive of tuberculosis, not sarcoidosis. Over time, fibroblasts proliferate within the core of old, inactive granulomas, eradicating the histiocytes and stereotypical appearance and producing a dense collagenous scar.

So the answer to this question is C


Instruction:
24 yr old mother with 7 week POG presents to ANC OPD with accidental exposure to radiation. What is to be done?
A. Immediate termination of pregnancy
B. Do Preinvasive Test
C. Do chromosomal Testing
D. Continue Pregnancy

Response:
In general,radiation exposureduring radiography, computed tomography (CT), or nuclear medicine imaging delivers adose much lowerthan that associated with fetal harm. If needed to supplement sonography or MR imaging or if more readily available, these should not be withheld Thus continue Pregnancy in above case

So the answer to this question is D


Instruction:
Griesinger's sign is observed in which of the following condition?
A. Abducent nerve paralysis
B. Otosclerosis
C. Lateral sinus thrombosis
D. Petrositis

Response:
Griesinger's sign: Erythema and oedema posterior to the mastoid process resulting from septic thrombosis of the mastoid emissary vein. It is seen in lateral sinus thrombosis.

So the answer to this question is C


Instruction:
A patient who was initially smear positive, who began the treatment and who remained or became smear positive again at five months or later during the course of treatment is called as:
A. Defaulter
B. Failure case
C. Relapse
D. None of the above

Response:
Failure case: A patient who was initially smear positive, who began
Rx and who remained or became smear positive again at five months or later during the course of Rx.
Relapse: A patient who returns sputum smear positive having previously been treated for tuberculosis and declared cured after the completion of his treatment.
Return after default: A patient who returns sputum smear positive, after having left Rx for at least two months.

So the answer to this question is B


Instruction:
A children presents with running nose, breathlessness, family history positive, Most likely diagnosis is -
A. Bronchiolitis
B. Viral pneumonia
C. Bronchial asthma
D. None

Response:
Ans. is 'c' i.e., Bronchial asthma o Except for bronchial asthma, no other option will have family history (+) ye.

So the answer to this question is C


Instruction:
Patient undergoing surgery was given a muscle relaxant. It produced marked fall in B.P. and increase in airway resistance which were reversed with diphenhydramine. The muscle relaxant was most probably :
A. Atracurium
B. Diazepam
C. Tubocurarine
D. Vecuronium

Response:
None

So the answer to this question is C


Instruction:
False statement about alagille syndrome
A. Complete absence of bile ducts
B. Normal liver
C. Mutations in Jagged 1 gene
D. No Risk of hepatocellular carcinoma

Response:
Ans. (d) No Risk of hepatocellular carcinoma(Ref: Robbins 9th/pg 853; 8th/pg 854)Alagille Syndrome (Syndromic Paucity of Bile Ducts; Arteriohepatic Dysplasia)An autosomal dominant disorder characterized by absence of bile ducts in portal tracts.Caused by mutations or deletion of gene encoding Jagged 1, on chromosome 20p.Patients can survive into adulthood but are at risk for hepatic failure & hepatocellular carcinomaMajor clinical features:#Chronic cholestasis#Peripheral pulmonary artery stenosis#Butterfly-like vertebral arch defects#An eye defect known as posterior embryotoxon,#A peculiar hypertelic, triangular facies.

So the answer to this question is D


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

Response:
Most common cancer in males in India → Oro-pharyngeal Ca (Aero-digestive Ca).
Most common cancer in males in world → Lung Ca.
Most common cancer in females in India → Cervical cancer.
Most common cancer in females in world → Brast Ca.
Most common overall cancer in the world (combined male & female) → Lung cancer.
Most common cancer related death in males in India & in world → Ca lung.
Most common cancer related death in females in India & in world → Breast cancer.

So the answer to this question is B


Instruction:
Best latrine for rural community is
A. Bore hole
B. Dug well
C. Water seal
D. septic tank

Response:
(B) Dug well # Advantages of Dug well type of latrine are:> It is easy to construct and no special equipment such as an auger is needed to dig the pit> The pit has a longer life than the bore hole because of greater cubic capacity. A pit 75 cm (30 in.) diameter and 3 to 3.5 m (10-12 ft.) deep will last for about 5 years for a family of 4 to 5 persons.> When the pit is filled up, a new pit is constructed.> The action of the dug well latrine is the same as in the bore hole latrine, i.e., anaerobic digestion.

So the answer to this question is B


Instruction:
Hormone responsible for BP regulation after a fall due to blood loss.
A. ADH
B. ANP
C. Epinephrine
D. Aldosterone

Response:
Ans. is'a' i.e., ADH o Blood pressure is regulated by following mechanisms.A) Short term regulation# These mechanisms act immediately and correct the blood pressure quickly. These arei) Baroreceptor reflex: Works during BP range 70-150 mmHg.ii) Chemoreceptor reflex: Works when BP below 80 mmHg.iii) CNS ischemic response: This the only hope of survival when BP is below 40 mmHg.iv) Hormonal release: These are -a) Antidiuretic hormone (ADH) : Increases water reabsorption in kidney.b) Angiotensin II: Causes vasoconstriction.B) Long term regulation# This is the mechanism which takes long time for regulation. This mechanism is present in kidneys. This mechanism adjusts the BP by adjusting volume of extracellular fluid and blood.# Mechanisms arei) Pressure diuresis.ii) Pressure natreuresis.iii) Renin-angiotensin-aldosterone system.Important facto Angiotensin II is involved in short term regulation.o But, full RAA system is involved in long term regulation.

So the answer to this question is A


Instruction:
A patient with heart failure developed ventricular arryhthmia. Treatment is/are -a) Encainideb) Flecainidec) Intracardiac Defibrilationd) Beta-blockerse) Amiodarone
A. abd
B. cde
C. bde
D. ade

Response:
None

So the answer to this question is B


Instruction:
An infant presents with the condition as shown below after a pharyngeal infection. The shown condition is:
A. Staphylococcal scalded skin syndrome
B. Epidermolysis bullosa simplex
C. Impetigo contagiosa
D. Pemphigus foliaceus

Response:
SSSS/ Pemphigus Neonatorum / Ritter's disease: - Caused by: Staph. aureus - Seen in neonates and infants - Usually follows pharyngeal infection. - Staph. aureus releases Exfoliative toxins A & B that destroys Desmoglein 1 - Mucosal involvement absent - Epidermal separation occurs superficially. - Nikolsky sign positive - when pressure applied tangentially to skin, overlying epidermis will separate. Treatment of SSSS - Usually requires hospitalisation i/v antibiotics are given. A penicillinase-resistant, anti-staphylococcal antibiotic such as flucloxacillin is used. Other antibiotics include nafcillin, oxacillin, cephalosporin and clindamycin.

So the answer to this question is A


Instruction:
The following diseases have a defect in DNA repair mechanism except for
A. Xeroderma pigmentosum
B. Huntington’s disease
C. Fanconi syndrome
D. Hereditary non polyposis colon cancer

Response:
Inherited autosomal recessive syndromes of defective DNA repair
Ataxia Telangiectasia
Bloom syndrome
Fanconi anaemia
Xeroderma pigmentosum
Hereditary Nonpolyposis cancer
Huntington’s disease is an example of trinucleotide repeat disorders

So the answer to this question is B


Instruction:
Ego's defense mechanism "Undoing" is typically seen in:
A. Depression
B. Schizophrenia
C. Obsessive compulsive neurosis
D. Hysteria

Response:
Defense mechanism are used by ego to prevent build up of excessive anxiety. They are unconscious Undoing is typically seen in obsessive compulsive disorder (OCD). It is an act done to nullify the previous act. Other defense mechanism seen in OCD- Displacement- Transfer of emotions from one individual to another Reaction formation- Transforming an impulse into its exact behavior Inhibition (Aim inhibition)- Accepting paial fulfillment of desires Isolation of effect- Removing feelings associated with a stressful event.

So the answer to this question is C


Instruction:
In the citric acid cycle, the reaction which produces succinyl CoA also forms carbon dioxide. The key intermediate enzymic step involves:
A. The decarboxylation of a hydroxy acid
B. The decarboxylation of an alpha-ketoacid
C. The decarboxylation of a beta-ketoacid
D. The oxidation of a keto group to a carboxylic acid

Response:
The enzyme is a-ketoglutarate dehydrogenase, an a-keto acid, which is decarboxylated. Therefore the second choice is correct. The only confusion might be with the last choice, since in effect it involves the oxidation of a keto group to a carboxylic acid. However, the product is the thio-ester of a carboxylic acid.

So the answer to this question is B


Instruction:
Most common supratentorial tumour in children is –
A. Craniopharyngioma
B. Astrocytoma
C. Glioma
D. Meningioma

Response:
Most common supratentorial tumours in children is - Craniopharyngioma.

So the answer to this question is A


Instruction:
Commonest cause of non–communicating hydrocephalus in children is –
A. Congenital anomaly
B. Perinatal injury
C. Post–inflammatory obstruction
D. Brain tumors

Response:
Hydrocephalus

Hydrocephalus is characterized by an increased volume of CSF in association with progressive ventricular dilatation.

So the answer to this question is A


Instruction:
Which of the following is not seen in a hyperkinetic child?
A. Aggressive outbursts
B. Decreased attention span
C. Left to right disorientation
D. Soft neurological signs

Response:
The term "left to right disorientation" is used for describing gross inability to distinguish left from right and is usually a feature of Gerstmann's syndrome. Patients presenting with Gerstmann's syndrome have a damage classically involving the angular gyrus of the parietal lobe. It is commonly caused by a stroke in this region of thebrain. In ADHD, "left to right discrimination" difficulties can also be found. The best answer here would be left to right disorientation.

So the answer to this question is C


Instruction:
Diagnosis of Hodgkin's disease is confirmed by ?
A. CT scan
B. Bone marrow biopsy
C. Lymph node biopsy
D. Lymphangiography

Response:
Ans. is 'c' i.e., Lymph node biopsy

So the answer to this question is C


Instruction:
A 40-year-old tailor complains of pain, numbness, and weakness of the right hand for the last three months. On examination, there is hypoaesthesia and atrophy of thenar eminence. Which one of the following nerves is likely to be involved?
A. Ulnar
B. Radial
C. Axillary
D. Median

Response:
Ans. is 'd' i.e. Median nerveRef Maheshwari 3rd/Ep 54, 55The main motor supply of the thenar muscles of hand is by the median nerve, hence its atrophy is s/o paralysis of the median nerve.Motor nerve supply of Median nerve in the handThenar muscles which includeFlexor pollicis brevisOpponens pollicisAbductor pollicisFirst two lumbricalsNote: Adductor pollicis is a thenar muscle which is not supplied by the median nerve. It is supplied by ulnar nerve (deep branch). The deep head of Flexor pollicis brevis is also supplied by the ulnar nerve.Also, know:Motor branches of the median nerve in the forearm.* All the flexor muscles of the forearm except the flexor carpi ulnaris and medial half of flexor digitorum profundus

So the answer to this question is D


Instruction:
Meralgia paraesthetica is -
A. Medial cutaneous nerve of thigh
B. Lateral cutaneous nerve of thigh
C. Lateral cutaneous nerve of hand
D. Medial cutaneous nerve of hand

Response:
Ans. is 'b' i.e., Lateral cutaneous nerve of thigh o The neuropathy affecting the lateral cutaneous nerve of thigh is called meralgia paraesthetica,o Cheralgia paraesthetica is a neuropathy of the hand - superficial branch of the radial nerve. The area affected includes:Base of thumb, near the anatomical snuffboxBack of thumb and index fingerBack of handThus,Meralgia paraesthetica - Lateral cutaneous nerve of thighCheralgia paraesthetica - Lateral cutaneous nerve of hand

So the answer to this question is B


Instruction:
Increased incidence of reaction to L.A will occur by
A. Rapid rate of injection
B. Using an aspirating technique
C. Addition of vaso constrictor to the solution
D. Premedication with barbiturate

Response:
None

So the answer to this question is A


Instruction:
Which of the following about cholera is true ?
A. Invasive
B. Endotoxin is released
C. Recent infections in india are of classical type
D. Vibriocidal antibody titre measures prevalence

Response:
Ans. is 'd' i.e., Vibriocidal antibody titre measures prevalence . Serological examination is of little use in the diagnosis of cases though it may be helpful assessing the prevalence of cholera in an area. The complement dependent vibriocidal antibody test is the most useful. Other tests are : Indirect hemagglutination Antitoxin assay Agglutination using live or killed vibrio suspensions. About other options Throughout the course of infection, the vibrios remain attached to the epithelium but do not damage or invade the cells. . V. cholerae possesses the endotoxin but it has no role in pathogenesis. . Recent infection in India are of E-1 Tor vibrios.

So the answer to this question is D


Instruction:
A 32-year-old woman with systemic lupus erythematosus (SLE) and chronic renal failure manifests rapidly progressive weakness. On physical examination, she appears pale and has slightly yellow sclerae and an enlarged spleen. Blood tests reveal severe anemia and mild, mostly unconjugated, hyperbilirubinemia. Coombs test is positive at 37 C but negative at 0-4 C. This patient developed anemia because of?
A. Bone marrow aplasia
B. IgG directed against red blood cells
C. IgM directed against red blood cells
D. Renal failure

Response:
First, what type of anemia is it? It must be a hemolytic form, since it is associated with unconjugated hyperbilirubinemia (hence the yellow sclerae), resulting from increased destruction of red blood cells. Increased erythrocyte destruction is the cause (not the effect) of splenomegaly. Fuhermore, a positive Coombs test implies that hemolysis is mediated by antibodies attached to red blood cells. Thus, the correct choice must be either IgG or IgM. Since the Coombs test is positive at warm temperature (37 C), the antibody is a warm agglutinin. Warm agglutinins are viually always of IgG type and may be triggered by a variety of disorders, including lymphomas, drugs, and autoimmune diseases such as SLE. IgG-coated red cells are then sequestered by the spleen, where hemolysis occurs, thus explaining splenomegaly. By contrast, cold agglutinins are IgM and can be demonstrated by Coombs test at cold temperature (0-4 C). Cold agglutinins are usually triggered by Mycoplasma pneumoniae infection or lymphomas. Note: Bone marrow aplasia is due to failure or suppression of myeloid stem cells, with decreased production of red blood cells, platelets, and leukocytes (pancytopenia). Most commonly, this condition is caused by chemical agents (especially drugs such as chloramphenicol, phenylbutazone, alkylating agents, and antimetabolites) or total body irradiation. Renal failure causes normochromic, normocytic anemia because of decreased synthesis of erythropoietin. Erythropoietin administration is currently the standard treatment for this form of anemia. Although renal failure is a frequent consequence of SLE, there is no evidence that it plays a role in this patient's anemia. Ref: Reid M.E. (2010). Chapter 137. Erythrocyte Antigens and Antibodies. 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 B


Instruction:
Pathological contraction ring is due to:
A. Obstructed labour
B. Uterine inertia
C. Preterm labour
D. Oligohydramnios

Response:
Ref: Outfit's Text Book of Obstetrics, 7th edition, pg. 404 Explanation:Pathological retraction ring/ Bandl's ring is seen in obstructed Labor.Contraction ring /Schroeder's ring is seen in incoordinate uterine contraction.Causes of obstructed labor:Fault in passage:CPD. contracted pelvisCervical/broad ligament fibroidImpacted ovarian tumourFault in passenger:1 ransverse lieBrow1 presentationCongenital malformationslike hydrocephalus, fetal ascites, double monstersMacrosomic babyLocked twinsSalient clinical features:Band Ps ringTonic upper segment and distended thinned out lower segmentBlood stained urineFeta! distress/deathCaput & 3rd degree mouldingFailure of descent of the presenting partComplications:Maternal:Metabolic acidosisGenital sepsisPPH & shockVesico vagi n al tl st u 1 aSecondary amenorrheaFetal:Asphyxia, acidosisIntracranial hemorrhageInfectionManagement: caesarean sectionCause of vesico vaginal fistula in obstructed labor: Pressure necrosis of the base of the bladder between pubic symphysis and fetal bead.

So the answer to this question is A


Instruction:
Specialized cell membrane structures that decrease electrical resistance between the cells allowing action potentials to pass efficiently from one cell to adjacent cells are the
A. Extensive capillary network
B. Intercalated disks
C. Mitochondria
D. Gap junctions

Response:
D: Gap junctions are a specialized intercellular connection between a multitude of animal cell-types. They directly connect the cytoplasm of two cells, which allows various molecules, ions and electrical impulses to directly pass through a regulated gate between cells.
A: Extensive capillary networks allows the abundant supply of oxygen and nutrients on tissues such as skeletal muscle, liver and kidney.
B: Intercalated disks support synchronized contraction of cardiac tissue. They occur at the Z-line of the sarcomere and can be visualized easily when observing a longitudinal section of the tissue.
C: Mitochondrion is an organelle found in large numbers in most cells, in which the biochemical processes of respiration and energy production occur.

So the answer to this question is D


Instruction:
Esophagus is present in all except ?
A. Superior mediastinum
B. Middle mediastinum
C. Anterior mediastinum
D. Posterior mediastinum

Response:
Ans. is 'c' i.e., Anterior mediastinum Esophagus mainly descends in superior and posterior mediastinum.Esophagus is usually not a content of middle mediastinum, but it forms posterior boundry of middle mediastinum (BDC Vol.-1, 6`"/e p. 246).Esophagus has no relation to anterior mediastinum. Thus, among the given options, best answer is anterior mediastinum.

So the answer to this question is C


Instruction:
Hyperparathyroidism (in 80% cases), pancreatic islet cell tumors, and pituitary adenomas are seen in:
A. Men 1 (Wermer)
B. Men 2A (Sipple)
C. Men 2B
D. All of the above

Response:
None

So the answer to this question is A


Instruction:
True about Vestibular Schwannoma is
A. Converging ABLB Laddergram
B. Recruitment phenomenon is present
C. High SISI score
D. Rollover phenomenon is seen

Response:
Meniere's disease is an impoant differential for acoustic neuroma as the patients suffer from similar symptoms. Meniere's is a cochlear pathology and acoustic neuroma is retrocochlear. Audiological diagnostics: Test Cochlear Retro- Cochlear S.I.S.I Positive ( >70%) Negative A.B.L.B Laddergram Converging Diverging Tone Decay Negative( <25 dB) Positive ( >25dB) Speech Audiometry SDS = 60-80% <40%, Roll over phenomenon B.E.R.A ( Wave V Latency) </= 4.2 msec >4.2 msec

So the answer to this question is D


Instruction:
Features ouring Pityriasis rubra pilaris over Psoriasis include following except:
A. Furfuraceous scalp scaling
B. No salmon patches
C. Keratoderma
D. Ahropathy

Response:
Differences between Pityriasis rubra pilaris and Psoriasis Pityriasis rubra pilaris Psoriasis Age at onset Bimodal Second decade Scalp scaling Furfuraceous Adherent Keratoderma Constant less common 'Islands' of pale skin Constant Less common Nail changes No salmon patches Present Nail growth rate Moderate increase Marked increase Epidermal Kinetics Moderate increase Marked increase Munro micro-abscesses Absent Common Response to UVB Poor Good Response to coicosteroids Poor Positive Response to methotrexate Variable Good Seronegative ahropathy Rare Common

So the answer to this question is D


Instruction:
Ovulation is due to surge of: September 2006, 2010
A. FSH
B. LH
C. Prolactin
D. TSH

Response:
Ans. B: LH

So the answer to this question is B


Instruction:
Which intraocular muscle inses closest to limbus
A. Lateral Rectus
B. Medial Rectus
C. Superior Rectus
D. Inferior Rectus

Response:
Answer- B. Medial RectusMedial rectus -Distance of inseion from limbus- 5.5 mm

So the answer to this question is B


Instruction:
Which of the following is the pathogen responsible for blindness in advanced HIV infections? (NOT RELATED)
A. Cytomegalovirus
B. Epstein-Barr virus
C. Fungus
D. Toxoplasma

Response:
.

So the answer to this question is A


Instruction:
The commonest anatomical position of the appendix is-
A. Retrocaecal
B. Pelvic
C. Paracaecal
D. Preileal

Response:
The most common position of the appendix is retrocaecal (12 O'clock).

So the answer to this question is A


Instruction:
All of the following agents are useful in acromegaly EXCEPT:
A. Bromocriptine
B. Somatostatin
C. Octreotide
D. Nafarelin

Response:
(Ref: KDT 6/e p239) Nafarelin is a GnRH agonist. It has no role in acromegaly.

So the answer to this question is D


Instruction:
Billing method is -
A. Maneuver for delivery of head of fetus
B. Method of contraception
C. Ethical guidelines for better doctor - patient relationship
D. Assessing KAP in society

Response:
Ans. is 'b' i.e., Method of contraception Natural methods of contraceptiono These methods are :A) Safe period (rhythm method)# This is also knwon as calendar method first described by Ogino. Its calculations are dependent on length of menstural cycle. The method is based on the fact that ovulation occurs from 12 to 16 days before the onset of mensturation.# Calculation is as followso The shortest cycle minus 18 days gives the first day of the fertile period.o The longest cycle minus 10 days gives the last day of fertile period.o For example, if a woman's menstural cycle varies from 26-31 days, the fertile period during which she should not have intercourse would be from the 8th day to 21st day of the menstural cycle, counting day one as the first day of the menstural period.B) Basal body temperature (BBT) method# It is based on the principle that there is rise BBT at or just before ovulation.C) Cervical mucus method (Billings method or ovulation method)# It is based on the observation that at the time of ovulation cervical mucus becomes watery clear resembling raw egg white, smooth, slippery and profuse.D) Symptothermic method# This method combines temperature, cervical mucus and safe period (calender method) methods.E) Abstinence# There is complete abstinence from sexual intercourse. It is not used and can hardly be considered as a method of contraception to be advocated to the masses.F) Coitus interruptus# It is the oldest method of voluntary fertility control. The male withdraws before ejaculation, and thereby tries to prevent deposition of semen into vagina. Failure rate is very high 25%

So the answer to this question is B


Instruction:
Definitive treatment for a case of severe pre eclampsia is -
A. MgSO4
B. Delivery of baby
C. Antihypertensive drugs
D. Rest

Response:
Ans. is 'b' i.e., Delivery of baby "For all types of PIH, irrespective of severity, definitive management is termination ofpregnancy".

So the answer to this question is B


Instruction:
A 3 month old child has moderate fever and non productive cough and mild dyspnea. After course of mild antibiotic the condition of the child improved transiently but he again developed high fever, productive cough and increased respiratory distress. Chest X ray shows hyperlucency and PFT shows obstructive pattern. Most probable diagnosis is:
A. Alveolar microlithiasis
B. Post viral syndrome
C. Follicular bronchitis
D. Bronchiolitis obliterans

Response:
Bronchiolitis obliterans is a rare chronic obstructive lung disease characterized by complete obliteration of the small airways following a severe insult. The most common form in children is postinfectious, following a lower airway tract infection commonly with adenovirus. Children with bronchiolitis obliterans usually experience dyspnea, coughing, and exercise intolerance. Chest radiograph abnormalities include evidence of heterogeneous air trapping and airway wall thickening. Ref: Federico M.J., Stillwell P., Deterding R.R., Baker C.D., Balasubramaniam V., Zemanick E.T., Sagel S.D., Halbower A., Burg C.J., Kerby G.S. (2012). Chapter 19. Respiratory Tract & Mediastinum. 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 D


Instruction:
The regional aerial resistance of the mesentery and kidney vessels is reduced by
A. Dopamine
B. Dobutamine
C. Nor adrenaline
D. Isoprenaline

Response:
In hyperdynamic sepsis, the peripheral aeriolar tone and BP are low but the cardiac output is often high; therefore the vasoconstrictor noradrenaline (norepinephrine) is appropriate to restore BP, usually at the price of some reduction in cardiac output.In most cases, a vasoconstrictor such as noradrenaline (norepinephrine) is necessary to increase SVR and BP, while an inotrope (dobutamine) may be necessary to maintain cardiac output. In the later stages of severe sepsis, the essential problem is at the microcirculatory level. Oxygen uptake and utilisation are impaired due to failure of the regional distribution of flow and direct cellular toxicity despite adequate global oxygen delivery. Tissue oxygenation may be improved and aerobic metabolism sustained by reducing demand, i.e. metabolic rate. ref:Davidsson&;s principles and practices of medicine,ed 21,pg no 598

So the answer to this question is C


Instruction:
In congenital adrenal hyperplasia most common deficiency
A. 21- alpha hydroxylase deficiency
B. 11- beta hydroxylase deficiency
C. 17 - hydroxylase deficiency
D. 3 beta hydroxylase deficiency

Response:
Ans) a (21- alpha ) Ref Nelson 18'h ed p 2360More than 90% of CAH cases are caused by 21 -hydroxylase deficiency.

So the answer to this question is A


Instruction:
The transition between the stomach and duodenum is marked by
A. Vein of Mayo
B. Hepatoduodenal ligament
C. Gastroduodenal aery
D. Incisura

Response:
Prepyloric vein of mayo distinguishes pyloric canal from the first pa of the duodenum. The angular incisure or angular notch also called the incisura angularis, is a small anatomical notch on the stomach located on the lesser curvature of the stomach near the pyloric end. Its location varies somewhat in position with the state of distension of the internal organs The gastroduodenal aery is a blood vessel that arises from the common hepatic aery The hepatoduodenal ligament is the poion of the lesser omentum extending between the poa hepatis of the liver and the superior pa of the duodenum Reference: SRB 5 th edition page no.815

So the answer to this question is A


Instruction:
Lymphatic drainage of cervix is to
A. Iliac lymph nodes
B. Para aoic lymph nodes
C. Superficial inguinal lymph nodes
D. Deep inguinal lymph nodes

Response:
A. i.e. Iliac lymph nodes

So the answer to this question is A


Instruction:
In percutaneous endoscopic gastrostomy (PEG), which of the following is not used?
A. Push technique
B. Pull technique
C. Retraction method
D. Introducer technique

Response:
Ans. (c) Retraction methodRef: Bailey 26th Edition Page 267There are three methods of putting PEG tube* Direct Stab technique (Introducer technique)* Push through technique!* Pull TechniqueThere is no retraction technique

So the answer to this question is C


Instruction:
Anti-Myeloperoxidase P-ANCA is positive in which of the following ?
A. Ulcerative colitis
B. Autoimmune hepatitis
C. SLE
D. Wegener's granulomatosis

Response:
ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES (ANCA) ANCA are antibodies directed against ceain proteins in the cytoplasmic granules of neutrophils and monocytes. There are two major categories of ANCA based on different targets for the antibodies. The terminology of cytoplasmic ANCA (cANCA) refers to the diffuse, granular cytoplasmic staining pattern observed by immunofluorescence microscopy when serum antibodies bind to indicator neutrophils. Proteinase-3, a 29-kDa neutral serine proteinase present in neutrophil azurophilic granules, is the major cANCA antigen. More than 90% of patients with typical active granulomatosis with polyangiitis (Wegener's) have detectable antibodies to proteinase-3. The terminology of perinuclear ANCA (pANCA) refers to the more localized perinuclear or nuclear staining pattern of myeloperoxidase; other targets that can produce a pANCA pattern of staining include elastase, cathepsin G, lactoferrin, lysozyme, and bactericidal/permeability-increasing protein. Anti-myeloperoxidase antibodies have been repoed to occur in variable percentages of patients with microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis (Churg-Strauss), isolated necrotizing crescentic glomerulonephritis, and granulomatosis with polyangiitis (Wegener's). A pANCA pattern of staining that is not due to anti-myeloperoxidase antibodies has been associated with non-vasculitic entities such as rheumatic and non-rheumatic autoimmune diseases, inflammatory bowel disease, ceain drugs, and infections such as endocarditis and bacterial airway infections in patients with cystic fibrosis. Ref: Harrison&;s Principles of Internal Medicine; 20th edition; Chapter 385 The Vasculitis Syndromes; Page no: 2180

So the answer to this question is D


Instruction:
N ANA antibody is seen in -
A. Sarcoidosis
B. Tuberculosis
C. Leprosy
D. Carcinoid

Response:
Answer is option1 Sarcoidosis is a chronic multisystem disorder characterized by an exaggerated cellular immune response to antigens with the production of various antibodies including rheumatoid factor and antinuclear antibodies (ANA). https:/ncbi.nlm.nih.gov.in

So the answer to this question is A


Instruction:
Causes of anterior polar ctaract
A. DM
B. Perforating (penetrating) corneal injury
C. Irradation
D. Chalcosis

Response:
B i.e. Perforating corneal injury

So the answer to this question is B


Instruction:
Reinke's layer seen in -
A. Vocal cord
B. Tympanic membrane
C. Cochlea
D. Reissner's membrane

Response:
Reinke’s Edema

It is diffuse edema of the Reinke’s space (of vocal cords) leading to irreversible fusiform swelling of the vocal cord—usually bilateral.
Commonest etiology is smoking though extra esophageal reflux, vocal strain and hypothyroidism has also been implicated.
Patient has a low-pitched hoarse voice; may present as stridor in severe cases.
Treatment is superior cordotomy (incising the superior surface of vocal cord preserving the medical vibrating edge) through microlaryngoscopy to decompress the edema fluid. The mucosal flap is then replaced after trimming off the excess epithelium.

So the answer to this question is A


Instruction:
Which of the following is not a part of epidemiological triad:
A. Agent
B. Host
C. Disease
D. Environment

Response:
None

So the answer to this question is C


Instruction:
Spontaneous absorption of lenticular material is seen in –
A. Myotonic dystrophy
B. Hallermann Streiff syndrome
C. Aniridia
D. Persistent hyperplastic primary vitreous

Response:
Spontaneous absorption of lens may occur in Hallermann-streiff-syndrome.

So the answer to this question is B


Instruction:
Interstitial nephritis is seen in all EXCEPT :
A. Diuretics
B. Beta lactams
C. Allopurinol
D. Isoniazid

Response:
Drugs causing interstitial nephritis are

Antibiotics: Cephalosporins, penicillins, ciprofloxacin, ethambutol, isoniazid, macrolides, rifampicin.
Sulfonamides, tetracyclines and vancomycin.
All NSAIDs.
Diuretics: Thiazides, furosemide, triamterene.
Others: Allopurinol, acyclovir, amlodipine, azathioprine, carbamazepine, captopril.

So the answer to this question is B


Instruction:
Mass chemoprophylaxis in endemic area is recommeded for all of the following, except
A. Yaws
B. Leprosy
C. Trachoma
D. Filaria

Response:
Cholera-tetracycline or furazolidone for household contacts Conjunctivitis bacterial-erythromycin ophthalmic ointment Diphtheria-erythromycin Influenza-oseltamivir Meningitis,meningococcal-ciprofloxacin and minocyclin Plague-tetracycline for contacts of pneumonic plague Chemoprophylaxis implies the protection from or prevention of disease. This may be achieved by causal prophylaxis of a disease or by clinical prophylaxis. 1)causal prophylaxis implies the complete prevention of infection by the early elimination of the invading or migrating causal factor 2)clinical prophylaxis implies the prevention of clinical symptoms Indications for chemoprophylaxis: Cholera,bacterial conjunctivitis,diphtheria,influenza,malaria,meningococcal meningitis,plague Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 137

So the answer to this question is B


Instruction:
In the immediate post operative period, body potassium is -
A. Exchanged with calcium
B. Exchanged with magnesium
C. Retained in body
D. Excreted excessively

Response:
Ans. is 'd' i.e., Excreted excessively There is increased Adreno coical activity which causes Na+ retention & K+ excretion

So the answer to this question is D


Instruction:
Drug causing cardiomyopathy -
A. Chloroquine
B. Trastuzumab
C. Methotrexate
D. Pemetrexed

Response:
Ans. is 'b' i.e., Trastuzumab o Important drugs causing cardiomyopathy (espcially dilated cardiomyopathy) are:i) Cocaineii) Amphetamineiii) Doxorobicin (Anthracycline)iv) Trastuzumab (Herceptin)

So the answer to this question is B


Instruction:
Maximum safe dose of bupivacaine
A. 1 mg/kg
B. 2 mg/kg
C. 3 mg/kg
D. 5 mg/kg

Response:
Maximum safe dose of bupivacaine is 2 mg/kg with or without adrenaline.

So the answer to this question is B


Instruction:
Disadvantages of high-speed instrumentation is
A. aerosol spray inhalation
B. Loss of tactile sensation to the operator
C. heat production
D. all the above

Response:
None

So the answer to this question is D


Instruction:
Zwitterions are examples of
A. Anions
B. Cations
C. Neutral ions
D. None of the above

Response:
Molecules that contain an equal number of positively and negatively charged groups bear no net charge. These ionized neutral species are termed zwitterions.
Zwitterions are one example of an isoelectric species the form of a molecule that has an equal number of positive and negative charges and thus is electrically neutral.
Ref: Harper’s illustrated biochemistry. 30th edition page no: 20

So the answer to this question is C


Instruction:
Finding in meningioma are all except:
A. Vascular markings around falx
B. Calcification
C. Erosion
D. Osteosclerosis

Response:
C i.e. Erosion

So the answer to this question is C


Instruction:
A man with diabetes insipidus has a glomerular filtration of 155 L/day. Which range most likely represents the upper limit for urine flow rate in this individual if he were not receiving treatment but had free access to water?
A. 1 to 3 L/day
B. 5 to 10 L/day
C. 15 to 20 L/day
D. 30 to 35 L/day

Response:
Ans. C. 15 to 20 L/dayUrine flow rate in the absence of antidiuretic hormone (ADH) can approach approximately 10% to 13% of the glomerular filtration therefore, for a glomerular filtration of 155 L/day, urine flow could be as much as 15 to 20 L/ day. To maintain this level of urine flow, the individual must consume an equivalent amount of water per day.

So the answer to this question is C


Instruction:
Which of the following agents is not used in the treatment of Diabetic Macular Edema/Retinopathy –
A. Ruboxistaurim
B. Pyridazinones
C. Benfotiamine
D. Tamoxifen

Response:
Tamoxifen is known to cause retinopathy and macular edema as an adverse effect. It is not used in the treatment of diabetic macular edema or retinopathy.
Ruboxistaurin, pyridazinones and benfotiamine are all emerging drugs being investigated for treatment of diabetic retinopathy.

So the answer to this question is D


Instruction:
A male was brought unconscious to the hospital with external injuries. CT shows no midline shift, but basal cisterns were full (compressed) with multiple small haemorrhage. The most probable diagnosis is:
A. Brain contusion
B. Diffuse axonal injury
C. Subdural hemorrhage
D. Multiple infarct

Response:
B i.e. Diffuse axonal injuries Diffuse axonal injuries (DAI) - shearing injuries caused by sudden rotational or accelerating / decelerating forces. Patient typically lose consciousness at the time of impactQ. On CT small petechial hemorrhages are seenQ

So the answer to this question is B


Instruction:
Internationally accepted definition of aboion is the expulsion of the products of conception :
A. Before 28th week of gestation or 1 kg (weight of foetus)
B. Before 24th week of gestation or 750 gms (weight of foetus)
C. Before 20 week of gestation or 750 gms (weight of foetus)
D. Before 20th week of gestation or 500 gms (weight of foetus)

Response:
Before 20th week of gestation or 500 gms (weight of foetus)

So the answer to this question is D


Instruction:
Serum sickness is due to which type of hypersensitivity?
A. Type I
B. Type II
C. Type III
D. Type IV

Response:
Ans: C (Type III) Ref: Ananthnarayan R, Paniker CKJ. Textbook of Microbiology. 8th Edition. Hyderabad: Universities Press: 2009. Pg. 161-168Explanation:HYPERSENSITIVITYGell and Coomb classificationType I - IgE mediated- anaphylaxis and atopyType II- cytotoxic or cytolyticType III- immune complex mediatedType IV- T cell mediatedNote: Grave's disease is known as Type V hypersensitivityType I hypersensitivityAnaphylaxis-acute, systemic, potentially fatal formAtopy- chronic, localized, non fatal, familial form (Coca, 1923)Type I HS is mediated by IgE antibodiesEg of subatances associated with Type I HS:Proteins-foreign serum & vaccinesFood-nuts, eggs, milk,seafoodPlant pollenDrugs-penicillin, local anestheticsInsect products- venom (bees, wasps, ants dust mitesMold sporesAnimal hair and danderType II hypersensitivityReactions involve combination of IgG or IgM antibodies to cell fixed antigensExamples of type II reactionsCell surface antigensRBC- transfusion reactions, erythroblastosis fetalis, A.I.H.AWBC- neutropeniaPLATELETS-thrombocytopeniaTissue antigens Goodpasture's syndrome PemphigusType III hypersensitivityAntibodies (usually IgA ) directed against soluble antigensExamples of type III hypersensitivityArthus reaction- localized hemorrhagic necrosis following SC injection of antigen in sensitized rabbitsSerum sickness- systemic form appears 7-12 days after injection of foreign serumInfection (microbial antigen)-kidneys- leptospirosis, malaria. Post streptococcal glomerulonephritisAutoimmune diseases- (self antigen)- kidney, skin, jointsInhaled antigens (molds, plant pollen)-lung (Farmer's lung)Type IV hypersensitivityAlso called delayed hypersensitivity because it takes 48-72 hours to developInvolves TDTH cells (subset of TH cells)Cannot be passively transferred by serumExamples-contact dermatitis, tuberculin test (48- 72 hours) and granuloma (21-28 days)

So the answer to this question is C


Instruction:
If there is a Gs alfa subunit gain-of-function mutation, this results in:
A. Decreased cAMP
B. Decreased IP3
C. Increased GTPase activity
D. Increased cAMP

Response:
D i.e. Increased cAMPGs-a subunit gain would cause increased adenyl cyclase level - ultimately resulting in increased c-AMP levelQ, (because adenyl cyclase conves ATP to c-AMP).

So the answer to this question is D


Instruction:
Crown completion of Mandibular 1st molar occur
A. At birth
B. 1 ½ year
C. 9 months after birth
D. 2 ½- 3 year

Response:
None

So the answer to this question is D


Instruction:
Sensations which are appreciated in thalamus -
A. Proprioception
B. Pain & temperature
C. Tactile sensations
D. Pressure

Response:
Ans. is "b1 i.e.. Pain & temperatureo Pain and temperature are primarily appreciated by the thalamus.o For other forms of sensation, the thalamus is unable to analyze the details of sensations.o Fibers carrying tactile and proprioceptive information ascend through the thalamocortical pathway to area 3 of primary somatic sensory cortex through the thalamic radiation,o Therefore, if the somatosensory cortex is removed, tactile sensations and proprioceptions are lost, but pain and temperature sensations persist.

So the answer to this question is B


Instruction:
Raised AFP is typically seen with?
A. Hepatitis
B. Seminoma
C. HCC
D. All of the above

Response:
Ans. C. HCC. (Ref. Robbin's Pathology8th/pg. 666, 695; Harrison-17th/pg. 483, 587, 614)AFP# AFP is a glycoprotein normally synthesized by the fetal yolk sac and several other fetal tissues. Approximately 50% of HCC patients have elevated serum?-fetoprotein.# However, this tumor "marker" lacks specificity, because modest elevations are also encountered in other conditions, such as- cirrhosis,- massive liver necrosis,- chronic hepatitis,- normal pregnancy,- fetal distress or death,- fetal neural tube defects such as anencephaly and spina bifida, and- gonadal germ cell tumors.# Very high levels (>1000 ng/mL), however, are rarely encountered except in HCC.PProstate-specific antigen (PSA)# It is a glycoprotein which is a serine protease.# Its function may be to facilitate liquefaction of semen, but it is a marker for prostatic disease.# It is measured by an immunoassay and the normal range can differ a little from laboratory to laboratory.# The normal upper limit is about 4 nmol/ml.# Its level in men with metastatic prostate cancer is usually increased to >30 nmol/ml and falls to low levels after successful androgen ablation.# Men with locally confined prostate cancer usually have serum PSA levels <15 nmol/ml. Although PSA is a reliable marker for the progress of advanced disease it is neither specific nor sensitive in the differential diagnosis of early prostate cancer and BPH, as both diseases are compatible with PSA in the range of 4-12 nmol/ml.# PSA measurement has superseded measurement of serum acid phosphatase.# PSA is good at following the course of advanced disease.# It is lacking in sensitivity and specificity in the diagnosis of early localised prostate cancer.# Nevertheless, the finding of a PSA >10 nmol/ml is suggestive of cancer and >35 ng/ml is diagnostic of advanced prostate cancer.# A decrease of PSA to the normal range following hormonal ablation is a good prognostic sign.Carcinoembryonic antigen (CEA):# CEA, which is elaborated by carcinomas of the colon, pancreas, stomach, and breast, and ?-fetoprotein, which is produced by hepatocellular carcinomas, yolk sac remnants in the gonads, and occasionally teratocarcinomas and embryonal cell carcinomas.# CEA and?-fetoprotein assays lack both specificity and sensitivity required for the early detection of cancers. They are still particularly useful in the detection of recurrences after excision. With successful resection of the tumor, these markers disappear from the serum.QTumor markers for testicular tumor# hCG: HCG produced by neoplastic syncytiotrophoblastic cells, is always elevated in patients with choriocarcinoma. Other germ cell tumors, including seminoma, may also elaborate hCG. Approximately 10% to 25% of seminomas elaborate hCG.# AFP: RAISED in yolk sac (endodermal sinus) tumor. AFP is a reliable indicator of the presence of a nonseminomatous component to the germ cell neoplasm, because yolk sac elements are not found in pure seminomas. Because mixed patterns are common, most nonseminomatous tumors have elevations of both hCG and AFP.# In addition to the primary diagnosis and staging of testicular germ cell tumors, serial determinations of hCG and AFP is useful for monitoring patients for persistent or recurrent tumor after therapy.TumorMarkersMelanomaHMB45, S-100, TyrosinaseCa PancreasCA 19-9, PIVKANeuroblastomaLDH, Ferritin, Neuron specific enolaseGistc-KITMCTCalcitoninSCLCNeuron specific enolaseOvarian cancer and some lymphomasCA-125Adenocarcinoma of colon, breast, pancreasCEACA-125NeuroblastomaLDHLymphoma Ewing's sarcoma Dysgerminoma Seminoma Gonadal germ cell tumor HCCAFPGonadal germ cell tumorHCG

So the answer to this question is C


Instruction:
False +ve VDRL is seen in:
A. Lepromatous leprosy
B. Infectious mononucleosis
C. HIV
D. Pregnancy

Response:
Ans. (b) i.e. Infectious mononucleosis Causes of False -positive VDRL Acute falss-posltlve roaction <6 monthg Chronlc false-posltlve reactlon > 6 month Recent viral illness or immunization - Aging Genital herpes - Autoimmune disorders HIV infection - SLE Malaria -Rheumatoid ahritis Parenteral drug used - Parenteral drugused Other lnfective endocarditis - Hepatitis infection Pregnancy - Infectious mononucleosis Infectious mononucleosis is acute infection of EBV and can give false (+)ve VDRL In CMDT '08, p 1269 Leprosy is also mentioned as cause of false (+)ve VDRL: but with use of newer non-lipoidal VDRL test, leprosy no longer give false positive result. False negative VDRL. Seen when very high antibody titre is present . Note: VDRL measures IgM and IgG directed against cardiolipin-lecithin-cholesterol antigen complex

So the answer to this question is B


Instruction:
The best mental attitude for denture acceptance:
A. Exacting
B. Philosophical
C. Hysterical
D. All of the Above

Response:
Mental attitude
Dr. M.M. House (1950) classified patients as philosophical, exacting, indifferent and hysterical. This is the most widely used classification.
Class I: Philososphical patients

They are rational and composed in difficult situations.
They desire treatment for maintenance of health and appearance and accept the complete denture treatment as a normal procedure.
They learn to adjust rapidly.
These patients have the best mental attitude for acceptance of the treatment.

Class II: Exacting patients

They are very methodical, precise and accurate, making severe demands.
They are comfortable when each procedure is explained and discussed with them in details.
They require extreme care, effort and patience on part of the dentist.
The intelligent and understanding category in this class can be the best type of patient, but for those lacking the same, extra time should be spent in education and treatment started only after an understanding is reached.

Class III: Indifferent patients

These patients are identified by their lack of concern and motivation and apathetic attitude.
They may not pay any attention to instructions, will not cooperate and are prone to blame others including the dentist for their poor health. In many cases, the lack of interest on part of the patient is the reason for their edentulousness.
A patient education programme is recommended before treatment.
If their interest cannot be stimulated, it may be best to refuse such patients.
They present a questionable or unfavourable prognosis.

Class IV: Hysterical patients

They are emotionally unstable, excitable and apprehensive.
They may not be aware that their symptoms may be more related to their systemic health.
They often present an unfavourable prognosis and additional psychiatric counselling is required prior to the treatment.

Key Concept:
The patients classified under philosophical category desire treatment for maintenance of health and appearance and accept the complete denture treatment as a normal procedure. They learn to adjust rapidly. Such patients have the best mental attitude for acceptance of the treatment.
Ref: Textbook of prosthodontics V Rangarajan Ed. 2nd

So the answer to this question is B


Instruction:
Which one of the following disorder is not x-linked recessive
A. Fragile-x syndrome
B. Lesch-Nyhan syndrome
C. Hunter syndrome
D. Charcot marie tooth disease

Response:
Charcot marie tooth disease : X-linked dominant

So the answer to this question is D


Instruction:
Botulism is a disease of ?
A. Neural transmission caused by the toxin of the bacterium clostridium botulinum
B. Muscular transmission caused by the toxin of the bacterium clostridium botulinum
C. Neuromuscular transmission caused by the toxin of the bacterium clostridium botulinum
D. Non neuromuscular transmission caused by the toxin of the bacterium clostridium botulinum

Response:
Ans. is 'c' i.e., Neuromuscular transmission caused by the toxin of the bacterium clostridium botulinum Botulinum Toxin Cl. botulinum produces a powerful exotoxin that is responsible for its pathogenicity. The toxin differs from other exotoxins in that it is not released during the life of organism. It is produced intracellularly and appears in the medium only on the death and autolysis of the cell. It is the most toxic substance known. Toxin is heat labile, but spores are highly heat resistant. It acts by blocking the release of acetylcholine at synapses and neuromuscular junction. It acts presynaptically. Toxin of all types (A, B, C, D, E, F, G) are neurotoxin except C2 which is a cytotoxin (enterotoxin).

So the answer to this question is C


Instruction:
The following is the finding seen in DIVC :
A. Increased fibrinogen , increased antithrombin III, increased thrombin-antithrombin III complexes
B. Increased FDP, decreased PT, increased antithrombin III
C. Increased FDP, prolonged PT, increased thrombin-antithrombin complexes
D. Increased FDP, prolonged PT, reduced Platlets

Response:
Answer is D (Increased FDP, prolonged PT, Reduced platelets) The laboratory manifestation of DIC include thrombocytopenia (Reduced platelets), prolonged PT, PTT and thrombin time (TT). Reduced fibrinogen levels from depletion of coagulation protein and elevated FDP from intense secondary fibromolysis

So the answer to this question is D


Instruction:
Which among the following is an angiotensin receptor antagonist?
A. Losartan
B. Enalapril
C. Ramipril
D. Captopril

Response:
None

So the answer to this question is A


Instruction:
HIV primarily infects?
A. CD4* cells
B. CD8+ cells
C. NK cells
D. All of these

Response:
ANSWER: (A) CD4+ cellsREF: Jawetz, Melnick, & Adelberg's Medical Microbiology, 24TH edition Chapter 44Repeat Microbiology December 2010

So the answer to this question is A


Instruction:
In indirect ophthalmoscopy the examining eye is made:
A. Myopic
B. Hypermetropic
C. Emmetropic
D. None of the above

Response:
Ans. Myopic

So the answer to this question is A


Instruction:
The effect of cholera toxin is mediated the stimulation of following second messenger:
A. cAMP
B. cGMP
C. Calcium-calmodulin
D. Acetylcholine

Response:
Ans. (a) cAMP

So the answer to this question is A


Instruction:
Fetal cells can be detected in maternal blood using-
A. Dct
B. let
C. Kleihauer betke test
D. Bubble test

Response:
Ans. is 'c' i.e., Kleiheaur betke test Kleiheaur betke testo It is quantitative test which is used to calculate the approx volume of the fetal blood entering into the maternal circulation. Based on the principle of acid elution technique and is done by using citric acid phosphate buffer. Fetal red cells (dark retractile bodies) are calculated as per 50 low power fields. If there are 80fetal erythrocytes in 50 low power fields in maternal peripheral blood films, it is estimated as transplacental haemorrhage to the extent of 4 ml of fetal blood.o Though more accurate tests are flow cytometry and immunofluorescence.o Apt test (Singer alkali denaturation test) is another test by which is used to detect the presence of fetal blood in maternal blood. But it is qualitative test. It uses KOH as reagent and is based on alkali denaturation.o Bubble test (shake test) is a bedside test to detect the fetal lung maturity.

So the answer to this question is C


Instruction:
The most pronounced effect on the oral microflora of reduction in rate of salivary flow is a
A. Significant increase in number of oral bacteria
B. Shift towards more acidogenic microflora
C. Significant decrease in number of oral bacteria
D. Shift towards more aerobic microflora

Response:
None

So the answer to this question is B


Instruction:
Herpes simplex encephalitis affects ………………………….. lobe
A. Temporal
B. Parietal
C. Occipital
D. Frontal

Response:
None

So the answer to this question is A


Instruction:
Which of the following X–ray should be advised for age determination between 1–13 years of age –
A. Shoulder
B. Wrist
C. Elbow
D. Iliac bones

Response:
Radiograph used to determine skeletal age

3-9 months --> Shoulder
1-13 years ---> Hand and wrist
12-14 years —> Elbow and hip

So the answer to this question is B


Instruction:
For FITTER the shortest needle length in Pens should be....... mm?
A. 4
B. 5
C. 6
D. 8

Response:
Ans. A. 4FITTER a congress which made new guidelines to help people on injections & pumps in Diabetes. We should use the shortest needle size (4mm for pens & 6mm for syringes].

So the answer to this question is A


Instruction:
Morbilliform eruptions is seen in – a) Scarlet feverb) Rubellac) Toxic shock syndromed)  Measlese) Mumps
A. c
B. bd
C. ab
D. ac

Response:
Viral infections causing nzorbilhform eruptions are measles, rubella, erythema infectiosum, EBV, CMV, adenovirus, echovirus, early HIV, coxasackie virus.
Scarlet fever and toxic shock syndrome cause scarlatiniform eruption.

So the answer to this question is B


Instruction:
In the forensic laboratory some samples are being examined under ultraviolet ray, the doctor notices blue white color of the sample. Which is the most probable content of the sample?
A. Semen
B. Urine
C. Pus
D. Leucorrhoea discharge

Response:
Ans. a. Semen (Ref: Reddy 33/e p434, 29/e p377-378: Parikh 6/e p7.26-7.27)In sexual offences, a preliminary examination under filtered ultraviolet light can be made.Stains of urine, vaginal discharge and seminal fluid show a bright fluorescence.The fluorescence of seminal stains is of a bluish-white colour and such stains are selected for further examinations.Examination of Seminal StainsPhysical Examination:A preliminary examination under filtered ultraviolet lightQ can be made.Stains of urine, vaginal discharge and seminal fluid show a bright fluorescence.The fluorescence of seminal stains is of a bluish-white colour and such stains are selected for further examinationsQ.Chemical Examination: Mnemonic - 'create A F B'Creatine Phosphokinase testQ: Depends on presence of CPKQ in semenAcid Phosphatase testQ: Depends on presence of acid phosphatase in semenFlorence testQ: Depends on presence of CholineQ in semen.Barberio's testQ: Depends on presence of SperminQ in semen.Microscopic examination:Involves identification of spermatozoa under microscope.Fluorescence microscopy is based on the principle that the Y-chromosome is fluorescence to quinacrineQ.Electrophoretic Methods:Acid-Phosphatase TestQLDH Isoenzyme TestQ

So the answer to this question is A


Instruction:
True about tuberculin test are all except ?
A. Recent conversion in adult is an indication for ATT
B. INH prophylaxis is staed if the test is positive
C. No risk in negative
D. May be false negative in immunocompromised patients

Response:
Ans. is `c' i.e., No risk in negative . Persons who have never had contact with tubercle bacilli are tuberculin negative. It means they are susceptible to T.B. infection as they have not developed cell mediated immunity against M. tuberculosis. About other options Option 'a' Indication for chemoprophylaxis by ATT. 1) Contacts of open cases who show recent montoux conversion (option 'a') 2) Children with positive montoux and a TB patient in the family. 3) Neonate of tubercular mother. 4) Patients of leukemia, diabetes, silicosis, or those who are HIV positive but are not energic, or are on coicosteroid therapy who show a positive Mantoux. 5) Patients with old inactive disease who are assessed to have received inadequate therapy. Option 'b' Is paially correct, because positive tuberculin test is not an indication for prophylaxis in all cases, but it is an indication for chemoprophylaxis for the contacts of open cases. Option 'd' Test may be false negative in immunocompromized patients - Ananthanarayan p. 361.

So the answer to this question is C


Instruction:
A pregnant woman develops deep, boring pain of her left thigh muscles associated with swelling and enhanced warmth of the same leg. The pain is worsened by extending the foot. The superficial veins of the leg are engorged. Her condition puts her at risk for which of the following?
A. Acute renal failure
B. Cerebral hemorrhage
C. Hepatic infarction
D. Pulmonary embolus

Response:
The patient has clinical findings strongly suggestive of deep venous thrombosis (DVT). Pain that increases upon extension of the foot is referred to as Homans' sign. Pregnancy, paicularly during the third trimester, induces a hypercoagulable blood state (possibly to limit the chance of fatal hemorrhage during delivery), which can manifest as DVT. The major complication of DVT is pulmonary embolism, which may be massive and can cause sudden death. Renal failure can be a serious problem in pregnancy, but is not related to deep vein thrombosis. Cerebral hemorrhage and hepatic infarction are complications of preeclampsia. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 47. Thromboembolic Disorders. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

So the answer to this question is D


Instruction:
Following drug which undergo most of its metabolism presystemically:
A. Salbutamol
B. Verapamil
C. Propranolol
D. Paracetamol

Response:
None

So the answer to this question is C


Instruction:
Insulin secretion is normally stimulated by ?
A. GLP-1
B. GLP-2
C. VIP
D. a-adrenergic receptors

Response:
Ans. is 'a' i.e., GLP-1Recently, attention has been focused on glucagon - like polypeptide 1 (7-36) (GLP-1 ) as an additional gut factor for insulin secretion and GLP-1 (7-36) is more potent insulinotropic hormone.Regulation of insulin secretion Factors affecting insulin secretion are : -i) Simulating insulin secretion :- Glucose; Mannose; Amino acids (arginine, leucine); Intestinal hormones (GIP. Gastrin, Secretin, CCK, GLP -1); b-keto acids; Parasympethetic stimulation (acetylcholine); cAMP; b-adrenergic stimulation; theophylline; Sulfonylureas; and ceain endocrine hormones like growth hormone, Glucagon and glucocoicoids.ii) Inhibiting insulin secretion : - Somatostatin; 2-deoxyglucose; mannoheptulose; a-adrenergic stimulation, P-adrenergic inhibitors; galanin; Diazoxide; Thiazide diuretics; K+ depletion; Phenytoin; Alloxan; microtubule inhibitors; and insulin itself.

So the answer to this question is A


Instruction:
Paralytic ileus is caused by
A. Peritonitis
B. Hyperkalemia
C. Acute intestinal obstruction
D. Head injury

Response:
None

So the answer to this question is A


Instruction:
Which of the following muscles is not supplied by mandibular nerve?
A. Masseter
B. Buccinator
C. Tensor veli palati
D. Posterior belly of digastric

Response:
Mandibular nerve supplies muscles of mastication, mylohyoid, anterior belly of digastric, tensor tympani and tensor veli palati. Nerve to the medial pterygoid is a small branch of mandibular nerve that supplies the medial pterygoid muscle. It gives off two branches which pass without interruption through the otic ganglion to supply tensor tympani and tensor veli palati.Ref: Practical Dentistry By Balwant Rai, Pages 107-111

So the answer to this question is D


Instruction:
Not included in numerator of dependency ratio?
A. 5 years age group
B. 10 years age group
C. 20 years age group
D. 70 years age group

Response:
Ans. is 'c' i.e., 20 years age group

So the answer to this question is C


Instruction:
Nagayama spots are seen in:
A. Measles
B. Roseola infantum
C. Mumps
D. Rubella

Response:
Nagayama spots: Roseola infantum Koplik spots- Measles Forchheimer spots- Rubella

So the answer to this question is B


Instruction:
Virchow's triad includes all except ?
A. Injury to vein
B. Venous thrombosis
C. Venous stasis
D. Hypercoagulability of blood

Response:
Venous thrombosis Virchow's triad describes three factors that lead to thrombosis i) Vascular (endothelial) injury ii) Abnormal blood flow (stasis) iii) Blood hypercoagulability Endothelial injury Endothelial cell injury exposes highly thrombogenic subendothelial extracellular matrix which allows platelet to adhere to the collagen of ECM. This effect is due to increased production of Von willebrand factor by endothelium, an essential cofactor for platelet binding to collagen. Disturbance in blood flow Normal blood flow is laminar such that the platelets flow centrally in the vessel endothelium by a slower moving clear zone of plasma. Stasis and turbulence leads to thrombosis because :? Disruption of laminar flow brings platelet into contact with endothelium Prevent dilution of activated clotting factors by fresh flowing blood Retard the inflow of clotting factor inhibitors Turbulence can cause endothelial injury or dysfunction.

So the answer to this question is B


Instruction:
The volume of the orbit is about:
A. 30 cc
B. 40 cc
C. 50 cc
D. 60 cc

Response:
Ans. 30 cc

So the answer to this question is A


Instruction:
Bone marrow depressive drugs in the treatment of AIDS patient are except
A. Didanosine
B. Zalcitabine
C. Cotrimaxazole
D. Ganciclovir

Response:
Drugs causing bone marrow suppression in patients with HIV infection Zidovudine Dapsone Trimethoprim Pyrimethamine. 5-flucytosine Gancyclovir Interferon alpha Foscarnet. Refer CMDT 2010/454

So the answer to this question is A


Instruction:
Treatment of diabetic retinopathy neovascularisation is/are:
A. Retinal laser photocoagulation
B. Pars plana vitrectomy
C. Phacoemulsion
D. LASIK

Response:
Ans. Retinal laser photocoagulation

So the answer to this question is A


Instruction:
Krabbe's disease is due to deficiency of-
A. Sphingomyelinase
B. Beta galactocerebroside
C. Hexosaminidase
D. Arylsulfatase

Response:
Ans. B. Beta galactocerebrosidase Examples of SphingolipidosesDiseaseEnzyme DeficiencyLipid AccumulatingClinical SymptomsTay-Sachs diseaseHexosaminidaseACer--Glc-Gal(NeuAc)-GalNAcGM2 GangliosideMental retardation, blindness, muscular weaknessFabry diseasea-GalactosidaseCer-Glc-Gal-GalGlobotriaosylceramideSkin rash, kidney failure (full symptoms only in males; X-linked recessive)Metachromatic leukodystrophyArylsulfatase ACer--Gal-OSO3 3- SulfogalactosylceramideMental retardation and psychologic disturbances in adults; demyelinationKrabbe diseaseb-GalactosidaseCer-Gal Galactosyl ceramideMental retardation; myelin almost absentGaucher diseaseb-GlucosidaseCer-Glc GlucosylceramideEnlarged liver and spleen, erosion of long bones, mental retardation in infantsNiemann-Pick diseaseSphingomyelinaseCer--P--choline SphingomyelinEnlarged liver and spleen, mental retardation; fatal in early lifeFarber diseaseCeramidaseAcyl--Sphingosine CeramideHoarseness, dermatitis, skeletal deformation, mental retardation; fatal in early life

So the answer to this question is B


Instruction:
All of the following are categorized as secondary lymphoid organs except
A. Lymph nodes
B. Spleen
C. Thymus
D. Subepithelial collec ons of lymphocytes

Response:
.

So the answer to this question is C


Instruction:
Burns present as all the following EXCEPT
A. Sepsis
B. Shock
C. Acute kidney injury
D. Air embolism

Response:
Ans. (d) Air embolismRef : Schwartz 10th ed. 1233The following Complications in burns may occur* Infections being the most common* Pneumonia, cellulitis, urinary tract infections* Anemia secondary to full thickness burns of greater than 10% TBSA is common.* Electrical burns may lead to compartment syndrome or rhabdomyolysis* Deep vein thrombosisLong term morbidity with burns* The hypermetabolic state result in a decrease in bone density and a loss of muscle mass.* Keloids may form subsequent to a burn* Significant psychological trauma* Social isolation, extreme poverty and child abandonment.

So the answer to this question is D


Instruction:
Hypokalaemia causes the following except -a) Paralytic ileusb) Tetanyc) Orthostatic hypotensiond) Rhabdomyo lys ise) Prolonged Q-T interval and tall T waves
A. be
B. ad
C. bc
D. ce

Response:
None

So the answer to this question is A


Instruction:
Common injury to baby is -
A. Fracture humerus
B. Fracture clavicle
C. Fracture scapula
D. Fracture femur

Response:
The most common bone to be fractured in children and during birth is clavicle.

So the answer to this question is B


Instruction:
Not used in emergency contraceptions aEUR'
A. LNG intra uterine device
B. Oral mifepristone
C. Oral levonorgesterol
D. Cu T intrauterine device

Response:
LNG intrauterine device Levonorgestrel alone, 0.75 mg stat F/B another 0.75 mg 12 hrs later, taken within 72 hrs of unprotected intercourse is the method of choice .for emergency contraception Emergency contraception is also k/a postcoital morning after contraception. Basically the methods used interfere with the physiological events before implantation, for e.g. inhibition or delaying of ovulation or interference with postovulatory events necessary for implantation & longevity of the blastocyst. Agents used for emergency contraception are known as 'interceptives'. Methods of emergency contraception Drugs Dosage Time frame Preg. rate * High dose estrogens (not used now) - Ethinyl estradiol (EE) 2.5 mg BD x 5 days Within 72 hrs of coitus -L. 0.15% - Conjugated equine estrogen (CEE) 15 mg BD x 5 days 0-0.6% * Estrogen & progestin combination pill - Yuzpe method EE 50 lag + d, 1-NG 0.5 mg (Ovral) 2 tabs stat & 2 tabs after 12 hrs (Total dose EE 0.2 mg & LNG 2 mg) " 0-2% - Low dose pills EE 30 lig + LNG 0 0.15mg (Ovral L, Mala-N etc.) 4 tabs stat & 4 tabs after 12 hors 0-2% * Levonorgestrel (LNG) alone (Ecee 2, i-pill, E-pill, unwanted-72, Plan-B) 0.75 mg stat FIB 0.75 mg after 12 hrs or 1.5 mg stat Preferably within 72 hrs but can be given upto 5 days 0-1% * Centchroman 30mg (Saheli) 2 tab BD x 1 day 400/800 x BD mg m 3 Within 5 days not known * Danazol days or 1200 mg BD x 2 days Within 72 hrs 0.8 - 1.7% * Mifepristone (RU 486) 600 mg/200 mg / 10 mg single dose Within 5 days to 27th day of cycle 1.3% * Copper HID (more effective than s steroids) ) To be inseed within 7 days < 1%

So the answer to this question is A


Instruction:
In HIV infected individual , Gram stain of lung aspirate shows yeast like morphology. All of the following are the most likely diagnosis except -
A. Candida tropicalis
B. Cryptococcus neoformans
C. Pencillium marneffi
D. Aspergillus fumigatus

Response:
Cryptococcus is yeast (GPRBYC: Gram positive round budding yeast cell) and candida (GPOBYC: Gram positive oval budding yeast cell) is yeast like fungus. Penicillium marneffi is a dimorphic fungi which can produce yeast like form (all dimorphic fungi have yeast form in host tissue). Aspergillus is neither a yeast nor yeast like. It is a mould (hyphae).

So the answer to this question is D


Instruction:
Which one of the following biochemical parameters is the most sensitive to detect open spina
A. Maternal serum alpha fetoprotein
B. Amniotic fluid alpha fetoprotein
C. Amniotic fluid acetyl cholinesterase
D. Amniotic fluid glucohexaminase

Response:
Ans. is c i.e. Amniotic fluid acetyl cholinesterase Spina Bifida, anencephaly and encephalocele are collectively included under neural tube defect. As I have already explained in answer 3, amniotic fluid cholinesterase level is elevated in most cases of neural tube defects and has got better diagnostic value than AFP. Extra Edge : Ultrasonographic signs indicating Spina bifida. Small biparietal diameter. Ventriculomegaly. Frontal bone scalloping (the so called lemon sign).deg Elongation and downward displacement of the cerebellum (the so called banana sign).deg Effacement or obliteration of the cisterna magna.

So the answer to this question is C


Instruction:
PH of drinking water
A. 4.5 - 6
B. 6.5 - 8.5
C. 7.5 - 9
D. 9.5

Response:
None

So the answer to this question is B


Instruction:
Branchial cyst is found in
A. Midine of neck
B. Upper and middle third of the sternomastoid muscle at its anterior border
C. Nape of neck
D. Upper one-third along anterior tender of trapezius

Response:
A branchial cyst probably develops from the vestigial remnants of the second branchial cleft, is usually lined by squamous epithelium, and contains thick, turbid fluid full of cholesterol crystals. The cyst usually presents in the upper neck in early or middle adulthood and is found at the junction of the upper third and middle third of the sternomastoid muscle at its anterior border. It is a fluctuant swelling that may transilluminate and is often soft in its early stages so that it may be difficult to palpate. If the cyst becomes infected it becomes erythematous and tender and, on occasions, it may be difficult to differentiate from a tuberculous abscess. Ultrasound and fine-needle aspiration both aid diagnosis and treatment is by complete excision, which is best undeaken when the lesion is quiescent. Although the anterior aspect of the cyst is easy to dissect, it may pass backwards and upwards through the bifurcation of the common carotid Bailey & Love ,25th,727.

So the answer to this question is B


Instruction:
Investigation of choice for dysphagia for solids
A. Endoscopy
B. X-ray chest
C. C.T. Scan
D. Barium swallow

Response:
History A detailed history is of paramount impoance. Asceain, if dysphagia is of: (a) Sudden onset: Foreign body or impaction of food on a pre-existing stricture or malignancy, neurological disorders. (b) Progressive: Malignancy. (c) Intermittent: Spasms or spasmodic episodes over an organic lesion. (d) More to liquids: Paralytic lesions. (e) More to solids and progressing even to liquids: Malignancy or stricture. (f) Intolerance to acid food or fruit juices: Ulcerative lesions. Oesophagoscopy(Endoscopic) It gives direct examination of oesophageal mucosa and permits biopsy specimens. Flexible fibreoptic or rigid scopes can be used. Ref : ENT textbook by Dhingra 6th edition Pgno : 347,348

So the answer to this question is A


Instruction:
Which of the following gene defect is associated with the development of medullary carcinoma of thyroid-
A. RET Proto Oncogene
B. Fap gene.
C. Rb gene
D. BRCA 1 gene

Response:
Thyroid carcinoma

The major types of carcinoma and their relative frequency:-

  Papillary carcinoma →  75% to 85% (most common)
  Medullary carcinoma  → 5%
  Follicular carcinoma → 10% to 20%
  Anaplastic carcinoma → < 5%

Most thyroid carcinomas are derived from the follicular epithelium , except for medullary carcinoma which is derived from the parafallicular or 'C' cells .
Genetic factors in different thyroid carcinoma
Papillary  →  Tyrosine kinase receptors RET or NTR K1

          RAS mutation
          BRAF oncogene

Follicular  → RAS oncogene (NRAS, HRAS and KRAS)

                   PAX8- PPARr 1 translocation

Medullary → RET proto oncogene.
Familial medullary cancers account for most inherited cases of thyroid cancer.
Familial nonmedullary thyroid cancers (papillary and follicular) are very rare.

So the answer to this question is A


Instruction:
Which one of the following diseases has the shoest incubation period -
A. Salmonella food poisoning
B. Staphylococcus food poisoning
C. Cholera
D. Diphtheria

Response:
<p> IP of staphylococcal food poisoning is 1-8 hours. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:238. <\p>

So the answer to this question is B


Instruction:
Munsen sign is seen in: March 2013 (h)
A. Corneal dystrophy
B. Perforated corneal ulcer
C. Keratoconus
D. Marfan syndrome

Response:
Ans. C i.e. Keratoconus Keratoconus Protrusion of central pa of cornea with thinning, Corneal nerves are visible, Associated features: - Munsen's sign, - Fleischer sign

So the answer to this question is C