Instruction:
A three years old boy presents with poor urinary stream. Most likely cause is :
A. Stricture urethra.
B. Neurogenic bladder.
C. Urethral calculus.
D. Posterior urethral valve.

Response:
Ans. is 'd' i.e. Posterior urethral valve Poor urinary stream in 3 years old boy suggests urinary tract obstruction (usually infravesical) and the most common cause of obstructive uropathy in a male child is posterial urethral valve.Posterior urethral valveThese are symmetrical folds of urothelium extending distally from prostatic urethra to external urinary sphincter.It most commonly lies just distal to the verumontanum or at the verumontanum*It occurs only in males.It behaves as flap valves so, although urine does not flow normally a urethral catheter can be passed without difficulty.Sometimes, the valves are incomplete and the patient remains without symptoms until adolescence or adulthood.Approximately 30% of patients experience end stage renal diseaseVesicoureteral reflux occurs in 50% of patients.Diagnosis is made byvoiding cystourethrogram* &endoscopyBoth of these investigations clearly depict the site of obstruction.The diagnosis can be established prenatally by ultrasound.*ManagementFirst a small polyethylene feeding tube is inserted in the bladder and left for several days. Then further management is done according to serum creatinine level.with normal serum creatinine - transurethral ablation of the valve leaflets. *With increased serum creatinine and the worsening of condition - vesicostomy to bypass the obstruction and when normal creatinine levels are achieved, transurethral ablation is done.

So the answer to this question is D


Instruction:
Pentose phosphate pathway (HMP shunt pathway) produces
A. ATP
B. ADP
C. NADH
D. NADPH

Response:
HMP shunt pathway gives NADPH and ribose-5-phosphate.

So the answer to this question is D


Instruction:
A patient aged 50 years, with Down's syndrome, presents with difficulty in speech, what is the diagnosis?
A. Cerebrovascular accident
B. Lacunar infarct in cerebellum
C. Senile dementia Alzheimer's type
D. Alzheimer with prion

Response:
(C) Senile dementia Alzheimer's type

So the answer to this question is C


Instruction:
A healthy young athlete is sitting at the edge of the table with knee at 90-degree flexion. He fully extends it. What will happen?
A. Movement of tibial tuberosity towards centre of the patella
B. Movement of tibial tuberosity towards lateral border of patella
C. Movement of tibial tuberosity towards medial border of patella
D. No change in position

Response:
In full extension the knee gets locked, which involves lateral rotation of tibia (since foot is off the ground). Hence, tibial tuberosity moves laterally towards the lateral border of patella. Physiological Knee locking happens in the last 30deg of knee extension and involves the rotation of either bone femur or tibia. a. It involves medial rotation of femur on tibia if the foot is fixed to the ground (weight bearing leg). b. If the foot is off the ground (as sitting on a table) then tibia has to rotate opposite (laterally) to lock the knee joint. Knee locking happens when we stand straight or straighten our lower limb in the air (e.g., during some exercise) a. It is the most stable position of the knee joint b. Femur & tibia are locked on to each other and there is maximum congruency between the two. c. Almost all ligaments are tightened and provide maximum stability to the joint. IV. Quadriceps femoris leads to knee extension and knee locking happens due to the continued action of quadriceps femoris. V. Unlocking of knee joint is carried out by popliteus muscle. a. It involves the rotation of any of the two bones (femur/tibia) in opposite direction to locking. b. Popliteus muscle is a very small muscle at the floor of popliteal fossa and is supplied by the tibial nerve. c. Popliteus has intracapsular origin. Pathological knee locking: It is an ohopaedic problem where patient has some meniscal injury and he finds difficulty in carrying out knee extension fully. Ref - The physiology of the joints (5th Ed.) ,Vol-2 Pg. 102,103 .

So the answer to this question is B


Instruction:
Most common site for secondary metastasis in a case of Hypemephroma:
A. Adrenal
B. Lungs
C. Brain
D. Bones

Response:
Answer is B (Lungs) 'The most common site of distant metastasis (in RCC) is the lung'

So the answer to this question is B


Instruction:
What is the GFR (mL/min per 1.73m2) of a patient who is in stage IV of chronic kidney disease?
A. 60 - 89
B. 30 - 59
C. 15 - 29
D. < 15

Response:
.

So the answer to this question is C


Instruction:
Complement component involved in both classical and alternate pathway:
A. C1
B. C2
C. C3
D. C5

Response:
Ans. C. C3a. C3 is involved in both classical and alternate complement pathways.b. Activation of C3 is the central process in complement cascade.c. Activation of C3 is achieved by C42 (classical C3 convertase) in classical pathway.d. The activation of C3 without prior participation of C142 is known as alternate pathway.

So the answer to this question is C


Instruction:
Drug useful in breast cancer is ?
A. Tamoxifen
B. Cyproterone
C. Testosterone
D. Chlorambucil

Response:
Ans. is 'a' i.e., Tamoxifen Pharmacotherapv of breast cancer Many breast carcinomas possess estrogen receptors Estrogen promotes their growth. Drugs which decrease the action of estrogen on breast CA by one or other mechanisms, can be used in breast CA. Drugs used in Breast cancer Selective estrogen receptor modulators (SERMs) - Tamoxifen, Tromifene. Selective estrogen receptor down regulators (SERDs) - Fulvestrant Aromatase inhibitors - Letrozole, anastrozole, exemestone LHRH (GnRh) analogues Aminoglutethemide High doses progesterones - Megastrol acetate.

So the answer to this question is A


Instruction:
Carey coombs murmur, which is false –
A. Delayed diastolic murmur
B. Seen in rheumatic fever
C. Can be associated with A.R.
D. Low pitched murmur

Response:
A short, mid-diastolic murmur is rarely heard during an episode of acute rheumatic fever (Carey-Coombs murmur) and probably is due to flow through an edematous mitral valve. An opening snap is not present in the acute phase, and the murmur dissipates with resolution of the acute attack. Complete heart block with dyssynchronous atrial and ventricular activation may be associated with intermittent mid- to late diastolic murmurs if atrial contraction occurs when the mitral valve is partially closed. Mid-diastolic murmurs indicative of increased tricuspid valve flow can occur with severe, isolated TR and with large ASDs and significant left-to-right shunting. Other signs of an ASD are present ( Chap. 236 ), including fixed splitting of S 2 and a mid-systolic murmur at the mid- to upper left sternal border. TTE is indicated for evaluation of a patient with a mid- to late diastolic murmur.

So the answer to this question is A


Instruction:
MMR is expressed as a rate per
A. 100 live bihs
B. 1000 live bihs
C. 10000 live bihs
D. 100000 live bihs

Response:
Ref:Park's Text book of Preventive and Social Medicine 25th ed

So the answer to this question is D


Instruction:
All of these cells are found in small intestine, EXCEPT?
A. Enterochromaffin cells
B. Goblet cells
C. Neck cells
D. Paneth cells

Response:
Mucous neck cells are present in clusters or as single cells among the other cells in the necks of gastric glands and include many progenitor and immature surface mucous cells. The major cell types in the epithelium of the small intestine are absorptive enterocytes, mucous cells, Paneth cells, endocrine cells, and M cells. Absorptive enterocytes are responsible for absorption; they arise from continually proliferating undifferentiated cells in the crypts of Lieberkuhn. Mucous cells originate in crypts and migrate to the tips of villi also; mature mucous cells are termed goblet cells. Enterochromaffin cells are the most numerous; N cells (containing neurotensin), L cells (glucagon), and other cells containing motilin and cholecystokinin are also present.

So the answer to this question is C


Instruction:
Primary idiopathic polymyositis does not involve:-
A. Pelvic girdle muscles
B. Neck muscles
C. Ocular muscles
D. Pharyngeal muscle

Response:
Answer is C (Ocular muscles): 'Ocular muscles are almost never affected' - Harrison. Occular muscles are spared, even in advanced untreated cases - Harrison Primary idiopathic polymyositis: Condition of autoimmuneQ etiology in which skeletal muscle is damaged by non suppurative inflammatory process) dominated by Lymphocytic infiltration!) It is characterized by: Symmetrical weakness of proximal limb muscles especially hips and thigh (pelvic girdle) and later shoulder girdle. Weakness of flexor muscles of neck Involvement of striated muscles of pharynx (dysphagia) Involvement of respiratory muscles (late) "Ocular muscles are almost never affected except in a rare case associated with myasthenia gravis. 'Facial muscles are unaffected in Polymyositis'. - Harrison

So the answer to this question is C


Instruction:
Minnsesota tube is used for the control of variceal bleeding in portal hypertension has -
A. One lumen
B. Two lumen
C. Three lumen
D. Four lumen

Response:
None

So the answer to this question is D


Instruction:
Lipoprotein X is most likely to be seen with in -
A. Cholestasis
B. Gilbe syndrome
C. Increased intake of trans fatty acids
D. Increased intake of PUPA

Response:
Lipoprotein X is an abnormal lipoprotein that appears in the serum samples of patients with obstructive jaundice and is a marker of cholestasis. Lipoprotein X is primarily responsible for the unusual lipid composition and characteristic plasma lipid concentrations in obstructive jaundice Ref Davidson 23rd edition pg 908

So the answer to this question is A


Instruction:
Non-selective serotonin and nor-adrenaline reuptake inhibitor is:
A. Sertraline
B. Citalopram
C. Venlafaxine
D. Paroxetine

Response:
None

So the answer to this question is C


Instruction:
A married woman died in unnatural conditions within 5 years of her marriage. Her parents complained of frequent demand of dowry. Her autopsy will be conducted under which section: AI 10; Punjab 10
A. Sec. 174 CrPC
B. Sec. 176 CrPC
C. Sec. 302 IPC
D. Sec. 304B IPC

Response:
Ans. Sec. 176 CrPC

So the answer to this question is B


Instruction:
TRUE about renal aerial system
A. Anastomosis lies between arcuate branches
B. Anastomosis lies at lobar level
C. Branches are end aeries
D. Medulla has more supply than coex

Response:
Renal aery(end aery) gives 5 segmental branches 4 from its anterior division 1 from its posterior division Segments are apical, upper, middle & lower in anterior aspect, on posterior aspect segments seen are posterior & pas of apical & lower segments Coex have more blood supply than medulla As shown above, renal aerial system has no anastomosis.

So the answer to this question is C


Instruction:
Enteric fever is caused by: September 2005
A. Salmonella typhi
B. Salmonella paratyphi A
C. Salmonella paratyphi B
D. All of the above

Response:
Ans. D: All of the above Typhoid fever is caused by Salmonella typhi. Paratyphoid fever is caused by Salmonella paratyphi A, B and C. The term enteric fever encompasses both typhoid and paratyphoid fevers.

So the answer to this question is D


Instruction:
pH of synovial fluid is:
A. Basic in resting.
B. Acidic on movement.
C. Neutral.
D. Both A& B

Response:
None

So the answer to this question is D


Instruction:
Sinuses are not seen in
A. Kidney
B. Spleen
C. Endocrine glane
D. Liver

Response:
Kidneys do not have any sinuses

So the answer to this question is A


Instruction:
Most common variety of lung carcinoma in women and children is?
A. Small cell carcinoma
B. Adenocarcinoma
C. Squamous cell carcinoma
D. Large cell carcinoma

Response:
Ans. is 'b' i.e., Adenocarcinoma Remember* Adenocarcinoma is the overall most common type of lung carcinoma.* Adenocarcinoma is the most common type of lung carcinoma in non-smokers and females.* Squamous cell (epidermoid) carcinoma is the most common type of lung carcinoma in India.* Squamous cell carcinoma is the most common type of lung carcinoma in smokers and males.* M.C Variety in young Patients - Adenocarcinoma* Histological Variety that cavitates - Squamous cell Ca* M.C Histological variety to metastasize - Small cell Ca* Ca which metastasize to opposite lung - Adenocarcinoma* Clubbing least common in which Ca - Small cell Ca* Gynaecomastia is seen in which type of Ca - Large Cell Ca* Thrombophlebitis is seen with which Ca -Adenocarcinoma* Most common site for metastasis from ca lung - Brain* Lung Ca with worst prognosis - Small cell Ca* Variety most responsive to chemotherapy - Small cell Ca* Variety most responsive to radiotherapy - Small cell Ca* M.C Endocrine Gland to be involved by metastasis - Adrenal* Variety with best prognosis - Squamous cell Ca* Variety that is central in location - Squamous cell & small cell Ca* Variety that is peripheral in location - Adenocarcinoma* Most common variety with Cushings syndrome - Small cell Ca* Most common variety with Hypercalcemia d/t PTH like substance Secretion ^ Squamous cell Ca

So the answer to this question is B


Instruction:
From vitreous humor, estimation of time since death is done by: WB 11; NEET 13
A. K+- level
B. Na+ level
C. Glucose level
D. Urea level

Response:
Ans. K+- level

So the answer to this question is A


Instruction:
Dangerous perforation of eardrum is located at:
A. Center
B. Attic
C. Paracentrally
D. All

Response:
Ans. b (Attic).(Ref. Diseases of ENT by PL Dhingra, / 3rd/pg.91)CHOLESTEATOMA can involve any area of the middle ear, hypotympanum, protympanum, epitympanum, and mastoid.Since most cases of cholesteatoma arise from a retraction of the tympanic membrane, it follows that most cases involve the middle ear space in some form. Pars flaccida retractions are the most common.These cholesteatomas typically invade Prussack space, which is the area between the pars flaccida laterally, and the malleus neck and the lower portion of the head medially. From here, the cholesteatoma can invade the middle ear inferiorly, the attic, and then the mastoid superiorly.

So the answer to this question is B


Instruction:
Endoplasmic reticulum is not involved in ?
A. Protein synthesis
B. Steroid synthesis
C. DNA synthesis
D. Triglyceride synthesis

Response:
Ans. is 'c' i.e., DNA synthesis Endoplasmic reticulum are involved in :-Rough ER : Protein synthesis (hormones, enzymes etc.)Smooth ER: Triglyceride synthesis, steroid synthesis, cholesterol synthesis, Phospholipid synthesis, fatty acid chain elongation.

So the answer to this question is C


Instruction:
Which of the following can cause secondary brain injury
A. Hypoxia
B. Intracranial pressure > 30mm Hg
C. Hypotension
D. All of the above

Response:
Causes of secondary brain injury
- Hypoxia: PO2 < 8 kPa
- Hypotension: systolic blood pressure (SBP) < 90 mmHg
- Raised intracranial pressure (ICP): ICP > 20 mmHg
- Low cerebral perfusion pressure (CPP): CPP < 65 mmHg
- Pyrexia
- Seizures
- Metabolic disturbance

So the answer to this question is D


Instruction:
A patient presents with complains of sciatica. On radioligical examination there was sclerotic lesions on his skull. Which of the following is most likely to be elevated in this patient -
A. CEA
B. Prostate specific antigen
C. Alkaline phosphatase
D. Alpha 1 antitrypsin

Response:
None

So the answer to this question is B


Instruction:
A 40-year-old gardener C/O several subcutaneous nodules on his right hand, where he had cut himself on rose thorns. Physical exam reveals several erythematous fluctuant lesions. Which organism is most likely responsible for his condition
A. Aspergillus
B. Malassezia
C. Onchocerca
D. Sporothrix

Response:
S schenckii, a dimorphic fungus causes sporotrichosis, a chronic granulomatous infection. The conidia or hyphal fragments of S schenckii are introduced into the skin by trauma. Patients frequently recall a history of trauma associated with outdoor activities and plants. The initial lesion is usually located on the extremities The initial episode is typically followed by a secondary spread with the involvement of the draining lymphatics and lymph nodesBiopsy of the tissue shows cigar-shaped yeast cells.Jawetz 27e pg: 670

So the answer to this question is D


Instruction:
Malleus develops from
A. 1st arch
B. 2nd arch
C. 3rd arch
D. Otic Capsule

Response:
Malleus and Incus develop from 1st arch.
Footplate of stapes develop from otic capsule.

So the answer to this question is A


Instruction:
ORS should be discarded
A. After 6 hours 13.
B. After 12 hours
C. After 24 hours
D. After 36 hours

Response:
After 24 hours

So the answer to this question is C


Instruction:
A 43-year-old man develops chronic hepatitis, which was attributed to a complication resulting from multiple blood transfusions for sickle cell anemia. He complains of chronic sweating, palpitation, and hunger attacks. What would be the most likely cause of these symptoms?
A. Hepatogenic hypoglycemia
B. Hemolytic anemia
C. Jaundice
D. Spontaneous hyperglycemia

Response:
The liver plays a role in glucose formation from various glucogenic amino acids and other substances. Hepatic disease removes this source of glucose supply. In insulin hypoglycemia, there is enhanced rapid uptake of glucose by fat tissue and muscle.

So the answer to this question is A


Instruction:
Which of the following is nucleotide reverse transcriptase inhibitor ?
A. Indinavir
B. Nelfinavir
C. Tenofovir
D. Lopinavir

Response:
Ans. is 'c' i.e., Tenofovir Antiretroviral drugs Nucleoside reverse transcriptase inhibitors (NIs) ? Zidovudin, Didanosine, Zalcitabine, Stavudine, Lamivudine, Abacavir. Nucleotide reverse transcriptase inhibitor- Tenofovir (Katzung 10th/e) Nonucleoside reverse transcriptase inhibitors (NNIS) - Nevirapine, Eirenz, Delavirdine, Etravirine. d)Protease inhibitors - Ritonavir, Indinavir, Nelfinavir, Saquinavir, amprenavir, Lopinavir, Fosamprenavir, Atazanavir, Darunavir, Tipranavir. Fusion inhibitor - Enfuviide, Maraviroc. Integrase inhibitors - Roltegravir, Elvitegravir.

So the answer to this question is C


Instruction:
Most abundant form of pro-vitamin A is:-
A. Beta carotene
B. Alpha-carotene
C. Retinol
D. Retinaldehyde

Response:
Carotenoids are provitamins of vitamin A which are present in plants. Most impoant carotenoid is beta carotene , which consists of two molecules of retinal joined end to end. ADDITIONAL READING ON VITAMIN A: There are three biologically active forms of Vitamin A: Retinol: necessary for reproductive system Retinal: involved in vision Retinoic acid: involved in growth and cellular differentiation Retinoids are all-natural/ synthetic compounds with Vitamin A like activity.

So the answer to this question is A


Instruction:
A 55-year-old male presented to emergency with complains of upper GI bleed. The doctor on duty stabilized the patient. He underwent upper GI endoscopy, that was found to be normal. An extra-luminal mass found on CECT abdomen. CECT is given below, Then CT guided biopsy was taken for histopathological examination revealed the diagnosis as follows. Studies revealed DOG-1 marker positivity and SDH-1 gene mutation. What of the following drugs can be given in the above condition: -
A. Imatinib
B. Sorafenib
C. Bevacizumab
D. None

Response:
This is a case of GIST with SDH-1 mutation mean it is resistant to tyrosine kinase inhibitors. The image spindle shaped neoplastic cells - suggestive of GIST. Upper GI bleeding is the most common clinical manifestation of GISTs, manifesting as hematemesis or melena. Bleeding occurs because of pressure necrosis and ulceration of the overlying mucosa with resultant hemorrhage from disrupted vessels. Most common site of GIST is stomach. Upper GI endoscopy is usually normal because of extraluminal mass so usually detected on CT scan. CECT Is IOC for GIST. BUT for recurrent GIST IOC Is PET Scan. Most specific marker is DOG-1 > CD117. Imatinib shows the highest activity in GISTs that contain the mutation in exon 11 of KIT. Most GISTs with PDGFRA gene mutations respond to imatinib. GISTs with mutations in the succinate dehydrogenase (SDH) gene that result in deficiency of SDH are also generally resistant to TKI therapy. Surgical resection is the mainstay of treatment for localized tumors in these patients

So the answer to this question is D


Instruction:
Pulp therapy which sweet name associated with
A. Formocresol pulpotomy
B. Beech wood cresol pulpotomy
C. Non vital pulpotomy
D. Pulpectomy

Response:
None

So the answer to this question is A


Instruction:
In Zollinger Ellison syndrome what is raised?
A. Insulin
B. VIP
C. Gastrin
D. Glucagon

Response:
Ans. is 'c' i.e., Gastrin Zollinger Ellison syndrome ? Severe peptic ulcer disease secondary to gastric acid hypersecretion due to unregulated gastrin release from a non 13 cell endocrine tumour (gastrinoma), defines the components of Zollinger Ellison syndrome. Pathophysiology of Zollinger Ellison syndrome The driving force responsible for clinical manifestations of Zollinger Ellison syndrome is hypergastrinemia originating from Gastrinoma (autonomus neoplasm, non [3 cell neoplasm) Gastrinoma Hyper gastrinemia Hyper acidemia Peptic ulcer, erosive esophagitis and diarrhoea Other impoant characteristic of Gastrinoma o Over 80% of these tumours are seen in Gastrinoma triangledeg (triangle formed between duodenum and pancreas) most of them are seen in the head of pancreas. o About 2/3'of these tumours are malignantdeg. o About one half of these tumours are multipledeg. o About one fouh of the patients have multiple endocrine neoplasia (MEN I) syndrome with tumours of parathyroid, pituitary and pancreatic islets being present. Remember : Most common site of gastrinoma's is - Duodenum (50-70%), (Pancreas 20-40%) Most common hormone to be secreted - ACTH besides gastrin is Most common site of peptic ulcers produced is - ls' pa of Duodenum. Most valuable provocative test in - The Secretin injection tests. identifying patients with ZES is Basal acid output is greater than 60% of out pu - BAO> MAO induced by maximal stimulation The term pancreatic endocrine tumour is misnomer because these tumours can occur either almost exclusively in the pancreas or at both pancreatic and extrapancreatic sites

So the answer to this question is C


Instruction:
Normal Cup : disc ratio of optic disc is
A. 0.3 to 0.4
B. 0.2 to 0.3
C. 0.5 to 0.6
D. 0.1 to 0.3

Response:
Normal Cup : disc ratio of optic disc 0.3 to 0.4.

So the answer to this question is A


Instruction:
Structure which is not present deep to hyoglossus is:
A. Glossopharyngeal nerve.
B. Genioglossus
C. Hypoglossal nerve.
D. Lingual artery.

Response:
Structures present deep to hyoglossus are

Glossopharangeal nerve.
Lingual artery
Stylohyoid ligament
Genioglossus
Intrinsic muscles of tongue

So the answer to this question is C


Instruction:
The action of acetylcholine at the neuromuscular junction is terminated primarily by:
A. Diffusion into the surrounding extracellular fluid
B. Uptake into the nerve ending
C. Uptake into the muscle
D. Enzymatic breakdown by acetylcholinesterase

Response:
The action of acetylcholine at the neuromuscular junction is terminated primarily by enzymatic breakdown by acetylcholinesterase. The acetylcholinesterase is attached to the basal lamina that fills the synaptic trough. There is no uptake of acetylcholine at the neuromuscular junction. A small amount of the acetylcholine will diffuse into the surrounding extracellular fluid but this is not the primary method by which its action is terminated.

So the answer to this question is D


Instruction:
Adjuvant used in DPT vaccine is
A. Zinc
B. Aluminium
C. Copper
D. Magnesium

Response:
Ans. is 'b' i.e. Aluminium DPT vaccine is of two types : plain & adsorbedAluminium phosphate or Aluminium hydroxide is used as adsorbent.Adsorption increases the immunological effectiveness.WHO recommends use of only adjuvant DPT vaccines in immunization programmes?Also know - Pertussis component in DPT vaccine enhances the potency of the diphtheria toxoid.

So the answer to this question is B


Instruction:
The largest volume of water is reabsorbed in the nephron at the
A. Collecting duct
B. Proximal convoluted tubule
C. Ascending loop of Henle
D. Descending loop of Henle

Response:
None

So the answer to this question is B


Instruction:
Gene amplification is by
A. Polymerase Chain Reaction
B. Ligase chain reaction
C. DNA hybridization
D. In situ hybridization

Response:
PCR is an in-vitro DNA amplification procedure in which millions of copies of paicular sequence of DNA can be produced within a few hoursRef: DM Vasudevan, 7th edition, page no: 638

So the answer to this question is A


Instruction:
Contraindication of rota virus vaccine is
A. SCID
B. Intussusception
C. Severe allergic raction
D. All of above

Response:
Ans. is 'd' i.e., All of above

So the answer to this question is D


Instruction:
Eiken test is which type of reaction used for E. coli?
A. Precipitation
B. Agglutination
C. Toxin antitoxin assay
D. CFT

Response:
Eiken test is a precipitation reaction. Option 1 Eiken Precipitation test Precipitation in Gel (Immunodiffusion). Detect heat labile (LT) enterotoxin. +ve for heat labile (LT) enterotoxin of E.coli. -ve for heat stable (ST) enterotoxin of E.coli. Types of immunodiffusion reactions: 1. Single diffusion in one dimension (Oudin procedure) 2. Double diffusions in one dimension (Oakley-Fulthorpe procedure) 3. Single diffusion in two dimensions (Radial immunodiffusion) 4. Double diffusion in two dimensions (Ouchterlony procedure) Elek's test (diphtheria toxin) Eiken test (E.coli toxin) Option 2 Agglutination is more sensitive than precipitation test and the clumps are better visualized and interpreted. Option 3 Examples of Neutralization Test: Viral neutralization test: Detects viral neutralizing antibodies. Plaque inhibition test: Done for bacteriophages. Toxin-antitoxin neutralization test. Option 4 CFT (complement fixation test) detects complement fixing antibodies in the patient's serum.

So the answer to this question is A


Instruction:
Normal parent with 2 siblings having osteogenesis imperfecta. Pattern of inheritance is
A. Mutation
B. Anticipation
C. Genomic imprinting
D. Germline mosacism

Response:
D i.e. Germline mosacism Differential expression of same gene depending on parent of origin is referred to as genomic imprinting. Germline (Gonadal) mosaicism results from a mutation only affecting cells destined to form gonads - postzygotically during early embryonic development. So the individual (parent) is phenotypically normal but can transmit the disease to offsprings through mutant gametesQ. And because the progenitor cells of gametes carry mutation, there is a high possibility that more than 1 child of such parent would be affected.

So the answer to this question is D


Instruction:
Blumberg's sign is
A. Rebound tenderness during abdominal palpation
B. Board-like rigidity of abdomen
C. Pressure over left iliac fossa causing pain in right iliac fossa
D. Pressure over right iliac fossa causing pain in left iliac fossa

Response:
Positive Blumberg's sign or rebound tenderness or Release sign is indicative of peritonitis which can occur in diseases like appendicitis, perforated peptic ulcer and may occur in ulcerative colitis with rebound tenderness in the right lower quadrant etc. Rebound tenderness on abdominal palpation is d/t the fact that the parietal peritoneum which has already been inflamed due to the presence of underlying inflamed organ also springs back along with the abdominal muscles. < p> Reference : page 458 A manual on clinical surgery Das 10th edition

So the answer to this question is A


Instruction:
Which among the following is the most common cause of stroke associated with moality?
A. Embolic
B. Thrombotic
C. Hemorrhagic
D. Absess

Response:
Strokes are classified as either hemorrhagic or ischemic. Acute ischemic stroke refers to stroke caused by thrombosis or embolism and is more common than hemorrhagic stroke. Cardiogenic emboli are a common source of recurrent stroke. They may account for up to 20% of acute strokes and have been repoed to have the highest 1- month moality. Thrombotic strokes are caused by in situ occlusions on atherosclerotic lesions in the carotid, veebrobasilar, and cerebral aeries, typically proximal to major branches. Embolus from the hea is a usual cause of stroke in people with hea disease.

So the answer to this question is A


Instruction:
Agoraphobia is:
A. Fear of getting caught in places from where escape would be difficult
B. Fear of heights
C. Fear of animals
D. Fear of closed spaces

Response:
Fear of getting caught in places from where escape would be difficult - Fear of open spaces Fear of crowded places Fear of enclosed places Fear of travelling alone Fear of public transpo Patient is usually home bound Agarophobia and panic disorder are usually comorbid Fear of heights is Acrophobia Fear of closed spaces is Claustrophobia Fear of animals is Zoophobia

So the answer to this question is A


Instruction:
Most Basic amino acid is
A. Lecuine
B. Istidine
C. Arginine
D. Glutamic acid

Response:
(C) Arginine # Aminoacid can be acidic, basic or neutral depending up on their side chain.> The lower the Pka of the R gp, the more acidic will be the amino acids, so aminoacid with the highest Pka of the RGP will be most basic.Basic Amino AcidPka of 'R' group* Arginine12.5* Lysine10.8* Histidine6.0

So the answer to this question is C


Instruction:
Sustained neutropenia is seen with?
A. Vinblastine
B. Cisplatin
C. Carmustine
D. Cyclophosphamide

Response:
Carmustine belongs to the group of alkylating agents. It interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal body cells may also be affected by carmustine, other effects may occur. Carmustine injection is used alone or together with other medicines to treat ceain type of brain tumors (e.g., glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma, and metastatic brain tumors), cancer of the lymph system (e.g., Hodgkin&;s disease, non-Hodgkin&;s lymphoma), and a ceain type of cancer in the bone marrow (e.g., multiple myeloma). Marked neutropenia is frequently observed following administration of this drug REFERENCE: www.mayoclinic.org

So the answer to this question is C


Instruction:
Pleomorphic adenoma usually arises from-
A. Parotid gland
B. Sub mandibular gland
C. Minor salivary gland
D. Superficial lobe

Response:
None

So the answer to this question is A


Instruction:
Transient erythroid hypoplasia in hereditary spherocytosis is caused by:
A. Epstein Barr virus
B. Parvovirus B19
C. CMV
D. Hepatitis B

Response:
Parvovirus B 19 can cause transient red cell aplasia in patients with hemolytic disorders. It can cause aplastic crisis. Ref: Harrisons principles of internal medicine, 18th edition, Page 874.

So the answer to this question is B


Instruction:
A 16 years old girl failed in her final examination. Disgusted with life , she cut across the front of wrist at the flexor retinaculum . She was rushed to hospital and the surgeon noticed that the cut was superficial. All the following structures would have been damaged by this cut EXCEPT?
A. Ulnar nerve
B. Median nerve
C. Palmar cutaneous branch of median nerve
D. Superficial branch of radial aery

Response:
Median nerve lies deep to the flexor retinaculum and is not damaged by cuts which are superficial. Structures crossing superficial to flexor retinaculum are:From medial to lateral:Superficial branch of ulnar nerve and ulnar aeryTendon of palmaris longusPalmar cutaneous branch of median nerveOrigin of the thenar musclesStructures passing deep to flexor retinaculum are:Median nerveTendons of flexor digitorum superficialisTendon of flexor digitorum profundusTendon of flexor pollicis longusUlnar bursa and radial bursa

So the answer to this question is B


Instruction:
In "Jiggling type" of trauma, the occlusal force cause
A. Funnel shaped destruction of socket wall
B. Distinct pressure and tension sides within periodontal Ligament
C. No changes in socket wall
D. Has no effect on periodontal ligament space

Response:
None

So the answer to this question is A


Instruction:
Mouse nibbled appearance of vocal cords is seen in:
A. Tb larynx
B. Syphilis
C. Achalasia Cardia
D. Lupus

Response:
Ref: Diseases of the Ear Nose and Throat by PL Dhingra .5th edn .2010 page. 312Explanation:TB LarynxTb larynx is almost secondary to pulmonary lbSeen mostly in middle aged malesBacilli reach the larynx by bronchogenic (via sputum) and hematogenous routeMost commonly posterior part of the larynx is affected i.e. arytenoids, inter arytenoids areaClinical FeaturesWeakness of voice (earliest symptom)Pain radiating to ear due to ulcerationOdynophagiaExamination FindingsMonocorditis - hyperemia of the vocal cord with impairment of adduction (earliest sign)Swelling in the inter arytenoids area giving it a niamiJated appearanceUlceration of the vocal cord - mouse nibbled appearanceUlceration and granulation over the arytenoids and inter arytenoid areaPsuedoedema of the epiglottis - Turban epiglottisPale mucosaSwelling of the false cord and aryepiglotticDiagnosis is by chest x-ray and sputum AFB examinationShould take a biopsy to rule out malignancy in suspected casesTreatment is with ATTLupusAffects the anterior part of larynxFirst epiglottis is affectedPainless and mostly asymptomaticGood prognosisTreatment is with ATTSyphilisCan affect any part any part of larynxLarynx generally affected in the tertiary stageDiagnosed with biopsy and serologyComplication - laryngeal stenosis

So the answer to this question is A


Instruction:
A patient with homonymous hemianopia is found to have asymmetric optokinetic nystagmus. The location of the lesion is
A. Parietal lobe
B. Occipital lobe
C. Temporal lobe
D. Lateral geniculate body

Response:
Optokinetic nystagmus (OKN), elicited with a rotating striped optokinetic drum, useful in localizing cause of an isolated homonymous hemianopia. Physiological OKN involves smooth pursuit of a target, followed momentarily by a saccade in the opposite direction to fixate on the next target. If a homonymous hemianopia is due to a lesion in the parietal lobe, smooth pursuit pathways towards the side of the lesion are likely to be affected, making this component of OKN defective. OKN will therefore be asymmetrical: erratic when the drum is rotated towards the side of the lesion, but regular when the drum is rotated away from the side of the lesion. If the lesion is in the occipital lobe, smooth pursuit pathways are intact and OKN will be symmetrical - this is the Cogan dictum, which also states that the parietal lobe lesion is more likely to be a tumour and the occipital lesion an infarction. optokinetic drum

So the answer to this question is A


Instruction:
Horner syndrome causes all of the following signs, EXCEPT:
A. Enophthalmos
B. Mydriasis
C. Anhidrosis
D. Narrowed palpebral fissure

Response:
Horner's syndrome occur secondary to a lesion of the sympathetic system. Features of Horner's syndrome are miosis, ptosis, facial anhidrosis,enophthalmos and heterochromia iridis. Three types of Horner's syndrome are: Central: Lesion is located between hypothalamus and the ciliospinal center of Bodge. Pre ganglionic: Lesion is located from C8 to T2 and the superior cervical ganglion. Post ganglionic: Lesion involves the third order neurons from the superior cervical ganglion to the dilator pupillae. Ref: Textbook of Ophthalmology edited by Sunita Agarwal, page 306.

So the answer to this question is B


Instruction:
Urease positive organism -
A. Proteus
B. Streptococcus
C. Vibrio cholera
D. Pseudomonas

Response:
Ans. is 'a' i.e., ProteusUrease positive bacteria* Proteus* Staph aureus* Morganella* Klebseilla* Nocardia* H. Pylori* Y. pseudotuberculosis* Y. enterocolitica* Cryptococcus (fungus)* Diphtheroids* Mycobacteria except MAC

So the answer to this question is A


Instruction:
Episodic vertigo, tinnitus and normal hearing is characteristic feature of -
A. Acoustic neuroma
B. Meniere's disease
C. Vestibular neuritis
D. All of the above

Response:
None

So the answer to this question is B


Instruction:
Most common organic cause of erectile dysfunction
A. Atherosclerosis
B. Multiple sclerosis
C. Penile fibrosis
D. Peyronie's disease

Response:
M/c organic cause of ED is Atherosclerosis.

So the answer to this question is A


Instruction:
Pagets disease increases the risk of
A. Osteoma
B. Osteosarcoma
C. Fivrosarcoma
D. All

Response:
Osteosarcoma Osteosarcomas are bulky tumors that are gritty, gray-white, and often contain areas of hemorrhage and cystic degeneration (Fig. 26-24). The tumors frequently destroy the surrounding coices and produce soft tissue masses. They spread exten- sively in the medullary canal, infiltrating and replacing hemato- poietic marrow. Infrequently, they penetrate the epiphyseal plate or enter the joint. When joint invasion occurs, the tumor grows into it along tendoligamentous structures

So the answer to this question is B


Instruction:
By spirometry, one can measure
A. Residual volume
B. FRC
C. TLC
D. Tidal volume

Response:
Most lung volumes are measured by Spirometer. Residual volume, total lung capacity, and functional residual capacity cannot be measured with a spirometer.Ref: Ganong review of medical physiology 23rd edition Page no: 593

So the answer to this question is D


Instruction:
Regarding CSF all the following statements are true except
A. Its pH is less than blood
B. No neutrophils present normally
C. Formed by arachnoid villi
D. Persistent leakage can cause headache

Response:
C i.e. Formed by arachnoid villi

So the answer to this question is C


Instruction:
The inclination of teeth towards Frankfort horizontal plane in Simon's classification is
A. Attraction
B. Protraction
C. Retraction
D. Distraction

Response:
None

So the answer to this question is A


Instruction:
In myasthenia gravis, antibodies are present against:September 2012
A. Muscarinic receptor proteins
B. Nicotinic receptor proteins
C. Protein actin
D. Protein myosin

Response:
Ans. B i.e. Nicotinic receptor proteinsMyasthenia gravisIt is an autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigability.It is an autoimmune disorder, in which weakness is caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular junction, inhibiting the excitatory effects of the neurotransmitter acetylcholine on nicotinic receptors throughout neuromuscular junctions.Myasthenia is treated medically with acetylcholinesterase inhibitors or immunosuppressants, and, in selected cases,thymectomy.

So the answer to this question is B


Instruction:
Hernia with hydrocele is ______ hernia:
A. Gibbon's
B. Fruber's
C. Dobson's
D. leobel's

Response:
Gibbon&;s hernia Hernia with Hydrocele Berger&;s hernia Hernia into pouch of Douglas Beclard&;s hernia Femoral hernia through opening of saphenous vein Amyand&;s hernia Inguinal hernia containing appendix Oglive&;s hernia Hernia through the defect in conjoint tendon just lateral to where it inses with the rectus sheath Stammer&;s hernia Internal hernia occuring through window in the transverse mesocolon after retrocolic gastrojejunostomy Peterson hernia Hernia under Roux limb after Roux-en-y gastric bypass Velpeau hernia Hernia infront of femoral vessels Holthouse hernia Inguinal hernia with extension of the loop of intestine along inguinal ligament Ref: Bailey 27th edition Pgno: 1252

So the answer to this question is A


Instruction:
ALL of the following are true about trigeminal neuralgia
EXCEPT
A. it is unilateral
B. it is of throbbing nature
C. it is triggered by touching cheeks, mucosa etc
D. occurs in bouts

Response:
None

So the answer to this question is B


Instruction:
Emergency contraception contains-
A. Cyproterone
B. Desogestrel
C. LNG
D. Medroxyprogesterone

Response:
Ans. is 'c' i.e., LNG * Two methods of emergency contraception are available now:1) Hormonal and2) Mechanical (IUD)* There are two types of hormonal emergency contraception (emergency window = 72 hours)1) LNG-only pills (most commonly used)# One tablet of 0.75 mg LNG pill should be taken as soon as possible after unprotected intercourse, followed by a same dose taken 12 h later; both doses must be taken within 72 h of intercourse.# Single 1.5 mg dose of LNG is as effective for emergency contraception as two 0.75 mg doses of LNG taken 12 h apart.# Failure rate (pregnancy rate) = 0-1%2) Combined Estrogen and Progestogen Pills (Also Known as the Yuzpe Regimen)# High-dose pills contain 50 pg of EE and 250 pg LNG (or 500 pg norgestrel). Two pills should be taken as soon as possible, but not later than 72 h of unprotected coitus; this must be followed by two other pills 12 h later.# When only low-dose pills containing 30 pg of EE and 150 pg of LNG (300 pg of norgestrel) are available, four pills should be taken as the first dose within 72 h of unprotected intercourse, followed by four more pills after 12 h.# Main side effect is nausea and vomiting# Failure rate = 0-2%* The mechanism of action of emergency contraceptive pills has not been clearly established. They may act through (1) inhibition or delay of ovulation, (2) prevention of implantation in the altered endometrium (interception = main action), and (3) prevention of fertilization due to quick transport of sperms or ova. They cannot interrupt already established pregnancy.

So the answer to this question is C


Instruction:
Varicose vein surgery is contraindicated in -
A. Varicose ulcers
B. Deep vein Thrombosis
C. Pigmentation Over limb
D. Hemorrhoides

Response:
Ans. is 'b' deep vein Thrombosis Ref Bailey & love, 24/e, p 963 (23/e, p 245)Surgical treatment of varicose vein is widely used and is effecive in removing varicose veins of the main saphenous trunks, as well as their tributaries, down to a size of about 3 mm. Veins smaller than this are best treated by Sclerotherapy. Surgical removal of varices is inappropriate where these form a major part of the venous drainage of the limb, for example where a deep vein thrombosis has destroyed the main axial limb veins and the pt. relies on the superficial veins." - Bailey & Love

So the answer to this question is B


Instruction:
The chances of acquiring HIV infection following needle prick is:
A. 0.30%
B. 3-0%
C. 0-30%
D. 0.00%

Response:
Ans. a. 0.3%

So the answer to this question is A


Instruction:
A 69-year-old man is informed that the cause of his dysphagis is a benign lesion. The barium swallow is shown in (Figure below). What should he be told regarding benign tumors and cysts of the esophagus?Leiomyoma of esophagus. Note smooth rounded density causing extrinsic compression of esophageal lumen
A. They occur more commonly than malignant tumors.
B. They are symptomatic at an early age.
C. Diagnosis is best confirmed on chest x-ray.
D. Leiomyoma is the most common benign tumor encountered in the esophagus.

Response:
Leiomyoma is the most common benign tumor encountered in the esophagus. Malignant transformation is thought to be rare. Less than 10%. of alimentary tract leiomyomas are found in the esophagus. They are composed of spindle cells and grow slowly and may progressively cause obstructive symptoms. Leiomyomas are not referred to as a benign GIST. Other benign lesions are congenital or acquired cysts, adenomatous polyps, papillomas, lipomas, neurofibromas, and hemangiomas.

So the answer to this question is D


Instruction:
Which of the followig is a derivative of otic capsule?
A. Membraneous labyrinth
B. Perilymphatic labyrinth
C. Bony labyrinth
D. Ossicles

Response:
Ans. is'c'i.e., Bony labyrinthRef Dhingra 4h/e p. 86; Langmann 317Otic capsule or the bony labyrinth ossifies from 14 centres, the first one appears in the region of cochlea at 16 weeks and the last one appears in the postero lateral pa of posterior semicircular canal at 20d week

So the answer to this question is C


Instruction:
All of following are the Cellular Components of Taste Buds except:-
A. Zymogenic Cells
B. Basal Cell
C. Sustentacular Cells
D. Gustatory Cells

Response:
Three different types of cells can be identified in taste buds: The Suppoing or Sustentacular Cells are elongated and exhibit a Darker Cytoplasm and Slender, Dark Nucleus. The Taste Cells or Gustatory cells exhibit a Lighter Cytoplasm and a more Oval, Lighter Nucleus. The Basal Cells are located at periphery of taste bud near the basement membrane. The Basal Cells give rise to both taste and suppoing cells. Zymogenic cells are seen in Gastric Glands.

So the answer to this question is A


Instruction:
Hydroxyurea mechanism of action in cancer is by inhibiting the enzyme -
A. Ribonucleoside diphosphate reductase
B. Ribonucleotide oxidase
C. DNA lyase
D. DNA synthetase

Response:
Ans. is 'a' i.e., Ribonucleoside diphosphate reductase Hydroxyureao It blocks the conversion of ribonucleotides to deoxyribonucleotides by inhibiting the enzyme ribonucleoside diphosphate reductase; thus inhibits the DNA synthesis; S phase specific,o Myelosuppression is the major toxicity. GI disturbances and cutaneous reactions (pigmentation) also occur,o It is used in CML, psoriasis, polycythemia vera and some solid tumors.o It is also used as radiosensitizer before radiotherapy and is a first line drug for sickle cell disease in adults.

So the answer to this question is A


Instruction:
Constituents of a typical embalming solution are all except -
A. Phenol
B. Glycerine
C. Formalin
D. Ethanol

Response:
Embalming solution contains formalin, methanol, phenol. Formalin one and half litres, sodium citrate 900g, sodium chloride 800g, sodium borate 600g, glycerine 600ml and one percent eosin 30 ml in ten litres water. Dr. Narayana Reddys Synopsis of Forensic Medicine & Toxicology 27 th edition pg. 87.

So the answer to this question is D


Instruction:
There have been many recent advances in TIVA compared to inhalational anesthesia. Which of the following is true about TIVA
A. Reduces cerebral metabolism (CMR) and CBF
B. Smooth induction with high incidence of post operative nausea and vomiting
C. Propofol inhibits pulmonary vasoconstriction d/t hypoxia, and is a/w increased pulmonary toxicity, malignant hypehermia and enhanced N20 effects
D. Higher chances of nephrotoxity

Response:
A i.e. Reduces cerebral metabolism (CMR) and CBF - TIVA (with propofol) provides extremely clear-headed awakening (which is useful after neurosurgery for patient evaluation) and reduced incidence of post operative nausea and vomiting (PONVP compared to volatile anesthesia. It can be safely used in patient susceptible to malignant hyperpyrexiaQ and reduces release of scavenged anesthetic gases into the atmosphere. The paralysis is not always required, avoiding reversal agents and emergence is rapidQ (especially when propofol TIVA is used with remifentanil).

So the answer to this question is A


Instruction:
Vaccine not given in Adolescents
A. MMR
B. Tetanus
C. Rotavirus
D. HPV

Response:
Adolescence ranges from 10 to 19 yrs Early ( 10-13yrs); Mid(. 14-16yrs); Late( 17-19yrs) DPT vaccine is given at 10-12 yrs, once every 10 yrs thereafter. HPV vaccine - 2 doses( if 9-14 yrs). 3 doses( if beyond 15 yrs) Influenza vaccine- Annually Rota virus vaccine presently is given in 4 states (AP, HP, Haryana, Odisha).It is given to prevent diarrhoea caused by rota virus. Three kinds of live attenuated oral vaccines ; Rotatrix( monovalent ) 2 doses:10 &14 wks Rotateq( pentavalent)3doses:6,10,14 wks Rotovac( monovalent recombinant )3doses Immunization of rotavirus vaccine should be completed by 8 months of age. Adolescents affected with rotavirus show mild symptoms in comparison to infants and toddlers Ref: Ghai, 9th edition, Chap 5 & 10.

So the answer to this question is C


Instruction:
Standard site for primary bone graft -a) Pelvisb) Greater trochanterc) Medial malleolusd) Lateral melleoluse) Fibula
A. a
B. b
C. ab
D. ae

Response:
Standard site for primary cancellous bone graft → Iliac crest of pelvis.
Standard site for primary cortical bone graft → fibula.

So the answer to this question is D


Instruction:
Not a feature of diabetes mellitus in pregnancy
A. Postdatism
B. Hydramnios
C. Neonatal hyperglycemia
D. congenital defect

Response:
Neonatal complications Respiratory distress syndrome Hypoglycemia Polycythemia Hyperbilirubinemia Hyperviscosity Cardiomyopathy Bih trauma Reference: Textbook of Obstetrics; Sheila Balakrishnan, 2nd edition; Page no: 241

So the answer to this question is C


Instruction:
Recptors for vibration sense-
A. Merkel's disc
B. Ruffini's end organ
C. Paccinian corpuscle
D. Meissner's corpuscle

Response:
Ans. is 'c' i.e., Paccinian corpuscle Tactile (touch) receptors* For touch (superfical touch) :- Meissner's corpuscle (detect texture of surface, i.e. rough or smooth), Merkel's disc (detect two point discrimination).* For pressure (deep touch) :- Ruffini's end organ (slowly adapting).* Vibrations :- Detected by Pacinian corpuscle (rapidly adapting).

So the answer to this question is C


Instruction:
Which of these scoring systems is helpful in assessing severity of wound infection and is used for research and surveillance?
A. Southampton grading scale
B. ASA classification
C. Glasgow score
D. APGAR

Response:
- Commonly using grading system: Southampton grading scale Asepsis score Southampton Wound Grading System 0: Normal healing Ia: Some bruising Ib: Considerable brusing Ic: Mild erythema I: Normal healing with mild bruising or erythema IIa: At one point IIb: Around sutures IIc: Along wound IId: Around wound II: Erythema plus other signs of inflammation IIIa: At one point only (<2cm) IIIb: Along wound (> 2 cm) IIIc: Large volume IIId: prolonged (>3 days) IV: Pus IVa: At one point only (<2 cm) IVb: Along wound (>2cm)

So the answer to this question is A


Instruction:
RMP of smooth muscle is
A. -50mv
B. -75mv
C. -90mv
D. -35mv

Response:
Average RMP value is approx -50mV. (Ref: Textbook of physiology AK Jain 5th edition page no.188)

So the answer to this question is A


Instruction:
A 32 yr old man present to ER with history of high-grade fever, dyspnea and fatigue. On physical examination reveals a new holosystolic murmur that is best heard over cardiac apex. Skin examination shows following skin lesion. What is most likely diagnosis?
A. Rheumatic hea disease
B. Infective endocarditis
C. Libman sack endocarditis
D. Kaposi sarcoma

Response:
Janeway lesion are nontender, macular and erythematous lesions on palms and soles of patient with acute infective endocarditis. Osler nodes are tender, violaceous nodules typically located in pulp of fingers and toes seen in patient with infective endocarditis. Libman Sack endocarditis occurs in up to 25% of patient with SLE. This condition can cause small cardiac valvular vegetations on wither side of a valve, resulting in fibrotic valve thickening in fibrotic valve thickening anf deformity. SLE may cause an acute coronary syndrome at young age even with angiographically normal coronary aeries. Rheumatic fever can lead to mitral stenosis, which is characterize by a late, rumbling, diastolic murmur at cardiac apex. Numerous symptoms are associated with acute rheumatic fever, these can be: fever, erythema marginatum, valvular damage, increase ESR, joint pain, Subcutaneous nodule and Sydenham chorea. Erythema marginatum is a nonpruritic, circular, pink eruption on the trunk that is present in few cases of acute rheumatic fever. Kaposi sarcoma: a vascular tumor that is the most common neoplasm in patients with AIDS.The lesions of KS are characterized by the proliferation of spindle-shaped cells that express markers of both endothelial cells (vascular or lymphatic) and smooth muscle cells.

So the answer to this question is B


Instruction:
Myofibroblast is seen in -
A. Normal connective tissue
B. Muscle septa
C. Wound margin
D. Bronchus

Response:
Ans. is 'c' i.e., Wound margin

So the answer to this question is C


Instruction:
True about epidural opioids are all except?
A. Act on dorsal horn substantia gelatinosa
B. Can cause Itching
C. Function of the intestine is not affected
D. Can cause respiratory depression

Response:
Epidural opiate administration is routinely used by many anaesthesiologists involved in obstetric anaesthesia. Epiduralinjection of a local anaesthetic combined with an opioid generates a more rapid onset of more profound analgesia with little motor blockade. Thus pain relief lasts longer than after either drug alone. Ref: KD Tripathi 8th ed.

So the answer to this question is C


Instruction:
Number of carpal bones seen in a radiograph of an infant is:
A. 0
B. 2
C. 3
D. 5

Response:
b) 2 ref: Sutton 7th/e p. 1848 fig A3

So the answer to this question is B


Instruction:
Malignant Otitis externa is most commonly caused by-
A. P. aeruginosa
B. S. aureus
C. St.penumoniae
D. S. epidermidis

Response:
Ans. is 'a' i.e., P. aeruginosaMalignant otitis externao Malignant otitis externa, also called necrotizing external otitis. is a misnomer as it is not a neoplastic condition, rather it is an infectious condition. Malignant otitis externa is a disorder involving inflammation and damage of the bones and cartilage at the base of skull in temporal bone as a result of spread of infection from outer ear. Malignant otitis externa is often caused by difficult to treat bacteria such as pseudomonas aeruginosa. Only rare cases of malignant otitis externa due to S.aureus, Proteus mirabilis and Aspergillus fumigatus have been reported. The infection spreads from the floor of the ear canal to the nearby tissues and into the bones at the base of the skull. The infection and inflammation may damage or destroy the bones. The infection may spread more and affect the cranial nerves, brain, or other parts of the body.Predisposing factors for malignant otitis externao Elderly diabetics (most common predisposing factor)o Individuals with altered immune function (immunodeficiency )o ChemotherapyClinical features of malignant otitis externao Severe pain inside the ear and may get worse when moving head.o Granulation tissue in the external auditory canal, at the junction of bony and cartilagenous part,o Drainage from the ear - yellow, yellow - green, foul smelling, persistent.o Fevero Itching of ear or ear canalo Troubled swallowing & weakness of face.Complicationso Cranial nerve palsies most commonly facial nerve is involved. Other cranial nerves can also be involved (glossopharyngeal, vagus, spinal accessory, hypoglossal, abducens, trigeminal),o Jugular venous thrombosiso Cavernous sinus thrombosiso MeningitisTreatment of malignant otitis externao In all cases, the external ear canal is cleansed and a biopsy specimen of the granulation tissue sent for culture. IV antibiotics is directed against the offending organism. For Pseudomonas aeruginosa, the most common pathogen, the regimen involves an antipseudomonalpenicillin or cephalosporin (3rd generation piperacillin or ceftazidime) with an aminoglycoside. A fluoroquinolone antibiotic can be used in place of the aminoglycoside. Ear drops containing antipseudomonal antibiotic e.g. ciproflaxacin plus a glucocorticoid is also used. Early cases can be managed with oral and otic fluoroquinolones only. Extensive surgical debridement once an important part of the treatment is now rarely needed.

So the answer to this question is A


Instruction:
Which of the following DMARD acts by increasing adenosine extracellularly?
A. Methotrexate
B. Sulfasalazine
C. Azathioprine
D. Leflunomide

Response:
Ans. (A) Methotrexate(Ref: Katzung 13/e p627)Major mechanism of methotrexate at low doses used in rheumatoid arthritis is inhibition of AICAR (Aminoimidazole carboxamide ribonucleotide) transformylase and thymidylate synthase enzymes. This results in accumulation of AICAR in the cells. AICAR is a competitive inhibitor of AMP deaminase resulting in accumulation of AMP. Later is converted to adenosine which is a powerful anti-inflammatory compound.

So the answer to this question is A


Instruction:
A chromosomal anomaly associated with alzheimer's dementia is -
A. Trisomy 18
B. Patau syndrome
C. Trisomy 21
D. Turners syndrome

Response:
None

So the answer to this question is C


Instruction:
Hoffman-Rigler sign for enlargement of the left ventricle is seen on:
A. PA view of the chest
B. AP view of the chest
C. Apicogram of the chest
D. Lateral view of the chest

Response:
Ans DThe Hoffman-Rigler sign Q is a sign of left ventricular enlargement Q inferred from the distance between the inferior vena cava and left ventricle. On a lateral chest radiograph Q, if the distance between the left ventricular border and the posterior border of IVC exceeds 1.8 cm, at a level 2 cm above the intersection of diaphragm and IVC, left ventricular enlargement is suggested. Hoffman-Rigler sign should not be confused with Rigler sign, Rigler triad or Rigler notch sign.

So the answer to this question is D


Instruction:
The volume in question mark is after:
A. Maximum inspiration
B. Maximum expiration
C. Normal inspiration
D. Normal expiration

Response:
Ans. (b) Maximum expiration(Ref: Ganong, 25th ed/p.629)It is residual volumeIt is the volume of air left in lungs after forced expiration

So the answer to this question is B


Instruction:
All of the following drugs are approved for treatment of Psoriasis except ?
A. Methotrexate
B. Alefacept
C. Infliximab
D. Tofacitinib

Response:
1. DOC for PSORIATIC AHRITIS : METHOTREXATE 2. DOC for EHRODERMIC PSORIASIS :METHOTREXATE 3. MONOCLONAL ANTIBODIES used in psoriasis : 1. TNF ALPHA inhibitors - Infliximab, Adalimumab, Etanercept, Ceolizumab 2. ANTI-IL-17A- Ixekizumab, Secukinumab 3. Blockers of IL-17 receptor - Brodalumab 4. ANTI-IL-23 - Guselkumab, Risankizumab, Tildrakizumab 5. ANTI-IL-12 AND IL-23 - Ustekinumab 6. ANTI-LFA-1 - Alefacept 7. ANTI-LFA-3 - Efalizumab 8. ANTI-CD-6 - Itolizumab NOTE : TOFACITINIB is a JAK 1 and 3 inhibitor and is used in treatment of rheumatoid ahritis (not psoriasis).

So the answer to this question is D


Instruction:
Which of the following statements regarding corneal transplantation is true?
A. Whole eye needs to be preserved in tissue culture
B. Donor not accepted if age > 60 years
C. Specular microscopy analysis is used to assess endothelial cell count
D. HLA matching is mandatory

Response:
Ans. (c) Specular microscopy analysis is used to assess endothelial cell countRef: Textbook of Ophthalmology by Sunita Agarwal (Jaypee) Is'* Corneoscleral button needs to be preserved, though whole eye can also be preserved.* Age is not a criteria for donor eye.* HLA matching is not mandatory as the cornea is immunologicaly previliged.

So the answer to this question is C


Instruction:
A 25-year-old woman is G5, P0, Ab4. All of her previous pregnancies ended in spontaneous abortion in the first or second trimester. She is now in the 16th week of her fifth pregnancy and has had no prenatal problems. Laboratory findings include maternal blood type of A positive, negative serologic test for syphilis, and immunity to rubella. Which of the following laboratory studies would be most useful for determining a potential cause of recurrent fetal loss in this patient?
A. Amniocentesis with chromosomal analysis
B. Genetic analysis of the CFTR gene
C. Maternal serum antibody screening
D. Maternal serum a-fetoprotein determination

Response:
Multiple fetal losses earlier in gestation suggest the likelihood of a chromosomal abnormality - the mother or father may be the carrier of a balanced translocation. Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations may lead to cystic fibrosis, and like most inborn errors of metabolism, with appearance of findings postnatally. The maternal serum level of a-fetoprotein can help identify fetal neural tube defects, but these defects are not a cause of early fetal loss. Maternal HIV infection is not a cause of significant fetal loss. Because the mother is blood type A positive, fetal loss with erythroblastosis fetalis is unlikely, although other blood group incompatibilities potentially may result in erythroblastosis fetalis.

So the answer to this question is A


Instruction:
Lucio phenomenon is treated with
A. Steroids
B. Lenalidomide
C. Clofazimine
D. Exchange transfusion

Response:
Answer- D. Exchange transfusionLucion phenomenon is a very rare comcomplication of leprosy.It presents as sudden necrotizing vasculopathy in Patients with longstanding, untreated lepromatous leprosy.TreatmentOptimal wound care and therapy for bacteremia are indicated. Ulcers tend to be chronic and heal poorly.In severe cases exchange transfusion is indicated.

So the answer to this question is D


Instruction:
The distance between tympanic membrane and medial wall of middle ear at the level of centre is:
A. 3 mm
B. 4 mm
C. 6 mm
D. 2 mm

Response:
(d) 2mm(Ref. BD Chaurasia, Human Anatomy 6th ed., Vol 3, page 277)Part of the middle ear cavityDistance from lateral to medial wallEpitympanum6mm (widest)Mesotympanum (centre)2mm (narrowest)Hypotympanum4mm

So the answer to this question is D


Instruction:
A 50 year old male presents with a 3 year history of irritability, low mood, lack of interest in surroundings and general dissatisfaction with everything. There is no significant disruption in his sleep or appetite. He is likely to be suffering from-
A. Major depression
B. No psychiatric disorder
C. Dysthymia
D. Chronic fatigue syndrome

Response:
Irritability, low mood (low self esteem, pessimism, hopelessness) and lack of interest for 3 years suggest the diagnosis of dysthymia (for details, see the table of diagnostic criteria in text).

So the answer to this question is C


Instruction:
Clinical testing of the function of the long thoracic nerve is done by?
A. Adduct the arm abducted to 90 degree against resistance
B. Hold the arm in abducted position against resistance
C. Initiate abduction of the arm from the side against resistance
D. Raise the arm above the head on the affected side

Response:
Injury to the long thoracic nerve or nerve to serratus anterior leads to inability to raise the arm beyond 90 degree i.e. overhead abduction. Serratus anterior rotates the inferior angle of scapula laterally during abduction of the arm above the head. Winging of scapula is another classical feature of long thoracic nerve injury.

So the answer to this question is D


Instruction:
Adson&;s test is positive in -
A. Cervical rib
B. Cervical spondylosis
C. Cervical fracture
D. Cervical dislocation

Response:
Adson&;s test is a provocative test for Thoracic Outlet Syndrome accompanied by compression of the Subclan aery by a cervical rib or tightened anterior and middle scalene muscles. Ref : Bailey and love surgery text book 27th Ed.

So the answer to this question is A


Instruction:
In aoic dissection blood enters in -
A. Intima
B. Media
C. Adventitia
D. Any of the above layer

Response:
Ans. is `b' i.e., MediaAoic dissection o Aoic dissection is a catastrophic illness characterized by dissection of blood between and along the laminar planes of aoic media.o Blood enters inside the aerial wall (in the media layer) and leads to formation of blood filled channels within the aoic wall, which often ruptures outward causing massive hemmorrhage.o The most frequent preexisting histologically detectable lesion is cystic medial degeneration.o In aoic dissection, there is an intimial tear through which the blood enters into the media.o Usually, the tear is within 10 Cms of aoic valve.o The dissecting hematoma spreads characteristically along the laminar planes of the aoa, usually between the middle and outer third.Some times, blood reruptures into the lumen distally, i.e. there is a second tear distally. So that a complete new vascular channel is formed inside the media of aoic wall --> Blood enters from proximal tear into the media and comes out into the lumen from distal tear.o This is called double - barrel aoa with a false-channel in the media.Later on this false channel becomes endothelized --> chronic dissection.

So the answer to this question is B


Instruction:
A 20 year old female repos that she was raised by an abusive father when she was young. Although he has changed and is no longer abusive towards her, she still becomes anxious as soon as she sees him. What is the best explanation for her anxiety based on psychological theory?
A. Classical conditioning
B. Operant conditioning
C. Free association
D. Reaction formation

Response:
The father is a conditioned stimuli and abuse is an unconditioned stimuli. The fear is the conditioned response. Even without the abuse, the patient is fearful of the father. This is known as classical conditioning.

So the answer to this question is A


Instruction:
Human colostrum contains more of the following nutrients than mature human milk, except –
A. Lactose
B. Minerals
C. Proteins
D. Vitamin A

Response:
Sugar is less in clostrum.

So the answer to this question is A


Instruction:
All of the following are side effects of valproic acid, except-
A. Alopecia
B. Hepatitis
C. Nephrotoxicity
D. Skin rash

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

So the answer to this question is C


Instruction:
Occult thyroid malignancy with nodal metestasis is seen in -
A. Medullary carcinoma
B. Follicular ca
C. Papillary ca
D. Anaplastic ca

Response:
Ans is C ie Papillary ca A small percentage of cancers present with enlarged lymph nodes in the jugular chain or pulmonary metastases with no palpable abnormality of the thyroid. The primary tumor may be no more than a few millimeters in size and is termed occult. Such primary foci of papillary carcinoma may also be discovered in thyroid tissue resected for other reasons. The term occult was formally applied to all papillary carcinomas less than 1.5 cm in diameter but the preferred terminology now is microcarcinoma for cancers less than 1 cm in diameter. These have an excellent prognosis although those presenting with nodal or distant metastases justify more aggressive therapy".

So the answer to this question is C


Instruction:
DNS may be associated with all the following except:
A. Recurrent sphenoiditis
B. Acute otitis media
C. Hyperophy of the inferior turbinate
D. Recurrent maxillary sinusitis

Response:
In deted nasal septum, the nasal chamber on the concave side of the nasal septum is wide and shows compensatory hyperophy of turbinates and not atrophy. The sphenoid sinus opens in the sphenoethmoid recess near the roof of nasal cavity and this opening is not affected by DNS.

So the answer to this question is A


Instruction:
Patch test is done to document
A. Type I hypersensitivity
B. Delayed type hypersensitivity
C. Autoimmune disease
D. Immunocomplex deposition

Response:
Patch test is done to determine delayed (type 4) hypersensitivity for the suspected contact allergen. IADVL textbook of dermatology,page 789

So the answer to this question is B


Instruction:
True about mosquito preventive nets are all except?
A. Hole size < 0.0475
B. 150 holes per square inch
C. Best pattern in circular
D. There should be no rent

Response:
Ans. is 'c' i.e.,Best pattern is circular The best pattern of mosquito net is the rectangular net.There should not be a single rent in the net.The Size of openings in the net is of utmost impoance, the size should not exceed 0.0475 inch in any diameter.The number of holes in one square inch in usually 150..

So the answer to this question is C


Instruction:
Serum alkaline phosphatase level increases in:
A. Hypothyroidism
B. Carcinoma of prostate
C. Hyperparathyroidism
D. Myocardial infarction

Response:
None

So the answer to this question is C


Instruction:
Primary amenorrhea, absent uterus, normal pubic hair. Diagnosisis -
A. Mullerian agenesis
B. Testicular feminization syndrome
C. WNT 4 syndrome
D. Hand foot genital syndrome

Response:
Ans. is 'a' i.e., Mullerian agenesis o MRKH syndrome is also known as MURCS syndrome (Mullerian agenesis, Renal aplasia and cervicothoracic somite dysplasia).o MRKH (Mayer Rokitansky Kuster Hauser) syndrome has a karyotype of 46, XX. So the gonads present are ovaries in contrast to Androgen Insensitivity Syndrome where testes are presento Vagina in its upper 2/3rds is absent, but lower one - third of vagina is present as it develops from the urogenital sinus.Characteristic findingsMRKH/ MURCSIsolated vaginal atresiaWNT 4 syndromeAndrogen insensitivityUpper vaginaAbsentVariableAbsentAbsentUterusAbsentPresentAbsentAbsentGonadsOvaryOvaryMasculinized ovaryTestisBreast developmentNormalNormalNormalNormalPubic hair developmentNormalNormalNormalSparseHyperandrogenismNoNoYesNoKaryotype46, XX46, XX46, XX46,XY

So the answer to this question is A


Instruction:
Telecanthus means-
A. Widened interpupillary distance
B. Widened root of nose with normal interpupillary distance
C. Widely separated medial orbital wall
D. Widely separated nose and medial canthi

Response:
Telecanthus Vs hypeelirism *Telecanthus is an increased distance between two inner canthi seen clinically as widened root of nose, but the inter- pupillary distance is normal. *Hypeelorism is an increased distance between two orbits often measured clinically as increased interpupillary distance. Ref: Kanski 6th/e p.756

So the answer to this question is B


Instruction:
In Dent's disease, which of the following is seen on laboratory evaluation ?
A. Hypercalciuria
B. Hypokalemia
C. Hypernatremia
D. Hypomagnesemia

Response:
Ans. is 'a' i.e., Hypercalciuria Dent's disease o Dent disease is a chronic kidney disease that occurs almost exclusively in males. In affected individuals, kidney problems result from damage to proximal tubules. Signs and symptoms of this condition appear in early childhood and worsen over time. o The most frequent sign of Dent disease is the presence of an abnormally large amount of proteins in urine (tubular proteinuria). o Other common signs of the disorder include:- - Excess calcium in the urine (hypercalciuria) - Calcium deposits in the kidney (nephrocalcinosis) and - Kidney stones (nephrolithiasis) o Kidney stones can cause abdominal pain and blood in the urine (hematuria). o Patient presents with end stage renal disease in early complications such as rickets or osteomalacia may occur, o The disease is caused by a mutation in either CLCN5 (Dent disease I) or OCRJL (Dent disease 2). o The phenotype of Dent's disease is explained by the predominant expression of CLC-5 in the proximal tubule segments of the kidney. o Diagnosis is based on the presence of all of the following three criteria Low molecular weight proteinuria. Hypercalciuria and At least one of the following Nephrocalcinosis Kidney stones Hematuria Hypophosphatemia Renal insufficiency

So the answer to this question is A


Instruction:
Train of four response is shown by all of the following neuromuscular blockers except:-
A. Succinyl choline
B. Mivacurium
C. Vacuronium
D. Rocuronium

Response:
Depolarizing neuromuscular blockers show no fade on Train of Four stimulus thus with succinylcholine there would be no train of four response. Non depolarizing neuromuscular blocker shows fade on train of four stimulus.

So the answer to this question is A


Instruction:
Ketanserin is :
A. 5HT1B antagonist
B. 5HT2 antagonist
C. 5HT1A agonist
D. 5HT1D antagonist

Response:
None

So the answer to this question is B


Instruction:
Desmoplakin is the target antigen in:
A. Pemphigus vulgaris
B. Drug induced pemphigus
C. Paraneoplastic pemphigus
D. Pemphigus foliaceous

Response:
Paraneoplastic pemphigus is a severe variant of pemphigus, associated with an underlying neoplasm - most frequently non hodgkin's lymphoma, chronic lymphocytic leukemia, thymoma, and castleman  disease. Tumor antigens are hypothesized to evoke an immune response that leads to the development of an autoimmune response to intercellular adhesins (plakins). This autoantibody response leads to blistering in mucosa and other epithelia.
Ref: Neville's oral and maxillofacial pathology 4th edition page 717-718

So the answer to this question is C


Instruction:
Cause of alpha thalassemia:
A. Deletion of alpha genes
B. Deletion of beta genes
C. Excess of alpha genes
D. Single amino acid substitution in alpha chain

Response:
Ans. a. Deletion of alpha genesCause of alpha thalassemia is deletion of alpha genes."The a-thalassemias are caused by inherited deletions that result in reduced or absent synthesis of a-globin chains.Normally, there are four a-globin genes, and the severity of a-thalassemia depends on how many a-globin genes are affected. As in b-thalassemias, the anemia stems both from a lack of adequate hemoglobin and the effects of excess unpaired non-a. chains (b, g, and d), which vary in type at different ages. In newborns with a-thalassemia, excess unpaired g-globin chains form g4 tetramers known as hemoglobin Barts, whereas in older children and adults excess b-glohin chains form b4 tetramers known as HbH. Since free b and g chains are more soluble than free a chains and form fairly stable homo tetramers, hemolysis and ineffective erythropoiesis are less severe than in b-thalassemias. A variety of molecular lesions give rise to a-thalassemia, but gene deletion is the most common cause of reduced a -chain synthesis. "- Robbins 9/e p64Ia-THALASSEMIASClinical SyndromesGenotypeClinical FeaturesMolecular GeneticsSilent carrier-/a a/aAsymptomatic; no red cell abnormalityMainly gene deletions0a-Thalassemia trait-/- a/a (Asian)Asymptomatic, like b-thalassemia minor -/a -/a (black African, Asian) HbH disease-/- -/aSevere; resembles b-thaiassemia intermedia Hydrops fetalis-/- -/-Lethal in utero without transfusions

So the answer to this question is A


Instruction:
Which of the following hormone is not secreted by kidney:
A. 1,25 dihydroxycholecalciferol
B. Angiotensin I
C. Renin
D. Erythropoietin

Response:
Ans. B. Angiotensin IThe kidney produces three hormones:a. 1,25 dihydroxycholecalciferolb. Reninc. erythropoietinAngiotensinogen is found in the D2 globulin fraction of the plasma. It is synthesized in the liver and is converted to angiotensin I by renin which is further converted to angiotensin II by the action of ACE in lungs.

So the answer to this question is B


Instruction:
Stem cells are taken from?
A. Skin
B. Bone marrow
C. Oral mucosa
D. Elementary tract

Response:
ANSWER: (B) Bone marrowREF: Harrison s 18th ed ch: 65, 66, 67Stem cells are biological cells found in all multicellular organisms, that can divide (through mitosis) and differentiate into diverse specialized cell types and can self-renewT to produce more stem cellsThere are three accessible sources of autologous adult stem cells in humans:Bone marrow, which requires extraction by harvesting, that is, drilling into bone (typically the femur or iliac crest),Adipose tissue (lipid cells), which requires extraction by liposuction, andBlood, which requires extraction through pheresis, wherein blood is drawn from the donor (similar to a blood donation), passed through a machine that extracts the stem cells and returns other portions of the blood to the donor.Stem cells can also be taken from umbilical cord blood just after birth. Of all stem cell types, autologous harvesting involves the least risk. By definition, autologous cells are obtained from one's own body, just as one may bank his or her own blood for elective surgical procedures.

So the answer to this question is B


Instruction:
Cracked nipple may be-
A. Due to syphilitic chancre
B. Cause of retention cyst
C. Pagets disease of nipple
D. Forerunner of breast abscess

Response:
• This may occur during lactation and be the forerunner of acute infective mastitis.
• If the nipple becomes cracked during lactation, it should be rested for 24–48 hours and the breast should be emptied with a breast pump.
• Feeding should be resumed as soon as possible.

So the answer to this question is D


Instruction:
What is not a feature of Sturge-Weber syndrome?
A. Rail track appearance
B. Hemiatrophy of the brain
C. Convulsion
D. Empty sella

Response:
Ans. (d) Empty sellaRef: Bailey 261 e p 599Sturge weber syndrome:* Sporadic usually* Large cutaneous angioma unilaterally (Port wine stain)* Brain angiomas* Focal seizures typically opposite to side of lesion* Adrenal Pheochromocytoma* Cortical atrophy.* Angiomas can be seen "Rail road" or "Tram track" calcification in Occipital region.

So the answer to this question is D


Instruction:
Piles occurs at-
A. Superior rectal vein
B. Inferior rectal vein
C. Superior Hemorrhoidal aery
D. None

Response:
Answer- A. Superior rectal veinInternal hemorrhoids in association with superior rectal vessels are located at 3, 7 and 11 O'clock positions corresponding to left, right posterior and right anterior branches of these vessels.

So the answer to this question is A


Instruction:
Recurrent laryngeal nerve is in close association with:
A. Superior thyroid artery
B. Inferior thyroid artery
C. Middle thyroid vein
D. Superior thyroid vein

Response:
Ans. is 'b' i.e. Inferior thyroid arteryRef: B.D. C 2nd/e Vol III page 137 & 138, Repeat Inferior thyroid artery is a branch of the thyrocervical trunk. During its course it passes behind the carotid sheath and the middle cervical sympathetic ganglion and its terminal part is related to the recurrent laryngeal nerve.More Questions about arterial supply of the thyroid glandThe thyroid gland in supplied by the following arteriesSuperior thyroid artery a branch of the external carotid arterylies in close association with the external laryngeal nerve.Inferior thyroid artery a branch of the thyrocervical trunk (which arises from the subclavian artery)- its terminal part is intimately related to the recurrent laryngeal nerve. Accessory thyroid arteriesarise from tracheal and esophageal arteriesThyroidea ima artery (or the lowest thyroid artery)found in only about 3% of individualsarises from the brachicephalic trunk or directly from the arch of aorta.During thyroidectomy the superior thyroid artery is ligated near to gland (to save the external laryngeal nerve); and the inferior or thyroid artery is ligated away from the gland (to save the recurrent laryngeal nerve)Questions on venous drainage of thyroid glandThe thyroid gland is drained by the following veinsSuperior thyroid vein.Drains in the internal jugular vein orthe common facial veinMiddle thyroid veinAlso drains in the internal jugular veinInferior thyroid veinDrains into the left brachiocephalic veinA fourth thyroid vein (of Kocher), may emerge between middle and inferior veins and drains into the internal jugular vein

So the answer to this question is B


Instruction:
Aificial rupture of membrane is contraindicated in :
A. Hea disease
B. Diabetes
C. Pregnancy induced hypeension
D. Intrauterine death

Response:
Intrauterine death

So the answer to this question is D


Instruction:
Ramkali bai, a 35 year old female presented with one year history of menstrual irregularity and galactorrhea. She also had off-and-on headache. Her examination revealed bitemporal superior quadrantopia. Her fundus examination showed primary optic atropy. Which of the following is the most likely diagnosis in this case :
A. Craniopharyngioma
B. Pituitary macroadenoma
C. Ophthalmic ICA aneurysm
D. Chiasmal glioma

Response:
Answer is B (Pituitary macroadenoma): Presence of long standing endocrinopathies (menstrual irregularities and galactorrhea) in an adult suggests a diagnosis of pituitary adenoma over craniopharyngiomas as the latter are primarily tumours of childhood. Visual field defects and optic atrophy suggest local mass effects which are associated with 'macroadenomas' and hence the most likely diagnosis is a pituitary macroadenoma. Note 'Pituitary adenomas are the most common cause of pituitary hormonal syndromes in adults - Harrison 'The functional tumors often produce clinical symptoms of endocrinopathies when they are still small (microadenomas) and restricted to sella. When a tumor grows outside the sella (macroadenoma) it compresses the optic chiasma and nerves and produces a variety of visual defects, the most common being a complete or incomplete bitemporal hemianopia'- API As the tumor progresses it may result in optic atrophy and blindness. Optic gliomas occur mainly in childhood and presentation is usually with visual loss and not endocrinal manifestations. Opthalmic ICA aneurysm is unlikely to present with long standing endocrinopathies over a year prior to appearance of visual symptoms. Craniopharyngiomas can be excluded as in the previous question.

So the answer to this question is B


Instruction:
Topic : Thyrotoxicosis 1. Amiodarone can cause thyrotoxicosis 2. Plummer's nails are seen 3. Pretibial myxoedema is a feature 4. Ferritin is usually elevated 5. Initial investigation is TSH and free T3
A. 1, 2 - True & 3, 4, 5 - False
B. 3, 4 - True & 1, 2, 5 - False
C. 1, 2, 3, 4 - True & 5 - False
D. 4, 5 - True & 1, 2, 3 - False

Response:
Initial investigation in a case of thyrotoxicosis includes estimation of TSH and unbound T4 levels. Amiodarone is associated with thyrotoxicosis without hypehyroidism. Other causes of thyrotoxicosis without hypehyroidism are subacute thyroiditis, silent thyroiditis and factitious thyrotoxicosis. Skin manifestations of hypehyroidism are 10Ps such as : Pretibial myxedema, Palmar erythema, Periorbital swelling, Persistent facial flush, Poor hair growth, Pink papules and plaques, Pigmentation increased, Propotosis, sweaty Palms and Plummer's nails. Ferritin levels are increased in thyrotoxicosis due to direct stimulation of ferritin synthesis by thyroid hormones.

So the answer to this question is C


Instruction:
To which of the following cell types do 'hea-failure' cells belong?
A. Myocytes
B. Macrophages
C. Adipocytes
D. Pacemaker cells

Response:
Left-sided hea failure leads to pulmonary congestion and edema. There is extravasation of red cells and plasma proteins in the alveoli which are phagocytosed and digested by macrophages The accumulated iron from ingested red cells is stored as hemosiderin. These hemosiderin-laden macrophages are also known as hea failure cells and are telltale signs of previous episodes of pulmonary edema. The common causes of left-sided cardiac failure Ischemic hea disease (IHD) Systemic hypeension Mitral or aoic valve disease Primary diseases of the myocardium (e.g., amyloidosis)

So the answer to this question is B


Instruction:
Which of the following is NOT a CONTRAINDICATION for laparoscopic surgery: March 2013
A. Severe cardiac compromise
B. Hiatus hernia
C. Bowel herniation
D. Endometriosis

Response:
Ans. D i.e. Endometriosis Routine laparoscopy in women with unexplained infeility ?nay reveal endometriosis in 10% of cases

So the answer to this question is D


Instruction:
True about bronchial adenoma
A. 10-15% of all lung tumour
B. Mostly malignant
C. Recurrent haemoptysis
D. Peripherally located

Response:
Ans. is 'c' i.e., Reccurrent haemoptysis

So the answer to this question is C


Instruction:
Misoprostol is a :
A. Prostaglandin E1 analogue
B. Prostaglandin E2 analogue
C. Prostaglandin antagonist
D. Antiprogestin

Response:
Natural prostaglandin in body is PGE2 whereas misoprostol and alprostadil are synthetic PGs which are PGE1 analogs.

So the answer to this question is A


Instruction:
A 45 years old male presented with recurrent attacks of cholangitis. MRCP and ERCP findings are given below. What is the treatment of choice for this condition?
A. ERCP with stenting
B. High dose ursodeoxycholic acid
C. High dose prednisolone
D. Liver transplantation

Response:
Primary sclerosing cholangitis. More common in males Smoking is protective Associated with ulcerative colitis. IOC - MRCP Gold standard - ERCP TOC is liver transplantation | if not available High dose ursodeoxycholic acid (to control inflammation).

So the answer to this question is D


Instruction:
OC pills intake cause psychiatric symptoms, and abdominal pain. Diagnosis is :
A. Acute intermittent porphyria
B. Systemic lupus
C. Thromobosis
D. Anemia

Response:
Ans. is a i.e. Acute intermittent Porphyria Patient taking OCP's and presenting with abdominal pain and psychiatric problem, diagnosis is undoubtedly Acute Intermittent Porphyria as OCP's can precipitate porphyria Some drugs which precipitate Porphyria are : Barbiturates * Sulfonamide antibiotics Meprobamate * Gluthemide Phenytoin * Carbamazepine Valproic acid * Pyrazolones Griseofulvin * Ergots Synthetic estrogen/progestogen (OCP) * Danazol Alcohol * Succinimide

So the answer to this question is A


Instruction:
While performing a lumbar puncture, a snap is felt just before entering into the epidural space. This is due to piercing of which structure?
A. Ligamentum flavum
B. Supraspinous ligament
C. Duramater
D. Posterior longitudinal ligament

Response:
Ans. a. Ligamentum flava (Ref: Gray's 40/e p729, Snell's 9/e p705)While performing a lumbar puncture, a snap is felt just before entering into the epidural space. This is due to piercing of ligamentum flava.Lumbar PunctureThe depth to which the needle will have to pass varies from 2.5 cm or less in a child to as much as 10 cm in obese adults.In caudal anesthesia, needle pierces skin & fascia & sacrococcygeal membrane that fills in the sacral hiatus.The membrane is formed of dense fibrous tissue & represents fused supraspinous & interspinous ligaments as well as ligamentum flavum. A distinct feeling of 'give' is felt when the ligament is penetratedQ.During lumbar puncture, the needle passes through the following anatomic structures before it enters the subarachnoid space:SkinQSubcutaneous tissueQSupraspinous ligamentQInterspinous ligamentQLigamentum flavumQDura materQArachnoid materQ

So the answer to this question is A


Instruction:
Contra-Indications of phenytoin
A. Hirsutism
B. Hepatotoxicity
C. Osteomalacia
D. All the above

Response:
Phenytoin ADRs-hirsutism,gingival hyperplasia,hemolysis-Megaloblastic anemia (folic acid def),hepatotoxic,osteomalacia,hypersensitivity,hyperglycemia,lymphadenopathy-pseudolymphoma Fetal hydantoin syndrome-cleft lip, cleft palate, microcephaly. Rerf: KD TTripathi 8th ed.

So the answer to this question is D


Instruction:
Rotterdam criteria are used to evaluate -
A. CA Breast
B. Aberrations in normal development and involution
C. PCOS
D. CA Cervix

Response:
Answer- C. PCOSRotterdam criteriaTwo of the following three criteria are required :Oligo/anovulationHyperandrogenismClinical (hirsutism or less commonly male pattern alopecia) orBiochemical (raised FAI or free testosterone)Polycystic ovaries on ultrasound

So the answer to this question is C


Instruction:
A male 25 years old presents to the dental clinic with a black spot. He also gives the history of previous dental treatments of other teeth as well and wants gold to be filled in his tooth. On examination, it is revealed that 16 no. tooth has pit and fissure caries. Which preparation is used for retention in this restoration?
A. Vertically oriented grooves
B. Horizontally oriented grooves
C. Coves
D. Skirts

Response:
Skirts.
  Skirts are preparation features used in cast gold restorations that extend the preparation around some, if not all, of the line angles of the tooth. When properly prepared, skirts provide additional, opposing vertical walls that increase retention of the restoration. The placement of skirts also enables increased resistance to fracture by allowing the envelopment of the remaining compromised tooth structure with the restorative material.
Sturdevant operative dentistry  7th  E D I T I O N, Page No:131

So the answer to this question is D


Instruction:
All of the following agents may be used for post coital contraception except:
A. Danazol
B. CuT
C. RU - 486
D. High dose estrogen

Response:
None

So the answer to this question is A


Instruction:
Van Gogh Syndrome is seen in
A. Mania
B. Depression
C. Schizophrenia
D. OCD

Response:
C i.e. Schizophrenia

So the answer to this question is C


Instruction:
Virilisation of the female is present in all, EXCEPT
A. 17-α  hydroxylase deficiency
B. 21-α  hydroxylase deficiency
C. 11-α  hydroxylase deficiency
D. 11-α  hydroxysteroid deficiency

Response:
Congenital adrenal hyperplasia -
Is commonly caused by following 3 enzyme deficiencies

21 α hydroxylase deficiency (complete)
21 α hydroxylase deficiency (partial)
11 α Hydroxylase deficiency
17 α hydroxylase deficiency

17 α hydroxylase deficiency

Hypertension
No virilization in females (because the gene that codes for 17 α also codes for the enzyme in adrenal cortex).
Primary amenorrhoea and failure of development of secondary sexual characteristic in females.
Male pseudohermaphrodites

21 α hydroxylase deficiency Complete (Salt losing virilizing syndrome)

Hypotension
Virilization (& Precocious puberty in males)

21α hydroxylase deficiency Partial (Simple virilizing)

Normal B.P.
Virilization (& Precocious puberty in males)

11 β hydroxylase deficiency

Hypertension
Virilization (& Precicous puberty in males)

So the answer to this question is A


Instruction:
CA-125 is a marker antigen for the diagnosis of
A. Colon cancer
B. Breast cancer
C. Brain cancer
D. Ovarian cancer

Response:
(D) Ovarian Carcinoma MARKERSMucins & other GlycoproteinsAssociated Cancers* CA-125Ovarian cancer* CA-19-9Colon cancer, pancreatic cancer* CA-15-3Breast cancer

So the answer to this question is D


Instruction:
Neoadjuvant chemotherapy is used in all except :
A. Esophageal carcinoma
B. Breast carcinoma
C. Thyroid carcinoma
D. Non–small cell carcinoma of lung

Response:
None

So the answer to this question is C


Instruction:
Toxic epidermal necrolysis is also called as
A. Lyell's syndrome
B. Duhring's disease
C. Sweet's syndrome
D. Hailey and Hailey's disease

Response:
Other name for toxic epidermal necrolysis is Lyell s. Syndrome Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, potentially life-threatening, severe mucocutaneous adverse reactions characterized by extensive epidermal detachment, erosion of mucosae and severe constitutional symptoms Ref Harrison20th edition pg 1278

So the answer to this question is A


Instruction:
A CKD patient on haemodialysis complains of chest pain and back pain after five minutes of dialysis initiation. On reassurance by nurse he feels gradually better and the symptoms resolve on their own. What is the cause?
A. Anxiety due to the procedure
B. Type B anaphylactoid reaction to dialyser
C. Anaphylaxis to ethylene dioxide used for sterilization of dialysis machine
D. Febrile non-haemolytic transfusion reaction

Response:
OPTION B- Type B anaphylactoid reaction to dialysis- release of cytokine due to chemical composition of dialysis OPTION C. Anaphylaxis to ethylene dioxide can be very lethal and cannot resolve by its own. OPTION D. Febrile non-hemolytic transfusion reaction is related to blood transfusion not dialysis.

So the answer to this question is B


Instruction:
Prolonged calcium hydroxide therapy for root resorption causes risk of:
A. Cervical root fracture.
B. Apical third fracture.
C. Middle third fracture.
D. None of the above.

Response:
Cervical root resorption is the best answer among the option but if in options vertical root fracture is given then go for vertical root fracture.

So the answer to this question is A


Instruction:
Which of the following amino acid can produce oxaloacetate directly in a single reaction?
A. Alanine
B. Cysteine
C. Threonine
D. Aspaate

Response:
Alanine, Cysteine and Threonine can also produce oxaloacetate but pyruvate only. Aspaate can directly produce oxaloacetate in a single step, i.e. transamination reaction.

So the answer to this question is D


Instruction:
K-complex is seen in -
A. REM
B. Stage 1 NREM
C. Stage 2 NREM
D. Stage 3 NREM

Response:
Ans is 'c' i.e., Stage 2 NREM Repeat from all India Dec 2015 of this book

So the answer to this question is C


Instruction:
Hundred day glaucoma is associated with:
A. Neovascular glaucoma
B. CRAO
C. CRVO
D. Steroid-related glaucoma

Response:
Ans. C: CRVO Occurrence of neovascular glaucoma in many patients with CRVO is observed in a span of three months, or 100 days, from the onset of occlusion. Diabetes is a primary risk factor for CRVO, along with elevated blood cholesterol, and high blood pressure. CRVO is an acute event

So the answer to this question is C


Instruction:
ICDS meals for pregnant women provides ?
A. 300 calories & 10 grams protein
B. 500 calories & 15 grams protein
C. 600 calories & 10 grams protein
D. 600 calories & 20 grams protein

Response:
Ans. is d i.e., 600 calories & 20 grams protein Under ICDS Scheme supplementary nutrition is given to: Children below 6 yrs Nursing mothers Expectant mothers The aim is to supplement nutritional intake for Each child 6-72 months of age 500 calories and 12-15 grams of protein (financial norm of Rs 6.00 per child per day). Severely malnourished child 6-72 months of age - 800 calories and 20-25 grams protein (financial norm of Rs 6.00 per child per day). Each pregnant and nursing woman - 600 calories and 18-20 grams of protein (financial norm of Rs 5.00 per beneficiary per day). Under the revised nutritional and feeding norms for supplementary nutrition, State goverments/UTs have been mandated to provide more than one meal to the children who come to AWCs, which include providing a morning snack in the form of milk/banana/egg/seasonal fruit/micronutrient foified food followed by a hot cooked meal. For children below 3 years of age and pregnant & lactating mothers, "take home ration" is to be provided. Supplementary nutrition is given for 300 days a year.

So the answer to this question is D


Instruction:
Child survival index is the percentage of children surviving till the age of -
A. 1 year
B. 3 years
C. 5 years
D. 15 years

Response:
park's textbook of preventive and social medicine 23rd edition. *child survival index:the basic measurement of infant and child survival is the under 5 moality.A child survival rate per 1000 bih can be simply calculated by subtracting the under 5 moality rate from 1000 dividing this figures by 10 shows the percentage of those who survive to the age of 5 year.

So the answer to this question is C


Instruction:
True about cardiac muscles are all except:
A. Propey of spontaneous and rhythmic contraction
B. Cardiac muscle exhibits cross striations
C. Cardiac muscle cells are linear and longitudinal
D. Cardiac muscle is supplied by autonomic nerve fibers

Response:
Cardiac muscle consists of striated muscle fibers that branch and unite with each other. It forms the myocardium of the hea.Its fibers tend to be arranged in whorls and spirals, and they have the propey of spontaneous and rhythmic contraction. Specialized cardiac muscle fibers form the conducting system of the hea.Cardiac muscle is supplied by autonomic nerve fibers that terminate in the nodes of the conducting system and in the myocardium.

So the answer to this question is C


Instruction:
Most common cranial nerve involved in CSOM is ?
A. V
B. VII
C. IX
D. XI

Response:
Ans. is 'b' i.e., VII

So the answer to this question is B


Instruction:
IT Based TB monitoring
A. e DOTS
B. Nischay
C. Nikshay
D. Ujjwala

Response:
None

So the answer to this question is C


Instruction:
All of the following are TRUE regarding myoglobinuria, EXCEPT:
A. Myoglobin is present in striated skeletal and cardiac fibers
B. 200 g of muscle must be destroyed to color the urine visibly
C. Benzidine tests performed on urine is positive
D. The serum is deep red in color

Response:
The red pigment myoglobin, responsible for much of the color of muscle, is an iron-protein compound present in the sarcoplasm of striated skeletal and cardiac fibers. Destruction of striated muscle, regardless of the cause liberates myoglobin, and because of its relatively small size, the molecule filters through the glomeruli and appears in the urine, impaing to it a burgundy-red color. Because of the low renal threshold for myoglobin, excretion of the pigment is so rapid that the serum remains uncolored. It is estimated that 200 g of muscle must be destroyed to color the urine visibly. As with hemoglobinuria, the guaiac and benzidine tests performed on urine are positive if myoglobin is present. Myoglobinuria should thus be suspected when the urine is deep red and the serum is normal in color. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 45. Electrophysiologic and Laboratory Aids in the Diagnosis of Neuromuscular Disease. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.

So the answer to this question is D


Instruction:
Pregnancy which continues following threatened abortion is likely to have increased incidence of;
A. Preterm labor
B. Fetal malformation
C. IUGR
D. All of the above

Response:
Ans. is d, i.e. All of the aboveRef. Dutta Obs 7/e p161Prognosis of threatened abortionIn about two-third, the pregnancy continues beyond 28 weeks. In the rest, it terminates either as inevitable or missed miscarriage. If the pregnancy continues, there is increased frequency of preterm labor, placenta previa, intrauterine growth restriction of the fetus and fetal anomalies.

So the answer to this question is D


Instruction:
An individual with megaloblastic anemia is found to have a significant folate deficiency. Erythropoiesis is hampered in this man due to his inability to perform which type of enzymatic reaction?
A. Acyl transfer
B. Carboxylation
C. Decarboxylation
D. Methylation

Response:
Folic acid is a pteridine vitamin that exists as tetrahydrofolate (TH4) in its most reduced form. TH4 can accept methyl, methylene, or formyl carbons and transfer them as methyl groups. This function is vital in nucleotide and amino acid synthesis. Pantothenic acid is a key vitamin in acyl transfer reactions. It forms pa of coenzyme A, which transfers acyl groups in thiol esters as acetyl CoA, succinyl CoA, and other acyl CoA forms. Impoant vitamins in carboxylation reactions include biotin and vitamin K. Biotin carries the carboxyl group in the pyruvate carboxylase and acetyl CoA carboxylase reactions, and vitamin K is utilized in post-translational carboxylation of amino acid residues in blood clotting factors. Oxidative decarboxylation reactions require thiamine (vitamin B1). Examples include the pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase complexes. Ref: Janson L.W., Tischler M.E. (2012). Chapter 5. Enzymes and Amino Acid/Protein Metabolism. In L.W. Janson, M.E. Tischler (Eds), The Big Picture: Medical Biochemistry.

So the answer to this question is D