Instruction:
Olfactory region in nose is
A. Below inferior trubinate
B. Above superior turbinate
C. Between middle & inferior trubiate
D. None

Response:
Olfactory region in nose is above superior turbinate.The skin covering the nose is thin and loosely attached to the underlying structures, hence freely mobile.Over the apex and alae it is thicker and more adherent and contains large sebaceous glands, their orifices are usually very distinct. The hyperophy of these sebaceous glands gives rise to a lobulated tumor the rhinophyma.

So the answer to this question is B


Instruction:
Not true regarding NK cells is?
A. Active against malignant cells
B. Involve MHC antigen for killing micro-organisms
C. First line defense against viral infections
D. No prior sensitization required

Response:
Ans. (b) Involve MHC antigen for killing microorganisms (Ref: Robbins 9th/pg 192; 8th/pg 188)Natural Killer Cells Destroy virus-infected cells and tumor cells without prior exposure;NK cells do not require MHC for killing micro-organismsSurface molecules of NK cells are CD16 & CD56

So the answer to this question is B


Instruction:
The structure related to arch of aoa is:
A. Left bronchus
B. Tracheal bifurcation
C. Ligament of teres
D. Right Vagus

Response:
Tracheal bifurcation

So the answer to this question is B


Instruction:
Chronic thick walled pyogenic abscess may be due to the following except
A. Presence of a foreign body
B. Prolonged antibiotic therapy
C. Virulent strains of organism
D. Inadequate drainage

Response:
None

So the answer to this question is C


Instruction:
Upper segment: lower segment ratio in 3 year old child -
A. 1[?]1:1
B. 1[?]5:1
C. 1[?]3:1
D. 1[?]7:1

Response:
Ans. is 'c' i.e., 1.3:1IAPText book of Paediatricp. 29At birth=1.7:13 to 4 years= 1.3:18 - 9 years=1:118 years= 0.9:8 Upper segment = Vertex to pubic symphysis.Lower segment = Pubic symphysis to sole & feet.Wt estimationAt birth = 3.2keHt. = EstimationBirth = 50 cm.1 year = 75 cm.= 2-12 years = (Age x 6) + 77 (cm)

So the answer to this question is C


Instruction:
Which of the following is TRUE/FALSE about weight loss? a) Psychiatric disorders are a major cause of involuntary weight loss. b) Up to 20% of all cancer deaths are caused directly by cachexia. c) Connective tissue diseases decreases metabolic demand. d) Hypehyroidism in the elderly have more prominent sympathomimetic features. e) Involuntary weight loss may be one of the earliest manifestations of Alzheimer's dementia.
A. a,b,c,d,e-True None-False
B. a,b,c-True & d,e-False
C. a,b,c,d-True & e-False
D. a,b,e-True & c,d,-False

Response:
Connective tissue diseases may increase metabolic demand and disrupt nutritional balance. Hypehyroidism in the elderly may have less prominent sympathomimetic features and may present as "apathetic hypehyroidism" or T3 toxicosis Ref:Harrisons Principles of Internal Medicine, 18th Edition, Pages 642- 44

So the answer to this question is D


Instruction:
The screening method of choice in area where the prevalence of leprosy is 1/1000 is -
A. Contact survey
B. Group survey
C. Mass survey
D. Any of the above

Response:
Contact survey is done in areas where prevalence of leprosy is generally low ie less than 1 case per 1000 population. Group survey when prevalence is 1 in 1000 Mass survey is done in hyperendemic area where prevalence is about 10 or more per 1000 population Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 339

So the answer to this question is B


Instruction:
Not true regarding influenza virus is-
A. All types exhibit antigenic shift
B. Only type A shows antigenic drift
C. Drift is accumulation of point mutations
D. None of the above

Response:
The influenza A virus is unique among the viruses because it is frequently subject to antigenic variation, both major and minor. When there is a sudden complete or major change, it is called a shift, and when the antigenic change is gradual over a period of time, it is called a drift . Antigenic shift results from genetic recombination. Antigenic drift involves point mutation. Ref:PARK&;S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 23rd edition , Page :154

So the answer to this question is A


Instruction:
All of the following are true about Classical dengue fever except -
A. Case fatality is low
B. Break bone fever
C. Positive tourniquet test
D. It is a self limiting disease

Response:
Positive tourniquet test is seen in Dengue haemorrhagic fever not in classical dengue fever.It is the most common haemorrhagic phenomenon. Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 264

So the answer to this question is C


Instruction:
Drugs used to remove the gingival enlargement:
A. Eschortic drugs
B. Dichortic drugs
C. Caustic drugs
D. No such drugs are available

Response:
None

So the answer to this question is A


Instruction:
Drug causing pulmonary eosinophilia are all the following EXCEPT-
A. Nitrofurantoin
B. Penicillin
C. Methotrexate
D. Amiodarone

Response:
Ans-B

So the answer to this question is B


Instruction:
Keratin contains
A. Arginine
B. Histidine
C. Lysine
D. All

Response:
Keratins: These are characteristic constituents of chidermal tissue such as horn, hair, nails, wool, hoofs, and feathers. All hard keratins on hydrolysis yield as pa of their amino acids, histidine, lysine, and arginine in the ratio of 1:4:12. The soft or pseudokeratins such as those occurring in the outermost layers of the skin do not have these amino acids in the same ratio. In neurokeratin, the ratio is 1:2:2. Human hair has a higher content of cysteine than that of other species it is called a aa aa-keratin. b bb bb-keratins are deficient in cysteine and, rich in glycine and alanine. They are present in spider&;s web, silk, and reptilian scalesRef: Textbook of medical biochemistry, MN Chatterji, 8th edition, page no: 84

So the answer to this question is D


Instruction:
In a patient only anti HBs Ag is positive in serum, all other markers are negative. This indicates ?
A. Acute hepatitis
B. Chronic active hepatitis
C. Persistent carrier
D. Hepatitis B vaccination

Response:
Ans. is 'd' i.e., Hepatitis B vaccination

So the answer to this question is D


Instruction:
EAC rosette formation is the property of one of the following type of immune cells -
A. T cells
B. B cells
C. Macrophages
D. All of the above

Response:
Erythrocyte antibody complement rosetting (EAC-rosetting), occurs when the antibody in the presence of complement is bound to the surface of a red blood cell. The complement binds to the tail region (Fc region) of the antibody. Finally, T-cells with a complement receptor are added and the T-cells bind to the complement on the antibody completing the rosette

So the answer to this question is A


Instruction:
N-acetyl cysteine replenishes intracellular levels of
A. Sodium
B. Potassium
C. Glutathione
D. None of the above

Response:
None

So the answer to this question is C


Instruction:
Physical quality of life index (PQLI) includes all, EXCEPT:
A. Literacy
B. MMR
C. IMR
D. Life expectancy at 1 year

Response:
Physical quality of life index (PQLI) includes Infant moality rate, Life expectancy at 1 year and literacy. Ref: Park, 20th Edition, Page 16.

So the answer to this question is B


Instruction:
A neonate delivered at 38 weeks of gestation with a birth weight of 2.2 kg develops intolerance to feed/abdominal distension on the second day. Physical examination is unremarkable. Sepsis screen is negative. PCV is observed to be 72%. Which of the following represents the best management option –
A. Hydration with IV Fluids
B. Partial Exchange Transfusion
C. Presumptive treatment for sepsis
D. Medical Management for intestinal obstruction

Response:
PCV 72% in a neonate suggests the diagnosis of neonatal polycythemia.
Polycythemia is defined as central venous hematocrit  level of greater than 65%.
The neonate in question is also having an intolerance to feed and abdominal distension.
So, this neonate is having symptomatic neonatal polycythemia.

Treatment of neonatal polycythemia

Therapy in newborns with polycythemia is based on both the measured central venous hematocrit level and the presence or absence of symptoms.

(1) Symptomatic polycythemia

Partial exchange transfusion is the treatment of choice.

(2) Asymptomatic polycythemia

In asymptomatic polycythemia, treatment depends upon hematocrit level (PCV).

(i) PCV 65-75%

Perform cardiorespiratory monitoring and monitoring of hematocrit and glucose levels every 6-12 hours and observe the patients for symptoms
If hematocrit (PCV) becomes more than 75%, consider partial exchange transfusion (PET).

ii) PCV> 75%

Partial exchange transfusion (PET) is the treatment of choice.

So the answer to this question is B


Instruction:
In CEAP clinical classification what does C-4b indicate
A. Edema
B. Pigmentation or eczema
C. Healed venous ulcer
D. Lipodermatosclerosis or atrophie blanche

Response:
The CEAP (Clinical - Etiology - Anatomy - Pathophysiology)classifi cation for chronic venous disorders is widely utilised.Clinical classification* C0: no signs of venous disease* C1: telangectasia or reticular veins* C2: varicose veins* C3: oedema* C4a: pigmentation or eczema* C4b: lipodermatosclerosis or atrophie blanche* C5: healed venous ulcer* C6: active venous ulcer

So the answer to this question is D


Instruction:
Composed mainly of triacylglycerols synthesized in intestinal epithelial cells is
A. Chylomicrons
B. VLDL
C. LDL
D. HDL

Response:
VLDL is synthesized in the liver, particularly after a high carbohydrate meal. It is formed from triacylglycerols that are packaged with cholesterol, apolipoproteins (particularly, apoB-100), and phospholipids, and it is released into the blood, where it acquires apoC-II and apo E.Chylomicrons contain triacylglycerols synthesized from dietary lipid in intestinal epithelial cells. LDL is the cholesterol-rich particle in the blood. Cells take up LDL by LDL binding to the LDL receptor, and the LDL-LDL receptor complex enters the cell via endocytosis. Once inside the cell, the cholesterol is released from cholesterol esters by a lysosomal enzyme and enters the cytoplasm of the cell for further processing. VLDL contains newly synthesized triglyceride and cholesterol produced by the liver. HDL is involved in reverse cholesterol transport, which requires the LCAT reaction. Fatty acids, because they are so hydrophobic, cannot travel freely in the blood and need to be bound to albumin for transport through the circulatory system.

So the answer to this question is A


Instruction:
Dose of Rabies immunoglobulin is
A. 10 IU/Kg body weight
B. 15 IU/kg body weight
C. 20 IU/kg body weight
D. 25 IU/kg body weight

Response:
The anti-rabies serum is given in class III bites (Single or multiple transdermal bites or scratches, licks on broken skin, Contamination of mucous membranes with sal, exposure to bats)It is found to prolong the incubation period.Passive immunization in rabies may be given by :Horse Anti-rabies serum: 40 IU/kg body wt (up to max 3000 units), infiltrated in the wound, & the rest gave IMHuman Rabies Immunoglobulin: (preferred) 20 IU/kg body wt infiltrated in the wound, & the rest given i.m.

So the answer to this question is C


Instruction:
Drug of choice for diarrhea in HIV is?(DNB 2012-section-1)
A. Loperamide
B. Somatostatins
C. Octreotide
D. Codeine

Response:
Ans. (c) OctreotideRef.:Goodman atidgillmati 11/e, p 635

So the answer to this question is C


Instruction:
On otological examination, all of the following will have positive fistula test, EXCEPT:
A. Dead ear
B. Labyrinthine fistula
C. Hypermobile stapes footplate
D. Following fenestration surgery

Response:
In a positive fistula test, a pressure change in the external ear canal is transmitted to the labyrinth by an abnormal opening thereby producing nystagmus and veigo. It also implies that the labyrinth is still functioning, and is absent when labyrinth is dead. The abnormal opening caused by a cholesteatoma eroding into the horizontal semicircular canal, following fenestrating operations and rupture of round window membrane are associated with positive fistula test. Hypermobile stapes footplate is associated with false positive fistula test.

So the answer to this question is A


Instruction:
Best index for chronic malnutrition is: September 2010
A. Height for age
B. Weight for age
C. Weight for height
D. All of the above

Response:
Ans. A: Height for age

So the answer to this question is A


Instruction:
Cavo surface angle for amalgam restoration is butt joint as:
A. It increass compressive and tensile strengths
B. Decreased compressive, increased strength
C. Decreased compressive, decrease tensile strength
D. Increased compressive, increased tensile strength

Response:
None

So the answer to this question is A


Instruction:
Atomic number of tungsten
A. 42
B. 181
C. 74
D. 82

Response:
Answer: c) 74

So the answer to this question is C


Instruction:
Most common tumour due to radiation arises from
A. Lung
B. Liver
C. Bone marrow
D. Breast

Response:
Ans. is 'c' i.e., Bone marrow o Hematological malignancies e.g., leukemias are the most common radiation induced cancers.

So the answer to this question is C


Instruction:
Most common site of lymphangioima is-
A. kidney
B. head and Neck
C. Groin
D. Hea

Response:
Lymphangiomas are the benign lymphatic counterpa of hemangiomas. Simple (capillary) lymphangiomas are slightly elevated or sometimes pedunculated lesions up to 1 to 2 cm in diameter that occur predominantly in the head, neck, and axillary subcutaneous tissues. Cavernous lymphangiomas (cystic hygromas) typically are found in the neck or axilla of children, and more rarely in the retroperitoneum. (Robbins basic pathology,9th edition,pg no.359)

So the answer to this question is B


Instruction:
The nerve supply of nail bed of index finger is ?
A. Superficial br of radial nerve
B. Deep br of radial nerve
C. Median nerve
D. Ulnar nerve

Response:
Ans. is 'c' i.e., Median nerve

So the answer to this question is C


Instruction:
The hea lesion not found in Congenital Rubella infection is -
A. ASD
B. VSD
C. PDA
D. PS

Response:
Ans. is 'a' i.e., ASD o Cardiac anomalies in Congenital rubella (In decreasing order of frequency) --> FDA (most common), PS, VSD, ASD o ASD is the best answer amongst the given options because amongst the given options, ASD is least commonly associated with congential rubella.

So the answer to this question is A


Instruction:
True treatment regarding hepatic amoebiasis
A. More common in females
B. Multiple lesions
C. Mostly treated conservatively
D. Jaundice is common

Response:
.

So the answer to this question is C


Instruction:
Anterioposterior stability of the eyeball is provided by all except
A. Orbital fat
B. S. O
C. S. R
D. Suapensory ligament of eye

Response:
Suapensory ligament extends from posterior lacrimal crests to lateral tubercle. The Anterioposterior stability to the eyeball is provided by the tenons capsule of facia bulbi

So the answer to this question is A


Instruction:
Type of injury in which there is brief temporary physiological paralysis of function without organic structural damage is:
A. Concussion.
B. Contusion.
C. Laceration.
D. None.

Response:
None

So the answer to this question is A


Instruction:
Following latrines are suitable for camps and temporary use except
A. Shallow trench latrine
B. Septic tank
C. Borehole latrine
D. Pit latrine

Response:
None

So the answer to this question is B


Instruction:
Austenite is an alloy of iron and carbon with the iron in:
A. Alpha form
B. Beta form
C. Gamma form
D. None of the above

Response:
At room temperature, pure iron has a body-centered-cubic (bcc) structure. This phase is stable up to 912 °C, where it transforms to a face-centered-cubic (fcc) structure. The solubility of carbon in bcc is very low and reaches a maximum of  0.02% at 723°C. This material is known as ferrite.
Above 723 °C, a solid solution of carbon in an fcc iron matrix called austenite is formed. The maximal solubility of carbon in fcc matrix is 2.1%.
When plain carbon steel containing 0.8% carbon is cooled slowly in the austenitic phase to 723 °C, it undergoes a solid-state eutectoid transformation to yield a microstructural constituent called pearlite, which consists of alternating fine-scale lamellae of ferrite and iron carbide (Fe3C), referred to as cementite, or simply, carbide.
The Fe3C phase is much harder and more rigid than austenite or ferrite.

Key Concept

It is an interstitial solid of a small of a carbon dissolved in γ iron.
The maximum solubility is 2.1%C at 1147o C.
The crystal structure of Austenite (γ) is F.C.C.
Hardness – 40 HRC and toughness is high.

Ref:Phillips Ed-12th P: 406

So the answer to this question is C


Instruction:
Parathyroid adenoma best diagnosed by
A. USG
B. CT scan
C. I-131 scan
D. Tc99m-Th201 scan

Response:
Ans d Tc99m-Th201 scan. (Ref. Grainger, Diagnostic Radiology 4th ed., 1380)PARATHYROID SCINTIGRAPHY# Tc-99m -thallium substraction scan has 70-92% sensitivity & 43% specificity# Tc-99m sestamibi has 88-100% sensitivity & 91-98% specificity best scan.# Radionuclide scintigraphy with 201 (Technetium-thallium) or "m Tc- MIBI (Technetium-99m sestamibi), using a subtraction technique whereby the image of thyroid gland as shown by "m Tc or 123 I is removed, is thus a noninvasive & other best technique for tumor & other lesions localization of parathyroid gland.Educational points:# Presently, Tc-99m sestambi is the best available agent for parathyroid scanning.# Parathyroid adenoma is the most common cause of primary hyperparathyroidism.# Subperiosteal resorption of bones including erosion of lamina dura, "Pepper-pot" skull, phalangeal erosions, platyspondyly, osteitis fibrosa cystica, Brown's tumors are few typical X-ray findings of hyperparathyroidism.# "Superscan" appearance on Tc99m-MDP bone scan is a prominent feature of hyperparathyroidism.# A notable point - in primary hyperparathyroidism osteoporosis is common feature while in secondray hyperparathy- roidism osteosclerosis ("Rugger-Jersey spine") is a important feature.

So the answer to this question is D


Instruction:
In a case of direct occipitoposterior position (face to pubis delivery) most commonly encountered problem is:
A. Intracranial Injury
B. Cephalhematoma
C. Paraurethral tears
D. Complete perineal tears

Response:
In minority :provide the fetal and maternal conditions permit one should teke a watchful expectancy for the anterior rotation of the occiput and descent of head.In occipito sacral position spontaneous delivery as face to pubis may occur.In such cases proper conduction of delivery and liberal episiotomy should be done to prevent complete perineal tear. D.C.DUTTA&;S TEXTBOOK OF OBSTETRICS,Pg no:371,7th edition

So the answer to this question is D


Instruction:
All of the following can cause SLE-like syndrome except:
A. Isoniazid
B. Penicillin
C. Hydralazine
D. Sulphonamide

Response:
Ans. (B) Penicillin(Ref: Harrison 18/e p2735)Important drugs causing SLE like syndrome include:S - SulfonamidesH - HydralazineI - IsoniazidP - Procainamide

So the answer to this question is B


Instruction:
Rule of 9 burns is used to denote -
A. Depth of burns
B. % of total body surface area
C. Severity of burns
D. Type of burns

Response:
RULE OF NINE: The estimation of the surface area of the body involved is usually worked out by the rule of nine. It is applied for adults. REF: The Synopsis of the Forensic Medicine and Toxicology 29th edition page no: 160.

So the answer to this question is B


Instruction:
All of the following vessels supply the duodenum, EXCEPT?
A. Right gastric aery
B. Supraduodenal aery
C. Right gastroepiploic aery
D. None of the above

Response:
The main vessels supplying the duodenum are the superior and inferior pancreaticoduodenal aeries. The first and second pas also receive contributions from several sources including the right gastric aery, the supraduodenal aery, the right gastroepiploic aery, the hepatic aery and the gastroduodenal aery. Branches of the superior pancreaticoduodenal aery may contribute to the supply of the pyloric canal, with some anastomosis in the muscular layer across the pyloroduodenal junction.

So the answer to this question is D


Instruction:
Steady state concentration of a drug is achieved in: September 2007
A. 2-3 half lives
B. 3-4 half lives
C. 4-5 half lives
D. 5-6 half lives

Response:
Ans. C: 4-5 Half Lives When a drug is infused IV, the plasma concentration continues to rise until elimination equals the rate of delivery into the body. Regardless of the drug, 50% of the plateau concentration is attained in 1 half-life of the drug; for 2, 3, and 4 half-lives, 75%, 87.5%, and 93.75% of the plateau concentration are reached, respectively. For practical purposes, steady state is achieved by 4-5 half-lives.

So the answer to this question is C


Instruction:
Which one of the following is NOT a feature of autosomal recessive disorder?
A. Wide variation in phenotype within a family
B. Males and females are equally affected
C. Parents of an affected child are heterozygous carriers
D. Display horizontal pattern in pedigrees

Response:
To have an autosomal recessive disorder, you inherit two mutated genes, one from each parent. These disorders are usually passed on by two carriers. Their health is rarely affected, but they have one mutated gene (recessive gene) and one normal gene (dominant gene) for the condition. Two carriers have a 25 percent chance of having an unaffected child with two normal genes (), a 50 percent chance of having an unaffected child who also is a carrier (middle), and a 25 percent chance of having an affected child with two recessive genes

So the answer to this question is A


Instruction:
A 20-year-old 70kg man is put on fast perioperatively. 100gm of glucose is given per day as 5% dextrose solution. This is to
A. Meet daily calorie requirement
B. Meet daily fluid requirement
C. Sustain cerebral energy metabolism
D. Sustain anabolic status

Response:
During starvation, the body is faced with an obligate need to generate glucose to sustain cerebral energy metabolism (100 g of glucose per day). This is achieved in the first 24 hours by mobilising glycogen stores and thereafter by hepatic gluconeogenesis from amino acids, glycerol and lactate. This eventually leads to accelerated loss of lean tissue (the main source of amino acids for hepatic gluconeogenesis) IV Glucose provided for surgical patients who are fasted has a significant protein- sparing effect.Ref: Bailey and love 27e pg: 10

So the answer to this question is C


Instruction:
In 29 days menstrual cycle ovulation takes place at?
A. 14th day
B. 15th day
C. 16th day
D. 17th day

Response:
ANSWER: (B) 15th dayREF: Ganong's 22nd ed p.434In a menstrual cycle the post ovulatory days remains constant, hence to calculate the day of ovulation substract 14 from the total days of cycle; i.e. in a 29 days cycle ovulation takes place on 15th day (29-14),

So the answer to this question is B


Instruction:
In severe exercise, decrease in pH is due to:
A. Respiratory acidosis
B. Lactic acidosis
C. H+ retention
D. HCO3 excretion

Response:
Ans. (b) Lactic acidosis(Ref: Guyton, 13th ed/p.1085)Accumulation of lactic acid causes decrease in pH, muscle cramps and muscle fatigue,

So the answer to this question is B


Instruction:
Laparoscopic cholecystectomy was done, on histopathology, stage was T2. Next line of treatment
A. Observation
B. Extended cholecystectomy
C. Po size excision
D. Chemotherapy

Response:
Treatment of carcinoma Gallbladder Gallbladder cancer: Incidental pathological finding after laparoscopic cholecystectomy T1a with negative cystic duct margin : No fuher therapy T1a with postive cystic duct margin : Reresection of cystic duct or CBD to negative margin T1b, T2, T3 tumor with no evidence of metastasis : Reresection, extended cholecystectomy (possible CBD or extended hepatic resection) T4: Extended cholecystectomy with extended right hepatectomy N2 or M1 disease : Clinical trial (Chemoradiation or chemotherapy) in good performance status. Laparoscopic trocar site scars are excised for staging purpose to identify M1 disease than for any potential therapeutic benefit Ref: Sabiston 20th edition Pgno : 1512-1514

So the answer to this question is B


Instruction:
Semi-Smoke less black powder is a mixture of
A. 50% black powder + 50% smokeless powder
B. 60% black powder + 40% smokeless powder
C. 70% black powder + 30% smokeless powder
D. 80% black powder + 20% smokeless powder

Response:
Semi-smokeless powder: It consists of a mixture of 80% black and 20% smokeless type Gunpowders: Black powder: It produces flame, smoke, and heat, and consists of granular ingredients, like sulfur, charcoal, and saltpeter (potassium nitrate) Smokeless powder: It is more effective than black powder as it burns more efficiently and produces much less smoke, resulting in less blackening and tattooing around the entry wound. Ref - Krishnan Vij 5th edition pg 238-240

So the answer to this question is D


Instruction:
A male was brought unconscious to the hospital with external injuries. CT brain showed no midline shift, but basal cisterns were compressed with multiple small hemorrhages. What is the diagnosis –
A. Cortical contusion
B. Cerebral laceration
C. Multiple infarcts
D. Diffuse axonal injuries

Response:
Diffuse axonal injury (DAI) and Cerebral contusions are the most common primary brain injuries in non-penetrating trauma to head, comprising almost 95% of primary injuries.
Diffuse axonal injury

(the most common primary brain injury), there is a shearing injury of axons most commonly at the cortico-medullary junction, due to sudden acceleration/deacceleration or rotational forces on the brain.
These shearing injuries tend to be diffuse & bilateral.
DAI is seen in cases of severe head injury and the patient loses consciousness at the moment of impact.

Cortical contusions

Are foci of hemorrhages, that occur because of brain hitting against the bony ridges of the skull and less often the dual fold.
Compared to DAI, cortical contusion are less frequently associated with the initial loss of consciousness unless they are extensive.

The above-given patient. presents a picture of.DAI. He is unconscious. His CT shows multiple small hemorrhages. There is no midline shift as the injuries are diffuse & bilateral. Basal cisterns are compressed due to diffuse cerebral edema

So the answer to this question is D


Instruction:
Best treatment for menigioma with low recurrence rate is
A. Tumour excision with cyst of dura mater removal
B. Excision surgery followed by radiotherapy
C. Chemotherapy
D. Preop embolization + Excision surgery

Response:
Surgical treatment should be, wherever possible, total excision. If this includes the site of dural attachment, the recurrence rate is less than 10 per cent. Incomplete excision of the dural attachment will result in a recurrence rate of between 20 and 30 per cent. Subtotal excision will result in 40 pet cent showing progressive growth. The role of radiotherapy is controversial and is usually reserved foumours with aggressive histological features or recurrenttumours, or where a subtotal resection has been performed. Ref:Surgery of Bailey and Love,26th edition.

So the answer to this question is A


Instruction:
A 15-year old boy presents with weakness in both lower limbs that has progressed to involve the trunk over the last 6 days. Examination shows reduced power in muscles of the lower limbs, abdomen and chest; deep tendon reflexes are absent. CSF examination shows no cells, sugar-80 mg/dl and protein 80 mg/dl. The treatment of choice is:
A. I/V methylprednisolone
B. I/V immunoglobulin
C. I/V anti-thymocyte globulin
D. Oral cycIosporin and prednisolone

Response:
The boy is suffering from Guillain-Barre syndrome, which is a postinfectious polyneuropathy that causes demyelination in mainly motor but sometimes also sensory nerves. The main clues for diagnosis are areflexic paralysis with alburnino-cytologic dissociation in CSF. The paralysis usually follows a nonspecific viral infection by about 10 days. Weakness begins usually in the lower extremities and progressively involves the trunk, the upper limbs, and finally the bulbar muscles, a pattern formerly known as Landry ascending paralysis. Tendon reflexes are lost, usually early in the course. Rapidly progressive ascending paralysis is treated with intravenous immunoglobulin (IVIg), administered for 2, 3, or 5 days. Plasmapheresis, steroids, and/or immunosuppressive drugs are alternatives, if IVlg is ineffective. Suppoive care, such as respiratory suppo, prevention of decubitus ulcerin children with flaccid tetraplegia, and treatment of secondary bacterial infections, is impoant.

So the answer to this question is B


Instruction:
A newborn infant has multiple hemorrhagic, cutaneous lesions and does not respond to sound stimuli. Head CT scan shows periventricular calcifications. Which of the following infectious agents is the most likely cause of this child's presentation?
A. Cytomegalovirus
B. Herpes simplex
C. Rubella
D. Syphilis

Response:
The infectious agents listed are all impoant causes of congenital disease. The triad of cutaneous hemorrhages ("blueberry muffin baby"), deafness, and periventricular CNS calcifications suggests congenital CMV infection, the most common cause of intrauterine fetal viral infection. Other manifestations include microcephaly and hepatosplenomegaly. Neonatal herpes may be congenital, but more commonly is acquired during vaginal delivery. The infection is characterized by vesicles on the skin and mucous membranes, encephalitis, or disseminated disease. Congenital rubella can cause mental retardation, hea abnormalities, blindness, encephalitis, and motor abnormalities. Congenital syphilis can cause death in utero, or a variety of problems including abnormal teeth, bones, and central nervous system.

So the answer to this question is A


Instruction:
Most commonly injured ligaments of Ankle is
A. Anterior Talofibular
B. Middle Calcaneofibular
C. Deltoid
D. Posterior Talofibular

Response:
None

So the answer to this question is A


Instruction:
Drug used for HER-2/neu positive breast cancer
A. Imitanib
B. Trastuzumab
C. Erlotinib
D. Cetuximab

Response:
Answer- B. TrastuzumabHerceptin (Trastuzumab)Herceptin is a humanized antibody and is used in breast cancers which are HER2 positive.HER2 stands for - human epidermal growth factor receptor.HER2 gene produces HER2 protein also called HER2 receptor.In HER2 (+ve) breast cancer the cancer cell have abnormally high number of HER2 genes per cell when this happens too much HER2 protein appears on the surface of these cancer cells.Currently transtuzumab is approved for HER2/neu overexpressing metastatic breast cancer in combination with paclitaxel as initial treatment or as monotherapy following chemotherapy.

So the answer to this question is B


Instruction:
Which is true statement?
A. Depression with suicidal tendencies require ECT
B. Chronic depression will require ECT
C. Reactive depression responds to ECT better
D. ECT is the treatment of choice for atypical depression

Response:
Ref: Synopsis of Psychiatry. Kaplan & Sadock, 10th edition. Diagnostic and Statistical Manual, IVth edition.Expanation:Electro-convulsive treatment (ECT)It is one of the physical methods used to treat major depression.Other methods to treat major depression are Vagal Nerve Stimulation (VNS), Deep Brain Stimulation (DBS), repetitive Transcranial Magnetic Stimulation (rTMS)The onset of action, hence the resolution of symptoms is rapid when compared to other modalities like anti-depressants and psychotherapy.ECT is also used to treat catatonia (of any cause), intractable OCD and unmanageable mania.ECT is useful in severe depression with high suicidal riski neglect of food intake/psychotic symptoms.Resistant depression (where symptoms persist in spite of at least two adequate drug trials), not chronic depression (which might be untreated or associated with organic conditions/social stressors) is the indication for ECTEndogenous depression is the one which occurs without any reasonable external stress and have strong genetic component.Reactive depression, as the name i ndicates occurs after a stress and usually subsides once the stressor is removed. It responds well to psychotherapy not to ECT.Typical symptoms of depressionPersistent (all the time) andPervasive {across any situation) sad mood.Decreased appetite (with weight loss) andInsomnia.Atypical depression is characterized bySad but reactive mood (with positive stimuli one feels better)Increased appetite (weight gain),Hypersomnia andIncreased interpersonal rejection sensitivity (hypersensitive to remarks/criticisms).It is usual 1 y seen in adolescent females, often associated with thyroid dysfunction.SSRIs, MAOIs (Mono Amine Oxidase Inhibitors) work better hut not TCAs (Tri Cyclic Antidepressants).

So the answer to this question is A


Instruction:
Slow waves are generated by:
A. Myentric neurons
B. Smooth muscle
C. Interstitial cells of cajal
D. Parasympathetic neurons

Response:
ANS. C* Slow waves are the oscillating membrane potential between -60 and -40 mv in smooth muscle of GI smooth muscle.* They are also called basal electric rhythm (BER)* BER is maximum at duodenum (12/minute) and minimum at ileum (2/min)* Acetyl choline increases BER and adrenergic stimulation decreases BER* Another topic asked in last November AIIMS 2016 was regarding migratory motor complex.* Migratory motor complex in the gut are initiated by motilin.* The contractions migrate at a rate of 5 cm/min and also occur at intervals of approximately 90 min.* Migrating motor complex (MMC) appear during fasting and are inhibited by meal.* When a meal is taken, motilin is supressed and MMC is abolished.* Gastric secretion, bile flow and pancreatic secretion increase during each MMC.

So the answer to this question is C


Instruction:
Group of 4-8 expes talking in front of a large group of audience is known as: September 2011
A. Symposium
B. Workshop
C. Seminar
D. Panel discussion

Response:
Ans. D: Panel Discussion In a panel discussion, 4-8 persons who are qualified to talk about the topic sit and discuss a given problem, or the topic, in front of a large group of audience Panel Discussion A panel consists of a small group of four or eight persons, who carry on a guided and informal discussion before an audience as if the panel were meeting alone. The proceedings of the panel should be the same as those described for informal discussion: volunteering of facts, asking questions, stating opinions-all expressed with geniality, with respect for the contributions of other members, without speech making, and without making invidious personal references. This primary function should occupy approximately two-thirds of the allotted time-say foy minutes of an hour's meeting. The secondary function of the panel is to answer questions from the audience. This discussion method is suitable for use when a relatively large audience is anticipated. The disadvantage of the method is that it confines most of the discussion to the panel itself. The audience listens and is given a chance to ask questions, but for the most pa is passive and receptive. Panel discussions, if well conducted, are usually more interesting to the audience than is the single-speaker forum. They provide sufficiently varied clash of opinion and presentation of facts to give even the quiet members of the audience a feeling of vicarious paicipation. Quality and tasks of leadership in panel discussion are similar to those described for informal discussion. The leader must in addition take special care to select panel members who can think and speak effectively. He must also be sure that they prepare themselves to discuss the subject. During the discussion by the panel the leader has substantially the same duties as in informal discussion except that he should keep himself more in the background as chairman of the panel. He can do so because each member of the panel is in reality an assistant to the leader and is responsible for specific contributions to the proceedings. When the subject is thrown open to the house, it is the leader's job to recognize appropriate questions and to reject those not bearing on the subject or involving personalities. Some questions he may answer himself, but usually he should repeat the question and call upon one of the panel to answer it. By preliminary announcement the leader may also tell the audience that they may direct questions at paicular members of the panel if they choose. In any case, during the question period the leader needs to maintain strict control.On many occasions this may be the toughest pa of his assignment to carry off efficiently and with good humor. While it is customary to confine audience questions to a specific period, some leaders permit questions from the floor at any time. Unless very carefully limited by the leader, this practice may interfere with effective discussion by the panel. Arranging the panel properly will lend effectiveness to this form of discussion.The members should face the audience.It is impoant that each panel member adjust his chair so that he can see every other member without effo the chairman will also find that the best places for his readiest speakers are at the extreme ends of the table.He should keep the more reticent members close to, him so that he can readily draw them out with direct questions. If the quieter ones sit on the fringes of the panel, the more voluble members are quite likely to monopolize the discussion.

So the answer to this question is D


Instruction:
Intra uterine insemination is indicated in all except
A. Hypospadiasis
B. Sperm count 5-10 million/ml
C. Antisperm antibodies in cervix
D. Retrograde ejaculation

Response:
Intra uterine insemination is indicated in oligospermia with sperm count 10-15 million/ml.

So the answer to this question is B


Instruction:
Male with history of bilateral undescended testis
A. Is likely going to be sterile
B. Risk of testicular neoplasm is same as other males
C. Pathophysiology is merely mechanical problem in descent of testis
D. Intervention for psychological purpose is not a requirement

Response:
Male with bilateral undescended testis (especially intra-abdominal testes) are usually sterile. To optimise spermatogenesis the testis needs to be in the scrotum below body temperature at a young age. Incompletely descended testes are often macroscopically normal in early childhood but by pubey the testis is poorly developed, gradually atrophies. The epithelial elements are immature histologically and by late pubey irreversible destructive changes halt spermatogenesis and limit the production of androgens leading to sterility.Malignant transformation in undescended testis is 20 times more common than normally descended testis. Pathophysiology include gubernacular dysfunction, lack of gonadotrophin, lack of 'calcitonin gene related peptide'(CGRP) , familial , altered hypothalamo-pituitary-gonadal axis, deficiency of mullerian inhibiting substance, Prune-Belly syndrome. These patients also require psychological intervention. Reference : page77 and 1377 Bailey and Love's sho practice of surgery 25th edition and page1079 SRB's manual of surgery 5th edition

So the answer to this question is A


Instruction:
Which of the following is the cause of donovanosis?
A. H. ducreyi
B. K. granulomatis
C. Leishmania donovani
D. Treponema pallidum

Response:
Granuloma inguinale/donovanosis-caused by Klebsiella granulomatis (formerly known as Calymmatobacteriumgranulomatis). Small, painless nodules appear after about 10-40 days of the contact with the bacteria. Later, the nodules burst, creating open, fleshy, oozing lesions. The lesions occur at the region of contact typically found on the shaft of the penis, the labia, or the perineum Diagnosis:painless, "beefy-red ulcer" with a characteristic rolled edge of granulation tissue. Wright Giemsa stain:Donovan bodies- rod-shaped, oval organisms that can be seen in the cytoplasm of mononuclear phagocytes or histiocytes in tissue samples.

So the answer to this question is B


Instruction:
Which of the following is the only intrinsic muscle of larynx that lies outside the laryngeal framework
A. Cricopharyngeus
B. Superior constrictor
C. Cricothyroid
D. Lateral cricoarytenoid

Response:
Cricothyroid muscle is the only intrinsic muscle which is supplied by external laryngeal nerve and lies outside the laryngeal framework. Ref:- Dhingra; pg num:-284

So the answer to this question is C


Instruction:
A 28-year-old HIV positive patient presents to the clinic with a history of a mild burning sensation in his mouth that is aggravated while eating spicy foods. The oral examination showed creamy white patches on the oral mucosa. The wet mount microscopy of the scraping obtained from the patches is given below. What is the most probable causative organism?
A. Candida
B. Cryptococcus
C. Aspergillus
D. Histoplasma capsulatum

Response:
The given clinical picture of creamy white patches on the oral mucosa and the wet mount microscopy showing budding yeasts and pseudohyphae are suggestive of oral candidiasis caused by candida. The risk factors for oral candidiasis include AIDS, diabetes mellitus, and other immunocompromised states. Treatment: Topical azoles or nystatin Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition

So the answer to this question is A


Instruction:
A 20 yrs aged patient, presents in coma with pin point pupils and fasciculations but no fever. Most probable diagnosis is:
A. Head injury
B. Dhatura
C. Pontine haemorrhage
D. Organophosphorus poisoning

Response:
D i.e. Organophosphorus poisoning Pinpoint pupils (miosis) is seen in 'Bar Car OR Mor - Chlor' i.e. Barbiturates, Carbolic acid (Phenol), Organophosphorus, Morphine (Opioid), Choral hydrate.Q & Pontine haemorrhageQ So we are left with two options - Pontine haemorrhage & Organophosphorus. Not useful in Carbamate poisoning Useful in Organophosphorus poisoning - Physo / Pyrido / Riva/Neo - - ParathionQ & MalathionQ stigmineQ - Dyflos (DEP - D-iso fluro - Ambenonium & phosphateQ) EdrophoniumQ - Diazinon (TIK - 20) - Carabaryl (sevin) - EchothiophateQ - PropoxurQ (Baygon) - Tabun, Sarin, Soman - Demecarium - Donepezil

So the answer to this question is D


Instruction:
Which among the following is not a premalignant lesion of vulva?
A. Paget's disease
B. Lichen Sclerosis
C. Bacterial Vaginosis
D. Bowen's disease

Response:
Bacterial vaginosis is not a premalignant lesion of vulva. Premalignant lesions of Vulva Vulval intraepithelial neoplasia (VIN) Paget's disease Lichen Sclerosis Squamous cell hyperplasia Condyloma accuminata Bowen's disease (erythroplasia of querat) Note: VIN is the most common premalignant lesion of vulva.

So the answer to this question is C


Instruction:
AML with worst prognosis
A. 8/21 translocation
B. Inversion 16
C. Normal cytogenetics
D. Monosomy 7

Response:
AMLs with t (15;17)have best prognosis. AMLs with t (8;21)or inv (16) have relatively good prognosis with conventional chemotherapy. Poor prognosis for AMLs that follow MDS or genotoxic therapy or that occurs in adults. AMLs following MDS or exposure to DNA damaging agents have deletions or monosomies involving chromosomes 5 and 7.There fore monosomy 7 has the worst prognosis Ref:Robbins and Cotran Pathologic basis of disease.South Asia Edition -9;volume 1.page no.614

So the answer to this question is D


Instruction:
All enzymes are not proteins. This statement is justified by
A. All enzymes do not follow the Michaelis Menton hypothesis
B. RNAs act as ribozymes
C. Antibodies take part in the catalysis of many reactions
D. Metals are involved in attachment to enzymes and catalysts

Response:
Ribozymes are RNA molecules with catalytic activities, which acts upon phosphodiester bonds in RNA & cause its hydrolysis . RNAs are not protein but meet all the classic criteria of the enzyme, therefore, all enzymes are not protein.

So the answer to this question is B


Instruction:
Millard Gubler syndrome includes the following except
A. 5th nerve palsy
B. 6th nerve palsy
C. 7th nerve palsy
D. Contralateral hemiparesis

Response:
Millard-Gubler syndrome (MGS) is one of the classical brainstem-crossed syndromes caused due to a unilateral lesion in ventral pons, manifesting as ipsilateral palsy of CN VI and VII with contralateral hemiplegia Ref Harrison20th edition pg 2234

So the answer to this question is A


Instruction:
T-cell mature in:(1991)
A. Peyer's patches
B. Lymph node
C. Thymus
D. Bursa of fabricius

Response:
Ans: c (Thymus)Ref: Ananthanarayan Micro, 7th ed, p. 123 & 6th ed, p. 117, 115; Fig. 15.4

So the answer to this question is C


Instruction:
Strabismic amblyopia is more common in patients with:
A. Intermittent squint
B. Alternate squint
C. Constant squint
D. Latent squint

Response:
Paralytic Squint (Incomitant): * Due to complete or paial palsy of one of the nerves t at supp y * . * Here, the angle of direction of gaze, being maximal in the direction of action of the weak muscle. Eg.: - Oculomotor Palsy -> - Abducens Palsy - Trochlear Palsy Latent Strabismus / tga.Ua o It is a condition in which the tendency of the eyes to dete is kept latent by fusion. Therefore, when the influence of fusion is removed the visual axis of one eye detes away. L Types L 1. Esophoria- It is a tendency to converge. L 2. Exophoria- It is a tendency to diverge. L 3. Hyperphoria- It is a tendency to dete upwards, while hypophoria is a tendency to dete downwards. L 4. Cyclophoria- It is a tendency to rotate around the anteroposterior axis. When the 12 O&;clock meridian of cornea rotates nasally, it is called incyclophoria and when it rotates temporally it is called excyclophoria. Constant squint Least common - alternate squint. Ref: AK khurana 7th ed.

So the answer to this question is C


Instruction:
Human papillomatosis is caused by?
A. INV
B. HPV
C. HIV
D. HBV

Response:
Ans. is b i.e., HPV Human upper respiratory papillomatosis is due to infection with human papilloma virus (HPV) type 6 and 11.

So the answer to this question is B


Instruction:
A patient with maxillofacial trauma requires how much amount of potassium daily:
A. 100 mmol.
B. 150 mmol.
C. 60 mmol.
D. 30 mmol.

Response:
A patient with maxillofacial trauma requires 100 mmol amount of daily sodium
A patient with maxillofacial trauma requires 60 mmol amount of daily potassium

So the answer to this question is C


Instruction:
Ammonia causes depletion of which of the following in TCA cycle?
A. Oxaloacetate
B. Alpha-Keto glutarate
C. Fumarate
D. Malate

Response:
In Hyperammonemia (i.e. excess amino groups in cells), a large amount of alpha keto glutarate (intermediate of TCA) combine with an excess of ammonia in cells to form glutamate which fuher give rise to glutamine by taking up more ammonia (see fig). This leads to depletion of alpha-KG. As alpha-KG is an intermediate of TCA cycle, so TCA cycle stops and the brain is affected as brain is highly dependent on this aerobic pathway for energy. So in case of hyper ammonia alpha-ketoglutarate & glutamate will decrease and glutamine will increase.

So the answer to this question is B


Instruction:
Cushing ulcers are:-
A. Stress ulcers in burns
B. Stress ulcers in head injury
C. Stress ulcers in hiatus hernia
D. Stress ulcers in depression

Response:
Cushing ulcers or stress ulcers: Stress induced gastritis (or) Haemorrhagic Gastritis M/C site - stomach M/C site in stomach - Fundus > Body > Antrum As the max. concentration of parietal cells are seen in fundus it is the m/c site of occurrence Two types of stress ulcers: CUSHING ULCERS - Head injury CURLING ULCERS - BURNS

So the answer to this question is B


Instruction:
In Fetal Life RBC are produced in all except
A. Liver
B. Lymph node
C. Spleen
D. Bone marrow

Response:
In fetal life, RBC is produced in 3 phases according to growth of foetusMesoblastic stage: In yolk sacHepatic stage: In Liver and spleenMyeloid phase: In bone marrowRef: Medical Physiology Indu Khurana 2015 edition page No:104

So the answer to this question is B


Instruction:
Which of the following can determine malignant conversion of nevi better?
A. Size
B. Colour
C. Site
D. Number

Response:
Number of nevi is the better indicator of malignant conversion. More the number of nevi, more the chances of malignancy.

So the answer to this question is D


Instruction:
A 34 year old female comes to psychiatrist with complaints of ' always feeling worried'. She repos that she always feels anxious and irritable and that her sleep is worsening gradually. What is the likely diagnosis-
A. Agoraphobia
B. Generalised anxiety disorder
C. Major depression
D. Dysthymia

Response:
Generalized anxiety disorder (GAD) is characterized by excessive, uncontrolled, and irrational worry about everyday things that is out of propoion to the actual source of the worry. The worry impairs function, as the patient typically catastrophizes and becomes overly concerned with normal issues of health, money, work, and relationships.

So the answer to this question is B


Instruction:
Hyperpigmentation of palms & soles is seen in which poisoning
A. Arsenic
B. Mercury
C. Lead
D. Copper

Response:
A i.e. Arsenic

So the answer to this question is A


Instruction:
For hospital cases and controls, there is different rates of admission to hospitals for people with different diseases, it will lead to what bias?
A. Hawthorne effect
B. Berkesonian bias
C. Ecological fallacy
D. Interviewer bias

Response:
Bias Feature Berkesonian bias Different rates of admission to hospitals for people with different diseases Interviewer bias When the interviewer knows the hypothesis and also knows who the cases are Ecological fallacy Assigning people into groups irrespective of the characteristics they may or may not possess Hawthorne effect When subjects of an experimental study change or improve the behavior being evaluated only

So the answer to this question is B


Instruction:
HLA B27 is commonly associated with which of the following: March 2010
A. Rheumatic fever
B. Rheumatoid ahritis
C. Osteoahritis
D. Ankylosing spondylitis

Response:
Ans. D: Ankylosing Spondylitis HLA-B27 helps in diagnosis of ankylosing spondylitis, Reiter's syndrome and at times anterior uveitis. These diseases are chronic disorders that occur more commonly in men than in women. Basically this blood test is conducted to look for specific protein which is found on the white blood cell's surface. This protein is known as Human Leukocyte Antigen B27 (subtypes B*2701-2724).

So the answer to this question is D


Instruction:
Burkitt&;s lymphoma shows which translocation?
A. 8:14
B. 9:22
C. 11:14
D. 14:18

Response:
All forms of Burkitt lymphoma are highly associated with translocation of MYC gene on chromosome 8 that lead to increased MYC protein levels.The translocation paner for MYC is usually the IgH locus (t (8;14)) but may also be the Ig kappa (t (2;8)) or lambda (t (8;22)) light chain loci. Reference : Robbins and Cotran Pathologic basis of disease.South Asia Edition volume 1.page no. 597

So the answer to this question is A


Instruction:
A 30 year old female patient complains of irritability and nervousness. Patient gives history of consumption of oral contraceptives. Lab investigation reveals presence of xanthurenic acid in urine. This patient may be suffering from deficiency of:
A. Vitamin C
B. Vitamin B1
C. Vitamin B2
D. Vitamin B6

Response:
Pyridoxine deficiency is associated with neurological symptoms such as depression, irritability, nervousness and mental confusion. Convulsions and peripheral neuropathy are observed in severe deficiency.
The synthesis of niacin coenzymes (NAD+ and  NADP+)  from tryptophan is impaired. Xanthurenic acid, produced in high quantities is excreted in urine, which serves as a reliable index (particularly after tryptophan load test) for B6 deficiency.

Satyanarayana- Biochemistry, 3rd edition, pg-146

So the answer to this question is D


Instruction:
A 4-year-old child presents with acute watery diarrhea and abdominal cramps. Stool microscopy reveals trophozoites with falling leaf motility. The etiological agent is -
A. Entamoeba histolytica
B. Giardia lamblia
C. Trichomonas tenax
D. Balantidium coli

Response:
Giardia lamblia. (A) Trophozoite--ventral view (B) Trophozoite--lateral view (C) Cyst Infection is acquired by the ingestion of cysts in contaminated food and water. Infectivity is high, as few as 10 cysts being capable of initiating infection. Within half an hour of ingestion, the cyst hatches out into two trophozoites which multiply successively by binary fission and colonise the duodenum. The trophozoites as they pass down the colon develop into cysts. G. lamblia is seen typically within the crypts in the duodenum. It does not invade tissues, but remains tightly attached by means of the sucking disc to the epithelial surface in the duodenum and jejunum. The diarrhoea in some cases may be steatorrhoeic with excess mucus and fat, but no blood. Children may develop chronic diarrhoea, malabsorption, weight loss and a sprue-like syndrome. The incubation period is variable, but is usually about 2 weeks. TEXTBOOK OF MEDICAL PARASITOLOGY,CKJ PANIKER,6TH EDITION,PAGE NO 39

So the answer to this question is B


Instruction:
Colovesical fistula
A. Most commonly presents with pneumaturia
B. More common in females
C. Most commonly caused by colon cancer
D. Readily diagnosed on barium enema

Response:
Colovesical fistulaA colovesical fistula is the presence of a communication between the lumen of the CausesDiveiculitis:Crohn&;s disease: ~ 10%RadiotherapyTraumaClinical presentationRadiographic featuresIn most instances, the diagnosis is suspected clinically due to pneumaturia, faecaluria, recurrent urinary tract infections, or passage of urine rectally.In some cases, it will be first diagnosed radiologically at the time of investigation for the primary diseaseCT scan - Presence of gas within the lumen of the bladder. Contrast may be instilled into the rectum &;on table&; prior to the acquisition of images in order to demonstrate a fistulaFluoroscopy Treatment and prognosisSurgical resection of the fistula and abnormal segment of bowel is usually required for cure, although in the setting of malignancy this suggests advanced disease (T4) making surgery complex.In such cases, if palliation only is required then de-functioning colostomy, colonic stent placement or a nephrostomy may be required.(Refer:

So the answer to this question is A


Instruction:
Vitamin causing Encephalomalacia
A. Vit E
B. Vit A
C. Vit D
D. Vit B

Response:
None

So the answer to this question is A


Instruction:
Backening of eye most common because of -
A. Friction abrasion
B. Patterned abrasion
C. Imprint abrasion
D. Contusion

Response:
The synopsis of forensic medicine & toxicology ; Dr .k.s.narayan reddy ; 28th edition ; Pg no . 107 Area around the eye is very delicate ,hence blackening of eye is most commonly due to contusion .Also called spectacle hematoma .It is caused due to direct trauma ,such as a punch in the eye or blunt impact to the forehead ,the blood gravitating downwards over the supra orbital bridge or due to the fracture of the floor of the anterior fossa of the skull .

So the answer to this question is D


Instruction:
Disease where distal interphalangeal joint is characteristically involved -
A. Psoriatic arthritis
B. Rheumatoid
C. SLE
D. Gout

Response:
None

So the answer to this question is A


Instruction:
Subjective test of hearing is?
A. Pure tone audiometry
B. Oto acoustic emission
C. BERA
D. Impedence audiometry

Response:
ANSWER; (A) Pure tone audiometryREF: Achars Textbook of Pediatrics (4th Edn) by Swama Rekha Bhat p: 612, Nelson's pediatrics 18th ed ch: 636Subjective testsObjectives testsBirth -5months : behavoria! tests without rein - forcement6months -30months: visual reinforcement audiometry30 months - 5 years: play audiometry> 5yrs: speech tests> 5yrs: pure tone audiometry> 5yrs: pure tone audiometryOtoacoustic emissions: low specificity and takesaround 12 minstympanometryBERA: high specificity , takes around 21 mins Impedence audiometry Acoustic reflectometryChild s cooperating is needed for subjective tests.

So the answer to this question is A


Instruction:
Indication of surgery in benign hyperplasia of prostate is
A. Post void urine volume is 200 ml
B. Weakened urinary stream
C. Dysuria
D. Residual urine < 100 ml

Response:
Indications for surgery in BPH are: * Prostatism *Acute retentionof urine *Chronic retention of urine with residual urine > 200ml*Complications like hydroureter, hydronephrosis, stone formation, recurrent infections, bladder changes.*HematuriaReference : page 1045 SRB's manual of surgery 5th edition

So the answer to this question is A


Instruction:
HbA2 levels are increased in all Except:
A. Alpha Thalassemia
B. Beta Thalassemia
C. Sickle cell anemia
D. Megaloblastic Anemia

Response:
Answer is A (Alpha Thalassemia) Alpha Thalassemia are associated with reduced levels of HbA2 Causes of Increased HbA2 levels Beta thalassemia Sickle cell anemia Megaloblastic anemia Hypehyroidism Unstable Hemoglobinopathies Malaria (doubtful! cases) Causes of Decreased HbA2 levels Iron deficiency Anemia Alpha thalassemia Delta thalassemia Sideroblastic anemia Myelodysplastic syndromes Acute myelocytic leukemia (minor reduction) lib Lepore

So the answer to this question is A


Instruction:
Which disorder is most likely associated with erythroid hyperplasia in the bone marrow?
A. Anemia of chronic disease
B. Thalassemia minor
C. 7 to 10 days after a GI bleed
D. Iron deficiency

Response:
Erythroid hyperplasia in the bone marrow is a response of the erythroid series to erythropoietin stimulation. These stimuli include hypoxemia (e.g., chronic, obstructive pulmonary disease), anemia less than 7 gm/ dl, a left-shifted oxygen dissociation curve (e.g., carbon monoxide poisoning), a bleed more than 5 to 7 days, and testosterone. Anemia of chronic disease, thalassemia minor, and iron deficiency have problems in hemoglobin synthesis, so these would not be expected to have a reticulocyte response. In chronic renal disease, there is a decreased concentration of erythropoietin, which results in a normocytic anemia and no reticulocyte response. Ref - Harrison's internal medicine 20e pg 391, 391f, 684, 696

So the answer to this question is C


Instruction:
The strip technique which is a variant of free gingival graft was developed by
A. Rateit-Schak et.al
B. Han et.al
C. Edel et.al
D. Bjorn et.al

Response:
None

So the answer to this question is B


Instruction:
All of the following are true about Right Ventricular Infarcts, Except?
A. Nocturia
B. Hepatomegaly
C. Ascites
D. Ohopnea

Response:
Right ventricular Infarcts will cause failure of Right Ventricle resulting in systemic congestion and features of Right hea failure. Ohopnea is typically a feature of left hea failure. Hea Failure: Left Hea Failure: Left hea failure is defined as clinical syndrome where the dominant feature is fluid congestion in the lungs (pulmonary) rather than in the systemic circulation. The Pulmonary capillary wedge pressure is typically elevated (increased PCWP). Right Hea Failure: Right hea failure is defined as a clinical syndrome where the dominant feature is congestion in the systemic circulation. The Pulmonary capillary wedge pressure is normal (Normal PCWP) Ref: Hurst 72th Pgno: 692

So the answer to this question is D


Instruction:
Broad spectrum antihelminthic
A. Niclosamide
B. Albendazole
C. Mebendazole
D. Pyrantal pamoate

Response:
None

So the answer to this question is B


Instruction:
A 70-year-old male who has been chewing tobacco for the past 50 years presents with a six months history of a large, fungating, soft papillary lesion in the oral cavity. The lesion has penetrated into the mandible. Lymph nodes are not palpable. Two biopsies taken from the lesion proper, show benign appearing papillomatosis with hyperkeratosis and acanthosis infiltrating the subjacent tissues. The most likely diagnosis is -
A. Squamous cell papilloma
B. Squamous cell carcinoma
C. Verrucous carcinoma
D. Malignant mixed tumour

Response:
Verrucous carcinomas also referred to as giant condyloma accuminatum or Buschke-Lowenstein tumor are considered an intermediate lesion between condyloma accuminatum and invasive squamous cell carcinoma. It is important to distinguish verrucous carcinoma from squamous cell carcinomas as these tend to remain localized and are cured by wide excision, however they may undergo malignant transformation into invasive squammous cell carcinomas.
Features of verrucuous carcinomas

Predilection for males > 50 years
Predisposed in tobacco users, poor oral hygiene

So the answer to this question is C


Instruction:
Which is true about stab wound -
A. Breadth is maximum
B. Length is maximum
C. Depth is maximum
D. It has wound of entry and exit

Response:
The synopsis of forensic medicine & toxicology ; Dr k.s narayan reddy ; 28th edition ; Pg.no. 116 ; In a stab wound the depth ( length of track ) is greater than the width & length of external injury ,the depth of a stab wound is usually equal to or less than length of blade ,that is used in producing it ,but in anterior abdominal wall depth of wound is greater due to the force of thrust that may press the tissue underneath .

So the answer to this question is C


Instruction:
Mean ± 250 in normal distribution
A. 68%
B. 95%
C. 99%
D. 50%

Response:
In normal distribution :

Mean ± 150 lovers 68% values.
Mean ± 250 lovers 95% values.
Mean ± 350 lovers 99% values.

So the answer to this question is B


Instruction:
Which of the following statement is false about MR vaccination campaign launched by WHO?
A. Children from 9 months to less than 15 vaccinated
B. Congenital rubella syndrome (CRS), responsible for irreversible bih defects
C. India has not yet launched this campaign
D. Will replace routine immunization for measles vaccine

Response:
* One of the world's largest vaccination campaign against measles, a major childhood killer disease, and congenital rubella syndrome (CRS), responsible for irreversible bih defects. * India, along with ten other WHO South East Asia Region member countries, have resolved to eliminate measles and control rubella/congenital rubella syndrome (CRS) by 2020 * .All children from 9 months to less than 15 years of age will be given a single shot of Measles- Rubella (MR) vaccination during the campaign * . Following the campaign, MR vaccine will become a pa of routine immunization and will replace measles vaccine, currently given at 9-12 months and 16-24 months of age of child. * For those children who have already received such vaccination, the campaign dose would provide additional boosting to them. REF : PARK TESXT BOOK 21ST ED

So the answer to this question is C


Instruction:
The typical bone marrow finding in ITP is:March 2004
A. Absent megakaryocytes
B. Foam cells
C. Increased megakaryocytes
D. Fragmented megakaryocytes

Response:
Ans. C i.e. Increased megakaryocytesDiagnosis of ITPDespite the destruction of platelets by splenic macrophages, the spleen is normally not enlarged.In fact, an enlarged spleen should lead to a search for other possible causes for the thrombocytopenia.Bleeding time is usually prolonged in ITP patients.Normal bleeding time does not exclude a platelet disorder.Bone marrow examination may be performed on patients over the age of 60 and those who do not respond to treatment, or when the diagnosis is in doubt.On examination of the marrow, an increase in the production of megakaryocytes may be observed and may help in establishing a diagnosis of ITP.An analysis for anti-platelet antibodies is a matter of clinician's preference

So the answer to this question is C


Instruction:
Drug induced lupus antibodies are-
A. Anti-Rho
B. Ds-DNA
C. Anti-Sm
D. Anti-histone antibody

Response:
harshmohan textbook of pathology 7th edition. *anti histone antibody which is antibody against histone associated with DNA in chromatin is seen paicularly in cases of drug infused lupus than in SLE

So the answer to this question is D


Instruction:
Hypothyroidism should be treated with daily administration of which of the following thyroid hormone preparations?
A. Thyroid extract
B. Thyroglobulin
C. Thyroxine (T4)
D. Triiodothyronine (T3)

Response:
None

So the answer to this question is C


Instruction:
The basal ganglia include all the following structures, EXCEPT?
A. Fornix
B. Claustrum
C. Globus pallidus
D. Caudate

Response:
The basal ganglia are symmetrical subcoical masses of gray matter. The bulk of the basal ganglia is called the corpus striatum and is composed of the caudate nucleus and the lentiform nucleus. The lentiform nucleus in turn is divided into the putamen and globus pallidus. The claustrum is a thin layer of gray matter that is found lateral to the putamen and medial to the insula. The amygdala is a small almond-shaped structure that lies at the tail of the caudate nucleus in the mesial temporal lobe. The fornix is a paired structure that connects the mamillary bodies with the hippocampus. It is considered pa of the limbic system. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 12. Reflex and Voluntary Control of Posture & Movement. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.

So the answer to this question is A


Instruction:
Gamma - Carboxylation of which of the following requires vitamin K?
A. Glutamine
B. Glutamic Acid
C. Glycine
D. Aspaate

Response:
IVitamin K Function 1. Cataelyzes gamma-carboxylation of glutamic acid residues on various proteins concerned with blood clotting. 2. Catalyzes gamma-carboxylation of glutamic acid to GABA. Deficiency 1.Neonatal hemorrhage with increased PT and aPTT, but normal bleeding time. 2. Synthesized by intestinal flora, so vitamin-K deficiency can occur after the prolonged use of broad-spectrum antibiotics. (Note: Vitamin-K dependent clotting factors are II, VII, IX, X and protein C and S. Warfarin is a vitamin-K antagonist) A specific protein known as PIVKA (Protein-induced in vitamin K absence) is impoant in diagnosing vitamin K deficiency. Ref: Biochemistry by U. Satyanarayana 3rd edition Pgno : 129

So the answer to this question is B


Instruction:
Harakiri method of suicide involves stabbing into: AIIMS 14
A. Chest
B. Wrist
C. Abdomen
D. Neck

Response:
Ans. Abdomen

So the answer to this question is C


Instruction:
True about rash of chickenpox
A. Centripetal
B. Deep Seated
C. Affectspalm
D. Slow to evolute

Response:
Rash of chicken pox : Superficial, unilocular, centripetal, pleomorphic, symmetrical, affects flexor surfaces and axilla, spares palms and sales, has inflammation around, rapid evolution and dew-drop on rose petal appeamace.

So the answer to this question is A


Instruction:
The anti-hypeensive agent which decreases libido is:
A. Methyldopa
B. Captopril
C. Diazoxide
D. Hydralazine

Response:
Methyldopa

So the answer to this question is A


Instruction:
Buerger’s disease is not associated with:
A. Affects male under the age of 30 year
B. Thrombophlebitis of deep or superficial veins
C. Involvement of large sized arteries
D. Characteristic ‘corrugation’ of femoral arteries on angiography

Response:
Buerger’s disease (Thromboangitis obliterans)
Occlusive disease of small and medium sized arteries
Thrombophlebitis of superficial or deep veins
Raynaud syndrome
Affects males (<30yrs)
Angiography sometimes shown a characteristic ‘corrugation’ of the femoral arteries as well as the distal arterial occlusions and helps to distinguish the condition from aggressive atheroma of early onset.

So the answer to this question is C


Instruction:
Which part of maxillary artery is closely involved in Le Fort 1,2 and 3 injuries
A. Mandibular part
B. Pterygoid part
C. Pterygoid palatine part
D. Terminal part

Response:
None

So the answer to this question is C


Instruction:
By which method foreign DNA is introduced into a cell by a virus or viral vector?
A. Transduction
B. Transcription
C. Lysogenic conversion
D. Transformation

Response:
(A) Transduction[?]TRANSDUCTIONoTransfer of genetic information from one cell to another by means of a viral vector.oRefers to the process whereby foreign DNA is introduced into another cell via a viral vectoroTransduction does not require physical contact between the cell donating the DNA and the cell receiving the DNA (which occurs in conjugation), and it is DNase resistant.oTransduction is a common tool used by molecular biologists to stably introduce a foreign gene into a host cell's genome.Other Options[?]Lysogenic ConversionoWhen a cell becomes lysogenized, occasionally extra genes carried by the phage get expressed in the cell. These genes can change the properties of the bacterial cell. This process is called lysogenic conversion.[?]Bacteriophages: Lysogenic Conversion-Some lysogenic phage carry genes that can enhance the virulence of the bacterial host.-For example, some phage carry genes that encode toxins.-These genes, once integrated into the bacterial chromosome, can cause the once harmless bacteria to release potent toxins that can cause disease.[?]Transcription-Transcription is the process of making a complementary molecule of mRNA (messenger RNA) from a DNA template. This takes place in the nucleus.-RNA polymerase unwinds, reads and places the correct nucleotide on the mRNA strand according to base pairing rules (A to U, C to G, T to A).[?]Transformation:oIntroduction of an exogenous DNA into cell, causing the cell to acquire a new phenotype.oInfection of Bacterium by phage begins with injection of its DNA.oIt can take either of 2 causes 1 lysogenic - viral DNA becomes as part of Bacterial DNA causing cell division.oLytic-viral DNA excises from host chromosome and replicates itself, Direct synthesis of viral proteins - then lysis of host occurs with release of viri.oTransduction is the process by which foreign DNA is introduced into a cell by a virus or viral vector. An example is the viral transfer of DNA from one bacterium to another.oTransformation is one of three processes for horizontal gene transfer, in which exogenous genetic material passes from one bacterium to another, the other two being conjugation (transfer of genetic material between two bacterial cells in direct contact) and transduction (injection of foreign DNA by a bacteriophage virus into the host bacterium). In transformation, the genetic material passes through the intervening medium, and uptake is completely dependent on the recipient bacterium.

So the answer to this question is A


Instruction:
A 60 year old man has both HTN and DM for 10 years. There is reduced vision in one eye. On fundus examination there is a central bleed and the fellow eye is normal. The diagnosis is –
A. Retinal tear
B. Optic neuritis
C. Diabetic retinopathy
D. Hypertensive retinopathy

Response:
Central bleed implies bleed in the macula and this is resulting in reduced vision in the involved eye.
Among the given options, macular bleed can be seen in diabetic retinopathy only. In diabetic retinopathy, neovascularization of macula may occur where there is growth of abnormal blood vessels under the retina which can cause leakage, bleeding and scarring resulting in reduced / loss of vision.

So the answer to this question is C


Instruction:
In childern, most common posterior fossa tumour is-
A. Meningioms
B. Astrocytoma
C. Medulloblastoma
D. Glioblastoma multiforme

Response:
None

So the answer to this question is B


Instruction:
Which of the following drug is not teratogenic?
A. ACE inhibitors
B. Aldosterone
C. AT receptor antagonist
D. Propylthiouracil

Response:
Propylthiouracil is the drug of choice for hypehyroidism during pregnancy. Carbimazole when used during pregnancy results in aplasia cutis of the neonate. ACEI and ARBs when given during later half of pregnancy results in fetal growth retardation, hypoplasia of organs and fetal death. So it is contraindicated in pregnancy.

So the answer to this question is D


Instruction:
Most radiosensitive cells are
A. Vegetative intermitotic cells
B. Differential intermitotic cells
C. Reverting post mitotic cells
D. Fixed post mitotic cells

Response:
None

So the answer to this question is A


Instruction:
Main pancreatic duct is derived from ?
A. Paly from the dorsal pancreatic bud and paly from the ventral pancreatic bud
B. Dorsal pancreatic bud only
C. Ventral pancreatic bud only
D. None of the above

Response:
The pancreas develops from the two endodermal buds, dorsal and ventral, that arise from the pa of the gut that later forms the second pa of the duodenum. The ventral bud forms the lower pa of the head, and the uncinate process of the pancreas, while the upper pa of the head, the body and the tail are formed from the dorsal bud. The main pancreatic duct is formed, in its distal pa, by the duct of dorsal bud, and in its proximal pa by the duct of the ventral bud. The islets of Langerhans are also derived from the primitive duct system. Ref: Textbook of Human Embryology, 6th Ed, Page 184.

So the answer to this question is A


Instruction:
Which of the following is a DNA repair defect?
A. Bloom syndrome
B. Incontinentia pigmenti
C. Aplastic Anemia
D. Tuberous sclerosis

Response:
Bloom syndrome (often abbreted as BS in literature), also known as Bloom-Torre-Machacek syndrome, is a rare autosomal disorder characterized by sho stature, predisposition to the development of cancer and genomic instability. BS is caused by mutations in the BLM gene leading to mutated DNA helicase protein formation. Cells from a person with Bloom syndrome exhibit a striking genomic instability that includes excessive crossovers between homologous chromosomes and sister chromatid exchanges (SCEs). Autosomal Recessive Syndromes of Defective DNA Repair Xeroderma pigmentosum Ataxia-telangiectasia Bloom syndrome Fanconi anemia Ref Robbins 9/e pg 172

So the answer to this question is A


Instruction:
Pascal&;s law is used in which technique of hernia repair?
A. Litchenstein mesh repair
B. Stoppa's preperitoneal repair
C. Bassini's repair
D. Darning repair

Response:
Stoppa&;s Preperitoneal Repair In Stoppa&;s preperitoneal repair, the expanding Intra-abdominal pressure holds the mesh in place without suture fixation According to Pascal&;s law, any additional pressure exeed upon an enclosed fluid mass is transmitted equally in all directions Use of large mesh extending 3-5 cm beyond the edge of defect in all sides utilized Pascal&;s law Ref: Recent advances in surgery 10th edition Pgno : 166

So the answer to this question is B


Instruction:
All are features of hypernatremia except
A. Convulsions
B. Elevated intracranial tension
C. Periodic paralysis
D. Doughy skin

Response:
Ans. is 'c' i.e., Periodic paralysis Periodic paralysis, is seen in hyponatermia Clinical features of Hypernatremia :? Most patients with hypernatremia are dehydrated and have the typical signs and symptoms of dehydration. Hypernatremia even without dehydration causes central nervous system symptoms that tend to parallel the degree of sodium elevation and the acuity of the increase. Patients are irritable, restless weak and lethargic Some have high pitched cry and hyperpnea. Ale patient are very thirsty. Hypernatremia causes fever although many patients have underlying process that contributes to the fever Except for dehydration, there is no clear direct effect of hypernatremia on other organs or tissues except the brain. Complication of hypernatremia :? Brain hemorrhage is the most devastating consequence of hypernatremia. As the extracellular osmolarity increases water moves out of brain cells, resulting in decrease in brain volume. This can result in tearing of intra cerebral veins and bridging vessels as the brain moves away from the skull and the meninges. Patient may have subarachnoid, subdural and parenchymal hemorrhage. Seizure and coma are possible sequale of the hemorrhage even though seizures are more common during t/t. Thrombotic complications are common in severe hypernatremic dehydration and include stroke, dural sinus thrombosis, peripheral thrombosis and renal vein thrombosis. The intracranial tension can be increased due to hemorrhage

So the answer to this question is C


Instruction:
"Cresentic glomerular deposits" are seen in?
A. Wegener granulomatosisG
B. Polyarteritis nodosa
C. Thrombangitis obliterans
D. All of the above

Response:
Ans. A. Wegener granulomatosis. (Ref, Robbin's Pathology8th/pg, Table 14-2)Rapidly Progressive (Crescentic) Glomerulonephritis# RPGN is a clinical syndrome and not a specific etiologic form of GN.# Clinically, it is characterized by rapid and progressive loss of renal function with features of the nephritic syndrome, often with severe oliguria and (if untreated) death from renal failure within weeks to months.# Regardless of the cause, the histologic picture is characterized by the presence of crescents (crescentic GN).# These are produced in part by proliferation of the parietal epithelial cells of Bowman's capsule in response to injury and in part by infiltration of monocytes and macrophages.# Pathogenesis:# Crescentic glomerulonephritis (CrGN) may be caused by a number of different diseases, some restricted to the kidney and others systemic.# Types of Crescentic Glomerulonephritis:A. Type I (Anti-GBM Antibody)1. Idiopathic2. Goodpasture syndromeB. Type II (Immune Complex)1. Idiopathic2. Postinfectious/infection related3. Systemic lupus erythematosus4. Henoch-Schonlein purpura/IgA nephropathyC. Type III (Pauci-Immune) ANCA Associated1. Idiopathic2. Wegener granulomatosis03. Microscopic angiitisAnti-Glomerular Basement Membrane Antibody (Type I) Crescentic Glomerulonephritis* Anti-GBM antibody crescentic glomerulonephritis, or type I CrGN, is characterized by linear deposits of IgG and, in many cases, C3 on the GBM, as described above. In some of these individuals the anti-GBM antibodies also bind to pulmonary alveolar capillary basement membranes to produce the clinical picture of pulmonary hemorrhages associated with renal failure. These persons are said to have Goodpasture syndrome, to distinguish their condition from socalled idiopathic cases in which renal involvement occurs in the absence of pulmonary disease. Anti-GBM antibodies are present in the serum and are helpful in diagnosis. It is important to recognize type I CrGN because these individuals benefit from plasmapheresis, which removes pathogenic antibodies from the circulation.* Immune Complex-Mediated (Type II) Crescentic Glomerulonephritis* Type II CrGNs are immune complex-mediated disorders. This can be a complication of any of the immune complex nephritides, including poststreptococcal GN, SLE, IgA nephropathy, and Henoch-Schonlein purpura. In some cases, immune complexes can be demonstrated but the underlying cause is undetermined. In all of these cases, immunofluorescence studies reveal the characteristic granular ("lumpy bumpy") pattern of staining of the GBM and/or mesangium for immunoglobulin and/or complement. These individuals cannot usually be helped by plasmapheresis.Pauci-Immune (Type III) Crescentic GlomerulonephritisType III CrGN, also called pauci-immune type CrGN, is defined by the lack of anti-GBM antibodies or significant immune complex deposition detectable by immunofluorescence and electron microscopy. Most of these individuals have antineutrophil cytoplasmic antibodies in the serum, which, as we have seen, have a role in some vasculitides. Therefore, in some cases type III CrGN is a component of a systemic vasculitis such as microscopic polyangiitis or Wegener granulomatosis. In many cases, however, pauci-immune CrGN is limited to the kidney and is thus called idiopathic

So the answer to this question is A


Instruction:
Most common complication of amoebic liver abscess is
A. Rupture into Plural cavity
B. Rupture into peritoneal cavity
C. Rupture into pericardial cavity
D. Sespis

Response:
Rupture into peritoneal cavity is the most common complication.

So the answer to this question is B


Instruction:
A 30 year old unmarried woman from a low socioeconomic status family believes that a rich boy staying in her neighbourhood is in deep love with her. The boy clearly denies his love towards this lady. Still the lady insists that his denial is a secret affirmation off his love towards her. She makes desperate attempts to meet the boy despite resistance from her family. She also develops sadness at times when her effort to meet the boy does not materialize. She is able to maintain her daily routine. She however, remains preoccupied with the thoughts of this boy. She is likely to be suffering from -
A. Delusional disorder
B. Depression
C. Mania
D. Schizophrenia

Response:
This patient has :-

Delusion of love/erotomanic delusion (an erotic conviction that a person with higher status in love with her).
Social and occupational activities are unaffected (she is able to maintain her daily routine).

Diagnosis is delusional disorder with content of love → De - clerambault's syndrome.

So the answer to this question is A


Instruction:
A child presented with headache, dizziness, intermittent claudication with occasional dyspnoea.The most probable diagnosis in –
A. ASD
B. PDA
C. TOF
D. Coarctation of aorta

Response:
Clinical manifestations of COA

Symptoms of coarctation of aorta occurs due to decrease in blood supply distal to aortic obstruction.
If obstruction is distal to left subclavian artery, manifestations are due to arterial insufficiency to lower limbs.
Intermittent claudication
Pain
Weakness of Leg
Dysnea on running
Weak pulses and lower BP in the lower extremities --> Delayed or weak impalpable femorals compared to strong brachial arteries.
Collateral circulation develops between precoarctation arterial branches and the post coarctation arteries through enlarged intercostal and internal mammaty arteries.
This produces radiologically visible erosions (notching) of undersurface (inferior) of ribs.
Hypertension --> Headache, dizziness.
If the obstruction is proximal to left subclavian artery ---> Blood supply to left arm (supplied by left subclavian) is interrupted whereas blood supply to right arm is normal -* Pressure difference in two arms.

Murmur in coarctation of aorta

The blood passing through the narrowed aorta —> Midsystolic murmur in anterior part of chest, back and spinous process.
When lumen becomes severly narrowed the blood flow through it, turns into a high velocity jet -p Continous murmur.
COA is associated with bicuspid aortic valve in 50-80% of patients. The bicuspid valve produce aortic regurgitation Diastolic murmur.

So the answer to this question is D


Instruction:
Which of the following is a metastasis suppressor gene in relation to prostate cancer
A. KAI - 1
B. NM 23
C. KISS
D. p53

Response:
Prostate cancers account for 43% of all cancers diagnosed in American men. It is estimated that in 1996, 317,000 new cases of prostate cancer were diagnosed and 41,000 men died of the disease. The challenge of treating prostate cancer lies in accurately distinguishing those histologically-localized cancers which will complete metastatic progression from those that will remain indolent. At this time, we lack appropriate histological markers to make such distinctions, therefore, it is often difficult to accurately predict the clinical course of an individual patient's disease. There is growing evidence that a critical event in the progression of a tumor cell from a non-metastatic to metastatic phenotype is the loss of function of metastasis-suppressor genes. These genes specifically suppress the ability of a cell to metastasize. Work from several groups has demonstrated that human chromosomes 8, 10, 11 and 17 encode prostate cancer metastasis suppressor activities. As a result of these effos the first prostate cancer metastasis-suppressor gene, KAI1, was identified and mapped to the p11-2 region of chromosome 11. In subsequent studies, an additional gene encoded by the same region, CD44 was also determined to have metastasis-suppressor activity. Recent studies have shown a correlation between decreased expression of KAI1 and CD44 and an increased malignant potential of prostate cancers. It is anticipated that the identification of other metastasis suppressor genes may allow for the development of diagnostic markers useful in the clinical substaging of individual tumors. This manuscript is intended to present our perspective on the impoance of these genes in the understanding of prostate cancer progression. More impoantly, we present new findings from our laboratory's effo to identify the metastasis-suppressor genes encoded by human chromosome 17. Specifically we repo the strategy currently being used to evaluate a series of candidate genes and the approach being utilized to pinpoint the metastasis-suppressor region on human chromosome 17.

So the answer to this question is A


Instruction:
Patey's mastectomy is a type of
A. Simple mastectomy
B. Extended mastectomy
C. Modified radical mastectomy
D. Halsted's radical mastectomy

Response:
Ans. (c) Modified radical mastectomy(Ref. Bailey and Love 26th edition Page 813)* In Patey's type of MRM- Pectoralis Minor muscle removed.

So the answer to this question is C


Instruction:
All of the following areas are commonly involved sites in pelvic fracture except -
A. Pubic rami
B. Alae of ilium
C. Acetabulum
D. Ischial tuberosities

Response:
Avulsion fracture of the pelvis are uncommon injuries, seen almost exclusively in adlosescent athletes. These are produced mainly as a result of sudden, forceful or unbalanced contraction of the attached musculo-tendinous unit, while the subject is engaged in a spriting event such as kicking a ball, running or jumping.
These fractures usually are related to the time of ossification nuclei appearance and their fusion to the corresponding pelvic tuberosities. Fracture of the ischial tuberosity is an example of an avulsion fracture and constitues the most uncommon fracture site amongst the options provided.
Lateral compression injury (Pubic rami & iliac wing fracture) is the most common injury pattern accounting for 41% of the patients, followed by anteroposterior compression injuries (symphyseal diastasis or longitudinal rami fracture) accounting for 26% and acetabular fractures (18%).

So the answer to this question is D


Instruction:
Autoimmune thyroiditis can be confirmed in a patient by
A. Thyroid peroxidase antibody (TPO)
B. Antinuclear antibody
C. Thyroid uptake resin
D. Thyroid aspiration

Response:
Once hypothyroidism is diagnosed by clinical features, TSH and free T4 measurements, etiology can be confirmed by measuring the presence of autoantibody—particularly thyroid peroxidase (TPO), which is present in 90 to 95% of patients with autoimmune hypothyroidism. Biopsy by fine needle aspirate can confirm the diagnosis but is not necessary in most cases.

So the answer to this question is A


Instruction:
Nerve of Grassi is related to?
A. Facial nerve
B. Glossopharyngeal nerve
C. Vagus nerve
D. Hypoglossal nerve

Response:
The nerve of Grassi is one of the branches of posterior vagal trunk that supplies the gastric fundus. It provides parasympathetic supply. -Reference: Textbook of anatomy, Abdomen and Lower limb, Vishram Singh, 2nd edition, page no.102

So the answer to this question is C


Instruction:
In alcohol withdrawal which is not seen -
A. Seizure
B. Blackout
C. Coarse tremor
D. Hallucination

Response:
Blackout occurs during acute intoxication (not during withdrawal). All the other options can occur in alcohol withdrawal.

So the answer to this question is B


Instruction:
Which of the following antihypeensive drug is contraindicated in pregnancy
A. Amlodipine
B. Labetolol
C. Enalapril
D. Hydralizine

Response:
ACE inhibitors and ARBs are absolutely contraindicated in pregnancy Pre-pregnancy counselling and management of chronic hypeensionis essential. Some commonly prescribed antihypeensive drugsare contraindicated or best avoidedbefore conception and duringpregnancy (Table 1 ). These include ACE inhibitors, angiotensin receptor antagonists, diuretics and most beta blockers. Refer Goodman and Gilman 12e p736

So the answer to this question is C


Instruction:
Serial interval measures -
A. Incubation period of disease
B. Sensitivity
C. Specificity
D. Positive predictive value

Response:
None

So the answer to this question is A


Instruction:
Dale's vasomotor reversal is due to -
A. Alpha blocker
B. Beta blocker
C. ACH inhibitor
D. All of the above

Response:
Ans. is 'a' i.e., Alpha blocker o In Dale's vasomotor reversal Neurotransmitter --> Adr Blockade --> a - receptors Stimulation --> [32-receptors o Re-reversal of vosomotor reversal is due to propranolol ((3-blockers).

So the answer to this question is A


Instruction:
Which of the following is not an intermediate of citric cycle?
A. Acetyl-CoA
B. Succinyl-CoA
C. a-ketoglutarate
D. Citrate

Response:
The citric acid cycle - also known as the tricarboxylic acid (TCA) cycle or the Krebs cycle - is a series of chemical reactions used by all aerobic organisms to generate energy through the oxidation of acetyl-CoA derived from carbohydrates, fats and proteins into carbon dioxide and chemical energy in the form of adenosine triphosphate. In addition, the cycle provides precursors of ceain amino acids as well as the reducing agent NADH that is used in numerous other biochemical reactions. Its central impoance to many biochemical pathways suggests that it was one of the earliest established components of cellular metabolism and may have originated abiogenically. The name of this metabolic pathway is derived from citric acid (a type of tricarboxylic acid) that is consumed and then regenerated by this sequence of reactions to complete the cycle. In addition, the cycle consumes acetate (in the form of acetyl-CoA) and water, reduces NAD+ to NADH, and produces carbon dioxide as a waste byproduct. The NADH generated by the TCA cycle is fed into the oxidative phosphorylation (electron transpo) pathway. The net result of these two closely linked pathways is the oxidation of nutrients to produce usable chemical energy in the form of ATP.Ref: DM Vasudevan, 7th edition, page no: 245

So the answer to this question is A


Instruction:
Most common anomaly of upper urogenital tract is
A. Uretero pelvic junction stenosis
B. Ectopic uretheral opening
C. Ureterocele
D. Ectopic ureter

Response:
The most common obstructed lateral fusion defects is unilateral obstruction and is most commonly seen in women with complete duplication of the reproductive tract(double uterus, cervix and vagina) . Unilateral UPJ obstruction is the most common prenatally detected obstructive disease, often picked up on maternal ultrasounds during pregnancy. Reference: GHAI Essential pediatrics, 8th edition

So the answer to this question is A


Instruction:
Gelastic seizure is a
A. Laughing epilepsy
B. Febrile epilepsy
C. Postpartum epilepsy
D. Clonic-tonic type epilepsy

Response:
(A) Laughing epilepsy # Gelastic seizure or "Gelastic epilepsy" is a rare type of seizure that involves a sudden burst of energy, usually in the form of laughing or crying. This syndrome usually occurs for no obvious reason and is uncontrollable. It is slightly more common in males than females.> Term Gelastic originates from the Greek word "Gelos" which means laughter. The main sign of a gelastic seizure is a sudden outhurst of laughter or crying with no apparent cause. The laughter may sound unpleasant and sardonic rather than joyful. The outburst usually lasts for less than a minute.> During or shortly after a seizure, an individual might display some twitching, strange eye movements, lip smacking, fidgeting or mumbling. If a person of who suffers from the seizures is hooked up to an electroencephalogram it will reveal interictal epileptic discharges.> A gelastic seizure is typically caused by a hypothalamic hamartomas, or a brain tumor.> Gelastic seizures are not responsive to therapy. They can produce secondary seizure characteristics which may respond to medications or surgery.

So the answer to this question is A


Instruction:
True about conn&;s syndrome-
A. Increased K+
B. Decreased K+
C. Proximal myopathy
D. Ted plasma renin activity

Response:
Ans is option 2 and 3 Decrease K+ and proximal myopathy In Conn&;s disease Proximal myopathy occurs due to hypokalemia. Hypokalemia causes alteration of electrical excitability of nerve and muscle fibre membranes, which prevents transmission of normal action potential, leading to severe muscle weakness. Ref Harrison 17/e p 2260,2261,2253

So the answer to this question is B


Instruction:
Characteristic problem in females taking Norethisterone is :
A. Irregular bleeding
B. Thromboembolism
C. Hirsutism
D. Weight gain

Response:
Ans. is a i.e. Irregular bleeding Nor-ethisterone acetate is commonly used as an injectable steroid - 'NET-EN' It is a progesterone based contraceptive like DMPA and its side effect are similar to those of DMPA. The most frequent side effect is irregular bleeding. NET-EN is given in doses of 200 mg at 2 monthly interval. Composition Features Lunelle/cyclofem 25mg DMPA + 5mg estradiol cypionate Mesigyna 4g 50 mg NET-EN + 5mg estradiol valerate ed - menstrual irregularities Rapidly reversible Monthly injection Inhibits lactation Rapid return of feility Monthly injection same as lunelle Extra Edge : Combined injectable contraceptive.

So the answer to this question is A


Instruction:
The adverse effects of oral pills are all, EXCEPT:
A. Weight gain
B. Hypeension
C. Thromboembolism
D. Dysmenorrhoea

Response:
The side effects of oral pills are: a. Weight gain, acne, chloasma. Other serious complications are: b. Venous thromboembolism, pulmonary thrombosis. c. Coronary and cerebral thrombosis resulting in myocardial infarction or stroke. The estrogen component of the OC has been mainly held responsible for the venous thromboembolism. Estrogen and progestin are blamed for the aerial phenomena like: Increased in blood clotting factors Decreased antithrombin III Decreased plasminogen activator in endothelium. Increased platelet aggregation. Rise in BP: If the B.P rises, best is to stop OCP. Note: An increased incidence of breast cancer, vaginal and cervical cancer is repoed. Lower incidence of ovarian malignancy is noted in contraceptive users. Ref: KDT 6th Ed Page 35, 316.

So the answer to this question is D


Instruction:
The Glomus jugulare tumour compression of carotid is diagnosed by:
A. MR angiography
B. CECT
C. X-ray
D. Jugular venography

Response:
(a) MR angiography(Ref. Cummings, 6th ed., 2756)Magnetic resonance angiography is used to evaluate for compression of internal carotid artery.CECT is diagnostic of Glomus jugulare.X-ray has no role in the assessment of Glomus jugulare.MR venography is useful to assess collateral circulation within the dural sinuses of the skull as the tumour blocks the blood flow in the internal jugular vein and in turn leads to blockade of the sigmoid sinus.Jugular venography is no longer used because intravenous tumour extension can be seen with MR venography.

So the answer to this question is A


Instruction:
Phase IV of Clinical trial is done:
A. To find safety and toxicity
B. To compare with existing drugs
C. Pre marketing surveillance
D. Post marketing surveillance

Response:
Ans. (d) Post marketing surveillanceRef.: K. Park 23rd ed. / 84-85Clinical TrialsPhaseSubjectsPurpose* Phase 1Healthy human volunteerSafety and non-toxicity* Phase 2Patients (20-200)Effectiveness* Phase 3PatientsComparison with existing drug* Phase 4PatientLong term side effects Post marketing surveillance* Most important phase of clinical trial: Phase 3* A new drug is launched in market after phase 3PHASE 4* Post marketing surveillance* Longest phase: 10-25 years* To study the long term side effects of a drug* Doesn't require ethical clearance.

So the answer to this question is D


Instruction:
In infants and toddlers, craniotabes is a sign related to the deficiency of __________
A. Vitamin A
B. Vitamin C
C. Vitamin D
D. Vitamin K

Response:
Craniotabes is one of the earliest manifestations of rickets.It is due to thinning of outer table of the skull and detected by pressing firmly over the occiput or posterior parietal bones.A ping-pong-ball sensation is felt. Page 185,Nelson textbook of pediatrics 16th edition

So the answer to this question is C


Instruction:
In a bimodal series, if mean is 2 and median is 3, what is the mode?
A. 5
B. 2.5
C. 4
D. 3

Response:
In a bimodal series, Mode = 3 Median -2 mean In the given question, mean is 2 and median is 3 Thus Mode = 3(3) -2(2) = 9 - 4 = 5

So the answer to this question is A


Instruction:
Cause of death in breech delivery:a) Intracranial hemorrhageb) Aspirationc) Atlanto axial dislocationd) Asphyxia
A. abc
B. ad
C. acd
D. bde

Response:
None

So the answer to this question is C


Instruction:
A patient of glaucoma with bronchial asthma presents to the emergency with status asthamaticus, causative agent might have been)
A. Pilocarpine eye drop
B. Timolol eye drop
C. Betaxolol eye drop
D. Levobunolol eye drop

Response:
Ans. is 'b' i.e. Timolol eye drops Timolol maleate is the most widely used drug for open angle glaucoma.It is non-selective B blocker (Blocks both B1 and B2B2 is responsible for bronchodilation, therefore blocking B2 would aggravate asthma.Instead of Timolol, Betaxolol can be used because it is a selective B1 blocker and causes less respiratory side effects.

So the answer to this question is B


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

Response:
None

So the answer to this question is C


Instruction:
Xanthochromia of CSF seen in all except:
A. Bloody tap
B. Carotene
C. Increased antibodies
D. Increased proteins

Response:
Ref: Harrison's Principles of Internal Medicine, 18th ed, page 46-1Explanation:Xanthochromia is yellow' discoloration of CSF supernatant. Seen in:SAHJaundiceIncreased proteins (>1.5-2 g/L)Froin's syndrome (spinal subarachnoid block, xanthochromia & excess proteins)Carotene addictionBloody tap Vs SAHBloody tapSAHCSF clears on centrifugationXanthochromic supernatant CSFBlood clears in subsequent tubesUniformly bloody in all the tubesCauses of high CSF protein:Guillian-Barre syndrome (GBS)Spinal tumorsMeningitisMultiple sclerosisAcoustic neuromaAlbumino-cytological dissociation seen in GBS CONTRAINDICATIONS: Patient needs neuroimaging before LP-Altered level of consciousnessPapilledemaFocal neurological deficitNew-onset seizureImmunocompromised stateLocal skin infectionPlatelet count <20,000/cmmCSFNormal ValuesPROTEIN15- 50mq/dLGLUCOSE40-7Dmg.'dLCELLS0-5: L & MPRESSURE5-18 cm H20VOLUME150 mL

So the answer to this question is A