Instruction:
Venkataraman-Ramakrishnan media is used for: March 2005
A. Sterptococcus pneumoniae
B. Staphylococcus aureus
C. Vibrio cholerae
D. Clostridium tetani

Response:
Ans. C: Vibrio cholerae Transpo media for cholera vibrios are: Modified Cary and Blair medium is recommended as a good transpo medium. It is a very stable medium and can be stored for use in screw capped containers. It is a semi-solid transpo medium. At least two swabs should be inoculated. Alternative transpo media for vibrio cholera are Venkataraman-Ramakrishnan medium (V-R fluid) or alkaline peptone water.VR fluid should be prepared in 30 ml (1 oz) screw capped bottles (MacCaney bottles). It preserves vibrios for more than 6 weeks and has also proved to be very convenient medium for transpoation as it can be kept at room temperature after collection of specimen. If none of the transpo medium is available, collect watery stool from suspected cholera case by soaking blotting paper strip in the stool, sealing the strip in a polythene bag or an aiight container where the strip does not dry. The moist blotting paper strip can then be transpoed to the laboratory. Blotting papers have been found to be superior to the filter paper as the former can soak more moisture and retain the same over longer periods thus maintaining the bility of vibrios absorbed on it.

So the answer to this question is C


Instruction:
Which of the following distension media used in hysteroscopy causes fluid overload and electrolyte disturbances
A. Carbondioxide
B. Glycine
C. Hyskon
D. Ringer Lactate

Response:
Glycine is absorbed from uterine cavity and peritoneum and lead to fluid overload and electrolyte disturbances.

So the answer to this question is B


Instruction:
Ossification centre Calcaneum appears in
A. 3rd month
B. 5th month
C. 7th month
D. 9th month

Response:
Ossification centres Foot calcaneum: 5 months of JULY Talus: 7 months Cuboid: 9 months Navicular: 1 year Cuneiforms: 1 to3 years Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 92

So the answer to this question is B


Instruction:
Isotretinoin to be stopped before pregnancy
A. 3 days
B. 2 week
C. 3 month
D. 3 years

Response:
Isotretinoin iseffective for treating severe acne but it is is category X drug in pregnancy. It is recommended that a woman should wait at least 1 month after stopping Isotretinoin before trying to became pregnant but the desirable time is 3 months.

So the answer to this question is C


Instruction:
Which is enrichment media -
A. Selenite F broth
B. Chocolate media
C. Meatextract media
D. Egg media

Response:
Alls, is 'a' i.e., Selenite F broth [Ref: Ananthanarayan 8F/e p. 40\TAYPES OF MEDIA1. Enriched mediao Substances such as blood, serum, or egg are added to provide nutritional support,o They are used to grow bacteria which are more exacting in their nutritional needs,o Examples - Blood agar, chocolate agar, and egg media.2 Enrichment mediao Substances which have a stimulating effect on the bacteria to be grown or an inhibiting effect on those to be suppressed are incorporated in the liquid media,o Example:* Tetrathionate broth-Salmonella* Selenite F broth-Salmonella and shigella* Thioglycolate broth-Anaerobic bacteria* Monsur's taurocholate tellurite Peptone water-V. cholerae* Alkaline peptone water-V. choleraeSelective mediao Substances which have a stimulating effect on the bacteria to be grown or an inhibiting effect on those to be suppressed are incorporated in the solid medium,o Examples:* Deoxycholate citrate agar (DC A)-Salmonella and shigella* Lowenstein Jensen (LJ) medium-M. tuberculosisIndicator mediao Media contain an indicator which changes colour when a bacterium grows in them,o Examples:* Wilson and blair medium-S. typhi* Mcleod's medium (potassium tellurite)-C. diphtheriaeDifferential mediao A medium has substances which bring out different characteristics of bacteria and thus helping to distinguish between them.o Example - MacConkey's medium.RememberMacConkey's medium acts both as indicator and differential media.

So the answer to this question is A


Instruction:
Which antimalarial drug can be safely administered baby with gluc ose-6-phosphate dehydrogenase' deficiency:
A. Chloroquine
B. Quinine
C. Mefloquinine
D. Primaquine

Response:
Chloroquine

So the answer to this question is A


Instruction:
Through a peripheral line, max % of dextrose that can be given is?
A. 10%
B. 12.50%
C. 15%
D. 25%

Response:
Through a peripheral line, max % of dextrose that can be given is 12.5%. If a higher concentration of Dextrose needs to be given central vascular access is required. If more than 12.5% sugar is given through peripheral line then it can lead to superficial thrombophlebitis.

So the answer to this question is B


Instruction:
Which of the following is given in the form of an intralesional injection to treat keloid?
A. Heparin
B. Triamcinolone
C. Danazole
D. Hydrocoisone

Response:
The long acting steroid Triamcinalone is used for treating keloid. Other treatment modalities include laser, silicone sheets, cryotherapy, interferon, fluorouracil, radiation.

So the answer to this question is B


Instruction:
Myocardial isonzyme of CK which is specific for myocardial infarction is-
A. CK-BB
B. CK-MB
C. CK-MM
D. All of the above

Response:
Ref: R. Alagappan Manual for Medicine 4th Edition pg no:184 Cardiac Enzymes a. CPK-MB: This cardiac isoenzyme stas rising within 4-6 hrs after development of acute MI, peaks during the 2nd day (4 fold rise) and disappears in 2-3 days. Other causes of total CK elevation: 1. Skeletal diseases - Polymyositis, Muscle dys- trophy, Myopathies 2. Electrical cardioversion 3. Skeletal muscle damage - trauma, convulsions, immobilisation 4. Hypothyroidism 5. Stroke 6. Surgery b. AST: Stas rising on the 1st day, peaks in 2-3 days (3 fold rise) and disappears by 3rd day. c. LDH1: Stas rising by second day, peaks around 3- 4 days ( 3 fold rise) and disappears in 10 days. d. Troponin T: Cardiac troponin T is a regulatory contractile protein not normally found in blood. Its detection in the circulation has been shown to be a sensitive and specific marker for myocardial cell damage. Troponin T and I reach a reliable diagnostic level in plasma by 12-16 hrs, maximal activity by 24-32 hrs, returns to normal in 10-12 days. Troponin I : 0-0.4 ng/ml Troponin T: 0-0.1 ng/ml Cardiac troponins are detected in the serum by using monoclonal antibodies. These antibodies have negligible cross reactivity to skeletal muscle. Cardiac troponins I and T sta to rise within 3-4 hours after myocardial infarction and remain raised for 4-10 days

So the answer to this question is B


Instruction:
Which of the following drug is a selective COX-2 inhibitor?
A. Ketorolac
B. Etoricoxib
C. Piroxicam
D. Nimesulide

Response:
(Ref: Katzung 14th ed. P 323, 647)Non-steroidal anti-inflammatory drugs classificationSelective COX-2 Inhibitor (Coxibs)Non-selective COX-1 and 2 inhibitor* Celecoxib* Etoricoxib* Valdecoxib* Rofecoxib* Parecoxib* Indomethacin* Ibuprofen* Naproxen* Piroxicam* Aspirin* Ketoprofen

So the answer to this question is B


Instruction:
All of the following are indications for use of coicosteroids in SLE except;
A. Neuropsychiatric lupus
B. Pericarditis
C. Endocarditis
D. Nephritic syndrome

Response:
It has not been proven that glucocoicoid or other immunosuppressive therapies lead to improvement of lupus myocarditis or endocarditis If diffuse proliferative glomerulonephritis (DPGN) is inadequately treated, viually all patients develop ESRD within 2 years of diagnosis. Therefore, aggressive immunosuppression is indicated (usually systemic glucocoicoids plus another immunosuppressive drug), unless damage is irreversible. Neuropsychiatric systemic lupus erythematosus (NPSLE) It is a generic definition referring to a series of neurological and psychiatric symptoms directly related to systemic lupus erythematosus (SLE). In NPSLE patients, although coicosteroids are commonly used when NPSLE is thought to reflect an inflammatory process, this practice can only be substantiated by clinical experience.NP disturbances have been related to the use of glucocoicoids. For example, approximately 10% of patients treated with 1mg/kg/day or more of prednisone will have a glucocoicoid-induced psychiatric disease. Depression, hypomania, and ove psychosis are known glucocoicoid-induced psychiatric manifestations. Symptoms usually occur within 8weeks of initiation or augmentation of glucocoicoids and resolve completely in most cases through dose reduction, which may help in the differentiation with NPSLE The pericardial friction rub of pericarditis resolves with steroids

So the answer to this question is C


Instruction:
Which among the following is main component of intracellular fluid?
A. Sodium
B. Chloride
C. Magnesium
D. Bicarbonate

Response:
Cations like Potassium and Magnesium, Anions like phosphate and sulfate are main component of intracellular fluid.

So the answer to this question is C


Instruction:
A 50-year-old man sustained posterior dislocation of left hip in an accident. Dislocation was reduced after 3 days. He started complaining of pain in left hip after 6 months. X-ray of the pelvis were normal. The most relevant investigation at this stage will be-
A. CRP Levels in blood
B. Ultrasonography of hip
C. Arthrography of hip
D. MRI of hip

Response:
It is a case of avascular necrosis of the femoral head which is one of the late complications of posterior dislocation of the hip.
If the dislocation is reduced early, avascular necrosis develops in at least 10% of the cases of dislocation.
If reduction is delayed for more then few hours (as with this patient) the figure rise to 40%.
Pain is a common presentation of avascular necrosis of head.
X-ray of the patient is normal because in the early stages bones are usually normal.
The first X-ray signs probably appear only 6-9 months after the occurrence of bone death.
MRI shows characteristic changes in the marrow long before the appearance of X-ray signs.
Therefore MRI is the most reliable way of diagnosing marrow changes and bone ischaemia (Avascular necrosis) at a comparatively early stage.

So the answer to this question is D


Instruction:
Eustachian tube patency seen by -
A. Valsalva
B. Methylene blue test
C. Toyn bee test
D. All the above

Response:
Ans. is 'd' i.e., All the above Tests for Eustachian tube patencyValsalva testo Politzer testo Catheterizationo Methylene blue testo Toynbee testo Inflation-Deflation testo Sonotubometry'o Frenzel maneuver

So the answer to this question is D


Instruction:
Which one of the antitubercular drug may precipitate gout :
A. Pyrazinamide
B. Rifampicin
C. Streptomycin
D. Isoniazid

Response:
None

So the answer to this question is A


Instruction:
Mechanism of action of paclitaxel is :
A. Topoisomerase inhibition
B. Increases the polymerization of tubulin
C. Inhibits protein synthesis
D. Alkylation of DNA

Response:
Taxanes (paclitaxel and docetaxel) act by increasing the polymerization of tubulin whereas vinca alkaloids (vincristine, vinblastine and vinorelbine) cause inhibition of tubulin polymerization. Both of these drugs act by causing the disruption of mitosis and are active in M-phase of the cell cycle.

So the answer to this question is B


Instruction:
Contraindications for a breast conservative surgery include all except
A. Diffuse suspicious microcalcifications
B. Known genetic predisposition
C. Tumor > 5cm
D. Age > 50 years

Response:
Patients who desire breast-conserving surgery must be willing to attend postoperative radiation therapy sessions and to undergo postoperative surveillance of the treated breast. A significant factor in determining whether breast-conserving therapy is feasible is the relationship between tumor size and breast size. In general, the tumor must be small enough in relation to the breast size so that the tumor can be resected with adequate margins and acceptable cosmesisContraindications for BCT requiring radiation therapy include the following:Absolute:Radiation therapy during pregnancyDiffuse suspicious or malignant-appearing microcalcificationsWidespread disease that cannot be incorporated by local excision through a single incision that achieves negative margins with a satisfactory cosmetic resultPositive pathologic marginRelative:Active connective tissue disease involving the skin (especially scleroderma and lupus)Tumors >5 cmFocally positive marginWomen with a known or suspected genetic predisposition to breast cancer:May have an increased risk of ipsilateral breast recurrence or contralateral breast cancer with BCTProphylactic bilateral mastectomy for risk reduction may be consideredRef: Sabiston, 20e, page: 846

So the answer to this question is D


Instruction:
Which of the following is false about salmeterol: March 2010
A. Regular use may worsen asthma
B. First long acting selective beta-2 agonist
C. Effective for acute asthmatic attacks
D. More beta-2 selective agonist than salbutamol

Response:
Ans. C: Effective for acute asthmatic attacks Salmeterol is a first, long acting beta-adrenoceptor agonist (LABA), usually only prescribed for severe persistent asthma following previous treatment with a sho-acting beta agonist such as salbutamol. The primary noticeable difference of salmeterol to salbutamol is that the duration of action lasts approximately 12 hours in comparison with 4-6 hours of salbutamol. When used regularly every day as prescribed, inhaled salmeterol decreases the number and severity of asthma attacks. However, like all LABA medications, it is not for use for relieving an asthma attack that has already staed. Inhaled salmeterol works like other beta 2-agonists, causing bronchodilation by relaxing the smooth muscle in the airway so as to treat the exacerbation of asthma.

So the answer to this question is C


Instruction:
The late features of kernicterus include all except -
A. Hypotonia
B. Sensorineural hearing loss
C. Choreoathetosis
D. Upward gaze palsy

Response:
Ans. is 'a' i.e., Hypotonia Hypotonia is an early feature (in Phase I) Clinical features o Clinically, kernicterus is described in 3 phases, which may progress over 24 hours to 7 days :? 1. Phase I --> Poor suck, lethargy, hypotonia, depressed sensorium. 2. Phase II --> Fever, hypeonia progressing to opisthotonus. 3. Phase III --> High pitched cry, convulsions, death. 3 Long term survivors demonstrate choreoathetoid cerebral palsy, upward gaze palsy, sensorineural hearing loss and mental retardation.

So the answer to this question is A


Instruction:
Perception of ordinarily non noxious stimuli as pain, is better known as
A. Allodynia
B. Hyperalgesia
C. Hyperesthesia
D. Radiculopathy

Response:
None

So the answer to this question is A


Instruction:
Conservative surgery is not done in breast carcinoma if there is?
A. Lymph node metastasis
B. Sub-areolar lump
C. Lump of size 4 cms
D. Disease involving the lower quadrant only

Response:
ANSWER: (B) sub-areolar lumpREF: Harrison s principles of internal medicine 17th ed chapter 86Breast-conserving surgery is not suitable for all patients: it is not generally suitable for tumor> 5 cm (or for smaller tumors if the breast is small)For tumors invoking the nipple areola complex.For tumors with extensive intraductal disease involving multiple quadrants of the breastFor women with a history of collagen-vascular disease.Do not have convenient access to radiation therapy.Women who either do not have the motivation for breast conservation

So the answer to this question is B


Instruction:
Which of the following situations is more specific of a panic disorder.
A. Panic attack at a death funeral
B. Panic attack at an interview
C. Panic attack at an exam
D. Panic attack waking one from sleep

Response:
While panic attack can happen with or without reasons, the diagnosis of panic disorder is considered when there are denovo (without reason) panic attacks. The other impoant features of panic disorder are: Anticipatory anxiety With or without agoraphobia As per the choices, the nocturnal panic attack awakening the individual from sleep is characteristic of panic disorder, whereas the other choices are more contextual panicky symptoms.

So the answer to this question is D


Instruction:
The roof of the olfactory region is formed by?
A. Nasal hone
B. Cribriform plate of ethmoid
C. Sphenoid
D. Temporal bone

Response:
Roof of olfactory region of nasal cavity is formed by cribriform plate of ethmoid boneQ.Other bones paicipating in non- olfactory roof formation are body of sphenoid, frontal bone, nasal bone and nasal cailages.

So the answer to this question is B


Instruction:
Transducin is a protein found in:
A. Glomerulus
B. Retina
C. Skeletal muscle
D. Adrenal medulla

Response:
Retina REF: Ganong 22nd edition, chapter 8, http://en.wikipedia.org/wiki/Transducin Transducin (also called Gt) is a heterotrimeric G protein that is naturally expressed in veebrate retina rods and cones. Mechanism of action: Heterotrimeric Transducin (alpha-beta-gamma subunits) is activated by a conformational change in rhodopsin due to the absorption of a photon by rhodopsin's active group retinal. Activation causes the GDP bound to the alpha subunit to be exchanged with GTP from solution and results in activated alpha dissociating from beta-gamma. Active Transducin-alpha then causes cyclic GMP Phosphodiesterase to increase its activity, thereby lowering the concentration of cGMP, an intracellular second-messenger molecule. Decrease in cGMP concentration leads to the closure of cGMP-regulated Na+ and Ca2+ ion channels and a hyperpolarized membrane potential. This chain of signaling events is also called "the veebrate photo transduction cascade"

So the answer to this question is B


Instruction:
When solid gets wet completely, the contact angle is:
A. 90°
B. 0°
C. 0 — 90°
D. >90°

Response:
None

So the answer to this question is B


Instruction:
Which is the most common site for chronic gastric ulcer?
A. Lesser curvature at incisura
B. High on lesser curvature
C. Greater curvature
D. Pre-pyloric

Response:
Modified Johnson classification for gastric ulcers Type 1 Gastric ulcer is the most common type of gastric ulcer Type Location Acid level I Lesser curvature at incisura Low to normal II Gastric body with duodenal ulcer Increased III Prepyloric Increased IV High on lesser curvature Normal V Anywhere Normal, NSAID-induced Type II gastric ulcer has the maximum risk for malignancy.

So the answer to this question is A


Instruction:
Water is maximally reabsorbed in?
A. Collecting duct
B. Loop of Henle
C. Distal convoluted tubule
D. Proximal convoluted tubule

Response:
Ans. D Proximal convoluted tubuleRef: Ganong, 25th ed. pg. 680, 683About 2/3rd of filtered water is reabsorbed in the proximal convoluted tubule along with salt absorption. Other molecules absorbed here are bicarbonate, glucose, amino- acids and phosphate.

So the answer to this question is D


Instruction:
Which of the following tests are helpful in diagnosing neural tube defect?
A. Acetyl choline esterase in the amniotic fluid
B. Alpha-ketoglutarate in the amniotic fluid
C. Glutamate in the amniotic fluid
D. Beta hydroxyl butyrate in the amniotic fluid

Response:
Ans. (a) Acetyl choline esterase in the amniotic fluidRef.: Nelson 18th ed. / ch. 592* Failure of closure of the neural tube allows excretion of fetal substances (I+- - fetoprotein , acetylcholinesterase) into the amniotic fluid, serving as biochemical markers for a neural tube defect. Prenatal screening of maternal serum for AFP in the 16th to 18th wk of gestation is an effective method for identifying pregnancies at risk for fetuses with neural tube defects in utero.

So the answer to this question is A


Instruction:
Which of the following statements about cerebellar astrocytomas in pediatric age group is false
A. These are usually low grade tumors
B. These tumors have a good prognosis
C. These are more commonly seen in the 1st and 2nd decades
D. These tumors are more common in females

Response:
Cerebellar astrocytoma is a low grade tumours and have good prognosis and is most commonly seen in first and second decades . These tumours are most commonly seen in males. Reference: GHAI Essential pediatrics, 8th edition.

So the answer to this question is D


Instruction:
The number of vessels seen in the cut section of the umbilical cord are:
A. One
B. Four
C. Three
D. Two

Response:
Three

So the answer to this question is C


Instruction:
The most common malignant tumor of the eyelids is
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Melanoma
D. Adenocarcinoma

Response:
B i.e. Basal cell carcinoma

So the answer to this question is B


Instruction:
A 40-year old male is admitted with complaints of abdominal pain and headache. General physical examination revealed six scars on the abdomen from previous surgeries. He seems to maintain a sick role and seeks attention from the nurses. He demands multiple diagnostic tests including a liver biopsy. The treating team failed to diagnose any major physical illness in the patient. His mental status examination did not reveal any major psychopathology. One of the treating staff recognized him to have appeared in several other hospital with abdominal pain and some other vague complaints. He is most likely suffering from:
A. Schizophrenia
B. Malingering
C. Somatisation disorder
D. Factitious disorder

Response:
D i.e. Factitious disorder

So the answer to this question is D


Instruction:
Hea rate increase with one of the following?
A. Stimulation of trigeminal nerve pain receptor
B. Increased intracranial tension
C. Decreased stimulation of Baroreceptors
D. Increased parasympathetic stimulation

Response:
The baroreflex or baroreceptor reflex is one of the body's homeostatic mechanisms that help to maintain blood pressure at nearly constant levels. The baroreflex provides a rapid negative feedback loop in which an elevated blood pressure reflexively causes the hea rate to decrease and also causes blood pressure to decrease. Decreased blood pressure decreases baroreflex activation and causes hea rate to increase and to restore blood pressure levels. The baroreflex can begin to act in less than the duration of a cardiac cycle (fractions of a second) and thus baroreflex adjustments are key factors in dealing with postural hypotension, the tendency for blood pressure to decrease on standing due to gravity. The baroreceptors are stretch-sensitive mechanoreceptors. At low pressures, baroreceptors become inactive. When blood pressure rises, the carotid and aoic sinuses are distended fuher, resulting in increased stretch and, therefore, a greater degree of activation of the baroreceptors. At normal resting blood pressures, many baroreceptors are actively repoing blood pressure information and the baroreflex is actively modulating autonomic activity. Active baroreceptors fire action potentials ("spikes") more frequently. The greater the stretch the more rapidly baroreceptors fire action potentials. Many individual baroreceptors are inactive at normal resting pressures and only become activated when their stretch or pressure threshold is exceeded. Ref: guyton and hall textbook of medical physiology 12 edition page number:216,217,218

So the answer to this question is C


Instruction:
Water-fluid balance is characterized by -
A. Maintained by endogenous water loss
B. Maintained by endogenous water loss
C. Daily fecal loss is 500 ml.
D. Daily respiratory loss is 500 ml.

Response:
Water and electrolyte homeostasis Total body water (TBW) is approximately 60% of body weight in an adult male, although the propoion is somewhat more for infants and less for women. In a 70 kg man TBW is therefore about 40 L. Approximately 25 L is located inside cells (the intracellular fluid or ICF), while the remaining 15 L is in the extracellular fluid (ECF) compament (Fig. 14.1). Most of the ECF (approximately 12 L) is interstitial fluid, which is within the tissues but outside cells, whereas the remainder (about 3 L) is in the plasma compament. The ion composition between the main body fluid compaments intracellularly and extracellularly is illustrated in Figure 14.1. The dominant positively charged ion (cation) within cells is potassium, whereas phosphates and negatively charged proteins constitute the major intracellular negatively charged ions (anions). In the ECF the dominant cation is sodium, while chloride and, to a lesser extent, bicarbonate are the most impoant ECF anions. An impoant difference between the intravascular (plasma) and interstitial compaments of the ECF is that only plasma contains significant concentrations of protein. The major force maintaining the difference in cation concentrations between the ICF and ECF is the sodium-potassium pump (Na,K-activated adenosine triphosphatase (ATPase)), which is present in all cell membranes. Maintenance of these gradients is essential for many cell processes, including the excitability of conducting tissues such as nerve and muscle. The difference in protein content between the plasma and the interstitial fluid compament is maintained by the impermeability of the capillary wall to protein. This protein concentration gradient (the colloid osmotic, or oncotic, pressure of the plasma) contributes to the balance of forces across the capillary wall that our fluid retention within the plasma compament. The concentration of sodium in the ECF plays a pivotal role in determining plasma osmolality and thereby controlling intracellular volume through changes in water balance between the intracellular and extracellular space. In contrast, plasma volume is largely controlled by total body sodium, which determines volume change. Therefore, disturbances in water homeostasis typically present with biochemical abnormalities such as hyponatraemia or hypernatraemia, whereas disturbances in sodium homeostasis present with hypervolaemia or hypovolaemia as the result of expansion or contraction of ECF volume, respectively. Ref Davidson 23rd edition pg 349

So the answer to this question is B


Instruction:
Pterygium of nail is characteristically seen in –
A. Lichen planus
B. Psoriasis
C. Tinea unguium
D. Alopecia arcata

Response:
Pterygium is the prolongation of proximal nail fold on to the nail bed. Pterygium is diagnostic for Lichen planus.

So the answer to this question is A


Instruction:
All are involved in bilirubin metabolism except?
A. ALA synthase
B. Heme oxygenase
C. Biliverdine reductase
D. Glucuronyl transferase

Response:
Ans. is 'a' i.e., ALA synthase

So the answer to this question is A


Instruction:
Transaminase is increased in:
A. Hepatitis A
B. Subacute bacterial endocarditis
C. Myocardial infarction
D. Jaundice

Response:
None

So the answer to this question is C


Instruction:
All of the following are seen in Rickets except -
A. Bow legs
B. Gunstock deformity
C. Pot belly
D. Craniotabes

Response:
Ans. is 'b' i.e., Gustock deformityo Gunstock deformity is seen in malunited supracondylar fracture of humerus.Note ?o Dont get confuse between option 'a' and answer of previous question. In this question the age of the child has not been mentioned. Bow legs can occur, once the child stas walking.

So the answer to this question is B


Instruction:
Lesion of facial nerve at level of stylomastoid foramen leads to:
A. a)Loss of taste sensation from Ant. 2/3 of tongue
B. Paralysis of orbicularis oculi muscle
C. Loss of innervation to stapedius
D. Loss of Lacrimal secretion

Response:
Involvement of "chordatympanic nerve" near its point of origin in the facial canal is accompanied by paralysis of motor, gustatory and autonomic functions of nerve.
Involvement of nerve after the level of stylomastoid foramen (Eg: sarcoidosis of parotid, melkerson rosenthal syndrome) results in paralysis of facial muscles without dysguesia.

So the answer to this question is B


Instruction:
Normal Beat to beat variability in an NST on a term fetus is ?
A. 25-Jun
B. 5-Jan
C. >25
D. any variability which is above 110 baseline is normal

Response:
Beat-to-Beat Variability - - Fetal hea variability is divided into four types: 1. Absent : Undetectable change in amplitude 2. Minimal: <= 5 bpm in range 3. Moderate : 6-25 bpm 4. High: > 25 bpm

So the answer to this question is A


Instruction:
Morbid jealousy is associated with
A. alcohol
B. heroun
C. cannabis
D. LSD

Response:
* JEALOUS TYPE of delusional disorder o ALSO KNOWN AS Conjugal paranoia * Othello syndrome * Marked jealousy * Pathological jealousy * Morbid jealousy o It is more common among alcoholic males ,the possible explanation that is given is alcoholic males have sexual dysfunction and that these women may sta suspecting their spouses. REf.Kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg No.330

So the answer to this question is A


Instruction:
All of the following are advantages of using raloxifene over estrogen in post-menopausal women EXCEPT:
A. Reduces fracture rates
B. Avoids endometrial hyperplasia
C. Reduces incidence of venous thrombosis
D. No increase in incidence of breast carcinoma

Response:
None

So the answer to this question is C


Instruction:
Which of the following are included in Malaria Vector Indices in pre-eradication era ? a)Spleen ratio b)Human blood index c) Slide positivity rate d)Parasite density index
A. 1,3
B. 1,4
C. 1, 2, 3
D. 4,3,1

Response:
Malaria vector indices are divided into 3 groups. 1.Pre-eradication era 2.Eradication ERA 3. Malaria vector indices Spleen ratio AV. Enlarged spleen Parasite rate Parasite density index IPR PCR API ABER AFI SPR SFR Human blood index Sporozoite rate Mosquito Density Biting density Inoculation rate

So the answer to this question is B


Instruction:
Which of the following disease show centrifugal spread of rash
A. Dengue
B. Small pox
C. Rocky mountain fever
D. Erythema multifotme

Response:
Description of rashes Deep seated All rashes in an area appeared in one stage, evolution was slow scentrifugal distribution - palm and sole and extensor surface were affected first. Fever subsided with appearance of rash. Ref: essentials of Medical microbiology apurba sastry 1st edition

So the answer to this question is B


Instruction:
The commonest site of otosclerosis is -
A. Round window
B. Utricle
C. Ossicles
D. Oval window

Response:
Ans. is 'd' i.e., Oval window o The most common site of disease is promontory in the region of the anterior margin of oval window, and inadvanced cases the stapes become ankylosed in position by a mass of new spongy bone.Why is it so# This area is involved most commonly because in this area is located the fissula ante fenestram, a vestigial structure which frequently contains cartilaginous remnants and which is particularly prone to otosclerotic changes.o Most common type of otosclerosis - Stapedial otosclerosiso Most common site of otosclerosis - Fissula ante fenestram (i.e, just in front of oval window)o Most common site for stapedial otosclerosis - Fissula ante fenestram (i.e, just in front of oval window)o Most common site for cochlear otosclerosis - Round window

So the answer to this question is D


Instruction:
Achalasia cardia
A. Absence of nerves
B. Absence of muscles
C. Hyperophy of nerves
D. Hyperophy of muscles

Response:
Achalasia of the oesophagus is a neuromuscular dysfunction due to which the cardiac sphincter fails to relax during swallowing and results in progressive dysphagia and dilatation of the oesophagus (mega-oesophagus). etiology. There is loss of intramural neurons in the wall of the oesophagus. Most cases are of primary idiopathic achalasia which may be congenital. Secondary achalasia may occur from some other causes which include: Chagas' disease (an epidemic parasitosis with Trypanosoma cruzi), infiltration into the oesophagus by gastric carcinoma or lymphoma, ceain viral infections, and neurodegenerative diseases. TEXTBOOK OF PATHOLOGY HARSH MOHAN 6TH EDITION PAGE NO:538

So the answer to this question is A


Instruction:
The conduction velocity of C fibers is about: M/second
A. 2
B. 5
C. 10
D. All

Response:
The conduction velocity of c type nerve fibers is about 2 M/second They are non myelinated and has least diameter Ref:Guyton and Hall textbook of medical physiology 12th edition,page number,: 73

So the answer to this question is A


Instruction:
A female having 6 weeks amenorrhea presents with ovarian cyst. The proper management is:
A. Immediate ovariotomy
B. Ovariotomy at IInd trimester
C. Ovariotomy 24 hours after delivery
D. Ovariotomy with cesarean

Response:
None

So the answer to this question is B


Instruction:
In a normal curve, the area of one standard deviation around the mean includes which of the following per cent of values in a distribution -
A. 0.486
B. 0.683
C. 0.954
D. 0.997

Response:
None

So the answer to this question is B


Instruction:
In asymmetrical IUGR which organ is not affected?
A. Subcutaneous fat
B. Muscle
C. Liver
D. Brain

Response:
In asymmetric IUGR, brain growth (head circumference) - spared

So the answer to this question is D


Instruction:
80 year old, asymptomatic man present with a Total Leucocyte Count of 1 lakh, with 80degA lymphocytes and 20% PMC's. What is the most probable diagnosis?
A. HIV
B. CML
C. CLL
D. TB

Response:
Answer is C (CLL) Incidental finding of Lymphocytosis (80,000/mcL) in an elderly and asymptomatic patient suggests the diagnosis of CLL. Why is CLL the single best answer of choice here ? 'CLL is a disease of older patients wth 90% of cases occurring after the age of 50 years and median age of presentation is 65 years'. - CMDT The patient in question is aged 80 years and hence falls in the bracket of CLL. 'Typical B cell CLL is often fbund incidentally when a complete blood count is done for another reason'. -Harrison 16th / 648 The patient in question is asymptomatic and the findings represent incidental observation on a full blood count done for an obscure reason. 'The hallmark of CLL is absolute lymphocytosis. White cell count is usually greater than 20,000/mcL may be markedly elevated to several 100,000/mcL. Usually 75-80% of circulating cells are lymphocytes'. - CMDT The patient in question is presenting with a white cell count of 100,000/mcL and 80% of circulating cells are lymphocytes. This finding is consistent with the blood picture of CLL.

So the answer to this question is C


Instruction:
Most common carcinoma in female worldwide
A. Breast
B. Cervix
C. Lung
D. Uterus

Response:
Global cancer incidence in women Breast cancer was the most common cancer in women worldwide, contributing 25.4% of the total number of new cases diagnosed in 2018. The top three - breast, colorectal and lung cancers - contributed 43.9% of all cancers (excluding non-melanoma skin cancer). Cervical cancer was the fouh most common cancer in women, contributing 6.9% of the total number of new cases diagnosed in 2018. Ref: src=" alt="" width="200" height="314" />

So the answer to this question is A


Instruction:
Anterolateral avulsion fracture of the distal tibial physis is known as
A. Potts fracture
B. Tillaux fracture
C. Chopa fracture
D. Jones fracture

Response:
Tillaux fracturesFracture occurring in older adolescentsMechanism of injury is an external rotation force with stress placed on the anterior tibiofibular ligament, causing avulsing of the distal tibial physis anterolaterallyIt occurs after the medial pa of the physis has closed but before the lateral pa closesIt is either Salter-Harris type III or IV fracture(Refer: Mohindra's Fundamentals of Ohopedics, 2nd edition, pg no. 496)

So the answer to this question is B


Instruction:
Type IV hypersensitivity reaction is mediated by which of following?
A. B cells
B. Active T cells
C. NK cells
D. Plasma cells

Response:
Ans. b (Active T cells). (Ref. Textbook of Microbiology by Anantanarayan, 6th/l 55)HYPERSENSITIVITY REACTIONSHypersensitivity Reaction typePrototypeImmune MechanismsImmediate (type I)AllergiesAnaphylaxisBronchial asthmaCasoni's test (JK'09)Production of IgE antibodyAntibody mediated/ CYTOTOXIC (type II)Autoimmune hemolytic anemia; GBSProduction of IgG, IgM absImmune complex mediated (type III)Autoimmune diseases (SLE, RA, etc),Some bacterial, viral and parasitic infections (e.g. PSGN, Hepatitis B, malaria, etc), Disseminated malignancies,Serum sickness, Arthus reaction(Necrotizing vasculitis).Deposition of ag-ab complexes and complement activationCell-mediated (type IV)Contact dermatitisMultiple sclerosisType-1 DM,TB,Transplant rejectionActivated T-Lymphocytes Macrophage activation T-cell mediated cytotoxicity.Type VGrave's diseaseLATS

So the answer to this question is B


Instruction:
A blow out fracture of orbit refers to a fracture in:
A. Roof of the orbit
B. Posterior wall of floor of orbit
C. Medial wall of orbit
D. Medial pa of floor of orbit

Response:
Medial pa of floor of orbit

So the answer to this question is D


Instruction:
1996 ASRM classification of endometritis includes-
A. Intensity of pain
B. Location
C. Size
D. Number

Response:
Ans. is 'b' i.e., Location "Endometriosis is classified into one of four stages (I-minimal, II-mild, Ill-moderate, and IV-severe) depending on location, extent, and depth of endometriosis implants; presence and severity of adhesions; and presence and size of ovarian endometriomas. Most women have minimal or mild endometriosis, which is characterized by superficial implants and mild adhesions. Moderate and severe endometriosis is characterized by chocolate cysts and more severe adhesions. The stage of endometriosis does not correlate with the presence of or severity of symptoms; with stage IV endometriosis, infertility is very likely."

So the answer to this question is B


Instruction:
Which among the following malignancy is MOST SENSITIVE to radiotherapy?
A. Serous cystadenoma
B. Dysgerminoma
C. Mucinous cystadenoma
D. Teratoma

Response:
Ans. B. DysgerminomaNormally, dysgerminomas are unilateral. They are considered to be the most common kind of germ cellular tumor found in patients suffering with gonadal dysgenesis. They are highly radiosensitive and chemo-sensitive.Serous cystadenoma: The most common epithelial cell neoplasm. About 70% of these tumors are benign. The treatment of choice in such cases is surgery.Mucinous cystadenoma: Considered to be the second most common epithelial cell tumor of the ovary. Again, surgery being the treatment of choice.Cystic teratoma: Comprises about 60% of all benign ovarian neoplasms and 10-25% of all ovarian neoplasms. Surgical excision is the treatment of choice in such cases.

So the answer to this question is B


Instruction:
True about gap junctions are all, except -
A. Transmit electric signals
B. Allow ions to pass
C. Intercellular space 1000 nm
D. Seen in cardiac muscle

Response:
Ans. is 'c' i.e., Intercellular space 1000 nm o Gap junctions are intercellular connections consist of a pair of hemichannels (connexons) inserted into the membrane of adjacent cells.o Each connexone is made of six identical protein subunits called connexins which enclose a central channel,o When the corresponding connexons of adjacent cell link up end-to-end, they form a continuous channel that permits substances to pass through from cell to cell.o At gap junctions, the intercellular space narrows down to 3nm, thereby helping in binding the cells together.o However, their real physiological significance lies in allowing ions to flow through them, i.e., they conduct ionic current.o This enables electrical excitation to spread from cell to cell, as in smooth and cardiac muscles.o The pore size of gap junctions decreases when intracellular Ca++ is high or pH is low, both of which are commonly associated with cell damage. Closure of gap junctions in response to these stimuli isolates damaged cells so that the Ca+2 and H" do not spread from the damaged to normal cells.

So the answer to this question is C


Instruction:
Which of the following investigation is preferred for diagnosis of vesicoureteric reflux:
A. Intravenous urography
B. Micturating cystourethrogram
C. Retrograde pyelography
D. Ultrasonography

Response:
Ans. (b) Micturating cystourethrogramRef: SRB Manual of Surgery 4th ed. /1118Steps in MCU# Catheterization to fill the bladder with a radio- contrast agent, typically cystografin.# Under fluoroscopy, we can see the contrast entering the bladder.# If the contrast moves into the ureters and back into the kidneys, the radiologist makes the diagnosis of vesicoureteral reflux.Indication of MCU* All males with recurrent UTIs, or abnormality on ultrasound if first UTI urinary tract infection* First episode UTI in females < 3 years of age* Febrile UTIs in females < 5 years of age* Older females with pyelonephritis or recurrent UTIs* Suspected obstruction (e.g. Bilateral hydronephrosis)* Suspected bladder trauma or rupture* Stress incontinence (urine)

So the answer to this question is B


Instruction:
Gissane's angle in the intraaicular fracture of Calcaneum-
A. Reduced
B. Increased
C. Not changed
D. Variable

Response:
*Bohler's angle is reduced in intra-aicular calcaneal fracture. *Crucial angle of Gissane is increased in intra-aicular calcaneum fractures. Ref : Ebnezar 4th ed pg.293

So the answer to this question is B


Instruction:
A green-stick fracture is: TN 06; UPSC 07; BHU 09; NIMHANS 10
A. Seen mostly in the elderly
B. Fatigue fracture
C. Spiral fracture of long bone
D. Pa of coex is intact and pa is crumpled

Response:
Ans. Pa of coex is intact and pa is crumpled

So the answer to this question is D


Instruction:
Trendelenberg sign is positive in paralysis of all except:
A. Gluteus medius
B. Gluteus minimus
C. Gluteus maximus
D. Tensor facia lata

Response:
C i.e. Gluteus maximusGluteus medius and gluteus minimus muscles are dominantly (mainly) supplied by superior gluteal aery(deep branch); and gluteus maximus by inferior gluteal aery.The aeries of gluteal region arise directly or indirectly, from internal iliac aery. The main branches include 1) superior gluteal 2) inferior gluteal and 3) internal pudendal aery. Superior gluteal aery is the largest branch and supplies most of gluteus medius & minimus and superior pa of TFL (by deep branch) and 1/3,d of gluteus maximus (by superficial branch). Whereas the inferior gluteal aery supplies most (2/3n9 of the gluteus maximus.Abductors of hip are - 'Sho Tense Middle class Men' i.e. Saorius , Tensor fascia lata (both are accessory); Medius gluteus , Minimums gluteus (both are main abductors) and trendelenburg test is positive in defective abductor mechanism In paralysis of gluteus medius & minimus (i.e. injury to superior gluteal nerve) trendelenburg sign is positive not in paralysis of gluteus maximus (i.e. inferior gluteal nerve)Q

So the answer to this question is C


Instruction:
Fatty liver is due to excessive accumulation of
A. Triacylglycerols
B. Phospholipids
C. Cholesterol
D. Free fatty acids

Response:
Imbalance in the rate of Triacylglycerol Formation & Expo Causes Fatty Liver For a variety of reasons, lipid--mainly as triacylglycerol--can accumulate in the liver. Extensive accumulation is regarded as a pathologic condition. Nonalcoholic fatty liver disease (NAFLD) is the most common liver disorder worldwide. When the accumulation of lipid in the liver becomes chronic, inflammatory and fibrotic changes may develop leading to nonalcoholic steatohepatitis (NASH), which can progress to liver diseases including cirrhosis, hepatocarcinoma, and liver failure. Reference: Harper; 30th edition; Page no: 260

So the answer to this question is A


Instruction:
Segment IV of liver corresponds to
A. Caudate Lobe
B. Quadrate Lobe
C. Left lateral superior
D. Left lateral inferior

Response:
Segment 1 - Caudate Lobe.
Segment IV - Quadrate Lobe.

So the answer to this question is B


Instruction:
Common site of regional enteritis is –
A. Colon
B. Rectum
C. Distal ileum and colon
D. Caecum

Response:
Crohn disease (Terminal ileitis or regional enteritis)

Crohn disease (CD) is an inflammatory bowel disease (IBD) which is characterized by -

Sharply delimited and typically transmural involvement of the bowel by an inflammatory process with mucosal damage.
The presence of non-caseating granulomas.
Fissuring with the formation of a fistula.

Any portion of intestine can be involved but most commonly small intestine is involved.

Small intestine  → 40%
Small intestine + colon  → 30%
Colon → 30%

So the answer to this question is C


Instruction:
A female presents with symptoms and signs suggestive of meningitis. MRI reveals a ring enhancing lesion in the frontotemporal region while CSF grows Gram positive bacilli. Other findings are minimally abnormal. Which of the following organisms is the most likely etiological agent ?
A. Listeria monocytogenes
B. Hemophilus influenza
C. Pneumococcus
D. Staphylococcal aureus

Response:
Ans. is 'a' i.e., Listeria monocytogenes . Amongst the given options only Listeria is Gram positive bacilli. - Listeria monocytogenes --> Gram positive bacilli - H. influnzae --> Gram negative bacilli - Pneumococcus, Staphylococcus aureus --> Gram positive cocci . MRI feature of ring enhancing lesion with other findings are minimally abnormal also suggests the diagnosis of Listeria monocytogenes. " The subacute course and often minimally abnormal CSF findings may delay the diagnosis which may be suggested by the MRI images showing a' ring enhancing lesion 'after gadolinium contrast. "-

So the answer to this question is A


Instruction:
Requirement of calcium in pregnancy is (in mg/ day): March 2013 (d, e, h)
A. 600
B. 800
C. 1000
D. 1200

Response:
Ans. D i.e. 1200 The current RDA for calcium intake during pregnancy and lactation is 1,200 mg/day.

So the answer to this question is D


Instruction:
NADH CoQ reductase is inhibited by -
A. Rotenone
B. Carbonmonoxide
C. Antimycin
D. Atractyloside

Response:
Ans. is 'a' i.e., Rotenone o Rotenone inhibits complex I (NADH-CoQ reductase).Inhibitors of electron transport chain-o Inhibitors of respiratory chain may be divided into three groups : -Inhibitors of electron transport chain properThese inhibitors inhibit the flow of electrons through the respiratory chain. This occurs at following sites.Complex I (NADH to CoQ) is inhibited by: - Barbiturates (amobarbital), Piericidin A (an antibiotic), rotenone (an insectiside), chlorpromazine (a tranquilizer), and guanethidine (an antihypertensive). These inhibitors block the transfer of reducing equivalents from FeS protein to CoQ.Complex II is inhibited by : - Carboxin and TTFA inhibit transfer of electon from FADH2 to CoQ, whereas malanate competitively inhibit from succinate to complex II.Complex III (Cytochrome b to cytochrome Cl) is inhibited by : - Dimercaprol, antimycin A, BAL (British anti lewisite), Naphthyloquinone. These inhibitors block the transfer of electrons from cytochrome b to cytochrome C i.Complex IV (cytochrome C oxidase) is inhibited by : - Carbon monoxide, CN-, ITS and azide (N3). These inhibitors block the transfer of electrons from cytochrome aa3 to molecular oxygen and therefore can totally arrest cellular respiration.Inhibitors of oxidative phosphorylationThese compounds directly inhibit phosphorylation of ADP to .ATP. Oligomycin inhibits Fo component of F0F1 ATPase. Atractiloside inhibits translocase, a transport protein that transports ADP into mitochondria for phosphorylation into ATP.UncouplesAs the name suggests, these componds block the coupeling of oxidation with phosphorylation. These compounds allow the transfer of reducing equivalents in respiratory chain but prevent the phosphorylation of ADP to ATP by uncoupling the linkage between ETC and phosphorylation. Thus the energy instead of being trapped by phosphory lation is dissipated as heat. Uncouplers may be :- Natural :-Thermogenin, thyroxineSynthetic :- 2, 4-dinitrophenol (2, 4-DNP), 2, 4-dinitrocresol (2, 4-DNC), and CCCP (chlorocarbonylcyanidephenyl hydrazone).

So the answer to this question is A


Instruction:
Mild head injury is having Glasgow coma scale of ?
A. 5-Mar
B. 8-May
C. 10-Aug
D. 15-Oct

Response:
Ans. is 'd' i.e., 10-15

So the answer to this question is D


Instruction:
The broad beta disease is due to defect in
A. Apo A
B. Apo B
C. Apo C
D. Apo E

Response:
Name Defect Remarks Familial type III hyperlipoproteinemia (broad beta disease, remnant removal disease, familial dysbetalipoproteinemia Deficiency in remnant clearance by the liver is due to the abnormality in Apo E. Patients lack isoforms E3 and E4 and have only E2, which does not react with the E receptor Increase in chylomicron and VLDL remnants of density <1.019 (b-VLDL). Causes hypercholesterolemia, xanthomas, and atherosclerosis Reference: Harper; 30th edition; Page no: 275

So the answer to this question is D


Instruction:
Maximum water reabsorption in the Gastrointestinal tract occurs in:
A. Stomach
B. Jejunum
C. Ileum
D. Colon

Response:
B i.e. Jejunum

So the answer to this question is B


Instruction:
Which one of the following drugs is an antipeudomonal penicillin ?
A. Cephalexin
B. Cloxacillin
C. Piperacillin
D. Dicloxacillin

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

So the answer to this question is C


Instruction:
A 20-yrs-old man suffers an injury to the posterior urethra. After appropriate initial management and follow-up care of this injury, the most likely late complication is:
A. Ascending urinary tract infection
B. Retrograde ejaculation
C. Sterility
D. Urethral stricture

Response:
Initial management involves passage of catheters through the urethral meatus and through an incision in the bladder.
After this has been accomplished, a Foley catheter is threaded through the urethra into the bladder and left in situ. Urethral healing occurs as the hematoma resolves, but a posterior urethral stricture is not uncommon. If the stricture is not managed appropriately, ascending urinary tract infection may result.

So the answer to this question is D


Instruction:
Hallucinations experienced outside the sensory field limit are called.
A. Extracampine Hallucination
B. Kinesthetic Hallucination
C. Reflex Hallucination
D. Functional Hallucination

Response:
Ans. A. Extracampine hallucinationExtracampine hallucinations: Patient has hallucination that is outside the limits of sensory field.For eg1. Patient sees somebody standing behind them when they are looking straight ahead2. Hear voices talking in Russia when they are in New Delhi.

So the answer to this question is A


Instruction:
Cutting of the pituitary stalk decreases all of the following hormones except -
A. ACTH
B. GH
C. Prolactin
D. FSH

Response:
None

So the answer to this question is C


Instruction:
Which is a non selective shunt
A. DSRS
B. Inokuchi shunt
C. 12mm Interpostion shunt
D. 8mm Interpostion shunt

Response:
Types of Poosystemic shunt Non-selective Dive all poal flow away from the lliver End - to- end or side - to-side anastomosis >11 mm Side-to-side shunts decompress varices and decompress the obstructed sinusoids, allete ascites Selective Only decompress the gastroesophageal and splenic segments Distal splenorenal shunt(Warren shunt) Inokuchi shunt consists of Interpostion of a vein graft between the left gastric or coronary vein and IVC Paial Only dives pa of poal venous flow Side-to-side anastomosis <10mm diameter Ref: Sabiston 20th edition Pgno : 1444

So the answer to this question is C


Instruction:
'Train of four' is characteristically used in concern with
A. Malignant hypehermia
B. Non-depolarizing neuromuscular blockers
C. Mechanical ventilation
D. To check hemodynamic parameters

Response:
Train-of-four stimulation devotes four successive 200 - ms stimuli in 2 s (2 Hz). The twitches in a train-of-four pattern progressively fade as relaxation increases. The ratio of the responses to the first and fouh twitches is a sensitive indicator of nondepolarizing muscle paralysis. Disappearance of the fouh twitch represents a 75% block, the third twitch an 80% block, and the second twitch a 90% block. Clinical relaxation usually requires 75-95% neuromuscular blockade. Ref: KD Tripathi 8th ed.

So the answer to this question is B


Instruction:
Which one of the following is Autosomal recessive
A. Homocystinuria
B. G6PD deficiency
C. Myotonic dystrophy
D. Otospongiosis

Response:
Answer is A (Homocystinuria) : Homocystinuria is inherited as an autosomal recessive disorder. Disorder Inheritance G-6 PD deficiency X-Linked Myotonic dystrophy Autosomal dominant Otospongiosis Autosomal dominant

So the answer to this question is A


Instruction:
The organism causing Early-onset neonatal septicemia
A. Streptococcus agalactiae
B. Streptococcus bovis
C. Streptococcus pyogenes
D. Streptococcus viridans

Response:
Early-onset sepsis(less than 72 hrs) is caused by organisms prevalent in the maternal genital tract or in the delivery area. The microorganisms most commonly associated with early-onset infection include the following: Group B Streptococcus (GBS)- Streptococcus agalactiae, Escherichia coli, Coagulase-negative Staphylococcus, Haemophilus influenzae, Listeria monocytogenes.
Late-onset sepsis(72hrs or later) is caused by organisms thriving in the external environment of the home or the hospital. Organisms that have been implicated in causing late-onset sepsis include the following: Coagulase-negative Staphylococcus, Staphylococcus aureus, E coli, Klebsiella, Pseudomonas, Enterobacter, Candida, GBS, Serratia, Acinetobacter, Anaerobes

So the answer to this question is A


Instruction:
True about rickets:
A. Hyperphosphatemia
B. Hypophosphatemia
C. Hypophosphaturia
D. Decreased alkaline phosphatase

Response:
Answer : B.) Hypophosphatemia. Rickets Failure of osteoid calcification (rickets) in children is because of a disruption in the pathway of either vitamin D or phosphate metabolism. Types of rickets include the following: Nutritional rickets Congenital rickets Rickets of prematurity Vitamin D resistance (type I and type II) Neoplastic rickets Hypophosphatemic rickets Drug-induced rickets. Low phosphate and high alkaline phosphatase levels characterize most of the disorders

So the answer to this question is B


Instruction:
A 36 year old woman has noticed, absence of menses for the last 4 months. A pregnancy test is negative. Serum levels of luteinizing hormone and follicle stimulating hormone are elevated and the serum estradiol levels is low. These findings suggest :
A. Bilateral tubal obstruction
B. Polycystic ovarian disease
C. Premature menopause
D. Exogenous estrogen administration

Response:
Premature menopause

So the answer to this question is C


Instruction:
Mental retardation is diagnosed if. (Intelligence quotient) is less than
A. 90
B. 80
C. 70
D. 60

Response:
70

So the answer to this question is C


Instruction:
Abnormality in Renal tubular acidosis with rickets is:
A. Loss of HCO3
B. Loss of Ca2+
C. Loss of K+
D. All of above

Response:
Rickets is mainly seen in Distal Renal tubular acidosis, where, Acidosis is due to loss of Bicarbonate. There is also hypokalemia due to Potassium loss, along with hypocalcemia.

So the answer to this question is D


Instruction:
Liquefactive necrosis is seen in:
A. Hea
B. Brain
C. Lungs
D. Spleen

Response:
Brain is most common organ to go into liquifactive necrosis due to more amount of soft tissue. REF: ROBBINS pathology 10th edition

So the answer to this question is B


Instruction:
Congenital rubella syndrome may cause all the following
except:
A. Patent ductus arteriosus
B. Spontaneous abortion
C. Sensory nerve deafness
D. None of the above

Response:
None

So the answer to this question is D


Instruction:
Darlings disease is
A. Histoplasmosis
B. Phycomycosis
C. Actinomycosis
D. Bleomycosis

Response:
None

So the answer to this question is A


Instruction:
A patient presented with uveitis with raised intraocular pressure (secondary glaucoma). Drug used is: March 2004
A. 1% pilocarpine
B. 1% atropine
C. Timolol
D. Acetazolamide

Response:
Ans. B i.e. 1% atropine

So the answer to this question is B


Instruction:
Which of the following is NOT related to root of penis: March 2013 (h)
A. Ischiocavernous
B. Bulbospongisus
C. Corpora spongiosum
D. Crus penis

Response:
Ans. C i.e. Corpora spongiosum

So the answer to this question is C


Instruction:
Which of the following is true about Criggler Najar type 1?
A. Less severe than type 2
B. Phenobarbitone improves bilirubin by 25%
C. Bile is colourless
D. Phototherapy is main stay of treatment

Response:
Impaired bilirubin conjugation occurs in three genetic conditions: Crigler-Najjar syndrome types I and II and Gilbe's syndrome. Crigler-Najjar type I is an exceptionally rare condition found in neonates and characterized by severe jaundice (bilirubin >342 mmol/L ) and neurologic impairment due to kernicterus, frequently leading to death in infancy or childhood.These patients have a complete absence of bilirubin UDPGT activity and are totally unable to conjugate bilirubin, and hence cannot excrete it.Crigler-Najjar type II is somewhat more common than type I. Patients live into adulthood with serum bilirubin levels of 103-428 mmol/L (6-25 mg/dL).In these patients, mutations in the bilirubin UDPGT gene cause the reduction--but not the complete eradication--of the enzyme's activity. Bilirubin UDPGT activity can be induced by the administration of phenobarbital, which can reduce serum bilirubin levels in these patients.Ref: Harrison; 19th edition; Page no: 282

So the answer to this question is C


Instruction:
Drug used for the management of ectopic pregnancy:
A. Methotrexate
B. Mifepristone
C. Procarbazine
D. Cytosine arabinoside

Response:
Ans: a (Methotrexate) Ref: Shaw, 13th ed. p. 258Drugs used - Methotrexate. KC1, hyperosmolar glucose, Ru - 486, PGF,oc and Actinomycin D.Indication for Methotrexate in ectopic pregnancy:(1) Patient haemodynamically stable(2) Tubal diameter < 4 cm without cardiac activities(3) Beta-HCG level < 10,000SurgeryLinear salpingostomyLineal- salpingotomySalpingectomyMilking of tubeMedical management and drugs used in gynaecologial conditions is an often asked question. Go through the list given below.Endometriosis:To decrease vascularity of fibroid:OCPsMifepristoneProgesteroneProgesteroneDanazolDanazolGnRH analoguesGnRH analoguesLetrazole PCOD:DUB:Clomiphene citrateCyproterone acetateOCPsGnRH analoguesDexamethasone and prednisoloneMetforminOCPsProgesteroneMDPADanazolIUCDs - Mirena, progestasertEthamsylateAntifibrinolytics - EACAGnRH analoguesNSAIDsEmergency contraception:DrugsDoseShould be usedFailure rateEstrogen1 mg x 5daysWith in 72 hrs1.5 %Levonorgestrel2 tabs 12 hrs apartWith in 120 hrs(5 days)1.1%Mifepristone600 mg single doseWith in 72 hrs0.9%Centchroman2 tabs twice in 24 hrsWith in 24 hrs1%IUCD-With in 5 days0.1%Danazol400 mg b.d x 5 days 2.5%

So the answer to this question is A


Instruction:
Which of the following enzymes found in the liver is involved in gluconeogenesis during the postabsorptive state?
A. Glucose-6-phosphate dehydrogenase
B. 6-phosphogluconate dehydrogenase
C. Glucose-6-phosphatase
D. Glucokinase

Response:
Glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase are irreversible enzymes in the pentose phosphate pathway. Glucokinase is involved with phosphorylation of glucose when hepatic concentrations of glucose are high. Glucose-6-phosphatase hydrolyzes glucose-6-phosphate to form free glucose as the final step in gluconeogenesis.

So the answer to this question is C


Instruction:
Most common infections after splenectomy are
A. Capsulated bacteria
B. Uncapsulated bacteria
C. Gram positive sepsis
D. Gram negative bacteria

Response:
Oppounist post-splenectomy infection is caused by capsulated bacteria.Post-splenectomy septicaemia may result from Streptococcus pneumoniae, Neisseria meningitides, Haemophilus influenzae and Escherichia coli.Bailey and love 26th edition pg: 1096

So the answer to this question is A


Instruction:
What is the COMMONEST complication of CSOM?
A. Subperiosteal abscess
B. Mastoiditis
C. Brain abscess
D. Meningitis

Response:
Mastoiditis is the most common complication of CSOM. Acute mastoiditis usually accompanies or follows acute suppurative otitis media. Complications of otitis media are classified into two main groups: A.Intratemporal: Mastoiditis Petrositis Facial paralysis Labyrinthitis B.Intracranial: Extradural abscess Subdural abscess Meningitis Brain abscess Lateral sinus thrombophlebitis

So the answer to this question is B


Instruction:
A loss which occur due to an error in judgement or carelessness or caution over duty of doctor is dealt under
A. Criminal negligence
B. Civil negligence
C. Contributory negligence
D. Corporate negligence

Response:
(A) Criminal negligence # CRIMINAL NEGLIGENCE may arise:> When a doctor shows gross absence of skill or care during treatment resulting in serious injury to or death of the patient, by acts of omission or commission.> When a doctor performs an illegal act.> When an assaulted person dies, the defence may attribute the death to the negligence or undue interference in the treatment of the deceased by the doctor.> Defences against Negligence: No duty owed to the plaintiff. Duty discharged according to prevailing standards. Misadventure Error of judgement Contributory negligence Res judicata (S. 300, Cr. P.C). If a question of negligence against a doctor has already been decided by a Court in a dispute between the doctor and his patient, the patient will not be allowed to contest the same question in another proceeding between himself and the doctor.> Limitation: A suit for damages for negligence against the doctor should be filed within two years from the date of alleged negligence. A suit filed after two years will be dismissed as being beyond the period of limitation.

So the answer to this question is A


Instruction:
The most ideal explanation for recurrence of odontogenic keratocyst is
A. Increased mitotic activity of the epithelial lining
B. Friability of the epithelial lining
C. Presence of satellite cysts or daughter cysts
D. Continued proliferation of rests of dental lamina

Response:
None

So the answer to this question is C


Instruction:
A 73-year-old woman is evaluated for obstructive jaundice after an injury to the CBD, 7 months previously at laparoscopic cholecystectomy. The alkaline phosphatase is elevated. In obstructive jaundice, which of the following statements is true regarding alkaline phosphatase?
A. Its level increases before that of bilirubin.
B. Its level is unlikely to be increased in pancreatic malignancy.
C. Its elevation indicates bone metastasis.
D. Its elevation excludes hepatic metastasis.

Response:
Alkaline phosphatase level usually is more sensitive than the bilirubin level for indicating cholestatic jaundice. It also is more likely to fall before the bilirubin level when the obstruction has been relieved. If an unexplained alkaline phosphatase elevation exists (even in the presence of a normal bilirubin), biliary pathology must be excluded. Elevation of the alkaline phosphatase from a possible source in bone disease can be excluded by measuring isoenzymes.

So the answer to this question is A


Instruction:
Type II paralysis in organophosphorous poisoning treatment is -
A. Atropine
B. Oximes
C. Symptomatic treatment
D. No treatment

Response:
Ans. is 'c' i.e., Symptomatic treatment o Paralysis due to organophosphate (OP) poisoning can be three types -Type I (cholinergic phase)It involves acute paralysis secondary to persistent depolarization at the neuromuscular junction caused by persistent stimulation by excessive Ach.Treatment of choice is atropine with or without oximes.TypeIIIt is also called as intermediate syndrome.It develops 1-4 days after resolution of acute cholinergic symptoms.It is manifested as paralysis and respiratory distress.It involves proximal muscles with relative sparing of distal muscle groups.The pathogenesis presumed to be dysfunction of neuromuscular junction caused by downregulation of presynaptic and postsynaptic nicotinic receptors due to release of excessive Ach and Ca^ respectively.Atropine is ineffective, symptomatic treatment is given.Type IIIIt involves OP-induced delayed polyneuropathy (OPIDN).It occurs 1-3 weeks after exposure and is associated with demyelination of axons.It is not caused by cholinesterase inhibition but rather by neuropathy target esterase (NTE) inhibition.It involves distal muscles with relative sparing of neck muscles, cranial nerves, and proximal muscles.

So the answer to this question is C


Instruction:
Cardiac index ratio is determined by
A. CO & surface area
B. Stroke Volume & surface area
C. Surface area only
D. Peripheral resistance

Response:
None

So the answer to this question is A


Instruction:
Ham test is done for detection of which of the following?
A. Ankyrin defect
B. GPI-linked protein defect
C. Spectrin defect
D. Mannose binding protein defect

Response:
Ham test (Acidified serum lysis test) This is the screening test for PNH Used to detect cells deficient in CD59 CD55 and CD59 are GPI-linked proteins which are defective in PNH due to acquired somatic mutation in PIGA gene located on X chromosome Acidification of serum activates complement alternate pathway and causes haemolysis of red cells if they are abnormally sensitive to complement Flow cytometry (FLAER) test is used to as confirmatory test for PNH

So the answer to this question is B


Instruction:
Probiotics are useful for :
A. Necrotizing enterocolitis
B. Breast milk jaundice
C. Hospital acquired pneumonia
D. Neonatal seizures

Response:
Probiotics are defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.
Bacterial colonization or infection of the intestine by pathogens such as Clostridium, Escherichia, Klebsiella, Salmonella, Shigella, Campylobacter, Pseudomonas, Streptococcus, Enterococcus, Staphylococcus aureus, and coagulase-negative staphylococcus increases the risk of necrotizing enterocolitis.
Other potential uses of probiotics are

Managing lactose intolerance
Cholesterol-lowering
Improving immune function and preventing infections
Antibiotic-associated diarrhea
Improving mineral absorption
Irritable bowel syndrome and colitis
Prevention of colon cancer
Lowering blood pressure
Helicobacter pylori
Reducing inflammation
Prevents harmful bacterial growth under stress

So the answer to this question is A


Instruction:
Most common cause of early miscarriages is
A. Natural diabetes
B. Cervical incompetence
C. Chromosomal abnormality
D. Genitourinary infections

Response:
Ans. c (Chromosomal abnormality). (Ref. Dutta, Obstetrics, 5th ed., 211)ETIOLOGY OF SPONTANEOUS ABORTION/MISCARRIAGE1. Ova- fetal factors (60%)- operate in early abortion.# Chromosomal abnormality (commonest being autosomal trisomy, monosomy)# Gross congenital malformations.# Blighted ovum, hydropic degeneration of villi# Interference with circulation (cord twist)

So the answer to this question is C


Instruction:
Ganciclovir is preferred over acyclovir in the following condition
A. Herpes simplex keratitis
B. Herpes zoster
C. Chicken pox
D. Cytomegalovirus retinitis in AIDs patients

Response:
Ref-KDT 6/e p769 Ganciclovir is the drug of choice for CMV infections. Acyclovir is highly effective against Herpes simplex and Varicellal zoster (chicken pox and herpes zoster) but it has very little activity against CMV.

So the answer to this question is D


Instruction:
Which of the following in ARDS is true?
A. Type 2 respiratory failure
B. Lung compliance decreased
C. Increase in diffusion capacity
D. none

Response:
ARDS is a clinical syndrome of severe dyspnoea of rapid onset,hypoxaemia and diffuse pulmonary infiltrates leading to respiratory failure.ARDS is characterised by Po2/Fio2(inspiratory O2 fraction)<200 mmHg.There will be no hypercapnia,so the patient will have type 1 respiratory failure.There will be stiff-lung syndrome with collapse and decreased compliance of the lungs due to loss of surfactant. Reference:Harrison's Medicine-20 th edition,page no:2032.Textbook of pathology-Harsh Mohan,6th edition,page no:463.

So the answer to this question is B


Instruction:
Most common site of metastasis from bronchogenic carcinoma:
A. Brain
B. Bone
C. Liver
D. Spine

Response:
Ans: b (Liver) Ref: Robbins, 7th ed, p. 760Among the options given liver is the most common site of metastasis from bronchogenic carcinoma. But according to Robbins more than half of the cases of lung carcinoma spread to adrenal, and adrenals are the most common site of metastasis from lung carcinoma. So if both liver and adrenals are given in the option, choose adrenals.Order of metastasisAdrenals: > 50%Liver: 30-50%Brain: 20%Bone: 20%Important points of the various types of bronchogenic carcinomaAdenocarcinomaMost common histological type worldwideMost common histological type in life time non- smokersMost common histological type in young patientsMost common Ca lung which metastizes to opposite lungPeripheral in distributionMost common variety associated with thrombophlebitisSquamous cell CaMost common histological type in IndiaCavities are seenCentral in distributionPancoast tumor is squamous cell variety. It is located in the apex (not in the centre)Most common variety associated with hypercalcaemiaIt has best prognosisSmall cell CaMost common variety associated with paraneoplastic syndromesMost common variety associated with hypokalemiaMost responsive to chemotherapy and radiation. But due to late detection it has the worst prognosisNoteMost common variety associated with gynaecomastia - large cell carcinoma

So the answer to this question is B


Instruction:
Normal anion gap is -
A. 8-10mmol/L
B. 10-12 mmol/L
C. 12-16 mmol/L
D. 16-20 mmol/L

Response:
(B) (10-12 mmoI/L) (365-H 18th) (443 - Davidson 21st)* Normal anion gap is 10 to 12 mmol/L* * Calculated as follows : AG = Na+ - (C1-+ Co-3)* It consist of for the most part of protein* ** in the anion form HP04" S04~) and organic acids. The unmeasured cations are K+, Ca+ or Mg+.Normal (6-12 meq) anion gap* Loss of HCO3 - Diarrhoea- Recovery from diabetic Ketoacidosis- Pancreatic fluid loss ileostomy (unadopted)- Carbonic anhydrase inhibitors* Chloride retension I. Renal tubular acidosisII. Ileal loop bladder* Administration of HC1 equivalent or NH4C1 Arginine and lysine in Parenteral nutritionCauses of High anion gap metabolic acidosis* Lactic acidosisToxins* Ketoacidosis- Ethylene glycol- Diabetic- Methanol- Alcoholic- Salicylates (Aspirin)- Starvation- Propylene glycol - Pyroglutamic acid Renal failure (acute and chronic.

So the answer to this question is B


Instruction:
Cervical lymph node involvement in papillary ca thyroid, the best treatment is -
A. Chemotherapy
B. Radioactive iodine
C. Radical neck dissection
D. Steroid

Response:
"Lymph node metastasis in the lateral neck in patients with papillary carcinoma usually should be managed with modified radical or functional neck dissection." - Schwaz Though the option mentions 'Radical neck dissection', not 'modified radical neck dissection, it still is the best choice among given option. Also know Modified radical neck dissection is done in any type of thyroid cancer with palpable or involved cervical lymph nodes (cervical lymph nodes are frequently involved in Papillary, Medullary Huhle cell and anaplastic carcinomas) It can also be done prophylactically in medullary carcinoma when the thyroid lesion is larger than 1 cm. Ref : Schwaz 9/e p1363

So the answer to this question is C


Instruction:
During pregnancy, GFR
A. Increases
B. Decreases
C. Remains Unchanged
D. Increases only in multiple gestations

Response:
GFR increases by 50% as filtering capacity of kidney increases due to - a) Decrease oncotic pressure due to hemodilution b) Increased renal blood flow by 80% in 2nd trimester and 50% in 3rd trimester.

So the answer to this question is A


Instruction:
Maximum dose of radiation exposure during pregnancy is
A. 0.5 rad
B. 1 rad
C. 1.5 rad
D. 5 rad

Response:
The biological effects of x-rays are caused by an electrochemical reaction that can damage tissue. Embryo-fetal risks from low-dose diagnostic radiation appear to be minimal. Current evidence suggests that there are no increased risks for malformations, growth restriction, or aboion from a radiation dose of less than 0.05 Gy (5 rad). Reference: William&;s Obstetrics; 24th edition; Chapter 46; General Considerations and Maternal Evaluation

So the answer to this question is D


Instruction:
The best investigation for cardiac tamponade is:
A. 2-D echocardiography
B. Real time echocardiography
C. Ultrasound
D. M-mode echocardiography

Response:
Ans. 2-D echocardiography

So the answer to this question is A


Instruction:
Maximum chance of infection in dialysis is by-
A. AV fistula
B. Tunnel catheter
C. AV graft fistula
D. Venous catheter

Response:
Grafts and catheters are associated with much higher rates of Infection than fistulas Intravenous catheters are often used in patients with ARF or CRF. For patients on maintenance hemodialysis, tunneled catheters(2 seperate catheters or single with 2 lumen) are often used when Av fistula and grafts are not feasible due to anatomical considerations. Tunneled catheters are tunneled under the skin, tunnel reduces bacterial translocation from the skin, so there is lower rate of infection with tunneled catheters than with non tunneled temporary catheters. Most tunneled catheters are placed in Internal jugular vein Other veins used are external jugular, femoral ,subclan(subclan stenosis is a frequent complication ) Ref:Harrison 20th edition pg no. 2123

So the answer to this question is D


Instruction:
The following are true related with regards to vasectomy except :
A. Leads to immediate sterility
B. Failure rate is 0.15/100women years
C. Involves ligation and division of spermatic cord
D. Paner (wife may be given DMPA for 3 months

Response:
It doesnot lead to immediate sterility. It is imperative that some other contraception should be used for the next three months or 15 ejaculation. TEXTBOOK OF GYNECOLOGY SHEILA BALAKRISHNAN SECOND EDITION PAGE NO 396

So the answer to this question is A


Instruction:
Episodic weakness is seen in all of the following, Except:
A. Eaten Lambe Sndrome
B. Hypokalemia
C. Hypercalcemia
D. Hyperglycemia

Response:
Answer is D (Hyperglycemia): Hyperglycemia is not associated with episodic weakness. Hypercalcemia, Hypokalemia and Lambe-Eaten syndrome may all be associated with episodic generalized weakness (Refer table in previous question)

So the answer to this question is D


Instruction:
Not included in human development index ?
A. GNI per capita
B. Life expectancy at 1 yr
C. Years of schooling
D. Knowledge

Response:
Ans. is 'b' i.e., Life expectancy at 1 year Life expectancy at bih is a dimension of HDI (not life expectancy at one year). HUMAN DEVELOPMENT INDEX (HDI) HDI is a composite index combining indicators representing three dimensions.

So the answer to this question is B


Instruction:
Spores are disinfected by?
A. Ethylene oxide
B. Beta Propiolactone
C. Formaldehyde
D. Hexachlorophene

Response:
Formaldehyde is markedly bactericidal and sporicidal and has lethal effect on viruses. It is used to preserve anatomical specimens, and for destroying anthrax spores in hair and wool. Formaldehyde vapor, an effective environmental decontaminant under conditions of high humidity, is sometimes used to decontaminate laboratory rooms that have been accidentally and extensively contaminated with pathogenic bacteria, including those such as the anthrax bacillus that form resistant spores. Ethylene oxide sterilization is used for heat-labile materials. Ref: Ray C.G., Ryan K.J. (2010). Chapter 3. Sterilization, Disinfection, and Infection Control. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e

So the answer to this question is C


Instruction:
What is safe maximum time for storage of kidney?
A. 24 hours
B. 48 hours
C. 36 hours
D. 80 hours

Response:
Optimal time for kidney transplant is within 18 hours. Max peroid is 36 hours.

So the answer to this question is C


Instruction:
Most Common site of perilymph fistula
A. Round window
B. Oval window
C. Otic capsule
D. both 1 and 2

Response:
Perilymph fistula: In this condition, perilymph leaks into the middle ear through the oval or round window. It can follow as a complication of stapedectomy or ear surgery when stapes is accidentally dislocated. It can also result from sudden pressure changes in the middle ear (e.g. barotrauma, diving, forceful Valsalva) or raised intracranial pressure (weightlifting or vigorous coughing). A perilymph fistula causes intermittent veigo and fluctuating sensorineural hearing loss, sometimes with tinnitus and sense of fullness in the ear (compare Meniere's disease). Ref: PL Dhingra 6th edition of Ear, Nose and Throat; pg no 46

So the answer to this question is D


Instruction:
Contraindiction for estrogen therapy nearly are all except:
A. Uterine cancer
B. Breast cancer
C. Hypertension
D. Previous H/O thromboembolism

Response:
Ans. is c, i.e. HypertensionRef: Williams Gynae 3rd/ed, p495Absolute C/I for use of Estrogen:1. Undiagnosed abnormal genital bleeding2. Known/suspected or H/O breast cancer3. Known/suspected estrogen dependent tumor4. Active or prior venous thromboembolism or any thromboembolic disease5. Liver dysfunction or disease6. Known or suspected pregnancy.

So the answer to this question is C


Instruction:
Which prion disease affect human ?
A. Scrapie
B. Madcow disease
C. Kuru
D. Bovine spongiform encephalopathy

Response:
Kuru prion Infection through ritualistic cannibalism

So the answer to this question is C


Instruction:
The most common presentation of neonatal meningitis is -
A. Bulging fontanels
B. Nuchal rigidity
C. Poor feeding
D. Convulsion

Response:
Ans. is 'c' i.e., Poor feeding Meningitis in neonates and young infants o Bacterial meningitis in the newborn and the first 4 to 6 months of life has many atypical features - i) Neck rigidity and Kernig's sign are seldom prominent ii) Anterior fontanel may or may not be bulging o Following arouse the suspicion of bacterial meningitis in a newborn - i) Vacant stare vi) Poor cry ii) Refusal to suck (Poor feeding) vii) Fever or hypothermia iii) Alternate irritability and drowsiness viii) Shock or circulatory collapse iv) Persistent vomiting with fever ix) Tremor or convulsions Poor tone x) Neurological deficits of varying types

So the answer to this question is C


Instruction:
A 55-year-old woman with cancer of the cervix undergoes hysterectomy and is found to have pelvic lymph nodes involved with cancer. She then receives a course of external beam radiation (4500 rads). When the physician counsels her prior to her radiation treatment, she should be told of all the possible complications of radiation enteritis. Which of the following is generally not associated with radiation injury?
A. Malabsorption
B. Intussusception
C. Ulceration
D. Fistulization

Response:
The effects of radiation on the intestine depend on a variety of factors, which include the age of the patient, temperature, degree of oxygenation, and metabolic activity. Acute intestinal radiation injury is manifested in the bowel by the cessation of viable cell production and is seen clinically as diarrhea or gastrointestinal bleeding. Progressive vasculitis and fibrosis are seen in the latter stages of radiation injury and may result in malabsorption, ulceration, fistulization, or perforation. Intussusception is generally not associated with radiation injury.

So the answer to this question is B


Instruction:
True about lymphangioma:
A. It is a malignant tumour
B. It is a congenital sequestration of lymphatic channel
C. Laser excision is done
D. Sclerotherapy is common done

Response:
Lymphangioma: Lymphangiomas are the lymphatic analogue of the hemangiomas of blood vessels. Divided into two types: Simple or Capillary lymphangioma Cavernous lymphangioma or cystic hygroma. Clinical Features: Most of these benign tumours are present at bih, and 90% of them can be identified by the end of the first year of life Site of cavernous lymphangiomas: Mainly in neck and axilla (rarely in the retroperitoneum) Site of simple capillary lymphangiomas: Subcutaneously in the head and neck region and axilla. Represent isolated and sequestrated segments of the lymphatic system that retain the ability to produce lymph. As the volume of lymph inside the cystic tumour increases, they grow larger within the surrounding tissues. Treatment: Surgical excision, taking care to preserve all normal surrounding infiltrated structures. Ref: Sabiston 20th edition Pgno: 1855

So the answer to this question is B


Instruction:
Most common cause of pneumonia in AIDS patients
A. Pneumococci
B. Staphylococci
C. Pneumocystis carni
D. All of the above

Response:
(C) Pneumocystis carnii > Pneumocystis carini is most common cause of pneumonia in AIDS.

So the answer to this question is C


Instruction:
The world health organization's objective in dental health is that by the year 2000 a person, at age of 12, shall not have decayed, missing and filled teeth (DMF) more than:
A. 1
B. 2
C. 3
D. 4

Response:
None

So the answer to this question is C


Instruction:
Klinefelter no of chromosomes -
A. 47
B. 46
C. 45
D. 44

Response:
Ans. is 'a' i.e., 47 o In Klinefelter syndrome there is extra X or Y chromosome to a male karyotype. Thus there are 47 chromosomes.

So the answer to this question is A


Instruction:
ESI act does not cover which of the following:September 2010
A. Hotel employee
B. Transpoters
C. Railway employees
D. Factory employees

Response:
Ans. C: Railway employeesThis act covers all employees including engaged through the contracts but whose remuneration does not exceed Rs. 10, 000 p.m. including staff in the class of administrative, canteen, loading-unloading, security, etc.Apprentices who are appointed for learning the work with no right of being absorbed in service, do not come with the ambit of this act.

So the answer to this question is C


Instruction:
All of following are true about measles except -
A. Maximum incidence in 6m-3 year age group
B. Best age for immunization is 9-12 months
C. Secondary attack rate is 30%
D. I.P. = 7-14 days

Response:
None

So the answer to this question is C


Instruction:
Stress fracture occurs most commonly in:
A. Metatarsals
B. Metacarpals
C. Calcaneum
D. Talus

Response:
Ans. (a) MetatarsalsRef: Essential Orthopedics Maheshwari, 5th edn/ 167* Stress fractures often develop from overuse, such as from high-impact sports like distance running or basketball.* Most stress fractures occur in the weight-bearing bones of the foot and lower leg. Studies show that athletes participating in tennis, track and field, gymnastics, dance, and basketball are at high risk for stress fractures.* It most commonly occurs in metatarsals.* It is seen due to imbalance between load and resistance on the bone.* 2 Types of stress fracture:# FATIGUE : Increased load, Normal resistance of bone# INSUFFICIENCY : Normal load, Decreased resistance of bone* Examples of stress fracture:# Lower extremity: March - 2nd MT > 3rd MT# Upper extremity: Olecranon

So the answer to this question is A


Instruction:
Intra-aerial calcium gluconate infusion is used in the management of burns caused by
A. Nitric acid
B. Hydrofluoric acid
C. Formic acid
D. Hydrochloric acid

Response:
Hydrofluoric acid causes Hypocalcemia. Calcium based therapies are main stay of treating Hydrofluoric acid burns. Topical application of calcium gluconate onto wounds and IV administration of calcium gluconate for systemic symptoms. Intra-aerial calcium gluconate infusion provides effective treatment of progressive tissue injury and intense pain.

So the answer to this question is B


Instruction:
In the grading of trachoma, trachomatous inflammation–follicular is defined as the presence of –
A. 5 or more follicles in the lower tarsal conunctiva
B. 3 or more follicles in the lower tarsal conjunctiva
C. 5 or more follicles in the upper tarsal conjunctiva
D. 3 or more follicles in the upper tarsal conjunctiva

Response:
Under WHO classification, trachocomatous inflammation follicular is defined as at least 5 or more follicles of at least 0.5 mm diameter on upper tarsal conjunctiva (for details see the table of WHO classification in the text of this chapter).

So the answer to this question is C


Instruction:
Laproscopic tubal ligation contraindication -
A. Post partum state
B. Post MTP
C. Gynaecologic malignancies
D. 3 previous childbirth

Response:
Ans. is 'a' i.e., Postpartum state "The operation is done in the interval period, concurrent with the vaginal termination of pregnancy or 6 weeks following delivery. Should not be done within 6 weeks following delivery."

So the answer to this question is A


Instruction:
Investigation of choice for DVT is-
A. Doppler USG
B. Angiography
C. CT scan
D. MRI

Response:
Ans. is 'a' i.e., Doppler USG o Doppler USG is the first investigation of choice for DVT.

So the answer to this question is A


Instruction:
A 67- year old lady is brought in by her 6 children saying that she has gone senile. Six months after her husband's death she has become more religious, spiritual and gives lot of money in donation. She is occupied in too many activities and sleeps less. She now believes thatshe has a goal to change the society. She does not like being brought to the hospital and is argumentative on being questioned on her doings. The diagnosis is:
A. Acute manic excitement
B. Delusion
C. Schizophrenia
D. Depression

Response:
A i.e. Acute manic excitement For ruling out depression : None of the essential criteria (i.e. depressed mood & loss of interest or pleasure) is present For ruling out schizophrenia : No disorganized speech, disorganized behaviour, delusions, hallucinations, or blunt affect or negative symptoms. For ruling out delusion : No fixed, firm, unshakable belief, which is not according to patients cultural or ethical background

So the answer to this question is A


Instruction:
Transport of carbon monoxide (CO) is diffusion limited because
A. High affinity of CO for haemoglobin
B. Alveolar membrane is less permeable to CO
C. CO crosses epithelial barrier slowly
D. On exposure to air there is sudden increase in partial pressure

Response:
Since CO binds to Hb very rapidly, there is always a pressure gradient for its diffusion.
There is no free CO in blood. CO diffusion can be increased only if the thickness of the capillary decreases or if the area of the capillary increases.
So transport of CO is diffusion limited.

So the answer to this question is A


Instruction:
Oblique view in XRAY of hand is required for diagnosis of
A. Capitate
B. Scaphoid
C. Navicular
D. Hamate

Response:
Oblique view of the wrist is required for scaphoid fracture * Most common fractured bone in the wrist * Peanut shaped bone that spans both row of carpal bones * Does not require excessive force and often not extremely painful so can be delayed presentation * Pain over the anatomic snuff box * Pain is not usually severe * Often present late Scaphoid Fracture Treatment * Cast 6-12 weeks * Sho arm vs. long arm * Follow patient every 2 weeks with x-ray * CT and clinical evaluation to determine healing * Consider screwing early Ref: Maheshwari and Mhaskar 9th ed pg 367.

So the answer to this question is B


Instruction:
During accomodation, changes in lens will be
A. Reduction in radius of curvature of anterior surface of lens only
B. Reduction in radius of curvature of posterior surface of lens only
C. Increase in radius of curvature of posterior surface of lens only
D. Both radius of curvature of anterior and posterior surfaces reduce

Response:
During accomodation, reduction in radius of curvature of anterior surface of lens. Posterior surface remains the same.

So the answer to this question is A


Instruction:
Achondroplasia shows which of the following type of inheritance?
A. Autosomal dominant
B. Autosomal recessive
C. X linked dominant
D. X linked recessive

Response:
Autosomal dominant : von villebrands , adult pkd , myotonic dystrophy , tuberous sclerosis, huntingtons disease , osteosclerosis Autosomal recessive:- cystic fibrosis , congenital deafness , PKU, spinal muscular dystrophy X LINKED dominant :- Xg group , vit D resistant rickets , incontinentia pigmentia X Linked recessive red green colour blindness , fragile X syndrome , Duchenne muscular dystrophy , hemophilia Y linked :- swyer syndrome

So the answer to this question is A


Instruction:
Which of the following can be considered as the better restorative option in a grossly carious tooth?
A. Cast metal onlay
B. Cast metal inlay
C. Full crown
D. Partial onlay

Response:
Onlay restorations have many clinical applications and may be desired by many patients. These restorations have a well-deserved reputation for providing excellent service. The cast-metal onlay restoration spans the gap between the inlay, which is primarily an intracoronal restoration, and the full crown, which is a totally extracoronal restoration.
The full onlay by definition caps all of the cusps of a posterior tooth and can be designed to help strengthen a tooth that has been weakened by caries or previous restorative experiences.
It can be designed to distribute occlusal loads over the tooth in a manner that greatly decreases the chance of future fracture.
It is more conservative of the tooth structure than the full crown preparation, and its supragingival margins, when possible, are less irritating to the gingiva.

Sturdevant operative dentistry 7th Edition, Page No:e116

So the answer to this question is A


Instruction:
All of the following are varients of Acne, EXCEPT:
A. Acne conglobata
B. Acne agminata
C. Acne fulminans
D. Pomade acne

Response:
Acne agminata also known as lupus miliaris disseminatus faciei or facial idiopathic granulomatous with regressive evolution is a disorder of unceain etiology. Ref: Rook Textbook of Dermatology, 8th Edition, Page 38.37.

So the answer to this question is B


Instruction:
All of the following statements regarding diatom are true, EXCEPT:
A. Diatoms are aquatic unicellular plants
B. Diatoms have an extracellular coat composed of magnesium
C. Acid digestion technique is used to extract diatoms
D. Presence of diatoms in the femoral bone marrow is an indication of antemoem inhalation of water

Response:
Diatoms are microscopic unicellular or colonial algae. It has a cell wall which is strongly impregnated with silica and contain chlorophyll and diatomin, a brown pigment. Diatoms secrets a hard silicaceous outer box like skeleton called a frustulae. They are heat and acid resistant. Ref:The Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, Pages 329-30

So the answer to this question is B


Instruction:
Bruxism is ?
A. Walking during sleep
B. Nocturnal enuresis
C. Grinding of teeth during sleep
D. Sleep apnoea

Response:
Ans. C. Grinding of teeth during sleep

So the answer to this question is C


Instruction:
Amphotericin B acts on:-
A. Cell membrane
B. Cell wall
C. Nucleus
D. Cytoplasm

Response:
Various drugs used in fungal infections with their mechanism of action are: Class of drugs Drugs bf action Polyenes * Amphotericin-B * Nystatin Bind to ergosterol and create pores in cell membrane. 5-flucytosine(5-FC) DNA polymerase inhibitor Azoles * Ketoconazole * Fluconazole * Itraconazole * Clotrimazole * Voriconazole Inhibits the enzyme lanosterol-14-a-demethylase resulting in reduced ergosterol synthesis. Allylamines * Terbinafine * Butenafine * Naftifine Inhibits squalene epoxidase-pores in cell membrane and accumulation of squalene(major factor) Griseofulvin Microtubule inhibition Echinocandins * Caspofungin Inhibit 1,3 beta glucan synthase enzyme resulting in inhibition of cell wall synthesis

So the answer to this question is A


Instruction:
Molecular interaction, found in the structure ofDNA -
A. Hydrogen bond
B. Glycosidic bond
C. Covalent interactions
D. All of the above

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

So the answer to this question is D


Instruction:
A 3,800 grams male infant is delivered vaginally. A shoulder dystocia was encountered. If a neonatal injury is suspected, what is the likely finding in the infant
A. Arm that is at its side and internally rotated
B. Arm that is fixed and flexed and hypeonic
C. Dislocated elbow
D. Clavicle fracture

Response:
An Erb palsy is the most common injury of the neonate in a shoulder dystocia. The arm is typically limp and at its side with the arm internally rotated. If the palsy is severe, then the infant may not be able to move its fingers. Eighty percent of the time, brachial plexus injuries will improve with physical therapy. However, if the nerve roots are avulsed rather than simply injured, the neuropathy usually will not resolve.

So the answer to this question is A


Instruction:
All of the following cause metabolic headache except:
A. Hypoxia
B. Hypercapnia
C. Hyperglycemia
D. Hyponatremia

Response:
Hypoxia Causes cerebral vasodilation --> headache. Hyperglycemia Hyperglycemia does not present as headache Hypercapnia Cause cerebral vasodilation and stretching of meninges. Hyponatremia Cerebral edema leads to a headache and seizures.

So the answer to this question is C


Instruction:
Best Test for intestinal malabsorption -
A. D-xylose test
B. NBT-PABATEST
C. Fecal fatestimation
D. Schilling test

Response:
D-xylose absorption test is a medical test performed to diagnose conditions that present with malabsorption of the proximal small intestine due to defects in the integrity of the gastrointestinal mucosa. D-xylose is a monosaccharide, or simple sugar, that does not require enzymes for digestion prior to absorption Ref Davidson edition23rd pg 809

So the answer to this question is A


Instruction:
which of following SSRI used in the panic disorder
A. paroxetine
B. clomipraamine
C. imipramine
D. trazadone

Response:
SSRI * IMPOANCE Most widely prescribed antidepressant * MECHANISM Specifically acts on serotonin transpoers and increases serotonin in synapse. DRUGS FLUOXETINE FLUVOXAMINE DAPOXETINE CITALOPRAM ESCITALOPRAM ESCITALOPRAM SERALINE PAROXETINE USE FLUOXETINE=============CHILDHOOD DEPRESSION FLUVOXAMINE===========OCD DAPOXETINE==============PME ESCITALOPRAM===========HEA SAFE, PATHOLOGICAL EMOTIONS PAROXETINE=========SEDATING, PANIC DISORDER IMPULSE CONTROL DISORDERS PME PARAPHILIA Ref, kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no. 955

So the answer to this question is A


Instruction:
A 10-year-old male child with sho stature presented to the pediatric OPD with complaints of frequent headaches over the past 6 months along with slowly progressive loss of vision of the right eye. Lately the child has also staed having trouble in walking along with frequent mood changes and excessive thirst. MRI brain showed a tumour in the sellar region which was resected. HPE examination showed reticular epithelial cells that have appearances reminiscent of the enamel pulp of developing teeth along with calcifications and wet keratin nodules. The gene involved in causing the above condition is also involved in causing which other condition: -
A. Hepatocellular carcinoma
B. Melanoma
C. Neuroblastoma
D. CML

Response:
This is a case of Craniopharyngioma. Benign tumour Arise in sellar/suprasellar region Arise from vestigial remnants of Rathke's pouch Bimodal age distribution Presents with headache and visual disturbance May present with sho stature due to GH deficiency (Pituitary hypofunction). Most commonly due to abnormalities in WNT signaling pathway including the activating mutations of the beta-catenin. MRI image shows a mass in the suprasellar region- likely craniopharyngioma OTHER CANCERS DUE TO WNT PATHWAY Mutations in b-catenin are present in: - 50% of hepatoblastomas. 20% of Hepatocellular carcinomas GENES INVOLVED IN: - Melanoma- NRAS, FGF3, HST1 Neuroblastoma- N-MYC, ALK CML- ABL

So the answer to this question is A


Instruction:
Which subtype of interstitial lung disease is seen in patients with Sjogren syndrome?
A. Usual interstitial pneumonia
B. Non-specific interstitial pneumonia
C. Acute interstitial pneumonia
D. Cryptogenic Organising pneumonia

Response:
Fibrotic NSIP is the most common subtype of ILD seen in patients with Sjogren syndrome. NSIP is also the most common subtype of ILD seen in patients with connective tissue disorders. Usual interstitial pneumonitis is found in idiopathic pulmonary fibrosis. Cryptogenic organising pneumonia has unknown etiology. Acute interstitial pneumonitis/ Hamman rich syndrome presents as ARDS like illness. Ahritis/ ahralgia:- Most common extraglandular manifestation of Sjogren's.

So the answer to this question is B


Instruction:
All of the following are quantitative variables except
A. Gender
B. Weight
C. Serum cholesterol
D. Celsius temperature scale

Response:
Variable: Is a characteristic or attribute that vary from person to person, from time to time and from person to person

So the answer to this question is A


Instruction:
Barbiturate ingestion is associated with hyperophy of which cellular organelle?
A. Mitochondria
B. Endoplasmic reticulum
C. Golgi apparatus
D. Nucleolus

Response:
Hyperophy usually refers to increase in size of cells or tissues, but sometimes a subcellular organelle may undergo selective hyperophy. Individuals treated with drugs such as barbiturates show hyperophy of the smooth endoplamic reticulum (ER) in hepatocytes, which is an adaptive response that increases the amount of enzymes (cytochrome P-450 mixed function oxidases) available to detoxify the drugs. Ref: Robbins, 8th edition, Chapter 1.

So the answer to this question is B


Instruction:
Which primary tooth is generally accepted as the first to erupt, and at about what mean age?
A. Maxillary central incisor, 8 to 12 months.
B. Maxillary central incisor, 7 to 9 months.
C. Mandibular central incisor, 7 to 9 months.
D. Mandibular central incisor, 8 to 10 months.

Response:
Eruption for the primary mandibular central incisor may be given as 6 months (Woelfel and Scheid, 2002); 6.5 months (Kraus et al., 1969); 7.5 months(Charlick et al.); or 8 (6 to 10) months (Ash and
Nelson, 2003).

So the answer to this question is C


Instruction:
A 38yr old bisexual man goes to the clinic for counselling about HIV. Which of the following is false about HIV transmission?
A. The risk of acquiring HIV with unprotected receptive anal intercourse is lower than that with penile-vaginal intercourse
B. Male-to- female HIV transmission is usually more efficient in causing infection than female-to-male transmission
C. Male circumcision is associated with a lower risk of HIV acquisition for heterosexual men
D. The quantity of HIV-1 in plasma is a primary determinant of the risk of HIV1 transmission

Response:
The risk of HIV acquisition associated with unprotected receptive anal intercourse is relatively higher than that seen in penile-vaginal intercourse. This is because the rectal mucosal membrane is thin and fragile and anal intercourse is associated with microtrauma (rectal tears). The differences in transmission rates between men and women are because the vagina and cervix are exposed to semen for a longer duration, increasing the risk of transmission. However, the penis and urethral orifice are exposed relatively briefly to infected vaginal fluid, lowering the risk. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition

So the answer to this question is A