Instruction:
Bosniak classification is for?
A. Renal tuberculosis
B. Renal cysts
C. RCC
D. VUR

Response:
The Bosniak classification system of renal cystic masses divides renal cystic masses into five categories based on imaging characteristics on contrast-enhanced CT. It is helpful in predicting a risk of malignancy and suggesting either follow up or treatment. Classification: Bosniak I -Simple cyst , imperceptible wall; Work up:nil; Percentage malignant: ~0% Bosniak 2 - Minimally complex, a few thin <1 mm septa or thin calcifications (thickness not measurable); non-enhancing high-attenuation (due to proteinaceous or haemorrhagic contents) renal lesions of less than 3 cm are also included in this category; these lesions are generally well marginated; Work-up: nil; Percentage malignant: ~0% Bosniak 2F - Minimally complex, increased number of septa, minimally thickened with nodular or thick calcifications there may be perceived (but not measurable) enhancement of a hairline-thin smooth septa hyperdense cyst >3 cm diameter, mostly intrarenal (less than 25% of wall visible); no enhancement; Requiring follow-up: needs ultrasound/CT follow up - no strict rules on the time frame but reasonable at 6 months; Percentage malignant: ~ 5% Bosniak 3 - Indeterminate thick, nodular multiple septa or wall with measurable enhancement, hyperdense on CT; Work-up: paial nephrectomy or radiofrequency ablation in elderly or poor surgical candidates; Percentage malignant: ~55% Bosniak 4 - Clearly malignant solid mass with a large cystic or a necrotic component; Treatment: paial or total nephrectomy; Percentage malignant: ~100%.

So the answer to this question is B


Instruction:
Fibroadenoma of the breast are
A. Fixed mass
B. Diffuse mass
C. Multiple duffuse mass
D. Solitary mobile mass

Response:
Ans. is 'd' i.e. Solitary mobile mass

So the answer to this question is D


Instruction:
A 30-year-old male presents with pain on the right flank and hematuria. A CECT abdomen reveals a large 8 x 8 cm sized solid mass in the right kidney and 3 x 3 cm solid mass occupying the upper pole of the left kidney. The most appropriate surgical treatment for this pt is -
A. Bilateral radical nephrectomy
B. Right radical nephrectomy and biopsy of the mass from opposite kidney.
C. Right radical nephrectomy and left paial nephrectomy
D. Right radical nephrectomy only.

Response:
This male pt. with flank pain, hematuria and demonstration of a solid renal mass is having renal cell carcinoma (in clinical practice any solid renal mass is considered RCC until proved otherwise) For patients with bilateral RCCs, paial nephrectomy with an adequate parenchymal margin is the preferred approach for kidney with the smaller lesion. Paial nephrectomy or Nephron-sparing procedures are found to be equally effective on radical nephrectomy if the tumor size is less than 4 cms. Ref : Smith's Urology 17/e p336

So the answer to this question is C


Instruction:
Blood platelets in stored blood do not remain functional after hrs. -
A. 24
B. 48
C. 72
D. 96

Response:
None

So the answer to this question is A


Instruction:
Basanti, a 28 years aged female with a history of 6 weeks of amenorrhoea presents with pain in abdomen; USG shows fluid in pouch of Douglas. Aspiration yields dark color blood that fails to clot. Most probable diagnosis is:
A. Ruptured ovarian cyst
B. Ruptured ectopic pregnancy
C. Red degeneration of fibroid
D. Pelvic abscess

Response:
Ans. is b, i.e. Ruptured ectopic pregnancyRef. Dutta Obs. 7/e, p 182; Williams Obs. 22/e, p 258, 259, 23/e, p 242, 243The picture given in the question classically represents a case of ruptured ectopic pregnancy.The women in the question is presenting with amenorrhea of 6 weeks and pain in abdomen.On USG - fluid is seen in POD and aspiration of dark coloured blood which fails to clot - all these features leave no doubt of ectopic pregnancy."Sonographic absence of uterine pregnancy, a positive pregnancy test (b-hCG), fluid in cul-de-sac and an abnormal pelvic mass, ectopic pregnancy is almost certain--Williams Obs. 22/e p 259Also Know:D/D of fluid in POD:1. Mid cycle2. PID3.Tubal abortion (ectopic)Culdocentesis:It is a simple technique used to identify hemoperitoneum.Fluid is aspirated from cul-de-sac via posterior fornix with the help of a needle.If non clotting blood is obtained, it is indicative of an intraperitoneal bleed and probably a ruptured ectopic.Note: If the aspirated blood clots, it may have been obtained from an adjacent blood vessel rather than from bleeding ectopic pregnancy.

So the answer to this question is B


Instruction:
Which of the following has to be present for a diagnosis of major depressive disorder -
A. Loss of interest or pleasure
B. Recurrent suicidal tendency
C. Insomnia
D. Indecisiveness

Response:
One of the following two should be present essentially : -

Depressed mood
Markedly diminished interest or pleasure in all or almost all activities.

So the answer to this question is A


Instruction:
Regarding outpatient hysteroscopy, all are true except
A. Abnormal uterine bleeding is an indication
B. Normal saline as distension medium can be used
C. It is not reliable to exclude endometrial carcinoma
D. It is less accurate than saline infusion sonography (SIS)

Response:
Description:

Hysteroscopy is the gold standard investigation for evaluation of the uterine cavity
Can be both diagnostic and therapeutic
Normal saline can be used as a distension medium but not suitable for monopolar electrosurgery. Other media: Carbon dioxide, Glycine, Mannitol
Indications: Abnormal uterine bleeding, Infertility, Mullerian anomalies, Recurrent haemorrhage, Misplaced IUCD, Chronic pelvic pain
Sonohysterography or Saline infusion sonography  includes installation of saline in the uterine cavity and study with Transvaginal sonography.

So the answer to this question is D


Instruction:
Osteoblasts produce -
A. Collagen
B. Calcium
C. Pyrophosphate
D. Monosodium urate

Response:
Osteoblast-Derived Proteins
Type 1 collagen
Cell adhesion proteins
     osteopontin, fibronectin, thrombospondin
Calcium-binding proteins
     Osteonectin, bone sialoprotein
Proteins involved in mineralization
    Osteocalcin
Enzymes
    Collagenase, alkaline phosphatase
Growth factors
   IGF-1, TGF-β, PDGF
Cytokines
   Prostaglandins, IL-1, IL-6, RANKL
Proteins Concentrated from Serum
β2-microglobulin
Albumin

So the answer to this question is A


Instruction:
Maximum risk of death is seen in which week of the neonatal period?
A. First week
B. Second week
C. Third week
D. Fouh week

Response:
The major causes of neonatal moality are prematurity/low bihweight (LBW) and congenital anomalies.Moality is highest during the 1st 24 hr after bih.Neonatal moality accounts for about two-thirds of all infant deaths (deaths before 1 yr of age).(Refer: Nelson, Chapter 93; pg no. 789)

So the answer to this question is A


Instruction:
Feature of osteoahritis is
A. Heberden node
B. Increased ESR
C. Onycholysis
D. Z deformity

Response:
Joint involvement in OACommon joints: Knee, Hip, Spine (cervical, lumbosacral), Hand (PIP, DIP, first carpometacarpal), first tarsometatarsalUncommon joint: ShoulderSpared: Wrist, elbow, ankle, metacarpophalangealIn osteoahritis of hand:Distal interphalangeal joint:- Heberden's nodeProximal interphalangeal joint: bouchard's node(Refer: Mohindra's Fundamentals of Ohopedics, 2nd edition, pg no. 88, 101, 127)

So the answer to this question is A


Instruction:
A 19-year-old girl develops sudden-onset non-bloody diarrhea. She was previously well and is not taking any medications or traveled anywhere recently. Her abdomen is soft and nontender on examination, and the anion gap is normal.For the above patient with new symptoms, select the most likely acid base disorder.
A. metabolic acidosis
B. metabolic alkalosis
C. respiratory acidosis
D. respiratory alkalosis

Response:
She has a non-anion gap metabolic acidosis because of bicarbonate loss from the diarrhea. The anion gap is calculated as the sodium concentration minus the chloride plus the bicarbonate concentration. Other causes of bicarbonate loss with normal anion gap include proximal RTA and primary hyperparathyroidism.

So the answer to this question is A


Instruction:
Co enzyme for dopa decarboxylase?
A. Biotin
B. Vitamin B6
C. Vitamin C
D. B12

Response:
Ans. is 'b' i.e., Vitamin B6All decarboxylases require pyridoxin (vitamin B6)

So the answer to this question is B


Instruction:
Cat scratch disease is -
A. Associated with positive Frei skin test
B. Caused by a DNA virus
C. Associated with a pathognomonic histological picture
D. All

Response:
Ans. is 'c' i.e., Associated with a pathognomonic histological picture Cat scratch disease (CSD) . Caused by Baonella henselae --) a gram negative bacteria. . Domestic cat is the animal reservoir . The flea acts as a vector in the cross-infection of cats, but its role in human infection is not clear. . Man is infected by a cat scratch . Clinical manifestations - Localized papule, pustule - Tender regional lymphadenopathy - Systemic symptoms -3 malaise, anorexia and weight loss - No fever - Encephalitis, meningitis, seizures, transverse myelitis - Granulomatous hepatitis, splenitis, osteomyelitis - Perinaud's oculoglandular syndrome. Pathology - The histopathologic hallmark of CSD is granulomatous inflammation with stellate necrosis but no evidence of angiogenesis. - Biopsy samples stained with wahin-starry silver. Remember Infection with B. henselae produces two entirely different pathologic reaction, depending on the immune status of the host : Granulomatous inflammation --> Cat scratch disease Angiogenesis --> Bacillary angiomatosis

So the answer to this question is C


Instruction:
Which among the following is not formed by kidney?(Repeat Q. 45 2009)
A. Erythropoietin
B. Renin
C. Vitamin D
D. Aldosterone

Response:
Ans: d (Aldosterone)Ref: Ganong 22nd ed Pg. 454)Aldosterone - is produced by Zona glomerulosa of adrenal cortex.Erythropoietin - by the interstitial cells in the peritubularcapillaries in kidneys (85%) and perivenous hepatocytes of liver (15%).Renin - by the juxta glomerular cells of the kidney.Kidney produces 3 hormones1) 1,25 (OH) cholecalciferol (vitamin D)2) Renin3) ErythropoietinAldosterone: is produced by Zona Glomerulosa of adrenal cortex.Erythropoietin: by the interstitial cells in the peritubular capillaries in kidneys (85%) and perivenous hepatocytes of liver (15%).Renin: by the juxta glomerular cells of the kidney.Renin Angiotensin SystemAngiotensinogen (from liver) - found in alpha 2 globulin fraction of plasma Renin (from JG cells)Angiotensin I ACE (Angiotensin converting enz. from Pulm. endothelium)Angiotensin IIMetabolism of vitamin D

So the answer to this question is D


Instruction:
Best investigation for optic nerve damage amongst the following is:
A. Opthalmoscopy
B. Flourscence angiograhy
C. Ultrasound
D. Perimetry

Response:
D i.e. Perimetry Investigations for Optic Nerve Disease Perimetry : Visual field defects are best detected by Goldmann kinetic perimetry (full-field) & Humphery automated threshold perimetry MRI: Best investigation for imaging of optic nerves Visually evoked potential Fluorescein angiography: Occasionally helpful in differentiating papilloedema(showsdisc leakage) from optic disc drusen (no leakage). Ophthalmoscopic appearance of the disc may vary considerably from normal to elevated to arophied, so they may not help in diagnosis, though may be useful in differential diagnosis. USG is not used for evaluation of optic nerve but for retinal function and structure.

So the answer to this question is D


Instruction:
Ans. is 'a' i.e., Infant parasite index is a poor index for assessment for transmission of malaria in the community
A. Chlorquine
B. Primaquine
C. Chloraquine + Primaquine
D. None

Response:
Ans. is 'c' i.e., Chloroquine + Primaquine o Previously presumptive treatment to suspected cases of malaria was used (Chloroquine + Primaquine). o But policy has changed now. - Read below Guidelines for diagnosis and treatment of Malaria - 2010 (Added in 22/e of Park) o According to the revised drug policy, there is no scope of presumptive treatment in malaria control. The new drug policy gives emphasis on complete treatment in diagnosed cases of malaria rather than one single dose presumptive treatment to suspected cases of malaria (waiting for the diagnosis) to avoid chloroquine resistance in P. falciparum. o All fever cases should be investigated for malaria either by microscopy or by Rapid diagnostic Test (RDT) for both vivax & falciparum, i.e., combo RDT. o Fuher treatment is as follows : - 1)For plasmodium vivax : - 3 days chlorquine plus 14 days Primaquine. 2) For plasmodium falciparum : ? All cases should be given Aemisinin combination therapy (ACT) which includes Aesunate (for 3 days) along with sulfadoxin-pyrimethamine (on day 0) plus single dose primaquine. 3) Treatment of mixed infection : - Should be treated as falciparum malaria. 4) When microscopy results are not available within 24 hours or if RDT for only falciparum is used : - a)P. falciparum RDT positive --> Treat as falciparum malaria (as above). b)P. falciparum RDT negative --> Send blood slide to laboratory, and give chloroquine for 3 days, and await microscopy results : - i) +ve for vivax --> Primaquine for 14 days. ii) +ve for falciparum --> Treatment of falciparum malaria as above. 5)Treatment of severe malaria : - Severe manifestations (e.g., Unconsciousness, Convulsions, Coma, Metabolic acidosis etc) can develop in P. falciparum infection. Treatment is as follows : - i) Sta with parentral aimisinin derivative (aesunate, aemether, aeether) or quinine. ii)Once patient can take oral therapy : ? a) Patients receiving parentral quinine should be treated with oral quinine along with doxycyclin for 7 days. In pregnant women clindamycin is given instead of doxycyclin. b)Patients receiving aemisinin derivatives should get full course of oral ACT. Treatment of malaria in pregnancy has also been included in 22n4/e of Park Treatment in pregnancy i) Falciparum malaria : - ACT in 2nd & 3rd trimester; quinine in first trimester. ii) Vivax malaria : - chloroquine

So the answer to this question is C


Instruction:
Best time to do quadruple test
A. 8-12 weeks
B. 11-15 weeks
C. 15-20 weeks
D. 18-22 weeks

Response:
* The quad screen is done in the second trimester, usually between 15 and 20 weeks of pregnancy. * Ideally, the test should be performed in conjunction with first-trimester screening tests. REF : DUTTA BOOK OF OBSTETRICS

So the answer to this question is C


Instruction:
The frontal TMJ projection is called as:
A. Transcranial projection
B. McQueen Dell technique
C. Zimmer projection
D. Infracranial projection

Response:
The frontal TMJ projection that shows medial displacement of fracture of condyle and fracture of neck of condyle is called transorbital or Zimmer's projection.

So the answer to this question is C


Instruction:
Which of the following is not true for hemophilia A
A. Hemophilia A is due to deficiency of factor VIII
B. In hemophilia A females are carriers
C. Desmopressin is useful in the management of hemophilia A
D. Levels of factor VIII Less than 50% are associated with spontaneous hemorrhage

Response:
None

So the answer to this question is D


Instruction:
&;Snow ball&; opacities near the ora serrata are pathognomonic of
A. Diabetic retinopathy
B. Pars planitis
C. Anterior choroiditis
D. Fungal endophthalmitis

Response:
INTERMEDIATE UVEITIS (PARS PLANITIS) It is inflammation of pars plana pa of ciliary body and most peripheral pa of the retina. Etiology: It is an idiopathic disease usually affecting both eyes (80 percent) of children and young adults. Clinical features Symptoms: Most of the patients present with history of floaters. Some patients may come with defective vision due to associated cystoid macular oedema. Signs: Slit-lamp examination may show: mild aqueous flare, and fine KPs at the back of cornea. Anterior vitreous may show cells. Fundus examination with indirect ophthalmoscope reveals the whitish exudates present near the ora serrata in the inferior quadrant. These typical exudates are referred as snow ball opacities. These may coalesce to form a grey white plaque called snow banking. Ref:- A K KHURANA; pg num:-161

So the answer to this question is B


Instruction:
An 8 days old child presents with yellow selera, whitish stool and turmeric colour urine on 3rd day of septicemia on broad spectrum antiboitics, the likely diagnosis is
A. Galactosidase deficiency
B. Ammonia toxicity
C. Galactose 1-4 phosphatase uridyl transferase deficiency
D. All

Response:
Ans. is 'c' i.e., Galactose 1-4 phosphatase uridyl transferase deficiency o Feature of conjugated bilirubinemia on the 3rd day accompanied by sepsis in a neonate suggests diagnosis of Galactosemia. o Due to accumulation of galacticol, damage to nerve tissue and liver occurs which cause. Hepatic parenchymal disease- jaundice, hepatomegaly and ascites Mental retardation Cataract Seizures Hypoglycemia Vitreous hemorrhage Acidosis Splenomegaly o Fanconi syndrome --> Aminoaciduria, proteinuria and phosphaturia. o The symptoms of the severe from of the disease are similar to the symptoms of the patient child in the Question -3 Jaundice, hepatomegaly vomiting and septicemia (due to E. coli).

So the answer to this question is C


Instruction:
PQLI includes:
A. Infant mortality, Life expectancy and Literacy
B. Maternal mortality, Life expectancy and Literacy.
C. Disability rate, Pregnancy rate and GNP
D. Longevity, Knowledge and Income

Response:
Ans. A. Infant mortality, Life expectancy and Literacy. (Ref. Park's Textbook of PSM 22nd/pg.l6) INDEXKEY POINTS1Physical Quality of Life Index (PQLI) include# Infant mortality,# Literacy,# Life expectancy at age one.# The ultimate obj is to attain PQLI of 100.2Human Development Index (HDI) include# Longevity (Life expectancy at birth),# Knowledge (adult literacy rate & mean years of schooling), and# Income (Per capita GDP). India - 0.612 rank 1283Human Poverty Index (HPI- I & II) includes# I - a long and healthy life, knowledge and a decent standard of living# II - a long and healthy life, knowledge and a decent standard of living, social exclusion.# India - 28%. rank 88.4Gender Related Development Index (GDI)# India- 97.1% -# Reflect achievements in basic human development adjusted for gender inequalities.5Gender Empowerment Measure (GEM)# Measure gender inequalities in economic & political opportunities.

So the answer to this question is A


Instruction:
Facial bevel, proximal ﬂare and chamfer ﬁnish line in a posterior three quarter crown  imparts:
A. Marginal integrity
B. Structural durability
C. Retention and resistance
D. All of the above

Response:
None

So the answer to this question is A


Instruction:
Flexner-Wintersteiner rossette is seen in?
A. Hepatoblastoma
B. Nephroblastoma
C. Neuroblastoma
D. Retinoblastoma

Response:
Ans. is 'd' i.e., Retinoblastoma

So the answer to this question is D


Instruction:
What enhances multiplication of T cells in culture
A. Phytohemagglutinin
B. Chemotactic factor
C. Leukotrienes
D. Prostaglandins

Response:
Option 1, 2, 3, 4 Mitogens like Phytohemagglutinin (PHA), Concanavalin (Con A), and Anti CD-3 induces T-cell blast transformation (multiplication). Option 2 Eosinophil chemotactic factor (ECF-A)- Eosinophil chemotaxis Neutrophil chemotactic factor (NCF-A)- Neutrophil chemotaxis Option 3, 4 Various cells and complement components of innate immunity cordinate and exe their effects through the production of soluble mediators. These mediators include cytokines, prostaglandins, and leukotrienes. Mediators released from activated macrophages and other cells include prostaglandins and leukotrienes. These inflammatory mediators regulate changes in local blood vessels such as vasodilataion During dilation, plasma escapes and accumulates in the area of injury. Fibrin is formed which occludes the lymphatic channels, limiting the spread of organisms. Prostaglandins and leukotrienes in Type I Hypersensitivity: Prostaglandins and leukotrienes are newly formed mediators derived from arachidonic acid the cyclooxygenase pathway. Prostaglandins induce edema and bronchoconstriction. Leukotriene B4 is a chemoattractant that activates and recruits leukocytes to the site of injury. Leukotrienes C4 and D4 cause vasodilation and vascular permeability. These mediators, along with TNF-a and IL-4, are referred to as secondary mediators of a type I reaction.

So the answer to this question is A


Instruction:
Internal fistula is most common between gall bladder and -
A. Colon
B. Duodenum Ist Pa
C. Jejunum
D. Transverse colon

Response:
Biliary fistula is a complication of gallstone (90% of Biliary fistulas are due to gallstone). The inflamed gall bladder becomes adherent to adjacent stomach, duodenum, colon and necrosis develops at the site leading to the development of fistulas. Most common site of fistula is duodenum 2nd most common site is colon. Ref : Hamilton Bailey, 10/e, p 432

So the answer to this question is B


Instruction:
The position of hand during application of POP cast for fracture scaphoid has been clasically described as
A. Boat shaped position
B. Clenched fist position
C. Tumbler holding position
D. Boxing position

Response:
In Scaphoid fracture, the cast is applied to maintain dorsi-flexion of the wrist area. This is called the Glass holding position/Tumbler holding position. In Colle&;s fracture, POP is applied to keep it in palmar flexion and ulnar detion. This is called Shake hand position. ref : maheswari 9th ed

So the answer to this question is C


Instruction:
Spinal cord compression may be caused by ?
A. Cysticercosis
B. Ankylostomiasis
C. Echinoccus Granulosus
D. Visceral larva migrans

Response:
Ans. is 'a' i.e., Cysticercosis Amongst the given options spine is involved only in cysticercosis.

So the answer to this question is A


Instruction:
A 70-year-old man presented to medicine emergency with worsening cough and difficulty in breathing especially at night. On physical examination, raised JVP is noted with bipedal edema. Abdominal examination reveals hepatomegaly. USG was done which reveals hepatomegaly ms. 16.8 cm. USG guided biopsy was carried out. The patient could not be resuscitated. The gross and HPE is shown below. What is the most common eitiology for the patient's clinical condition? Right hea failure Hepatitis A Riedel lobe of liver Metabolic disease of liver.
A. Right hea failure
B. Hepatitis A
C. Riedel lobe of liver
D. Metabolic disease of liver.

Response:
Nutmeg liver: Centri-lobular region is depressed (cell death) with adjacent parenchymal accentuation giving this appearance. HPE: Centri-lobular hemorrhage, with variable degree of hepatocyte necrosis and drop outs. Most common cause is right hea failure (increases IVC pressure, that increases central venous pressure and congestion in liver) and left hea failure ( hypoperfusion and ischemia) Right-sided hea failure leads to passive congestion of the liver. On gross examination: liver is mildly enlarged and cyanotic. It often has rounded edges. Microscopically there is congestion of centrilobular sinusoids. Later, hepatocytes become atrophic, resulting in markedly attenuated liver cell plates. Left-sided hea failure or shock: causes liver hypoperfusion and hypoxia, leading to ischemic coagulative necrosis of hepatocytes in the central region of the lobule which is the centrilobular necrosis. Clinically evident as transient elevation of serum aminotransferases or jaundice

So the answer to this question is A


Instruction:
An elderly male admitted for pneumonia presents with diarrhoea and gripping abdominal pain five days after discharge from hospital. Drug which is likely to benefit is
A. Imodium
B. Metronidazole
C. Diphenoxylate
D. Levofloxacin

Response:
The macrolides (especially azithromycin) and the respiratory quinolones are now the antibiotics of choice and are effective as monotherapy. Compared with erythromycin, the newer macrolides have superior in vitro activity, display greater intracellular activity, reach higher concentrations in respiratory secretions and lung tissue, and have fewer adverse effects. The pharmacokinetics of the newer macrolides and quinolones also allow once- or twice-daily dosing. Quinolones are the preferred antibiotics for transplant recipients because both macrolides and rifampin interact pharmacologically with cyclosporine and tacrolimus Ref Harrison 19th edition pg 1017

So the answer to this question is D


Instruction:
All are true regarding Plummer Vinson syndrome,except -
A. Oesophageal web
B. Predisposes to malignancy
C. Koilongchia
D. Common in elderly males

Response:
None

So the answer to this question is D


Instruction:
Earliest & characteristic radiological finding of leukemia
A. Translucent transverse metaphyseal bands
B. Metaphyseal Osteosclerosis
C. Periosteal reaction
D. Metaphyseal cortical erosions

Response:
All the above are the findings of leukemia. But Earliest & characteristic finding is option A.

So the answer to this question is A


Instruction:
A 52-year-old woman presents with polyuria, polydypsia, constipation, and fatigue. She has no significant past medical history, and she is not on any medications. She was recently diagnosed with hyperparathyroidism.Select the characteristic ECG findings.
A. shortened PR interval
B. lengthened PR interval
C. lengthened QU interval
D. shortening of the QT interval

Response:
With severe hypercalcemia, the QT interval is markedly shortened. There is a correlation between the length of QT interval and the degree of hypercalcemia.

So the answer to this question is D


Instruction:
Kartagener's syndrome is characterized by all EXCEPT
A. Dextrocardia
B. Bronchiectasis
C. Bronchitis
D. Sinusitis

Response:
(Bronchitis) (11, 18-LT) (409-Maqbool 1lth)Kartagener's syndrome (immobile cilia). These patients have a constantly runny nose, secretory otitis media, chronic sinusitis, bronchiectasis and often sinus inversus (Dextrocardia) Cystic fibrosis of pancreas.

So the answer to this question is C


Instruction:
Variation in eruption in permanent dentition
A. 4-5 months
B. 7-9 months
C. 1-2 months
D. 12-18 months

Response:
None

So the answer to this question is D


Instruction:
Anti - T.T.G. antibodies are seen in:
A. Giardia malabsorption
B. Gluten enteropathy
C. Lactose deficient
D. Bile acid malabsorption

Response:
Anti-endomysial antibodies of the immunoglobulin A (IgA) type can detect celiac disease with a sensitivity and specificity of 90% and 99%, respectively. Serology for anti-T.T.G antibodies was initially repoed to have a higher sensitivity (99%) and specificity (>90%) for identifying coeliac disease. However, it is now thought to have similar characteristics to anti-endomysial antibody. Modern anti-TTG assays rely on a human recombinant protein as an antigen. TTG testing should be done first as it is an easier test to perform

So the answer to this question is B


Instruction:
Which of the following features on mammogram would suggest malignancy?
A. Well defined lesion
B. A mass of decreased density
C. Areas of spiculated microcalcifications
D. Smooth borders

Response:
Ans. is 'c' i.e. Areas of spiculated microcalcifications Distinguishing features between benign and malignant lesions on mammogram:- BenignMalignantOpacitySmooth marginIII defined margin, Irregular stellate, spiculated margin, comet tail Low densityHigh density HomogeneousIn homogeneous Thin halowide haloCalcificationMacrocalcification (> 5mm inMicrocalcification (< 5 mm in diameter)diameter)Breast ParenchymaNormalArchitectural distortionNipple/areola+- Retracted+- RetractedSkinNormalthickenedCooper ligamentsNormalthickened, increase numberDuctsNormalfocal dilatationSubcutaneous retro mammary spaceNormalobliterated

So the answer to this question is C


Instruction:
A 45-year-old man presents to his physician with hematuria. Renal biopsy demonstrates a focal necrotizing glomerulitis with crescent formation. The patient has a history of intermittent hemoptysis and intermittent chest pain of moderate intensity. A previous chest x-ray had demonstrated multiple opacities, some of which were cavitated. The patient also has chronic cold-like nasal symptoms. Which of the following is the most likely diagnosis?
A. Aspergillosis
B. Polyaeritis nodosa
C. Renal carcinoma metastatic to the lung
D. Wegener's granulomatosis

Response:
While in real life, other diseases (or combinations of diseases) may occasionally cause concurrent pulmonary, sinus, and renal involvement, if you see this pattern on a test question, you should immediately think of Wegener's granulomatosis. This is a rare focal necrotizing vasculitis of still unclear etiology, which also features prominent granulomas, some of which are centered on the vascular lesions. The vasculitis and granulomatous can involve the entire respiratory tract, and an easily obtained nasal biopsy may sometimes yield the diagnosis. The renal involvement is usually in the form of a necrotizing glomerulonephritis. The disease typically affects middle aged men, and its formerly poor prognosis has been improved by coicosteroid and cyclophosphamide therapy. Note: Aspergillosis can cause prominent lung disease, but does not usually have renal involvement. Polyaeritis nodosa is a possibility, but usually spares the lungs. Renal cell carcinoma might cause lung nodules, but there is no evidence of tumor in the kidney.

So the answer to this question is D


Instruction:
Otolith organs are concerned with the function of?
A. Oculovestibular reflex
B. Rotary nystagmus
C. Linear acceleration
D. Angular acceleration

Response:
Otolith organs: Utricle and saccule are the otolith organs. Their Sensory epithelium is called maculae.
They are concerned with linear acceleration-deceleration. They sense the position of the head with respect to gravity. Otoliths: They are crystals of calcium carbonate located on the otolithic membrane present in the maculae. Also called the otoconia.

So the answer to this question is C


Instruction:
Difference between postmoem staining and contusion are all, except: PGI 10; NEET 14
A. Bluish in color
B. Disappear on pressure
C. Margins are regular
D. Extravasation is found

Response:
Ans. Extravasation is found

So the answer to this question is D


Instruction:
Non-immune hydrops fetalis is due to all except :
A. Chromosome defect
B. Alpha thalassemia major
C. Parvo B - 19 virus
D. ABO incompatibility

Response:
ABO incompatibility

So the answer to this question is D


Instruction:
A 24-year-old woman presents 6 months after the delivery of her first child, a healthy girl, for evaluation of fatigue. She suspects that the fatigue is related to getting up at night to breastfeed her baby, but she has also noticed cold intolerance and mild constipation. She recalls having a tremor and mild palpitations for a few weeks, beginning 3 months after delivery. On examination, her BP is 126/84 and her pulse rate is 56. The thyroid gland is two times normal in size and nontender. The rest of the physical examination is normal. Laboratory studies reveal a free T4 level of 0.7 ng/mL (normal 0.9-2.4) and an elevated thyroid-stimulating hormone (TSH) at 22 microU/mL (normal 0.4-4). What is the likely course of her illness?
A. Permanent hypothyroidism requiring lifelong replacement therapy
B. Eventual hyperthyroidism requiring methimazole therapy
C. Recovery with euthyroidism
D. Infertility

Response:
This patient has postpartum thyroiditis, a condition that follows 5% to 8% of all pregnancies. Like other forms of destructive thyroiditis (including subacute or de Quervain thyroiditis), this illness is triphasic. Initially there is hyperthyroidism due to inflammation and release of preformed thyroid hormone from the inflamed follicles; this phase usually lasts 2 to 4 weeks. In subacute thyroiditis, the initial phase is usually noticed because of pain and tenderness over the thyroid gland, but in postpartum thyroiditis the thyroid is usually painless, and the hyperthyroid phase may be overlooked. This phase is then followed by transient hypothyroidism, usually lasting 1 to 3 months. The third phase is resolution and euthyroidism. Whereas Hashimoto thyroiditis usually leads to permanent autoimmune hypothyroidism, most patients with destructive thyroiditis have a full recovery. Some will be symptomatic enough to require thyroid supplementation for 1 to 3 months until the process resolves. Although the initial hyperthyroid phase can suggest Graves' disease, in thyroiditis the absence of infiltrative ophthalmopathy and a suppressed radioiodine uptake will make the distinction.Antithyroid drug treatment of thyroiditis is ineffective and puts the patient at unnecessary risk of toxicity such as agranulocytosis. Although hypothyroidism can cause amenorrhea and hence impair fertility, the hypothyroid phase of postpartum thyroiditis is transient. Low-level radiation exposure, but not thyroiditis, increases the risk of subsequent development of thyroid cancer. Interestingly, therapeutic radioactive iodine, such as is given for Graves' disease, does not increase the long-term risk of cancer, probably because the thyroid cells are destroyed.

So the answer to this question is C


Instruction:
The incisor over-jet is increased for a class II case that is undergoing treatment. The reason is
A. Loss of anchorage
B. Arch collapse
C. Crowding in the lower arch
D. None of the above

Response:
None

So the answer to this question is A


Instruction:
What is the most common ECG finding for pulmonary embolism?
A. Sinus tachycardia
B. S1 Q3 T3
C. T wave inversion
D. Epsilon waves

Response:
M/C ECG abnormality in pulmonary embolism- Sinus tachycardia M/C symptom is unexplained breathlessness. Screening test - D-dimer test. Most specific finding is S1Q3T3. The classic findings of right hea strain and acute cor pulmonale are tall, peaked P waves in lead II (P pulmonale); right axis detion; right bundle-branch block and S1Q3T3 pattern.

So the answer to this question is A


Instruction:
The mechanism that protects normal pancreas from autodigestion is :
A. Secretion of biocarbonate.
B. Protease inhibitors present in plasma.
C. Proteolytic enzymes secreted in inactive form.
D. The resistance of pancreatic cells.

Response:
Ans. is 'c' i.e. proteolytic enzymes secreted in inactive form The pancreatic enzymes have the capability of digesting the pancreas itself (mainly proteases)(Auto digestion of pancreas is considered to be the main pathogenic mechanism for pancreatitis)Normally, auto digestion of pancreas is prevented by several means :The enzymes are synthesized as inactive pro enzymes (with the exception of amylase and lipase)They are sequestered in membrane bound zymogen granules in acinar cellsActivation of pro enzymes requires conversion of inactive trypsinogen to active trypsin by duodenal enteropeptidaseTrypsin inhibitors are present within acinar and ductal secretionsIntra pancreatic release of trypsin activates an enzyme or enzymes that degrades other enzymes to inert products.Lysosomal enzymes are capable of degrading zymogen granules when normal acinar secretion is impaired or blocked.Acinar cells are remarkably resistant to the action of trypsin, chymotrypsin and phospholipase A2Regarding option V pancreatic enzymes require alkaline medium for their activity so bicarbonate secretion will help in their activity.

So the answer to this question is C


Instruction:
Vertebral plana is a finding in a child with
A. Hyperparathyroidism
B. Osteomalacia
C. Eosinophilic granuloma
D. None of the above

Response:
Ans. (c) Eosinophilic granuloma.Vertebra plana or pancake vertebra is the term given when a vertebral body has lost almost its entire height anteriorly and posteriorly, representing a very advanced crush fracture. It can occur with a variety of settings, including:1. Trauma2. Osteoporosis3. Eosinophilic granuloma (LCH)4. Osteogenesis imperfecta5. Leukemia6. Vertebral metastases7. Multiple myeloma8. Lymphoma9. Osteomyelitis

So the answer to this question is C


Instruction:
Not states responsibility -
A. Enpower women
B. Protect children against exploitation
C. Protect children from abuse
D. Raising level of nutrition

Response:
Ans. is 'a' i.e., Enpower women State responsibility The responsibility for health does not end with the individual and community effo. In all civilized societies, the state assumes responsibility for the health and welfare of its citizens. The consititution of india provides that health is a state responsibility. The relevant poions are to be found in the directive principles of state policy, which are as below - The state shall, in paicular, direct the policy towards securing - ...that the health and strength of workers, men and women and the tender age of children are not abused and that citizens are not forced by economic necessity to enter ovocations unsuited to their age or strength. ...that childhood and youth are protected against exploitation and against moral and material abandonment. The state shall, within the limits of its economic capacity and development, make effective provision for secruring the right to work, to education and to public assistance in cases of unemployment, old age, sickness and disablement, and in other cases of undesrved want. The state shall make provision for securing just and humane conditions of work and maternity relief The state shall regard the raising of the level of nutrition and standard of living of its people and the improvement of public health as among its primary duties. -- The constitution of India; Pa IV

So the answer to this question is A


Instruction:
Which of the following drug is not a component of triple drug therapy for helicobacter pylori: March 2008
A. Lansoprazole
B. Clarithromycin
C. Metronidazole
D. Cimetidine

Response:
Ans. D: Cimetidine Triple therapy is considered to be the standard treatment for children. A proton pump inhibitor combined with two antibiotics has been shown to be very effective in clearing H pylori from the stomach. The current recommendation is treatment with amoxicillin, clarithromycin, and a proton pump inhibitor (lansoprazole) for 2 weeks.

So the answer to this question is D


Instruction:
Propoional moality rate is :-
A. Rate
B. Ratio
C. Propoion
D. None

Response:
Propoional Moality Rate (PMR) x 100. Numerator is a pa of the denominator & expressed in %. Hence, it is a propoion. Rate Ratio Propoion IMR Incidence Crude death rate MMR Sex ratio Relative risk Prevalence Case fatality rate Survival rate Propoional moality rate

So the answer to this question is C


Instruction:
Thyroxine can be given in which thyroid carcinoma: September 2009
A. Papillary
B. Medullary
C. Anaplastic
D. Undifferentiated

Response:
Ans. A: Papillary On the basis that most of the tumours are TSH depedent it is a standard practice to prescribe thyroxine for all patients after operation for differentiated thyroid carcinoma (papillary and follicular type) to suppress endogenous TSH production.

So the answer to this question is A


Instruction:
Most common cause of abortion in first trimester is-
A. Genetic
B. Maternal
C. Immunologic
D. Anatomic abnormalities

Response:
Ans. is 'a' i.e., GeneticCauses of first trimester abortiono Genetic: Majority (50%) of the early miscarriages are due to the chromosomal abnormality of the conceptus.Autosomal trisomy is the commonest cytogenetic abnonnality. Trisomy 16 is the most common.o Endocrine and metabolic (10 - 15%)Luteal phase defect, deficient progesterone, thyroid abnormalities, diabetes mellitus. o Anatomical abnormalities (10 - 15%)Cervico - uterine factors (mostly related to second trimester abortion) - cervical incompetence and congenital malformation of the uterus.o Infections: (5%)Can cause early as well as late abortions.o Immunological disorders (5- 10 %)o Blood group incompatibilityo Premature rupture of membraneso Environmental: Cigarette smoking, alcoholo Unexplained.

So the answer to this question is A


Instruction:
The enzyme marker of electron transpo system is
A. Cytochrome reductase
B. Fumarase
C. Pyruvate
D. Malate dehydrogenase

Response:
Complex III: CoQ-Cyt.C Reductase Functions as * Proton pump, and * Catalyses transfer of electrons SECTION TWO This system catalyses transfer of electrons from CoQ.H2 to Cyt-c Cyt-b and Cyt-c1. The electrons from CoQ.H2 is first accepted by Cyt-b566 and then transferred to Cyt-b562, which reduces Co.Q.H2 CoQ Fe+++ accepts electron and is oxidised to Fe++. The system also acts as a proton pump. It is believed that 4 (four) protons are pumped across the mitochondrial membrane during the oxidation. The energy change permits ATP formation (Site II). Role of Q cycle and Rieske FeS in complex III Electrons are passed from Q.H2 to cytochrome C complex III-Q cytochrome C oxidoreductase: Q. H2 + 2 Cyt C + 2H+ - Q + 2 CytC + 4H+ Oxidised matrix reduced membrane space The process is believed to involve cytochromes C1, b1 and bHH and a Rieske FeS. Rieske FeS is an unusual FeS in which one of the Fe atoms is linked to two histidine -SH groups rather than two cysteine -SH groups and is called as the Q cycle. Q may exist in three forms: * Oxidised quinone, * Reduced quinol, or * Semiquinone. The semiquinone is formed transiently during the cycle, one turn of which results in the oxidation of 2Q.H2 to Q, releasing 4H+ into the intermembrane space, and the reduction of one Q to QH2, causing 2H+ to be taken up from the matrix. Note It is to be noted that while Q carries two electrons, the cytochromes carry only one, thus the oxidation of one Q.H2 is coupled to the reduction of two molecules of cytochrome C the Q. cycle. Other options are not paicipating in ETC.Ref: MN Chatterjea Textbook of Medical Biochemistry, 8th edition, page no: 142

So the answer to this question is A


Instruction:
Side effects of a drug arise due to interactions of the drug to molecules other than the target.These effects of the,drug can be minimized by its high:
A. Specificity
B. Solubility
C. Affinity
D. Hydrophobicity

Response:
If a drug is more specific in action, it acts only in that paicular organ so no systemic side effects will be seen and targeted cancer therapy using nanopaicles is also bases on this approach Ref; KD Tripathi pharmacology 7 th edition (page no; 84)

So the answer to this question is A


Instruction:
Adenocarcinoma cervix is associated with all, except:
A. HPV 11
B. HPV 16
C. HPV 18
D. HPV 51

Response:
HPV strains for carcinoma cervix are HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56 & 58 Ref: Novak's Gynaecology, 14th Edition, Page 568

So the answer to this question is A


Instruction:
In Indoor air pollution, carbon monoxide is produced by
A. Combustion equipment
B. Stove
C. Gas heaters
D. All of the above

Response:
(All of the above) (593 - Park 19th) (642-Park 20th)Sources of Indoor air pollutantsPollutantSources* Respirable particle* Carbon monoxide* Nitrogen - dioxide* Sulphur dioxide* Formaldehyde* Ozone* Radon and daughters* Asbestos* Mineral fibresTobacco smoke, stove, Aerosol spraysCombustion equipment, stove, Gas heatersGas cookers, cigarettesCoal combustionParticle board, carpet adhesives insulationElectric arcing, UV light sourcesBuilding materialInsulation, fire proofingAppliances

So the answer to this question is D


Instruction:
Which is not heterophile agglutination test?
A. Weil-Felix test
B. Widal test
C. Paul-Bunnel, test
D. Streptococcus MG

Response:
Ans. (b) Widal Test Ref. Ananthanarayan 8/e, p 93 The same or closely related antigen may sometimes occur in different biological species/classes, etc. It is called heterogenetic or heterophile antigen, e.g. Forssman antigen for Pneumococcus, Salmonella. Weil Felix reaction (between proteus and Rickettsia). Paul Bunnell test in infectious mononucleosis. Cold agglutination test in primary atypical pneumonia. Streptococcus MG agglutination. Antigen between E. coli and human RBC of B. Remember Widal test is tube agglutination test.

So the answer to this question is B


Instruction:
A man comes to emergency depament after alcohol binge the previous night and sleeping on arm chair. In the morning he is unable to move his hand and diagnosis of ulnar palsy is made. What is the next line of management?
A. Knuckle bender splint
B. Do EMG study after 2 days
C. Immediately operate and explore the nerve
D. Wait and watch

Response:
The first procedure to be adopted in every case of nerve injury is to splint the limb in position which will most effectively relax the affected muscles. Since this patient has developed ulnar nerve palsy Knuckle bender splint should be used. Here EMG after 2 days is useless since changes begin to appear in EMG after 2 weeks of a nerve injury. Also there is no need of open exploration since in a case of neurapraxia transmission of impulses is physiologically interrupted for some time, but recovery is complete in a few days or weeks. Splints used for various nerve injuries: Axillary nerve paralysis : Aeroplane splint Radial nerve palsy : Cock up splint Sciatic or common peroneal nerve palsy : Foot drop splint

So the answer to this question is A


Instruction:
What is the color-coding of bag in hospitals to disposeoff human anatomical wastes such as body pas -
A. Yellow
B. Black
C. Red
D. Blue

Response:
Ans. is 'a' i.e., Yellow Human anatomical wastes such as human tissues, organs, and bodv pas are classified as Waste Category No. 1 They are disposed in 'plastic bags' with a 'yellow color code' and treated by 'Incineration or deep burial'.

So the answer to this question is A


Instruction:
Remission with SSRI or TCA patient again havingrelapse. There may be deficiency of ?
A. Pyridoxine
B. Cobalamine
C. Ascorbate
D. Retinol

Response:
Ans. is `b' i.e., Cobalamine Subjects with vitamin B 12deficiency and depression may present with history of past episodes with spontaneous remission or response to treatment with antidepressants and later recognition or development Budeficiency" Studies have found that some people with depression may have low levels of folic acid, vitamin B12 or vitamin D.

So the answer to this question is B


Instruction:
Drug of choice for Acute Adrenal Crisis is:
A. Norepinephrine
B. Hydrocoisone
C. Dexamethasone
D. Fludrocoisone

Response:
Answer is B (Hydrocoisone): The treatment of choice for acute adrenal insufficiency is Glucocoicoid Replacement Therapy. Hydrocoisone is the preferred steroid fir Glucocoicoid replacement therapy in acute adrenal crisis since it has both glucocoicoid and mineralocoicoid actions. In cases where the diagnosis of acute adrenal insufficiency is suspected (not confirmed) Dexamethasone is preferred as the initial steroid of choice because Dexamethasone does not compete with the coisol assay. 'Glucocoicoid replacement should be initiated by bolus injection of 100 mg Hydrocoisone, followed by the administration of 100-200mg hydrocoisone over 24 hours either by continuous infusion or provided by several IV or IM Injections. Mineralocoicoid replacement can be initiated once the daily hydrocoisone dose has been reduced to less than 50 mg because at higher doses hydrocoisone provides sufficient stimulation of glucocoicoid receptors'

So the answer to this question is B


Instruction:
Which of the following statements about mollaret meninigitis is true -
A. Caused by herpes simplex 2 in most of the cases
B. Is a recurrent, benign septic meningitis
C. Is also referred to as4 'Benign recurrent neutrophilic meningitis"
D. Does not resolve without treatment

Response:
Ans. is 'a1 i.e., Caused by herpes simplex 2 in most of the cases Recurrent (Mollaret 's ') meningitiso Mollaret s meningitis is a form of recurrent benign lymphocytic meningitis (RBLM), an uncommon illness characterized by greater than three episodes of fever and meningismus lasting two to five days, followed by spontaneous resolution.There is a large patient-to-patient variation in the time course to recurrence that can vary' from weeks to years.One-half of patients can also exhibit transient neurological manifestations, including seizures, hallucinations, diplopia, cranial nerve palsies, or altered consciousness.o The most common etiologic agent in Mollaret's meningitis is HSV-2

So the answer to this question is A


Instruction:
Bimodal distribution is seen in -
A. Thyroid carcinoma
B. Hodgkins lymphoma
C. Renal carcinoma
D. Liver carcinoma

Response:
Ans. is 'b' i.e., Hodgkins lymphoma * One important phenomenon in age distribution is bimodality, i.e. some disease show two peaks in different age groups. Diseases showing bimodality are Hodgkin's disease, leukaemia, and female breast cancer.

So the answer to this question is B


Instruction:
Broca's area situated in:
A. Inferior frontal gyrus
B. Superior temporal gyrus
C. Angular gyrus
D. None of the above

Response:
Ans. a. Inferior frontal gyrusMotor speech area of Broca (areas 44 and 45 of Brodmann)The motor speech area of Broca is located in the pars triangularis (area 45) and pars opercularis (area 44) of inferior frontal gyrus of frontal lobe of left hemisphere (dominant hemisphere) in most of the individuals, and the persons are right handed.However, in 30% cases it is present in the right hemisphere and persons are left handed.Brocas area is responsible for the production of expressive speech/vocalization.It brings about the formation of words by its connections with the adjacent primary motor area, which in turn appropriately stimulate the muscles of the larynx, mouth, tongue, soft palate, and the respiratory muscles.It connected to Wernicke speech area by the arcuate fasciculus.Broca AphasiaResults from lesions in Broca speech area.Also called motor, expressive, nonfluent, or anterior aphasia.Causes patients to speak slowly (nonfluent) and with effort; however, they have good comprehension of spoken and written language.Frequently accompanied by contralateral weakness of the lower face and arm and a sympathetic apraxia of the left hand (the inability to write with the nonparalyzed hand).

So the answer to this question is A


Instruction:
Which one of the following is not included in Jone's Major criteria aEUR'
A. Pan carditis
B. Chorea
C. Subcutaneous nodule
D. High ESR

Response:
High E.S.R. * The Jones criteria for rheumatic fever: Major criteria Minor cieria * Carditise * Migratory polyahritise * Sydenham's chorea0 * Subcutaneous nodulese * Erythema marginaturne Clinical * Fever0 * Ahralgiae Laboratory * Elevated acute phase reactants0 * Prolonged PR interval PLUS * Suppoing evidence of a recent group A Streptococcal infection (e.g. positive throat culture or rapid antigen detection test; and or elevated or increasing streptococcal antibody test).

So the answer to this question is D


Instruction:
Maximum dose of lignocaine given with adrenaline for infiltration anaesthesia is:
A. 3 mg/kg
B. 5 mg/kg
C. 7 mg/kg
D. 10mg/kg

Response:
KD Tripathi essentials of medical pharmacology; edition7 ;pgs no-368 Dilute solutions or LA is infiltrated under the skin in the areas of operation-blocks sensory nerve endings.onset of action is almost immediate and duration is shoer than that after nerve block, e.g.lidocaine 30-60 min, bupivacaine 120-180 min. Infiltration is used for minor operations, e.g. incisions,excisions, hydrocele, herniorrhaphy, etc. when the area to be anaesthetized is small. Relatively large amount of LA is required compared to the area anaesthetised, but motor function is not affected

So the answer to this question is C


Instruction:
Veebral level of body of sternum is
A. T3 to T4
B. T4 to T5
C. T5 to T7
D. T5 to T9

Response:
Veebrae level of body of sternum is T5-T9. Ref - medscape.com

So the answer to this question is D


Instruction:
Name the condition in which blood by passes the liver through an abnormal connection between poal vein and hepatic vein
A. Sturge weber syndrome
B. Abernethy Malformation
C. Couvorier syndrome
D. Stockholm syndrome

Response:
Congenital absence of the poal vein (CAPV) is a rare malformation of the splanchnic venous system. No gross anatomical connections between the poal and the hepatic veins within the liver normally. In CAPV, blood carried by the superior mesenteric vein and splenic vein bypasses the liver and drains into a systemic vein and it is known as 'The Abernethy Malformation'.

So the answer to this question is B


Instruction:
Which of the following is not a pa of Kubler Ross Stages of impending death?
A. Depression
B. Bargain
C. Aggression
D. Anger

Response:
Aggression REF: Kaplan & Sadock's Synopsis of Psychiatry: 10th Edition, page 62, 63 Stages of Death and Dying:Elisabeth Kubler-Ross, M.D. (July 8, 1926 - August 24, 2004) was a Swiss-born psychiatrist, a pioneer in Near-death studies and the author of the groundbreaking book On Death and Dying (1969), where she first discussed what is now known as the Kiibler-Ross modelStage 1: Shock and DenialStage 2: AngerStage 3: BargainingStage 4: DepressionStage 5: Acceptance

So the answer to this question is C


Instruction:
Which of the following is true regarding gastrulation:
A. Establishes all the three germ layers
B. Occurs at the caudal end of the embryo prior to its cephalic end.
C. Involves the hypoblastic cells of inner cell mass
D. Usually occurs at 4 weeks

Response:
A i.e. Establishes all 3 germ layers in embryo

So the answer to this question is A


Instruction:
The highest malignant potential is seen in -
A. Crohn's disease
B. Ulcerative colitis
C. Familial polyposis
D. Infantile polyp

Response:
“Colorectal cancer develops in 100% of untreated FAP patients often before the age of 30”.

So the answer to this question is C


Instruction:
A 45-year-old woman presents with a 6-month history of fatigue and swelling in her neck. Physical examination shows a goiter. A CBC discloses megaloblastic anemia and a normal reticulocyte count. Additionally, there is an elevated serum level of TSH and antithyroid antibodies. Needle aspiration of the left lobe of the thyroid reveals benign follicular cells and numerous lymphocytes. Anemia in this patient is most likely caused by antibodies directed to which of the following targets?
A. Chief cells
B. Intrinsic factor
C. Paneth cells
D. TSH receptor

Response:
This patient has chronic lymphocytic thyroiditis (Hashimoto thyroiditis) and pernicious anemia. Pernicious anemia is a megaloblastic anemia that is caused by malabsorption of vitamin B12 due to a deficiency of the intrinsic factor. In many cases, pernicious anemia is associated with other autoimmune diseases (e.g., Hashimoto thyroiditis, Graves disease, Addison disease, or diabetes mellitus type 1). Circulating antibodies to parietal cells, some of which are cytotoxic in the presence of complement, occur in 90% of patients with pernicious anemia. Two thirds of patients display an antibody to the intrinsic factor that prevents its combination with vitamin B12 thereby preventing formation of the complex that is later absorbed in the ileum. Half of all patients with pernicious anemia have circulating antibodies to thyroid tissue.Diagnosis: Pernicious anemia, Hashimoto thyroiditis

So the answer to this question is B


Instruction:
Best test to differentiative between medical and surgical jaundice is
A. Akaline phosphatase
B. Bilirubin and serum enzymes
C. Enzymes
D. Ultrasound

Response:
Investigations for Obstructive Jaundice 1. Serum bilirubin. A normal value is less than 1.0 mg%. Both direct and indirect bilirubin are assessed. Direct is increased in obstructive jaundice, i.e. conjugated hyperbilirubinaemia. van den Bergh's test is done. 2. Serum albumin, globulin and A: G ratio. Normal S. albumin is more than 3.5 gm%. 3. Prothrombin time. A normal value is 12-16 seconds. It is significant if it is more than 4 from the control or more than one and half times the control. It is corrected by injection vitamin K, 10 mg IM OD for 5 days or by FFP--5-10 units. 4. Serum alkaline phosphatase, SGPT, SGOT, 5' nucleotidase. 5. U/S abdomen. 6. ERCP to visualise the site of obstruction, brush biopsy, bile sample for analysis. 7. MRCP--Non-invasive diagnostic tool. Ref: SRB&;s manual of surgery,3 rd ed, pg no 588

So the answer to this question is D


Instruction:
For which of the following has the cytoxic effect of vitamin on human lymphocytes in vitro at high concentration been repoed -
A. Vitamin A
B. Vitamin D
C. Vitamin E
D. Vitamin K

Response:
VITAMIN E (Tocopherol) Vitamin E is the generic name for a group of closely related and naturally occurring fat soluble compounds, the tocopherols. Of these alpha-tocopherol is biologically the most potent. Vitamin E is widely distributed in foods. By far the richest sources are vegetable oils, cotton-seed, sunflower seed, egg yolk and butter. Foods rich in polyunsaturated fatty acids are also rich in vitamin E. The usual plasma level of vitamin E in adults is between 0.8 and 1.4 mg per 100 ml. While there is no doubt that man requires tocopherol in his diet, there is no clear indication of dietary deficiency. The role of vitamin E at the molecular level is little understood. The current estimate of vitamin E requirement is about 0.8 mg/g of essential fatty acids. This roughly works out to 8-10 mg tocopherol per day depending on the edible oil used. Recently the cytotoxic effect of vitamin E on human lymphocytes in vitro at high concentrations has been repoed. This being so, caution should be exercised against the mega-dose consumption of vitamin E in clinical practice. Ref : Park 25th edition Pgno : 657

So the answer to this question is C


Instruction:
Cause of clostridium difficle associated diarrhea ?
A. Trauma
B. Dairy products
C. Fried rice
D. Antibiotic use

Response:
Ans. is 'd' i.e., Antibiotic use

So the answer to this question is D


Instruction:
Which of the following passes through the foramen magnum -
A. Vertebral Artery
B. Sympathetic chain
C. XIth cranial nerve
D. Internal carotid Artery

Response:
Structures passing through foramen magnum are :

Anterior part:- Apical ligament of dens, membrane tectoria, vertical band of the cruciate ligament.
Posterior part:- the Lowest part of the medulla oblongata, three meninges (dura, arachnoid and pia mater).
Subarachnoid space:- Spinal accessory nerves, vertebral artery and sympathetic plexus around it, posterior spinal arteries, anterior spinal arteries.

So the answer to this question is A


Instruction:
Which of the following is not a treatment method for fissure in ano?
A. Sitz bath
B. Botox injection
C. Diltiaem gel
D. Seton’s procedure

Response:
Seton’s procedure is done for fistula in ano.

So the answer to this question is D


Instruction:
All of the following mechanisms might account for a reduce-risk of upper genital tract infection in users of progestin - releasing lUDs, except:
A. Reduced retrograde menstruation
B. Decreased ovulation
C. Thickened cervical mucus
D. Decidual changes in the endometrium

Response:
Decreased ovulation does not protect from upper genital tract infection. Also it doesn't inhibit ovulation in all women. THE TEXTBOOK OF GYNAECOLOGY SHEILA BALAKRISHNAN SECOND EDITION PAGE NO 379

So the answer to this question is B


Instruction:
Infective endocarditis is not seen in one of the following condition :
A. PDA
B. ASD
C. TOF
D. VSD

Response:
Ans. is 'b' Atrial Septal defect .Repeat

So the answer to this question is B


Instruction:
The Epwoh scale is used for assessing -
A. Body mass index
B. Vital capacity in post-operative patients
C. Sleep apnea
D. Risk of embolism in perioperative patient

Response:
Answer- C. Sleep apneaThe Epwoh Sleepiness Scale-Obstructive sleep apneaNarcolepsyIdiopathic hypersomnia

So the answer to this question is C


Instruction:
All of the following are true of pulmonary embolism except:
A. Sudden onset of pleuritic pain and hemoptysis and hypotension.
B. ECG shows evidence of acute left ventricular stress.
C. Pulmonary angiography is gold standard
D. CTPA is imaging modality of choice

Response:
Classic Findings in Pulmonary Embolism:- Right Hea strain and Acute Cor Pulmonale - sudden onset of pleuritic chest pain, hemoptysis and hypotension - Tall, peaked P waves in lead II (P pulmonale) - Right axis detion - Right bundle-branch block - S1Q3T3 pattern. On Xray :- Hampton's hump, Westermark sign (areas of relative oligemia secondary to decreased caliber of regional pulmonary aeries) and Palla's sign (Enlarged right descending pulmonary aery )are seen. - CTPA is imaging modality of choice - It shows Rt. ventricular stress instead of left ventricular stress.

So the answer to this question is B


Instruction:
A patient committed suicide by shooting a bullet into his right temple. On post-moem examination, the skull was burst open. There was charring and cherry red discoloration along the track of bullet and the weapon was firmly clasped in the right hand of deceased. The bullet was fired from what distance
A. Contact shot
B. Close shot at a distance of one feet from hand
C. Shot within range of smoking
D. Shot within range of tattooing

Response:
Ans. a. Contact shot In a contact shot, the discharge from the muzzle, consisting of flame, powder grains, metallic paicles, and hot gases are blown into the track of the bullet. This leads to charring of the track inside and pink coloration owing to formation of carboxyhemoglobin. Gases entering the track in a contact shot are under high pressure, which may lead to 'bursting fracture' of skull

So the answer to this question is A


Instruction:
A 17 year old female presented with primary amenorrhea, well developed breast and scanty axillary and pubic hair. ultrasonography of the patient shows absence of the uterus and vagina. Genotype of the patient is most likely to be:
A. 46 XX
B. 45 XO
C. 46 XY
D. 47XXY

Response:
Patient has Testicular-feminizing syndrome. It is most common form of male intersex. Genotype is 46 XY There are functional testes which secrete androgens but since there is androgen insensitivity, external feminisation occurs In this external genitalia appears female breast are well developed, clitoris is normal in size axillary and pubic hair are scanty, due to insensitivity to androgen NOTE: the answer could also have been MRKH with XX normal karyotype, however, scanty pubic hair points more towards androgen insensitivity, in MRKH breast development, axillary and pubic hair are normal

So the answer to this question is C


Instruction:
Dabigatran toxicity is treated by
A. Protamine sulphate
B. Andexanet alfa
C. Idarucizumab
D. Argatroban

Response:
Idarucizumab is a monoclonal antibody used to treat Dabigatran toxicity.

So the answer to this question is C


Instruction:
Swelling of deep lobe of parotid gland presents as swelling in:-
A. Parapharyngeal space
B. Cheek
C. Temporal region
D. Below the ear

Response:
Swelling of deep lobe of parotid gland presents as swelling in parapharyngeal space. The parotid gland is the most common site for salivary tumours. Most tumours arise in the superficial lobe and present as slow-growing, painless swellings below the ear, in front of the ear or in the upper aspect of the neck. Less commonly, tumours may arise from the accessory lobe and present as persistent swellings within the cheek. Rarely, tumours may arise from the deep lobe of the gland and present as a parapharyngeal mass. Symptoms include difficulty in swallowing and snoring. Clinical examination reveals a diffuse firm swelling in the soft palate and tonsil.

So the answer to this question is A


Instruction:
A 45-year-old woman who smokes is found to have a splenic artery aneurysm. It was most likely caused by:
A. Atherosclerosis
B. Trauma
C. Medial dysplasia
D. Pancreatitis

Response:
Splenic artery aneurysms in women are almost always caused by medial dysplasia of the artery. It may be the cause of rupture in pregnancy and can be life-threatening if not treated promptly by laparotomy. Aneurysms may be caused by atherosclerosis, trauma, and pancreatitis (when complicated by pseudocyst formation). Portal hypertension is not a cause of aneurysm.

So the answer to this question is C


Instruction:
Most common type of bladder cancer is
A. Squamous cell carcinoma
B. Urothelial carcinoma
C. Adenocarcinoma
D. Carcinoid

Response:
Types of bladder cancers*Epithelial tumours: (95%)*Urothelial ( Transitional ) carcinomas- Most common*Squamous cell carcinoma*Adenocarcinoma Rare types*Small cell carcinoma*Mesenchymal tumours: (5%)*Sarcomas

So the answer to this question is B


Instruction:
Oral incretin analogue
A. Semaglutide
B. Dulaglutide
C. Exenatide
D. Liraglutide

Response:
GLP analogues are usually given by SC route but now recently oral analogue was prepared-semaglutide. Ref: Ktzung 12 th ed.

So the answer to this question is A


Instruction:
Which of the following variables is measured on the ordinal scale-
A. Type of anemia
B. Severity of anemia
C. Hemoglobin
D. Serum ferritin

Response:
When data is ranked e.g. mild, moderate, severe  → ordinal scale is used. Therefore the severity of anemia is measured on the ordinal scale.
Type of anemia can be divided into qualitative categories (Macrocytic/microcytic, hemolytic/non-hemolytic) → Nominal scale is used.
Serum ferritin and hemoglobin are quantitative variables with a possible absolute zero value → Ratio scale is used.

So the answer to this question is B


Instruction:
Brain contains which neurotransmitter:
A. Tyrosine
B. Glutamate
C. Serine
D. Tryptophan

Response:
Ans. (b) GlutamateRef.: Lange medical physiology by Ganong 23rd ed., ch. 15* Glutamate is the most abundant excitatory neurotransmitter in the vertebrate nervous system.* At chemical synapses, glutamate is stored in vesicles. Nerve impulses trigger release of glutamate from the presynaptic cell. Glutamate acts on ionotropic and metabotropic (G-protein coupled) receptors.* Because of its role in synaptic plasticity, glutamate is involved in cognitive functions such as learning and memory in the brain.* Excitotoxicity due to excessive glutamate release and impaired uptake occurs as part of the ischemic cascade and is associated with stroke, autism, some forms of intellectual disability, and diseases such as amyotrophic lateral sclerosis, lathyrism, and Alzheimer's disease.* In contrast, decreased glutamate release is observed under conditions of classical phenylketonuria

So the answer to this question is B


Instruction:
Incubation period of scabies is:
A. 7 days
B. 2 weeks
C. 4 weeks
D. 2-3 days

Response:
Scabies - Causative agent: Sarcoptes Scabies Var Hominis Incubation Period: 3-4 weeks after the infection is acquired. If pt. reinfested- ICP is 2 days

So the answer to this question is C


Instruction:
Diuretic that is useful in mild to moderate hypertension is:
A. Loop diuretics
B. Thiazides
C. Osmotic diuretics
D. Potassium sparing diuretics

Response:
Ans. (B) Thiazides(Ref: Harrison 19th/e p1623)Thiazides are not only diuretics of choice for mild to moderate hypertension but also the first line antihypertensive drugs in these patients.

So the answer to this question is B


Instruction:
A 13 year old male patient complains of pain in  upper front teeth region and gives a history of fall on the ground while playing. Intra-oral examination reveals grade I mobility with maxillary left central incisor. Radiologic finding is suggestive of root fracture with 21. Which of the following could be the least favourable form of repair for this tooth?
A. Healing with calcified tissue
B. Healing with interposition of connective tissue, in which the fractured root surfaces are covered by cementum with connective tissue fibers  joining  the  two  fragments.
C. Healing  with  interposition of bone and connective tissue, in which a bony bridge  and  connective  tissue  are  positioned  between  the fragments.
D. Interposition of granulation tissue

Response:
Root fractures that occur in the apical half of the tooth are more likely to undergo repair. Fractures in the apical third are often repaired without treatment. In fact, many apparently are undetected until evidence of a calcified repair is seen radiographically sometime after the injury.
Andreasen has described four tissue reactions after root fracture:
(1) Healing with calcified tissue, which is characterized by a uniting callus of hard tissue that may consist of dentin, osteodentin, or cementum.
(2) Healing with interposition of connective tissue, in which the fractured root surfaces are covered by cementum with connective tissue fibers joining the two fragments.
(3) Healing with interposition of bone and connective tissue, in which a bony bridge and connective tissue are positioned between the fragments.
(4) Interposition of granulation tissue.
The last is the least favorable form of attempted repair, and the fracture will not heal spontaneously.
The teeth usually present unfavorable symptoms that may be accompanied by fistulas resulting from necrosis of the coronal portion and also sometimes the apical portion of the pulp. These teeth require follow-up endodontic treatment or extraction.

So the answer to this question is D


Instruction:
Affinity chromatography deals with the
A. Specific binding of a protein constituents for another molecule
B. Protein - protein interaction
C. Protein - carbohydrate interaction
D. None of the above

Response:
Methods for Separating and Purifying Biomolecules1Salt fractionation (eg, precipitation of proteins with ammonium sulfate)Chromatography: Paper, ion exchange, affinity, thin-layer, gas-liquid, high-pressure liquid, gel filtrationElectrophoresis: Paper, high-voltage, agarose, cellulose acetate, starch gel, polyacrylamide gel, SDS-polyacrylamide gelUltracentrifugationAffinity chromatography exploits the high selectivity of most proteins for their ligands. Enzymes may be purified by affinity chromatography using immobilized substrates, products, coenzymes, or inhibitors. In theory, only proteins that interact with the immobilized ligand adhere. Bound proteins are then eluted either by competition with free, soluble ligand or, lessselectively, by disrupting protein-ligand interactions using urea, guanidine hydrochloride, mildly acidic pH, or high salt concentrations. Commercially available stationary phase matrices contain ligands such as NAD+ or ATP analogs. Purification of recombinantly expressed proteins is frequently facilitated by modifying the cloned gene to add a new fusion domain designed to interact with a specific matrix-bound ligand

So the answer to this question is A


Instruction:
Cold agglutinins are seen in?
A. Influenza
B. PAN
C. Multiple myeloma
D. SLE

Response:
Ans is 'a' i.e. Influenza Cold agglutinin hemolytic anemiao This form of hemolytic anemia is caused by cold agglutinin IgM antibodies. Antibodies react with RBC at 0deg to 4degC. Both intravascular and extravascular hemolysis may occuro Causes of cold agglutinin immunohemolytic anemiaMycoplasma infection, IMN, CMV, Influenza, HIV, Malignant lymphoma.Important causes of warm antibody autoimmune hemolytic anemiao Autoimmune disorders - SLE, RA, Ulcerative colitis, Scleroderma, Antiphospholipid antibodieso Chronic lymphocytic leukemia (CLL), Hodgkin disease, Non-Hodgkin lymphomao Multiple myelomao Thymomao Drugs - Methyldopa, penicillin, Cephalosporine, quinidine.o PAN

So the answer to this question is A


Instruction:
In atresia of cardiac end of stomach, X-ray chest is best done with:
A. Conray 240
B. Urograffin
C. Barium sulphate
D. Dianosil

Response:
Ans. Dianosil

So the answer to this question is D


Instruction:
All are true about emphysema except:
A. Cyanosis
B. Barrel-shaped chest
C. Associated with smoking
D. Type 1 respiratory failure

Response:
OPTION A) CLINICAL FEATURE OF EMPHYSEMA SYMPTOMS; The three most common symptoms in COPD are cough, sputum production, and exeional dyspnea. Activities involving significant arm work, paicularly at or above shoulder level, are paicularly difficult for many patients with COPD . the principal feature is worsening dyspnea on exeion with increasing intrusion on the ability to perform vocational or avocational activities. In the most advanced stages- patients are breathless doing simple activities of daily living. CLINICAL FEATURE OF COPD - EMPHYSEMA The classic presentation of emphysema with no "bronchitic" component. Patients barrel-chested and dyspneic, with prolonged expiration, sitting forward in a hunched-over position. In these patients, air space enlargement is severe and diffusing capacity is low. Dyspnea and hyperventilation are prominent, so that until very late in the disease, gas exchange is adequate and blood gas values are relatively normal. Because of prominent dyspnea and adequate oxygenation of hemoglobin, these patients sometimes are sometimes called "pink puffers." CHRONIC BRONCHITIS -emphysema with pronounced chronic bronchitis and a history of recurrent infections. Dyspnea usually is less prominent, and in the absence of increased respiratory drive the patient retains carbon dioxide, becoming hypoxic and often cyanotic .such patients tend to be obese--hence the designation "blue bloaters." OPTION 2) ON PHYSICAL EXAMINATION Early stages of COPD, patients usually have an entirely normal physical examination. More severe disease, the physical examination - prolonged expiratory phase and may include expiratory wheezing. Signs of hyperinflation 1) barrel chest and enlarged lung volumes with poor diaphragmatic excursion as assessed by percussion. 2)Patients with severe airflow obstruction -use of accessory muscles of respiration, sitting in the characteristic "tripod" position to facilitate the actions of the sternocleidomastoid, scalene, and intercostal muscles. 3 CYANOSIS if emphysema with chronic bronchitis Patients may develop cyanosis, visible in the lips and nail beds. 4) SIGN OF ADVANCED COPD cachexia ,significant weight loss, bitemporal wasting, anddiffuse loss of subcutaneous adipose tissue. Clubbing of the digits is not a sign of COPD. The development of lung cancer is the most likely explanation for newly developed clubbing. OPTION C) RISK FACTORS CIGARETTE SMOKING AIRWAY RESPONSIVENESS AND COPD RESPIRATORY INFECTIONS OCCUPATIONAL EXPOSURE. D)COMPLICATION OF COPD- progressive disease is marked by the development of pulmonary hypeension, sometimes leading to cardiac failure, recurrent infections; and ultimately respiratory failure.

So the answer to this question is A


Instruction:
Epiglottitis in a 2-year-old child occurs most commonly due to infection with:
A. Influenza virus
B. Staphylococcus aureus
C. Haemophilus influenzae
D. Respiratory syncytial virus

Response:
Though the introduction of Hib vaccine has reduced the annual incidence of acute epiglottitis but still most of the pediatric cases seen today are due to haemophilus influenzae B. --Harrison 17th/ed p212 In adults it can be caused by group A streptococcus, S. pneumoniae, S. aureus and Klebsiella pneumoniae

So the answer to this question is C


Instruction:
Placental abnormality related to PPH is-
A. Placenta accreta
B. Placenta percreta
C. Retained placental
D. All the above

Response:
Ans. is 'd' i.e., All the above Causes of Post partum hemorrhage (PPH)o Atonic - 80% commonesto Traumatico Retained tissueso Blood coagidopathyConditions which contribute to the development of atonic PPHo Grand multiparao Overdistention of uteruso Malnutrition and anemiao Antepartum hemorrhageo Prolonged labouro Anesthesiao Iniatiation or augmentation of the delivery by oxytocino Malformation of the uteruso Uterine fibroido Mismanaged third stage of labouro Placenta: morbidly adherent placenta (accrete, percreta), partially or completely separately separated placenta but with retained bits of placental tissue leads to PPH.o Precipitate labour

So the answer to this question is D


Instruction:
Complications of tuberular meningitis include all except-
A. Hydrocephalus
B. Cortical venous thrombosis
C. Cerebral Artery Thrombosis
D. Cranial Nerve Palsy

Response:
None

So the answer to this question is B


Instruction:
The paraneoplastic syndrome associated with Hodgkin's disease is -
A. Nephrotic syndrome
B. Retinopathy
C. Cerebellar degenerative disease
D. Acanthosis nigricans

Response:
Ans. is 'c' i.e., Cerebellar degenerative disease CNS Paraneoplastic syndromes:SyndromeTargetTumour* Subacute cerebellar degenerationPurkinje cellHodgkin lymphoma, Breast, Ovary, Small cell Ca lung, Neuroblastoma* Limbic encephalitisVarious neuronsSCLC, Neuroblastoma* Brainstem encephalitisIn mesial temporal lobe, brainstemTesticular, others* Subacute sensoryDorsal root ganglionSCLC,neuropathyneuronNeuroblastoma* Opsoclonus myoclonusUnknown (presumed brain stem)Neuroblastoma,Breast* Retinal degenerationPhotoreceptorsSCLC* Stiff-man syndromeSpinal interneuronBreast* Lambert-Eaton myasthenic syndromePresynaptic terminals at neuromuscular junctionSCLC

So the answer to this question is C


Instruction:
Insulin resistance in pregnancy is because of:
A. Human placental lactogen
B. Progesterone
C. Estrogen
D. All the above

Response:
During pregnancy, insulin levels are increased because of increased insulin secretion as well as increase in insulin resistance due to number of contra insulin factors. These are Estrogen Progesterone Human placental lactogen Coisol Prolactin The main hormone responsible for insulin resistance is HPL. Ref:Dutta Obs 9e pg 55.

So the answer to this question is D


Instruction:
The origin of thyroglossal duct is
A. Foramen caecum
B. Tuberculum impar
C. Rathke's pouch
D. Rosenmuller's fossa

Response:
None

So the answer to this question is A


Instruction:
Vi polysaccharide vaccine is a parenteral vaccine consisting of purified Vi polysaccharide from the bacterial capsule. Which of the following is TRUE statement regarding Vi polysaccharide vaccine?
A. Has a high incidence of local reactions
B. Has significant adverse effects
C. Contraindicated in hepatitis
D. Can be given along with yellow fever and hepatitis vaccines

Response:
Both the oral (Ty21a) and parenteral (Vi polysaccharide) vaccines are well tolerated, and adverse reactions are uncommon and usually self-limited. Vi polysaccharide vaccine can be given with other vaccines such as Meningococcal, Hepatitis B, Tetanus, Yellow fever and Hepatitis A. There is no contraindication other than prior severe reactions to vaccine components. Ref: Daley M.F., O'Leary S.T., Simoes E.A., Nyquist A. (2011). Chapter 9. Immunization. In W.W. Hay, M.J. Levin, J.M. Sondheimer, R.R. Deterding (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 20e.

So the answer to this question is D


Instruction:
Which of these doesn't present with granulomatous Vasculitis?
A. Polyarteritis nodosa
B. Wegeners
C. Churg strauss syndrome
D. Microscopic polyangitis

Response:
Ans. (d) Microscopic polyangitisRef: Harrison 19th ed. / 2186* MPA is characterized by pauci-immune, necrotizing, small vessel vasculitis without clinical or pathological evidence of granulomatous inflammation* The family of vasculitic granulomatoses comprise# Wegener s granulomatosis# Necrotising sarcoidal granulomatosis# Churg-Strauss syndrome# Lymphomatoid granulomatosis# Polyarteritis nodosa# Bronchocentric granulomatosis# Giant cell arteritis# Systemic lupus erythematosus.

So the answer to this question is D


Instruction:
A patient presents with Thrombocytopenia, eczema and recurrent infection. The most probable diagnosis is:
A. Wiskott Aldrich syndrome
B. Chediak-Higashi syndrome
C. Job's syndrome
D. Bruton's Agammaglobulinemia

Response:
Answer is A (Wiskott Aldrich syndrome) Thrumbocytopenia, Eczema and Recurrent Infections (Immunodeficiency) represents the charachteristic triad of Wiskott - Aldrich syndrome.

So the answer to this question is A


Instruction:
True about end plate potential (EPP) is:-
A. It occurs as a result of altered permeability for Na+ and K+
B. It is a self-regenerative change
C. It results from release of a single transmitter vesicle
D. It exhibits all-or-none propey

Response:
Non-specific cation channel (same channels allow Na+ to come in & same channel allows K+ to go out) are acetylcholine-gated channels which opens and causes the electrical potential inside the fiber at the local area of the end plate to increase in the positive direction as much as 50 to 75 millivolts, creating a local potential called the end plate potential. EPP is a graded response. It doesn't obey all or none propey. Its amplitude decreases over distance and it can be summated. EPP develops conves into one AP. This action potential then travels.

So the answer to this question is A


Instruction:
Wolff-chaikoff effect is ?
A. Reduced thyroxine synthesis by radiotherapy
B. Reduced thyroxine synthesis by propylthiouracil
C. Reduced thyroxine synthesis by iodides
D. None of the above

Response:
Ans. is 'c' i.e., Reduced thyroxine synthesis by iodides Iodine and Iodides Iodine is the fastest acting thyroid inhibitor. Most impoant action is inhibition of hormone release (thyroid constipation); but all facets of thyroid synthesis may be affected. Excess iodide inhibits its own transpo in thyroid cells and may alter the redox potential of cells, thus interfering iodination -reduced TIT3 synthesis ( Wolffichaikoff effect).

So the answer to this question is C


Instruction:
Schwannoma of 8th cranial nerve site is
A. Intra — petrous
B. Intracanalicular
C. Cisternal
D. Parotid

Response:
None

So the answer to this question is C


Instruction:
ORS contains how much potassium -
A. 20
B. 30
C. 40
D. 10

Response:
ORS Aim of oral rehydration therapy is to prevent dehydration and reduce moality. Oral fluid therapy is based on the observation that glucose given orally enhances the intestinal absorption of salt and water and is capable of correcting electrolyte and water deficit. At first the composition of oral rehydration salt recommended by WHO was sodium bicarbonate based. Inclusion of trisodium citrate in place of sodium bicarbonate made the product more stable and it resulted in less stool output especially in high output diarrhoea, probably because of direct effect of trisodium citrate in increasing intestinal absorption of sodium and water. More recently an improved ORS formulation has been developed which is safe and effective as the original in preventing and treating diarrhoeal dehydration. It is focussed on reducing the osmolarity of ORS solution to avoid adverse effects of hypeonicity on net fluid absorption by reducing the concentration of glucose and sodium chloride in the solution. Decreasing the sodium concentration of ORS solution to 75 mOsm/l improved the efficacy of ORS regimen for children with acute non cholera diarrhoea. Reduced osmolarity ORS:-(g/L) Sodium chloride- 2.6 Glucose,anhydrous- 13.5 Potassium chloride- 1.5 Trisodium citrate,dihydrate-2.9 Total =20.5 g/L Reduced osmolarity ORS:-(mmol/L) Sodium-75 Chloride-65 Glucose,anhydrous-75 Potassium-20 Citrate-10 Total = 245 mmol/L {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.224}

So the answer to this question is A


Instruction:
Flexor of hip joints are all except
A. Psaoas major
B. Saorius
C. Gluteus maximus
D. Rectus femoris

Response:
Muscles assisting in flexion are psoas major ,iliacus,saorius ,rectus femoris and pectineus. Gluteus maximus is the chief extensor of the hip joint. Reference: Textbook of anatomy,Abdomen and Lower limb, Vishram Singh, 2nd editon, page no.383

So the answer to this question is C


Instruction:
Pseudotumor cerebri is most commonly seen in
A. Obese females in the age group 20-45 years
B. Obese males in the age group 20-45 years
C. Thin built females in the age group 50-60 years
D. Thin built males in the age group 50-60 years

Response:
Ans. a. Obese females in the age group 20-45 years Pseudotumor cerebri is most commonly seen in obese females in the age group 20-45 years. Pseudotumor Cerebri (Idiopathic Intracranial Hypeension) Benign self-limiting disorder with a orable outcome Majority of patients are young, female and obesee It occurs due to decreased CSF absorptione Mostly idiopathic in nature but seen in hypervitaminosis, expired tetracyclines, OCPs and steroid usee Causes of Pseudotumor Cerebri High doses of vitamin AQ Withdrawal of coicosteroid therapyQ Outdated TetracyclineQ Addison's diseaseQ QuinolonesQ SLEQ HypoparathyroidismQ Clinical Features: Manifested by headache, papilledema, normal CSF and normal ventricle size on imaging. No focal neurological signs Characteristic features of Pseudotumor Cerebri Elevated intracranial pressure (intracranial hypeension) with: Normal or Small sized ventricular systemQ No focal neurological signse PapilledemaQ(enlarged blind spot in visual fluid) Normal CSF findingse Normal CT scan, MRI and isotope brain scane Excessive slow-wave activity on ECGe Treatment: Carbonic anhydrase inhibitor (acetazolamide) lowers ICP by reducing the production of CSF. Weight reduction is vital but often unsuccessful. If acetazolamide and weight loss fail and visual field loss is progressive, a shunt should be performed without delay to prevent blindness. Occasionally, emergency surgery is required for sudden blindness caused by fulminant papilledema

So the answer to this question is A


Instruction:
Most common area of pressure sore is
A. Ischium
B. Greater trochanter
C. Sacrum
D. Heel

Response:
Pressure sore frequency in descending order Ischium Greater trochanter Sacrum Heel Malleolus (lateral than medial) Occiput Bailey and Love 27e pg: 29

So the answer to this question is A


Instruction:
What gas is used to create pneumoperitoneum -
A. O2
B. Nitrogen
C. CO2
D. Nitrous dioxide

Response:
Ans. is 'c' i.e., CO2 & ''d' i.e., Nitrous dioxide Choice of Gas for pneumoperitoneum* First Pneumoperitoneum was created by filtered room air. Carbon dioxide 8c N2O are now preferred gas because of increased risk of air embolism with room air.* CO2 is used for insufflation as it is 200 times more diffusible than O2, is rapidly cleared from the body by the lungs and will not support combustion.* N2O is only 68% as rapidly absorbed in blood as CO2. N2O has one advantage over CO2 that it has mild analgesic effect, and so causing no pain if diagnostic laparoscopy is performed under local anaesthesia. For short operative procedures like sterilization or drilling, under local anaesthetic N2O may also be used. During prolonged laparoscopic procedure N2O should not be a preferred gas for pneumoperitoneum because it supports combustion better than air.* CO2 when come in contact with peritoneal fluid converts into carbonic acid. Carbonic acid irritates diaphragm causing shoulder tip pain & discomfort in abdomen. Carbonic acid has one advantage also that it alters pH of peritoneal fluid (acidotic changes) and it is mild antiseptic so the chances of infection may be slightly less compared to any other gas.* Helium gas being inert in nature is also tried in many centers but it does not have any added benefit over CO2.

So the answer to this question is C


Instruction:
A clinical diagnosis of meningitis is confirmed with a latex agglutination test on CSF for the capsular polysaccharide of the organism. The most likely causative agent is
A. Candida albicans
B. Cryptococcus
C. Paracoccidioides brasiliensis
D. Histoplasma capsulatum

Response:
C. neoformans occurs widely in nature, particularly in soil contaminated with bird droppings. Human infection occurs when inhalation of the organism occurs. Lung infection is often asymptomatic but can result in pneumonia. Meningitis occurs through dissemination, particularly in immunosuppressed patients. India ink preparations of CSF reveal a budding yeast with a wide, unstained capsule in infected persons.

So the answer to this question is B


Instruction:
HRCT is investigation of choice for all EXCEPT:
A. Sarcoidosis
B. Miliary tuberculosis
C. Interstitial fibrosis
D. Pulmonary artery aneurysm

Response:
ANSWER: (D) Pulmonary artery aneurysmREF: Harrison's 18th ed chapter 253-5This question is based upon your basic knowledge of radiology Remember vascular structures are either best evaluated by angiography or magnetic resonance imaging.In high-resolution CT (HRCT), the thickness of individual cross-sectional images is 1-2 mm, rather than the usual 7-10 mm in conventional CT. The visible detail on HRCT scans allows better recognition of subtle parenchymal and airway disease, thickened interlobular septa, ground-glass opacification, small nodules, and the abnormally thickened or dilated airways seen in bronchiectasis. Using HRCT, characteristic patterns are recognized for many interstitial lung diseases such as lymphangitic carcinoma, idiopathic pulmonary fibrosis, sarcoidosis, and eosinophilic granulomaAdditionally, MR is well suited to distinguish vascular from nonvascular structures without the need for contrast. Blood vessels appear as hollow tubular structures because flowing blood does not produce a signal on MR imaging. Therefore, MR can be useful in demonstrating pulmonary emboli, defining aortic lesions such as aneurysms or dissection, or other vascular abnormalities

So the answer to this question is D


Instruction:
Nerve arising by two roots that surround middle meningeal Artery
A. Facial Nerve
B. Maxillary Nerve
C. Jacobson's Nerve
D. Auriculotemporal Nerve

Response:
None

So the answer to this question is D


Instruction:
Cocaine withdrawal causes all except ?
A. Dysphoria
B. Fatigue
C. Disturbed sleep
D. Creeping bugs

Response:
Ans. is 'd' i.e., Creeping bugs Patients withdrawing from cocaine typically experience fatigue, dysphoria, diurbed sleep, and some craving; some may experience depression".___________ Kaplan & Saddock. o Creeping bugs are seen in chronic cocaine abuse (not due to withdrawal). Cocaine Cocaine is an alkaloid derived from the Coca bush, Erythrexylum CoCa. It was the first local anaesthetic which was used clinically. Toxicity of cocaine may be : ? A. Acute toxicity : - Acute cocaine intoxication is characterized by : ? Sympathetic hyperactivity : - Tachycardia, hypeension, mydriasis, sweating, nausea & vomiting. Hypoinanic state : - Increased psychomotor activity, grandiosity, elation, hypervigilance, Increased speech output. B. Chronic overuse : - Chronic overuse can cause : ? Psychotic episodes (Cocaine psychosis) : Persecutory delusions with tactile hallucinations (formination). Tactile hallucinations are manifested as bugs crawling under the skin --) Cocaine bugs or magnan's symptoms. Other : - Anxiety reaction, compulsive behavior, delirium and delusional disorders. Black pigmentation of tongue and teeth.

So the answer to this question is D


Instruction:
All of the following show ulnar nerve injury EXCEPT:
A. Clawing of medial 2 digits
B. Abductor pollicis palsy
C. Adductor pollicis palsy
D. Weak grip

Response:
Ans. B Abductor pollicis palsyRef: BDC, 6th ed. vol. I pg. 109-110, 120* In ulnar nerve palsy grip is weak due to paralysis of intrinsic muscles (all interossei, lateral 3rd& 4th lumbricals, hypothenar and adductor pollicis muscles).* Sensory supply of ulnar nerve is medial 1 1/2 fingers.* Abductor pollicis is supplied by median nerve.* Finger drop i.e. loss of extension of metacarpophalangeal joint is seen in Radial & Posterior interosseous nerve palsySigns of Ulnar Nerve palsy (remembered as BCDEF)* Book test/Fromet sign: While holding the book between thumb and rest of hand, there is overaction of flexor pollicis longus due to adductor pollicis nerve palsy.* Claw hand: Clawing of medial 2 digits* Card test: for testing palmar interossei, i.e. adduction of fingers. (PAD)* aDDuctor pollicis paralysis: Adduction of thumb lost* Egawa's test: To test dorsal interossei i.e. abduction of fingers (DAB).* Froment signExtra Mile* In low ulnar nerve palsy forearm muscles are spared but the clawing is more (as compared to high ulnar n. palsy) this phenomenon is known as ulnar paradox.* Lower the lesion, more the clawing.

So the answer to this question is B


Instruction:
What is the use of this instrument?
A. Create pneumoperitoneum by open method
B. Drain hydatid cyst
C. Suction cannula
D. None of the above

Response:
Ans. (a) Create pneumoperitoneum by open method* Hassan cannula used in creating pneumoperitoneum by open method* The risk of Vascular injury is less with Open method but the risk of bowel injury is same or high as compared to closed technique using Veress needle

So the answer to this question is A


Instruction:
Dying back neuropathy is seen in all, except:
A. Diabetic neutropathy
B. Arsenic neuropathy
C. Porphyria
D. Gullian Bare Syndrome (GBS)

Response:
Dying back neuropathy or distal axonopathy is the result of some metabolic or toxic derangement of neurons. It is the most common response of neurones to metabolic or toxic disturbances, and may be caused by metabolic diseases such as diabetes, renal failure, malnutrition, toxins, drugs etc. GBS is a post infectious polyneuropathy that causes demyelination in mainly motor but sometimes also sensory nerves. It is not predominant distal axonopathy. Ref: Fundamentals of Neurology: An Illustrated Guide By Marco Mumenthaler, Heinrich Mattle, Page 176

So the answer to this question is D


Instruction:
Example of mixed tumours is:
A. Adenoacanthoma.
B. Hamartoma.
C. Glomus Tumour.
D. Osteoma.

Response:
Mixed tumours: When two types of tumours are combined in the same tumour, it is called a mixed tumour. For example:

Adenosquamous carcinoma is the combination of adenocarcinoma and squamous cell carcinoma in the endometrium.
Adenoacanthoma is the mixture of adenocarcinoma and benign squamous elements in the endometrium.
Carcinosarcoma is the rare combination of malignant tumour of the epithelium (carcinoma) and of mesenchymal tissue (sarcoma) such as in thyroid.
Collision tumour is the term used for morphologically two different cancers in the same organ which do not mix with each other.

So the answer to this question is A


Instruction:
Syndrome associated with anosmia is:
A. Goldenhar syndrome
B. Kallmann syndrome
C. Prader Willi syndrome
D. All of the above

Response:
The most well-known type of congenital anosmia is Kallmann syndrome, an X-linked disorder. Caused by mutation in the KAL gene, Kallmann syndrome is characterized by hypogonadotropic hypogonadism, which results when olfactory receptor neurons and neurons synthesizing gonadotropin-releasing hormone fail to migrate from the olfactory placode.

So the answer to this question is B


Instruction:
Second degree of under nutrition means –
A. Weight below 50% of the harvard standard
B. Weight below 60% of the harvard standard
C. Weight between 60% & 81% of the harvard standard
D. Weight between 60 % & 71% of the harvard standard

Response:
None

So the answer to this question is D


Instruction:
Placido disc is used for
A. Uveitis
B. Keratoconus
C. Retinoblastoma
D. Retinal detachment

Response:
It is a disc painted with alternating black and white circles. Used to assess the smoothness and curvature of corneal surface. It shows irregularity of circles in keratoconus. Ref khurana page no.126

So the answer to this question is B


Instruction:
In Budd Chiari syndrome, the site of venous thrombosis is
A. Infrahepatic inferior vena cava
B. Infrarenal inferior vena cava
C. Hepatic veins
D. Portal veins

Response:
None

So the answer to this question is C


Instruction:
Tetany may be a feature of the following except -
A. Hyperventilation
B. Hypokalaemic alkalosis
C. Hypomagnesaemia
D. Hyponatraemia

Response:
None

So the answer to this question is D


Instruction:
Both antibody dependent and independent complement pathway converge on which complement component-
A. C3
B. C5
C. C4
D. C8

Response:
The complement proteins can be activated by 3 pathways; classical, lectin and alternate pathways the terminal pathway that is common to all pathways of the complement system leads to the formation of membrane attack complex consists of factors C5, C6, C7, C8 and C9 (C5b6789). ref robbins 9th/e p 50-51

So the answer to this question is B


Instruction:
The medium that is most ideal for antibiotic sensitivity testing of bacterial isolates is
A. Blood agar
B. Chocolate agar
C. Nutrient agar
D. MacConkey agar

Response:
Nutrient agar is good for antibiotic sensitivity testing Muller Hinton medium for testing aerobes and facultative anaerobes Ref: Textbook of Microbiology Baveja 4th ed Pg 628

So the answer to this question is C


Instruction:
Commonest type of Ano rectal abscess is -
A. Ischio rectal
B. Submucous
C. Pelvi-rectal
D. Perianal

Response:
None

So the answer to this question is D


Instruction:
A patient suffering from symmetrical and persistent painless swelling of lacrimal and salivary gland with no or less xerostomia, responds to steroid therapy. What could be the possible diagnosis for this patient?
A. Mikulicz disease
B. Primary Sjogren syndrome
C. Secondary Sjogren syndrome
D. All of the above

Response:
IgG4-related disease (Mikulicz disease ) often requires immediate, aggressive treatment with systemic corticosteroids to prevent significant organ damage and failure. Glucocorticoid-sparing agents, such as azathioprine, mycophenolate mofetil, and methotrexate, also can be used. Most patients show a rapid response to immunosuppressive therapy and have a favorable prognosis. For patients with recurrent disease, B-cell depletion with rituximab can be effective.

The treatment of the patient with Sjögren syndrome is mostly supportive. The dry eyes are best managed by periodic use of artificial tears. Artificial salivas are available for the treatment of xerostomia; sugarless candy or gum can help to keep the mouth moist. Symptoms often can be relieved by the use of oral hygiene products that contain lactoperoxidase, lysozyme, and lactoferrin.
Ref: ORAL AND MAXILLOFACIAL PATHOLOGY, Neville, FOURTH EDITION  page no 434,437

So the answer to this question is A


Instruction:
A 27-year old primigravida presented to the OPD with pregnancy induced hypeension at 32 weeks of gestation. She had no other complications. On examination she had a blood pressure of 150/100 mm of Hg. Her blood pressure was later controlled with treatment. lf there are no complications, the pregnancy should be terminated at?
A. 40 completed weeks
B. 37 completed weeks
C. 36 completed weeks
D. 34 completed weeks

Response:
37 weeks Ref : Dutta book of obstetrics 8th Ed

So the answer to this question is B


Instruction:
Guthrie test can be used for the diagnosis of ?
A. Tyrosinemia
B. Galactosemia
C. Alkaptonuria
D. Phenylketonuria

Response:
Ans. is 'd' i.e., Phenylketonuria

So the answer to this question is D


Instruction:
The following infection resembles malignancy ?
A. Echinococcus granulosus
B. E. multilocularis
C. E.vogeli
D. E. oligahus

Response:
Ans. is 'b i.e., E. multilocularis The chief character of E. multilocularis cyst is its tendency to proliferate, thereby resembling a neoplasm.

So the answer to this question is B