PGIMER ENTRANCE EXAM

MAY 2012

1. A. B. C. D. E.

Most commonly used cylinder in anaesthesia machine is: A B D E F

Ans: D(E) [Ref:Ajay Yadav 1st/ 20-21 ; Miller 7th/ 675 ; Lee 13th/ 84-85 ] Most commonly used cylinder in anaesthesia machine is E Cylinder: Smallest size available is AA and biggest is H. Commonly used cylinders on anaesthesia machine are of type E- Ajay Yadav 1st/ 20 Anesthesia workstations have E-cylinders for use when a pipeline supply source is not available or the pipeline system fails- Miller 7th/ 675

2. A. B. C. D. E.

Feature of malignant hyperthermia includes: Tachycardia Hypotension Excessive sweating ed ETCO2 ed O2 saturation

Ans: ACE [Ref:Ajay Yadav 1st/101-02 ; Miller 7th/ 1187-89 ; Lee 13th/ 353 ; Morgan's clinical aneasthesia 4th/945-950; Wylie's Anaesthesia 7th/365, 367] Clinical feature: Hypoxia, cyanosis,tachycardia, hypertension & cardiac arrhythmiaAjay Yadav 1st/102 Falling SpO2 despite increase in FiO2; cyanosis-C.Y.Lee 2006/840
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Cardiovascular instability with labile B.P- C.Y.Lee 2006/840 Unexpected change in B.P- Lee 13th/ 353

Signs of malignant hyperthermia Lee, Wylie's Hyperthermia : fever, sweating

3. A. B. C. D. E.

Common Eye lid tumors are: Squamous cell carcinoma Sebaceous gland carcinoma Malignant melanoma Basal cell carcinoma Malignant germ cell tumor

Ans:ABCD [Ref: Khurana 4th/359; Parson 20th/439-40 ]

Malignant tumours of eyelid: Commonly observed tumours include squamous cell carcinoma, basal cell carcinoma, malignant melanoma and sebaceous gland adenocarcinoma.

4. A. B. C. D.

True about Sympathetic ophthalmitis : Occur after trauma and surgery Injured eye is exciting eye Occur in opposite eye any time B/l non-suppurative uveitis occur

Ans:ABD [Ref: Khurana 4th/413 ; Parson 20th/374-76 ]

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Sympathizing (sound) eye. It is usually involved after 4-8 weeks of injury in the other eye, rarely earlier. Earliest reported case is after 9 days of injury. Most of the cases occur within the first year. However, delayed and very late cases are also reportedKhurana 4th/413 ; Parson 20th/375

5. A. B. C. D.

True about Retinoblastoma: It is most common primary intraocular tumor of childhood It is most common secondary intraocular tumor of childhood Seen in young & middle-age adult Most commonly seen in children

Ans:AD [Ref: Khurana 4th/ 280-83 ; Parson 20th/357-58 ] Retinoblastoma is the most common primary ocular tumor of childhood. About 90% cases are diagnosed by age 3-4 yrs & 98% by 5 yrs-O.P.Ghai 7th/594 The tumor is confined to infants & very young children & is frequently congenital, although it may remain quiescent or pass unnoticed until the fifth or sixth year of life or sometime even later- Parson 20th/357 It is the most common intraocular tumour of childhood occurring 1 in 20,000 live births.

6. A. B. C. D. E.

Spirometry measures :Tidal volume TLC ERV FRC IRV

Ans: A(Tidal..),C(ERV) &E(IRV) [Ref: Harrison 18th/ ; Guyton 11th/ 476; Ajay Yadav 1st/7-8 Lee 13th/ 762 ] Spirometry measures: tidal volume, inspiratory reserve volume, inspiratory capacity, expiratory reserve volume & vital capacity. It can not measure residual volume(RV), so any lung volume requiring RV can not be measured i.e Functional residual capacity(FRC) & Total lung volume(TLV)- Ajay Yadav 1st/7-8

7.

Which of the following score is/are not included in mild mental

retardation: A. B. C. D. E. 85 50 45 75 65

Ans: ACD [Ref:Park 21st/536; Niraj Ahuja 6th/169-72;Kaplan 10th/1139] Degrees of Severity of Mental Retardation Kaplan 10th/1139-40 Mild mental retardation (IQ range, 50 to 70) represents approximately 85

percent of persons with mental retardation. Moderate mental retardation (IQ range, 35-50) Severe mental retardation (IQ range, 20-35)

8. All have effects on oxygen-hemoglobin dissociation curve except: A. 2,3-DPG B. CO2 pressure C. Cl- concentration D.Acidosis E.Temperature

Ans:C

[Ganong 22th/667-669; Guyton 11th/507; Chatterjea & Shinde 7th/149; Harrison 17th/636, Lehninger 4th/173 Kumar & Clark 4th/357 6th/430]

9.Drug that increases QT interval : A. B. C. D. E. Haloperidol Fexofenadine Amiodarone Ebastine Sotatol

Ans:CDE

[Ref: KDT 6th/510,495,428-29] Fexofenadine does not prolong QTc interval- KDT 6th/158 Haloperidol also not mentioned as cause of QT prolongation

10. A. B. C. D. E.

Positive benzidine test is/are seen in : Hemoglobin Myoglobin Porphobilinogen Glucose Bilirubin

Ans: A & B [Ref : Harrison 16th / 608;P.J.Mehta 15th/404; Reddy 27th/394]

11. Polar amino acids are : A. B. C. Serine Tryptophan Tyrosine

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D. E.

Valine Lysine

Ans:A(Serine),C(Tyrosine) & E(Lysine)

12. Ectopia lentis is/are seen in : A. B. C. D. E. Marfan syndrome Homocystinuria DM Hypertension Sulfite oxidase deficiency

Ans:ABE

[Ref: Khurana 4th/ 202-03,3rd / 210; Parson 20th/506]

13.False statement regarding diabetic retinopathy : A. B. C. D. E. Flame shaped haemorrahges Arteriovenous nipping Neovascularisation Hard exudates Exudative macular edema

Ans: B

[Ref: Khurana 4th/260-62; Parson 20th/294-98] Arterio venous nipping is found in hypertensive retinopathy- Khurana 4th/258

14. True about Parathyroid hormone : A. B. It is steroid Stimulate 1,25 D3 formation

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C. D.

Inhibits Ca+2 absorption from the intestines Increases the resorption of bone

Ans:BD [Ref: Ganong 23nd/367-70 ; Guyton 11th/986-988 ] Parathyroid hormone (PTH) is the peptide hormone (10 amino acids) PTH also increases renal synthesis of 1,25(OH)2D3

15. Second messengers is/are :A. B. C. D. E. Mg+2 P04-3 cAMP Ca+2 Cl- ion

Ans:CD [Ref: Ganong 23nd/446-48; Guyton 11th/912-15; Harper27/445; KDT6th/231-32]

Types of secondary messenger molecules Ca2+ (H2S) Gases: nitric oxide (NO), carbon monoxide (CO) and hydrogen sulphide Hydrophobic molecules: water-insoluble molecules, like diacylglycerol, and

phosphatidylinositols Hydrophilic molecules: water-soluble molecules, like cAMP, cGMP, IP3, and

16. Central cyanosis not occurs when total Hb and reduced Hb level is respectively (in gm%) : A. B. C. 10.9 & 4.1 10.9 & 5.1 10.9& 6.1
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D. E.

8.9 & 4.1 8.9 & 6.1

Ans:AD [Ref: Ganong 23nd/ CMDT 06/222; A.K.Jain 5th/482; Guyton 11th/531; Harrison 17th/230-31; Nelson 18th/2033; P.J.Mehta 15th/15] B B Majority of textbooks favour cutoff limit of 5gm% reduced Hb(not 4gm%) So answer would be A & D (i.e option involving <5gm% reduced Hb- cyanosis

not occur) Cyanosis is due to increased amount of reduced Hb (>5mg%)Q in capillary bloodP.J.Mehta 15th/15 In severe anaemia where Hb is less than 5 gm%, even if all the Hb is reduced in the capillaries, it will be less than the critical level of 5 gm% & cyanosis does not occurP.J.Mehta 15th/18 In general, definite cyanosis appears whenever the arterial blood contain more than 5 gms of deoxygenated Hb in each 100 ml of blood- Guyton 11th/531 Cyanosis is due to increased amount of reduced Hb (>5mg%)Q in capillary blood-P A.K.Jain 5th/482 & CMDT 06/222 In general, cyanosis becomes apparent when the concentration of reduced hemoglobin in capillary blood exceeds 40 g/L (4 g/dL)Q- Harrison 17th/230

17. In findings of SIADH includes: A. B. C. D. E. Urine Na+ S. Na+ Urine osmolality Serum osmolality Postural hypotention

Ans:AC
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[Ref: A.K.Jain 5th/698;Harrison 18th/2908-10;Williams Textbook of Endocrinology, 11th ed.]

Postural hypotention does not occur in SIADH as it is euvolemic hypoosmolality Feature of SIADH A.K.Jain 5th/698 urinary excretion of Na+, Hypernatriuria & hyponatremia Urine osmolality( become higher than plasma osmolality

18. Incorrect statement about Small cell Ca of lung: A. B. C. D. E. Not associated with smoking Surgery is treatment of choice Associated with paraneoplastic syndrome Most patients have distant metastases on diagnosis Contain neurosecretory granules

Ans: AB

[Ref: Harrison 18th/737-745 ; Robbins 8th/758-63 ; CMDT 06/ 267 ]

Small cell Ca of lung(SCLC) Eighty-five percent of patients with lung cancer of all histologic types are

current or former cigarette smokers(Squamous> Small cell ca> adenocarcinoma) Most common variety associated with paraneoplastic syndrome Highly malignant tumor with least 5-yr survival rate Electron microscopy shows dense-core neurosecretory granules 100 nm in

diameter in two thirds of cases.

19. Features seen in Menkes disease: A. B. Increased serum Cu Decreased circulating ceruloplasmin
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C. D. E.

Hypopigmented & brittle hair Mental retardation Failure of thrive

Ans: BCDE

[Ref: Harrison 18th/ 604; Nelson 18th/2730] Menkes kinky hair syndrome is an X-linked metabolic disturbance of copper metabolism characterized by mental retardation, hypocupremia, and decreased circulating ceruloplasmin- Harrison 18th/ 604

It is characterized by sparse and coarse hair, growth failure, and deterioration

of the nervous system. Onset of Menkes syndrome typically begins during infancy. Signs and symptoms of this disorder include weak muscle tone (hypotonia), sagging facial features, seizures, mental retardation, and developmental delay. The patients have brittle hair and metaphysealwidening.

20. Clubbing is /are seen in : A. B. C. D. E. Mesothelioma Bronchial asthma Idiopathic pulmonary fibrosis TB Sarcoidosis

Ans: ACDE

[Ref: Harrison 18th/ 279,289-90; Robbins 8th/ ; P.J.M 15th/14;CMDT 06/ 221-22 ] Clubbing is seen in chronic interstitial lung diseases(Idiopathic pulmonary fibrosis). It does not normally accompany asthma or COPD;when seen in later, commitant lung cancer should be suspected. It is observed less often in small cell cancer than in other histological types- CMDT 06/ 222

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Clubbing may be hereditary, idiopathic, or acquired and associated with a variety of disorders, including cyanotic congenital heart disease, infective endocarditis, and a variety of pulmonary conditions (among them primary and metastatic lung cancer, bronchiectasis,asbestosis, sarcoidosis, lung abscess, cystic fibrosis,tuberculosis and mesothelioma), as well as with some gastrointestinal diseases (including inflammatory bowel disease and hepatic cirrhosis).- Harrison 18th/ 290

21. Correct combinations are : A. s sec B. Hypopneas = 10 s events in which there is continued breathing but the Apnoea = Airway blockage or no air entry through nasal aperture for 10

ventilation is reduced by at least 50% from the previous baseline during sleep C. D. E. Snoring occur from obstruction of lower airway Apnoea index- no of apnoeic episode/hr Apnoea-Hypocapnia index > 10 indicates mild obstruction

Ans: ABDE

[Ref: Harrison 18th/ 2186; Guyton 11th/522-23; CMDT 06/1080,305-06 ] Obstructive sleep apnoea & Snoring are caused by blockage of the upper Apneas are defined in adults as breathing pauses lasting 10 s and

airway- Guyton 11th/522 hypopneas as 10 s events in which there is continued breathing but the ventilation is reduced by at least 50% from the previous baseline during sleep. As a syndrome, OSAHS is the association of a clinical picture with specific abnormalities on testing; asymptomatic individuals with abnormal breathing during sleep should not be labeled as having OSAHS. The apneahypopnea index (AHI) is an index of sleep apnea severity

thacombines apneas and hypopneas. The AHI, as with the separate apnea index and hypopnea index, is calculated

by dividing the number of events by the number of hours of sleep. (AHI values are typically categorized as<5= Normal; 515/hr = mild; 1530/hr = moderate; and > 30/h = severe.)
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22. Causes of secretory diarrhea is/are: A. B. C. D. E. V. cholera Laxatives Excess Phenolphthalein intake Ulcerative colitis Pancreatic exocrine insufficiency

Ans: ABC

[Ref: Harrison 18th/313 ; Robbins 8th/832; Harrison 17th/249, 814; Manual of Gastroenterology 4th/184; CMDT 09/496-97] Ulcerative colitis causes inflammatory diarrhoea whereas Pancreatic exocrine insufficiency Steatorrheal diarrhoea

23. CRF can differentiated from ARF by presence of : A. B. C. D. E. Anemia in CRF Small size kidney Hyperphosphatemia Hyperkalemia Peripheral neuropathy

Ans: Ans: B(Small Kidneys) E( Peripheral neuropathy)

[Ref: Harrison 18th/ ;Harrison 17th/1761-1770 ; CMDT 09 / 797-807]

Anaemia , metabolic acidosis, hyperphosphatemia, hypocalcemia & hyperkalemia can occur with both acute & chronic renal failure- CMDT 06 / 908

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CRF : CMDT 09 / 797-807 : states Bilateral small kidneys in ultrasound are diagnosticQ. Peripheral neuropathiesQ manifest themselves as sensorimotor

polyneuropathies (stocking and glove distribution) and isolated or multiple isolated mononeuropathies.

24. Feature of acute rheumatic fever includes: A. Carey coombs murmur B. Pancarditis C. Always cause residual jt disease D. Chorea E. Group A Streptococcal infection

Ans:ABDE [Ref: Robbins 7th/593-94; Harrison 18th/2752-55; Harrisons 17th/2093-94;Ghai 7th/381-82,6th / 382] There is no residual damage to the joint- Ghai 7th/381 During acute RF, diffuse inflammation and Aschoff bodies may be found in any of the three layers of the heartpericardium, myocardium, or endocardiumhence the lesion is called a pancarditis.- Robbins 7th/593

25. 100 gram of dates contains: A. B. C. D. E. Iron 7.3 gram Vit C: 100 mg Calorie: 317 Carotene:44 g Calcium 10 mg

Ans: ACD TABLE 20(Park 21st): Nutritive value of some common fruits (per 100g of edible portion)
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Date : 317 Calories; Calcium(120 mg); Iron(7.3mg); Carotene (44 g); Vit. C 3 mg

26. Alkylating agents is/are: A. B. C. D. E. Methotrexate Busulfan Doxorubicin Daunorubicin Chlorambucil

Ans:BE [Ref : K.D.T. 6th/819-20; Katzung 10th/887-88; Goodman & Gilman 11th/1335-36]

1. Alkylating agents Nitrogen mustard : Chlorambucil

Alkyl sulfonate

BusulfanQ

27. Isolation is beneficial in : A. B. C. D. E. Diphtheria Measles Typhoid TB Cholera

Ans: A (Diphtheria); B (Measles); C (Typhoid); D (T.B.);& E (Cholera) [Ref:Park 21th / 111] According to table ( Park 21th / 111), isolation is recommended in all diseases given in option although its benefits is controversial in someQ

28. Ganciclovir true is : A. B. C. Inhibits human DNA polymerase Used in CMV Used in HSV
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D.

Active against Kaposi's sarcoma-associated herpesvirus

Ans:All [Ref: KDT 6th/770-71 ;Katzung 10th/ 795-96] Action Inhibits cytomegalovirus (CMV) and other virus replication by competitive inhibition of viral DNA polymerases and direct incorporation into viral DNA. Ganciclovir has in vitro activity against CMV, HSV, VZV, EBV, HHV-6, and KSHV (Kaposi's sarcoma-associated herpesvirus). Its activity against CMV is up to 100 times greater than that of acyclovir-Katzung 10th/ 796

29. True statement(s) is/are: A. Hemicholinium leads to increased storage of Ach B. Botulinum blocks Ach release C. Tyramine inhibit release of NA D. Imipramine is NA & 5-HT reuptake inhibitor E. Black widow spider toxin induces massive release of Ach

Ans:BDE [Ref : K.D.T. 6th/93 ; Katzung 10th/ 78,80,90 ]

Two toxins interfere with cholinergic transmission by affecting release: botulinus toxin inhibits release, while black widow spider toxin induces massive release & depletion- K.D.T. 6th/93 Tyramine is a indirectly acting sympathomimetics, acts on the adrenergic neurons to release NA, which then acts on the adrenoreceptors- K.D.T. 6th/120 Hemicholinium-3 (HC3), also known as hemicholine, is a drug which blocks the reuptake of choline by the high-affinitycholine transporter (ChT; encoded in humans by the gene SLC5A7) at the presynapse. The reuptake of choline is the rate limiting step in the synthesis of acetylcholine; hence, hemicholinium-3 decreases the synthesis of acetylcholine. It is therefore classified as an indirect acetylcholine antagonist .Acetylcholine is synthesized from choline and a donated acetyl group from acetyl-CoA, by the action of choline acetyltransferase (ChAT)- Katzung 10th/ 78
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30.Which of the following is/are not calcium-channel blocking agent(s): A. B. C. D. E. Verapamil Propranolol Carvedilol Nicardipine Nebivolol

Ans:BCE [Ref : K.D.T. 6th/ 137 ; Katzung 10th/ 175] Nebivolol : It is a selective 1 blocker & also acts as a NO donor- K.D.T. 6th/142 Carvedilol is a 1 + 2+ blocker- K.D.T. 6th/143

31. Which of the following Drug-receptor pair correctly matched: A. B. C. D. E. Buspirone : 5HT-1 agonist Granisetrine 5HT-2 antagonists Cisapride 5 HT-3 agonist Methysergide-5 HT-4 antagonist Imipramine :TNF- inhibitor

Ans: A [Ref : K.D.T. 6th/167 ; Katzung 10th/272] Methysergide is a potent 5HT-2A/2C antagonist with tissue specific agonistic actions as well, but is non-selec tive act on 5HT-1 receptor also- K.D.T. 6th/167 Methysergide have partial agonist effects at 5-HT2 vascular receptors- Katzung 10th/272 Imipramine inhibit monoamine reuptake & interact with a variety of receptors viz. muscarinic, adrenergic, histamine H1, 5-HT1, 5-HT2 &occasionally dopamine D2K.D.T. 6th/441

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Buspirone, a 5-HT1A agonist, has received wide attention for its usefulness as an effective nonbenzodiazepine anxiolytic- K.D.T. 6th/163 Cisapride is a 5-HT4 agonist as well as weak 5-HT3 antagonist- K.D.T. 6th/645 Granisetron is a 5-HT3-receptor antagonists-K.D.T. 6th/647 TNF- inhibitors are: infliximab adalimumab, certolizumab and golimumab

32. Acute hepatitis B can be diagnosed by : A. B. C. D. E. HBsAg IgM anti-HBc Ab HBeAg IgG anti-HBc Ab Core antigen

Ans: A (HBsAg); B (IgM...)& C (HBeAg)

[Ref : Park 21th/193-194;Harrison 17th / 1933-34;Ananthanarayan 8th/543]

HBcAg is called as core antigen.It is not demonstrable in circulation because it is enclosed within the HBsAg coat, but its antibody, anti-HBc appears in serum a week or two after the appearance of HBsAg- Ananthanarayan 8th/543 HBsAg is the first biomarker to appear in blood after infection.HBeAg appears in blood concurrently with HBsAg or soon afterwards- Ananthanarayan 8th/543

33. Vaccines NOT contraindicated in pregnancy : A. B. C. D. E. Measles Varicella Mumps Rabies Hepatitis

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Ans: D (Rabies); E (Hepatitis)

[Ref: Park 21th/98] Live vaccineS are C/I in pregnancy

34. Screening is effective in : A. B. C. D. E. Carcinoma lung Carcinoma prostate Carcinoma ovary Carcinoma breast Carcinoma cervix

Ans : B (Carcinoma pros.) &D(Carcinoma b..)& E (Carcinoma Cervix) [Ref: Harrison 18th/660-63,17th/490-91; Park 21st/356-572]

Screening is not helpful in Ca lung, Ca ovaries and Ca endometrium Effective screening have been developed for cervical cancer, breast cancer & oral cancerQ- Park 21st/356 Prostate Ca: DRE and PSA estimationQ detects carcinoma in early resectable stage. Hence decreases mortality

35. Disease infectious before onset of symptoms: A. B. C. D. Hepatitis B Measles Mumps Cholera

Ans: A (Hepatitis B); B (Measles); & C (Mumps) [Ref: Park21th/91] As a rule, infectious diseases are not communicable during the incubation period, but there are exceptions, as for example, measles, chickenpox, whooping cough or hepatitis A Q are communicable during the later part of the incubation period- Park
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21th/94 Park21th/91: Writes: INCUBATORY CARRIERS: Measles, mumps, polio, pertussis, influenza, diphtheria and hepatitis B

36. Endemic ascites is caused by : A. Argimone mexicana seeds B.Junjhunia seeds C.Argot poisoning D.Fusarium toxin E. Aflatoxin

Ans: B (Jhunjhunia seeds) [Ref: Park 21th/607-8] Endemic ascites: On chemical analysis Jhunjhunia seeds were found to contain pyrrolizidine alkaloids which are causative agent for Endemic ascites- Park 21th/608

37. True about HPV vaccination : A. B. C. D. E. Given in woman of age group 25-40 years Primary immunization consists of 2 dose Efficacy >70% for cervical cancer Two types of vaccine are available in the market Protect against HPV 16 & 18

Ans: C (Efficacy..), D (Two types..) & E (Protect..) [Ref:Harrison 18th/148485;Harrison 17th/1119;Internet] The ACIP recommends routine vaccination of females 11-12 years of age with 3 intramuscular dose; the second & third dose should be given 2 & 6 months after the first- CMDT 09/1173 ACIP of the Centers for Disease Control and Prevention has recommended that HPV vaccination be routinely offered to girls and young women 926 years of ageHarrison 18th/1484-85 The quadrivalent vaccine has also been licenced in US for use in male(9-26 yr of age) for prevention of anogenital warts- Harrison 18th/1485
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38. Teratogenic drug(s) is/are: A. B. C. D. E. Phenytoin Methotrexate Folic acid Ampicillin Enalapril

Ans:ABE [Ref:;KDT 6th/84-85, 909-910; Drug in Pregnancy & Lactation by G.Briggs 6th/339] A recent report indicates 2.7 fold higher malformation rate in fetuses exposed to ACE inhibitors(e.g Enalapril) in first trimester. ACE inhibitors must be stopped when women conceives- KDT 6th/484 Prophylactic folic acid administration is given during pregnancy to reduce the risk of neural tube defect- KDT 6th/592

39. Drug that increases QT interval : A. B. C. D. E. Haloperidol Fexofenadine Amiodarone Ebastine Sotatol

Ans:CDE

[Ref: KDT 6th/510,495,428-29] Fexofenadine does not prolong QTc interval- KDT 6th/158

Drugs that prolong Q-T interval Antiarrhythmics QuinidineQ, procainamideQ, disopyramide, propafenone,
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AmiodaroneQ, Sotalol Antimicrobial Quinine, mefloquine, artemisinin, halofantrine, sparfloxacin, gatifloxacin Antihistaminic Antidepressants Antipsychotics Prokinetics TerfenadineQ, astemizole, ebastine Amitryptyline & other tricyclics Thioidazine, risperidone, Ziprasidone(Katzung 10th/463)

CisaprideQ

40. Anti MRSA drugs are : A. B. C. D. E. Linezolid Vancomycin Daptinomycin Cefepime Piperacillin-tazobactam

Ans: ABC [Ref: clinicalpharmacy.ucsf.edu/idmp/whatsnew/dapto_monograph.htm ;Harrison 18th/2134 ;KDT6th/700,708,732,734; G & G 11th/1132; Jawetz, Melnick, & Adelberg's Medical Microbiology, 24th Edition]

Piperacillin-tazobactam: spectrum include b-lactamase-producing strains of S aureus as well as some b-lactamase-producing gram-negative bacteria- Katzung 10th/741 Cefepime (fourth-generation cephalosporin): It has good activity against P aeruginosa, Enterobacteriaceae, S aureus, and S pneumoniae.- Katzung 10th/741 The drug of choice for these organism is vancomycinQ/linezolidQ, but ciprofloxacin can also be used. ImipenemQ, DalfopristinQ/Quinupristin, Mupirocin, Teicoplanin are also effective against MRSA- KDT 6th/708,732,733,734 Daptomycin is a newly-approved antibacterial agent, highly resistant species (MRSA, VISA, VRSA, VREclinicalpharmacy.ucsf.edu/idmp/whatsnew/dapto_monograph.htm Daptomycin : Its spectrum of activity is similar to that of vancomycin except that it is
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more rapidly bactericidal in vitro and it is active against vancomycin-resistant strains of enterococci and vancomycin-intermediate and -resistant strains of S aureusKatzung 10th/741

41.MOA of verapamial is: A. B. C. D. E. Inhibition of Ca+2 channel Inhibition of Na+ channel Inhibition of K+ channel Block membrane repolarisation Membrane stabilisation

Ans:A [Ref: KDT 6th/ 511,517-18 ; Katzung 10th/ 221-23 ] Classification of antiarrhythmic drugs: four classes

1. Class 1 action is sodium channel blockade(Membrane stabilizing drugs): 2. Class 2 action is sympatholytic. Drugs with this action reduce b-adrenergic activity in the heart. 3. Class 3 action is manifest by prolongation of the APD. Most drugs with this action block the rapid component of the delayed rectifier potassium current, IKr. 4. Class 4 action is blockade of the cardiac calcium current. This action slows conduction in regions where the action potential upstroke is calcium dependent, eg, the sinoatrial and atrioventricular nodes. Class IV agents act by blocking voltage-sensitive calcium channels. Class IV drugs slow conduction in the SA and AV nodes where action potential propagation depends on slow inward Ca2+ current, slowing the heart and terminating SVT by causing partial AV block. They shorten the plateau of the action potential and reduce the force of contraction. Reduced Ca2+ entry reduces after-depolarisation and thus suppresses premature ectopic beats.

42. Phenytoin causes: A. Pure red cell aplasia

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B. C. D. E.

Megaloblastic anaemia Aplastic anaemia Hemolytic anaemia Thrombocytopenia

Ans:All [Ref : K.D.T. 6th/ 404-05 ; A to Z Drug Facts 2003 by David S. Tatro ;Goodman & Gilman 11th/335 ] Adverse Reactions of of Phenytoin A to Z Drug Facts 2003 by David S. Tatro HEMATOLOGICAL: Thrombocytopenia; leukopenia; granulocytopenia; agranulocytosis; pancytopenia; macrocytosis; megaloblastic anemia; eosinophilia; monocytosis; leukocytosis; simple anemia; hemolytic anemia; aplastic anemia. Phenytoin: Hematological reactions include neutropenia and leucopenia, or more rarely, red-cell aplasia, agranulocytosis, and thrombocytopenia. Lymphadenopathy is associated with reduced immunoglobulin A (IgA) production.Hypoprothrombinemia and hemorrhage have occurred in the newborns of mothers who received phenytoin during pregnancy; vitamin K is effective treatment or prophylaxis- Goodman & Gilman 11th/335

43. Morphological feature of rosacea includes: A. B. C. D. E. Papules Pustules Vesicles Telangiectasia Comedones

Ans: ABDE [Ref: Neena Khanna 3rd/ 104 ; Harrison 18th/404;Roxburg 17th/162-63 ] Vescicles not mentioned as feature in any above textbooks Acne rosacea or rosacea: It is characterized by the presence of erythema, telangiectases, and superficial pustules , but is not associated with the presence of comedones. Often, individuals with rosacea initially demonstrate a pronounced flushing reaction. As the disease progresses, the flush persists longer and longer and may eventually become permanent. Papules, pustules, and telangiectases can
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become superimposed on the persistent flush- Harrison 18th/404

44. Intra epidermal blisters are seen in : A. B. C. D. E. Bullous pemphigoid Pemphigus folliaceous Dermatitis herpeteformis Hailey Hailey disease Bullous impetigo

Ans:B (Pemphigus..) D (Hailey..) [Ref: Pathology of Skin by Farmer & Hood 2nd/235,237,655 Neena Khanna 3rd/6265,67,1th/52;Roxburg 17th/255,82] Hailey Hailey disease(Benign familial pemphigus): It is a Intra epidermal bullous disorder & present as flaccid vesicle, crusted erosion & circinate plaques onerythematous base. Usually worse in summertime- Neena Khanna 3rd/67;Roxburg 17th/255

Bullous ImpetigoQ is subcorneal disorder while Dermatitis herpeteformis, Bullous SLE & Bullous pemphigoid are Dermo-epidermal (Subepidermal) lesionsQ Pemphigus group of diseases are intra-epidermal bullous disorderQ- Neena Khanna 1th/52

45. Woods lamp examination is used in diagnosis of: A. B. C. D. E. Erythrasma Lichen planus Psoriasis P. veriscolor T.capitis

Ans: ADE Woods lamp examination is not done in diagnosis of Psoriasis & Lichen planus [Ref: Neena Khanna 3rd/13,209 ; Harrison 18th/ 394 ; Rooks Textbook of
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Dermatology 7th/ 5.11-5.14;Roxburg 17th/38,41]

46. Drugs used in scabies are all except : A. B. C. D. E. Crotamiton Permethrin Gamma-benzene hexachloride(BHC) Tacrolimus Benzyl benzoate

Ans:D [Ref: Neena Khanna 3rd/297; Harrison 18th/3577;KDT 6th/863-64]

Tacrolimus is a calcineurin inhibitor(immunomodulator) used in atopic dermatitis, vitiligo & rosacea- Neena Khanna 3rd/345 Scabicides used are: Permethrin creamQ (5%), Gamma benzene hexachloride(GBHC1%), Crotamiton (10%), Benzyl benzoate (25%) & Ivermectin (single oral dose 200 g/kg)- Neena Khanna 3rd/297

47. Cutaneous T.B includes: A. B. C. D. E. Lupus vulgaris Scrofuloderma Lichen planus Lupus erythematosus Lupus pernio

Ans: AB [Ref: Neena Khanna 3rd/ 217 ; Harrison 18th/ 1349 ; Behl 7th/202;Rooks Dermatology 7th/28.10-28.30] Lupus erythematosus includes SLE(systemic lupus erythematosus, DLE & SCLENeena Khanna 3rd/ 186 Lupus pernio is found in sarcoidosis. Microscopically, it resembles lupus vulgaris.
26

Biopsy shows granulomatous infiltration- Harrison 18th/ 2808 Cutaneous manifestations of tuberculosis include primary infection due to direct inoculation, abscesses and chronic ulcers, scrofuloderma, lupus vulgaris (a smoldering disease with nodules, plaques, and fissures), miliary lesions, and erythema nodosum- Harrison 18th/ 1349

48. Painful genital ulcer is/are seen in : A. B. C. D. E. Chancroid Lymphogranuloma Venereum Primary syphilis Herpes G ranuloma inguinale

Ans: AD [Ref :Neena Khanna 3rd/ 259-270; Ananthnarayan 8th/420; Harrison 18th/1108,17th/831-32] Primary syphilis cause Hunterian chancre(painless)- Neena Khanna 3rd/259 Lymphogranuloma Venereum:Primary lesion is a small painless papulovesicualar lesion appearing on external genitalia- Ananthnarayan 8th/420 Granuloma inguinale begins as a painless papule on the genitalia, which leads to a slowly progressive, autoinoculable ulcer- Ananthnarayan 8th/396

49. Laparoscopy is /are C/I in : A. B. C. D. E. Pregnancy Distension of intestine Severe cardio-pulmonary disease Peritonitis Inguinal hernia

Ans:ABCD
27

[Ref : L & B 25th/247-49 ;Washington Manual of Surgery 5th/642-43 ; Maingot's Abdominal Operations; Mastery of Surgery 5th/ 1116 Massive abdominal distention may result in an increased risk of iatrogenic bowel injury- Washington Manual of Surgery 5th/643 Pregnancy is a relative C/I C/I for Laparoscopy are relative & includes uncorrectable coagulation defects, severe congestive heart failure, respiratory insufficiency, suspected acute & diffuse peritonitis & presence of distended bowel- emedicine.medscape.com/ article

50. Predisposing factors for Varicose vein includes : A. B. C. D. E. Incompetent valve b/w superficial and deep vein Deep vein thrombosis Buergers disease Female sex Hormone Family history

Ans:ABDE [Ref : L & B 25th/ 927,923-24 ; S.Das Textbook of Surgery 5th/205-06;Sabiston 18th/2006 ;CSDT 11th/873;Manipal Surgery 3rd/103 ] Very often, the valve at saphenofemoral junction is incompetent/absent. The valves can also be absent where the superficial vein join the deep vein- Manipal Surgery 3rd/103 Buergers disease(thromboangitis obliterans) is occlusive diseases of small & medium sized arteries- L & B 25th/ 923 Although Buergers disease can cause migratory thrombophlebitis of superficial & deep vein, but it is not mentioned as a cause of varicose vein in any above textbooks

51. Biopsy in Hirschsprungs disease can be taken from : A. B. 4 cm above the dentate line 4 cm below dentate line
28

C. D. E.

6 cm below dentate line At the level of dentate line Anywhere feasible- site not important

Ans:A(Single best option) [Ref : Sabiston 18th/2065 ; CSDT11th/1321 ; Nelson 18th/1565-67; S.Das Textbook of Surgery 5th/1035-36] Biopsy should be taken atleast 2 cm above the dentate line- S.Das Textbook of Surgery 5th/1036 Rectal biopsy:It is important to obtain the sample at least 2 cm above the dentate line-Sabiston 18th/2065 Rectal suction biopsies are the procedure of choiceQ & should be performed no closer than 2cm to the dentate line to avoid the normal area of hypoganglionosis at the anal verge-Nelson 18th/1566 The definitive diagnosis of Hirschsprung's disease is made by rectal biopsy. Samples of mucosa and submucosa are obtained at 1 cm, 2 cm, and 3 cm from the dentate line-Schwartz 8th

52. True about Keloid: A. B. C. D. E. Seen in caucasians Treatment is excision and grafting Grows beyond margin Precancerous lesion leading to cancer Everted margin

Ans:BC [Ref : L & B 25th/ 30,598-99, 24th/93 ; Sabiston 18th/206-07 ; CSDT11th/ 1243 ; Scwartz 8th/ ] Coloured races are particularly liable to keloid formation. Negroes are commonly affected- S.Das Textbook of Surgery 5th/123 Shaving away the excess scar tissue & then resurfacing the area by a thin skin
29

graft, though advocated by a few surgeon to give encouraging results, yet such treatment has never produced good result by large- S.Das Textbook of Surgery 5th/123 Everted edge(rolled out) is a characteristic feature of squamous cell Ca or ulcerated adenocarcinoma- S.Das Textbook of Surgery 5th/125

53. Breast conservative surgery is not done in : A. B. C. D. E. Scleroderma Multicentric lesion 1st & 2nd trimester Pregnancy Diffuse microscopic calcification Fixity of tumor to chest wall

Ans: All

[Ref: Sabiston 18th/877; S.Das 5th/727; L & B 25th/843, 24th / 841; Devita 7th/1437; CSDT 11th/330; Mastery of Surgery, 5th Edition] Clinically detectable multifocality is a relative contraindication to breast-conserving surgery, as is fixation to the chest wall or skin or involvement of the nipple or overlying skin.- CSDT 11th/330 Contraindications for BCS: 1. Multicentric breast cancer. 2. Diffuse malignant looking micro calcifications on mammogram 5. Collagen vascular disease. 6. Early pregnancy.

54.Irreversible step(s) in glycolysis is/are: A. B. C. D. Enolase Phosphofructokinase Pyruvate kinase Glyceradehyde -3-phosphate dehydrogenase
30

E.

Hexokinase

Ans:BCE [Ref: Vasudevan 5th/85-88;Harper 28th/158; Chatterjea & Shinde 7th/306-09 ] Phosphofructokinase catalyse conversion of Fructose 6-P to F-1,6-bi-P (Irreversible) Q- Chatterjea & Shinde 7th/308 Enolase catalyse conversion of 2-phosphoglycerate to phosphoenol pyruvate(Reversible)- Vasudevan 5th/87 Pyruvate kinase catalyse conversion of phosphoenol pyruvate to pyruvate(Irreversible) -Chatterjea & Shinde 7th/310 Glyceraldehyde-3-phosphate-dehydrogenase catalyse conversion of Glyceraldehyde-3-p to 1,3-biphosphoglycerate-(Reversible) Q- Chatterjea & Shinde 7th/306

55. High energy phosphate compound is/are : A. B. C. D. E. ATP Creatine phosphate Glucose- 1- phosphate Glycerol -3-phosphate ADP

Ans:AB [Ref;Harper 28th/94; Vasudevan 5th/228; Satyanarayan 3rd/222-23 ] Classification of high-energy compounds There are at least 5 groups of high-energy compounds 1. 2. 3. 4. 5. Pyrophosphates e.g. ATP. Acyl phosphates e.g. 1, 3-bisphosphoglycerate. Enol phosphates e.g. phosphoenolpyruvate. Thioesters e.g. acetyl CoA. Phosphagens e.g. phosphocreatine

56. Which of the following enzyme is not involved in Urea cycle :

31

A. B. C. D. E.

Glutamate dehydrogenase Argininosucinate synthetase - KG dehydorogenase Isocitrate dehydrogenase Fumarase

Ans: ACDE [Ref ; Harrison 18th/3216,3219;17th/2472-74; Harper 28th/243;Shinde 7th/450-51] - KG dehydorogenase, fumarase & Isocitrate dehydrogenase are enzymes of TCA(citric acid cycle- Shinde 7th/317

Glutamate dehydrogenase catalyses the formation of glutamate & ammonia in mitochondria. It provide ammonia for Carbamoyl phosphate synthase(1st step of urea cycle- so Glutamate dehydrogenase is not part of urea cycle

57. Protein separation based on mass / molecular weight (size) is/are done in all EXCEPT : A. B. C. D. E. Ultrafiltration Electrophoresis 2D gel electrophoresis Gel Filtration chromatography Centrifugation

Ans:B [Ref : Harper 28th/24,37-38;Satyanarayan 3rd/59; Lippincott 4th/21; www.ncbi.nlm.nih.gov NCBI LiteratureQ 25 June 2009;Harper27th/21-25;Protein purification Handbook: laboratory Manual Chapter II;NMS Biochemistry 4th/19-23; Shinde 7th/90; Vasudevan 5th/481-90] Centrifugation: masses or densities Ultrafiltration: concentrates a protein solution using selective permeable membranes. The function of the membrane is to let the water and small molecules pass through while retaining the protein.
32

Electrophoresis Separates Molecules according to Their Charge:Mass Ratio SDS-PAGE: The proteins in SDS-PAGE are separated on the sole basis of their size. Two-Dimensional Gel Electrophoresis: Electrophoresis of all cellular proteins through an SDS gel can separate proteins having relatively large differences in molecular weight

58. Which is/are not transport proteins : A. B. C. D. E. Transferrin Collagen Ceruloplasmin Hb Albumin

Ans:B [Ref: Harper 28th/569,271 ;Satyanarayan 3rd/184;Vasudevan 5th/241 ] Hemoglobin is largely responsible for the transport of oxygen from the lungs to tissue. It also helps to transport CO2 from the tissues to the lungs- Harper 28th/197 Transport protein: Hb, the transporter of oxygen is a tetrameric protein- Vasudevan 5th/28 Structural protein: Collagen is the most abundant protein in mammals & the main fibrous component of skin, bone, tendon, cartilage & teeth- Vasudevan 5th/28

59. Selenium deficiency causes: A. B. C. D. E. Dermatitis Cardiomyopathy Diarrhoea Alopecia Gonadal atrophy

33

Ans:B [Ref: Harrison 18th/604,595; Shinde 7th/ 594;Satyanarayan 3rd/422:Vasudevan 5th/329 ] Gonadal atrophy, alopecia, dermatitis & diarrhoea are the feature of zinc deficiencyHarrison 18th/595(table) Alopecia, dermatitis & diarrhea are feature of selenium toxicity- Satyanarayan 3rd/422

60.Copper containing enzymes is/are : A. B. C. D. E. Superoxide dismutase Cytochrome oxidase Myeloperoxidase Tyrosinase Amine oxidase

Ans:ABDE [Ref: Harper 28th/ 573 ]

Myeloperoxidase (MPO) is a peroxidase enzyme. It is a lysosomal protein stored in azurophilic granules of the neutrophil. MPO has a heme pigment.

61. Gestational diabetes mellitus more likely occurs in: A. B. C. D. E. Morbid obesity Previous h/o GDM Family history of GDM Advanced age H/o pregnancy losses

Ans: All [Ref : Duttas Obstetrics 6th/284-286 ;Williams Obstetrics 23rd/1109; CDTOG 10th/ch-18 ]
34

The potential candidates for GDM are Duttas Textbook of Obstetrics 6th/284 a) Positive family history of diabetes (parents or sibling). Family history should

include uncles, aunts and grand parents b) c) d) e) Having a previous birth of and overweight baby of 4kg or more Previous stillbirth with pancreatic islet hyperplasia revealed on autopsy Unexplained perinatal lossQ Presence of polyhydramnios or recurrent vaginal candidiasis in present

pregnancy f) g) h) i) Persistent glycosuria Age over 30 Q ObesityQ Ethnic group (East Asian, Pacific island ancestry)

62. Maneuver used in shoulder dystocia is/are: A. B. C. D. E. Lovset maneuver Woods corkscrew maneuver Ritzen maneuver Mauriceau-Smellie-Veit technique McRoberts maneuver

Ans: B (Woods..); E (Mc Roberts..) [Ref : Duttas Obstetrics 6th/407-408, 384 ;Williams Obstetrics 23rd/ ] Mauriceau-Smellie-Veit technique is used in delivery of after-coming head in assisted breech delivery- Duttas Obstetrics 6th/382 Lovset maneuver is used in bringing down arm in breech deliver- Duttas Obstetrics 6th/387 Ritzen maneuver: It is assisted delivery of head in normal labour- Duttas Obstetrics 6th/138 Mc Roberts maneuver & Woods maneuver Q are used in Shoulder dystociaDutta Obstetrics 6th / 407-408
35

63. True statement related to Hormonal replacement therapy : A. B. C. D. E. ed chance of hip fracture ed Breast cancer ed Colon Ca ed Endometrial Ca ed risk of DVT

Ans: A(ed ..), C (ed Colon..); E (ed risk . .) [Ref : Shaws Gynae 14th/57-59 ;Dutta Gynaecology 5th/59-60; CDTOG 10th/ch-59 ;Novaks 14th/1334-35 ]

Benefits of Hormonal replacement therapy Dutta Gynaecology 5th/59 Decreased risk in vertebral & hip fracture(25-50%) Reduction in colorectal cancer(20%)

Risk of Hormonal replacement therapy Dutta Gynaecology 5th/60 Endometrial Ca Breast Ca Venous thromboembolism(DVT)

64. Risk factor for ectopic pregnancy is/are: A. B. C. D. E. Tubal sterilization Infertility IUCD use OCP Multiparity

Ans: A (Tubal..); B (Infertility); C (IUCD) [Ref: Q 202 Nov 2009;Shaw's 14th/208; Duttas Obstetrics 6th/179-80;Williams
36

Obstetrics 23th/239]

65. Criteria for severe pre- eclampsia includes all except: A. B. C. D. E. Fetal growth restriction Prematurity Proteinuria Oliguria Pulmonary edema

Ans: None (all are correct) [Ref : Duttas Obstetrics 6th/226-228 ;Williams Obstetrics 23rd/ 708 ; CDTOG 10th/ch-19 ] Fetal hazard in severe pre- eclampsia :Intrauterine death, IUGR, asphyxia & prematurity- Duttas Obstetrics 6th/228

66. Risk factor for Acute PID includes: A. B. C. D. E. Advanced age OCP use IUCD users Previous h/o PID no of sexual partner

Ans: C (IUCD); D (Previous..); E ( no. of..) [Ref : Shaws Gynae 14th/399-404; Duttas Gynae 5th/125 ; Williams Gynae 1st/73 ] PID is a disease of young women, who are sexually & reproductively active.Two thirds are restricted to young women of less than 25 years & remaining one-third limited among 30 years or older- Duttas Gynae 5th/125

37

>>. Risk factor for Acute PID Duttas Gynae 5th/125 Multiple sexual partner Absence of contraceptive pill use Previous history of acute PID IUD users Menstruating teenagers

Protection for Acute PID Duttas Gynae 5th/125 Contraceptive methods- Barrier method & Oral steroidal

contraceptives(produce thick mucus plug & decrease in duration of menstruation) Women with monogamous partner who had vasectomy Pregnancy Menopause Husband who is azoospermic

67. Left gastric vein drain into: A. B. C. D. E. IVC Portal vein Directly into splenic vein Splenic vein through short gastric vein Left gastro-epiploic vein

Ans:B

[Ref: BDC4th/Vol.II 270 ; Snells' Anatomy 8th/ 220] The Lt & Rt gastric veins drains directly into the portal vein. The short gastric veins & the left gastroepiploic veins join the splenic. The right gastroepiploic veins joins the superior mesenteric vein- Snells' Anatomy 8th/ 220

68. A person met with Knife injury to face & resultant damage to facial nerve. It lead to impaired/decreased secretion from:
38

A. B. C. D. E.

Parotid gland Sublingual gland Lacrimal gland Parotid gland, sublingual gland & submandibular gland Submandibular gland

Ans: BCE

[Ref: BDC4th/Vol.III 133, 140,161-61 ; Snells' Anatomy 8th/765 ] The parotid gland receives its parasympathetic input from the glossopharyngeal nerve(CN IX, Auriculotemporal nerve) via the otic ganglion, while the submandibular and sublingual glands receive their parasympathetic input from the facial nerve (CN VII) via the submandibular ganglion- BDC4th/Vol.III 137 Five terminal branch emerge along the anterior border of the parotid glandBDC4th/Vol.III 137(But not supply) Greater petrosal nerve: The post-ganglinic fibres are secretomotor to the lacrimal gland & the glands of the nose & the palate- Snells' Anatomy 8th/765

69. Structures injured while resecting the free edge of lesser omentum : A. B. C. D. E. Portal vein Hepatic artery proper Hepatic vein Cystic duct Common bile duct

Ans:ABE [Ref: BDC4th/Vol.II 240-41 ; Snells' Anatomy 8th/249 ; Grays 40th/1102 ] Right free margin of the lesser omentum contains portal vein, common bile duct, hepatic artery, portocaval lymph node & lymphatics & the hepatic plexus of nerves
39

ensheathed in a perivascular fibrous capsule- Grays 40th/1102

70. Correct statement about tongue is/are: A. B. C. D. E. Facial N. supplies filiform papillae Glossophanygeal nerve supplies cirumvallate papillae The posterior most part of tongue develops from Ist pharyngeal arch Genioglossus is the safety muscle Blood supply is derived from lingual artery

Ans:A(Most probably? could not got direct reference) BDE [Ref: BDC4th/Vol.III 250-253; Snells' Anatomy 8th/781 ; Grays 40th/ 503,507 ] Glossophanygeal nerve supplies cirumvallate papillae- Snells' Anatomy 8th/781 The posterior most part of tongue develops from 4th pharyngeal archBDC4th/Vol.III 253 Why genioglossus is called safety muscle of tongue? wiki.answers.com Biology Human Physiology Muscular System; Grays 40th/ 503 The genioglossus muscle is the muscle of the tongue. it's attached the base of the tongue to the inside front of the jaw bone. It pulls the tongue forward. In the people with obstructive sleep apnea, the genioglossus is more active in holding the airway open at rest. If it relaxes during sleep, the airway narrows and collapses. as it keeps the airway open thus saves life, it's called a life saving muscle. Fliform papillae occurs on anterior part of tongue Grays 40th/ 503 Chorda tympani is nerve of taste for A2/3 of the tongue except cirumvallate papillaeBDC4th/Vol.III 250-253

71. Tibial nerve injury/palsy causes : A. Dorsiflexion of foot at ankle joint

40

B. C. D. E.

Planter flexion of the foot at ankle joint Loss of sensation of dorsum of foot Paralysis of muscles of anterior compartment of leg Loss of sensation over the medial border of foot

Ans:A [Ref: BDC4th/Vol.II 173,85-86 ; Snells' Anatomy 8th/660 ;Grays 40th/1427 ] The muscles of anterior compartment of leg are supplied by deep peroneal nerve. Paralysis of the muscles of anterior compartment of leg results in loss of the power of dorsiflexion of the foot. As a result the foot is plantar flexed. The condition is called foot drop- BDC4th/Vol.II 100

Sensory supply of leg & foot Snells' Anatomy 8th/660 Common peroneal nerve: anterior & lateral side of leg & dorsum of foot &

toes, including the medial side of the big toe Tibial nerve(through sural nerve): lower half of back of leg & lower 1/3 of

lateral area of calf & whole of lateral border of the foot till the tip of little toe Saphenous nerve(Branch of femoral nerve): medial area of leg & medial

border of the foot as far as the ball of the big toe Posterior cutaneous nerve of thigh: upper half of the central area of calf

Tibial Nerve Injury Snells' Anatomy 8th/660 Motor: All muscle in the back of leg & the soles of the foot are paralyzed. The opposing muscles dorsiflex the foot at ankle joint & evert the foot at the subtalar & transverse tarsal joints, an attitude referred to as calcaneovalgus Sensory: Sensation is lost on the sole of foot; later trophic ulcers develop

72. Breast is/are supplied by : A. B. C. D. Lateral thoracic artery Internal mammary artery Musculophrenic artery Superior thoracic artery
41

E.

Superior epigastric artery

Ans: ABD [Ref: BDC Vol. I 4th / 41-42,212 ; Snells' Anatomy 8th/427]

Deep Arteries of anterior abdominal wall BDC Vol. II 4th / 204 Musculophrenic (branch of Internal mammary artery) artery gives branch to the diaphragm, the anterior abdominal wall & the seventh, eighth & ninth intercostals spaces as the anterior intercostals arteriesSuperior epigastric artery (branch of Internal mammary artery) gives muscular, cutaneous, anastomatic & hepatic branch

73. In injury to upper trunk of the brachial plexus following seen: A. B. C. D. E. Supination of forearm Pronation of forearm Inability to initiate abduction of shoulder Decreased sensation of medial hand Paralysis of deltoid muscle

Ans: BCE [Ref : B.D.C. 4th/Vol I 51-54; Snell's Anatomy 8th/ 536-37 ] Decreased sensation of medial hand occurs in lower trunk injury(Klumpkes paralysis)- B.D.C. 4th/Vol I 53

74. Posterior Cutaneous Nerve of thigh supplies skin overlying: A. B. C. D. E. Medial aspect of thigh Posteroinferior aspect of buttocks Scrotum Back of thigh Popliteal fossa
42

Ans: All [Ref : B.D.C. 4th/Vol II 110 ; Snell's Anatomy 8th/ 565-66 ;Grays 40th/1384 ] Posterior Cutaneous Nerve of thigh supplies skin of back & medial side of thigh, the popliteal fossa & the proximal part of the back of the leg- Grays 40th/1384 Posterior Cutaneous Nerve of thigh (S1,S2,S3) B.D.C. 4th/Vol II 76 1. A perineal branch which supplies the skin of the posterior two-third of the

scrotum or labium majus 2. Gluteal branch which supply the skin of the posteroinferior quadrant of the

gluteal region Sensory supply of legB.D.C. 4th/Vol II 110 Posterior cutaneous nerve of thigh: upper half of the central area of calf

75. Which of the following does not form boundary of femoral ring: A. B. C. D. E. Femoral aretry Femoral vein Femoral nerve Lacunar ligament Inguinal ligament

Ans:AC

[Ref: BDC4th/Vol.II 53 ; Snells' Anatomy 8th/ 579]

Femoral ring BDC4th/Vol.II 53 ; Snells' Anatomy 8th/ 579 It is the baseor upper end of the femoral canal. It is directed upward and is oval in form, its long diameter being directed transversely and measuring about 1.25 cm. Boundaries The femoral ring is bounded as follows: anteriorly by the inguinal ligament. posteriorly by the pectineal ligament.
43

medially by the crescentic base of the lacunar ligament. laterally by the fibrous septum on the medial side of the femoral vein

76. True about anatomy of Fallopian tubes: A. B. Length is 20 cm Medial to lateral structures are isthmus, Interstitial part, Ampulla &

Fimbriae C. D. E. Ovary is attached to uterus by Ovarian ligament Uterine artery supplies medial 2/3 of tube Ampulla is largest part

Ans:CDE

[Ref: BDC4th/Vol. II 355-57; Dutta Obs 6th/ 7]

Uterine artery supplies medial 2/3 & ovarian artery supplies the lateral 1/3 of the tube- BDC4th/Vol. II 357

The fallopian tubes stretch from the uterus to the ovaries and measure about 8 to 10 cm (4 to 6 inches) in length. Segments of the fallopian The fallopian tube is not just a passive pipe or a conduit, but an active organ with its separate locations performing separate functions. Starting from the ovarian end (fimbria) and proceeding toward the uterus, these are the: Fimbrial segment - faces the ovary Infundibular segment(1.25 cm) - funnel shaped segment behind the fimbria Ampullary segment(5 cm) - wide middle segment Isthmic segment (2.5 cm)- narrow muscular segment near the uterus Interstitial segment (1.25cm)- passes through the uterine muscle into the

uterine cavity

77. Blood brain barrier is/are formed by :

44

A. B. C. D. E.

Oligodendrocytes Microglial cell Astrocytes Schwann cell Neuroglial cell

Ans:CE

[Ref: BDC4th/Vol.III386-87 ; Ganong 23rd/572-73;Robbins 7th/1349-50;Grays 40th/48-49;Guyton 11th/766]

Bloodbrain barrier (BBB): made up of BDC4th/Vol.III386-87 1. 2. 3. 4. Vessel wall Arachnoid layer of the perivascular sheath The perivascular space Neuroglia & the ground substance of the brain

Some astrocytic processes are directed toward neurons and their processes and synapses, where they are believed to act as metabolic buffers or detoxifiers, suppliers of nutrients, and electrical insulators. Others surround capillaries or extend to the subpial and subependymal zones, where they contribute to barrier functions controlling the flow of macromolecules between the blood, the CSF, and the brainRobbins 7th/1349-50:

78. During incision & drainage of ischiorectal abscess, which nerve is/are affected/injured : A. Superior rectal nerve B. Inferior rectal nerve C.Superior gluteal nerve D.Inferior gluteal nerve E. Ilioinguinal nerve

45

Ans: B

[Ref: BDC4th/Vol.II 328-29 ,76 ,196 ; Snells' Anatomy 8th/394 ]

Contents of the Ischiorectal fossa 1. Ischiorectal pad of fat. 2. Inferior rectal nerve and vessels. 3. Posterior scrotal / posterior labial nerve and vessels. 4. Pudendal canal and its contents(pudendal nerve & internal pudendal vessel) 5. Perineal branch of fourth sacral nerve. 6. Perforating cutaneous branch of S2 , S3 nerve .

Ilioinguinal nerve: supply the skin of external genitalia & upper part of the medial side of the thigh- BDC4th/Vol.II 196

79. True statement about Restriction endonuclease : A. B. C. D. Palindromic sequences observed Protects bacteria from infection by virus Present only in eukaryotes Restrict replication of DNA

Ans:ABD

[Ref:Lippincott 4th/465-66;Harper 28th/388-90,27th / 403; Satyanarayana 3rd / 580] A restriction enzyme (or restriction endonuclease) is an enzyme that cuts DNA at specific recognition nucleotidesequences (with Type II restriction enzymes cutting double-stranded DNA) known as restriction sites. Such enzymes, found in bacteria and archaea, are thought to have evolved to provide a defense mechanism against invading viruses RE can specifically recognize DNA with particular sequence of 4-6 mucleotides and cleave. The recognition sequences are palindromicQ (i.e., twofold rotational symmetry- Lippincott 4th/466 RE restrict DNA replication- Satyanarayana 3rd / 579
46

80. Non coding RNAs are : A. B. C. D. siRNA miRNA tRNA mRNA

E. rRna

Ans: A (siRNA), B (miRNA), C (tRNA) E (rRna) [Ref: Harper 28th/310;

Lippincott 4th/ 417; .; en.wikipedia.org/wiki/Non-coding_RNA]

81.Technique(s) used detecting for Gene Mutation is/are: A. B. C. D. E. RT- PCR Denaturing gradient gel electrophoresis DNA sequencing Restriction fragment polymorphism (RFLP) Single-strand conformational polymorphism

Ans:All [Ref: Harrison Table 18th/ 508, 17th/406 ; Vasudevan 5th/454-56]

82. MHC II is/are presented by: A. B. C. D. E. Macrophage Dendritic cells Lymphocyte Epithelial cell Platelets

Ans: A(Macrophage), B(Dendr..) & C(Lymphocyte)

[Ref: Robbins 7th/203-04;Ananthanarayan 8/132-35; Harrison17/2045-53 ] In contrast to class I molecules, the tissue distribution of MHC class II molecules is
47

largely restricted to antigen-presenting cells (macrophages, dendritic cells, and B cells). Expression of class II molecules can be induced on several other cell types, however, including endothelial cells and fibroblasts, by the action of IFN-- Robbins 7th/204

83. Which of the following are activators of lymphocyte: A. B. C. D. E. CD 79b CD 3 CD 28 CD 14 LCK

Ans : All (A, B, C, D & E) [Ref : Immunology by David male 7th/107-108, 192-193, 31 kuby Immunology 6th/259] LCK (Internet) Lymphocyte specific tyrosine kinase, lck is critical for lymphocyte

development & activation LCK, is one of the eight members of the src family of tyrosine kinase, is

activated after T cell stimulation & is required for T-cell proliferation & IL-2 production. Inhibition of lck has been a target to prevent lymphocyte activation & acute

rejection

84. Dyeing declaration can be recorded by: A. B. C. D. E. Doctor Sister incharge Village headman Executive magistrate Judicial magistrate

48

Ans: All [Ref: Reddy 27th/ 9; Parikh 6th/ 1.15-1.16 ]

DYING DECLARATION If there is time a Magistrate should be called to record the declaration before

recording the statement, the doctor should certify that the person is conscious and his mental faculties are normal (compos mentis). If the condidtion of the vicitim is serious, and there is no time to call a

Magistrate, the doctor should take the declaraton in the presence of two witnesses. The statement can also be recorded by the village headman, police or any other person, but its evidential value will be less. In a landmark judgment, the division bench comprising Justice M Sasidharan Nambiar and Justice P Bhavadasan(Kerala High court) ruled that there is no law or statute that dying declaration should be recorded only by a magistrate. The bench said that dying declaration recorded by the doctor or anybody with credibility in the society can be accepted as evidence after analysing its evidentiary value as per law- TOI Jul 4, 2012

Dying declaration recorded by police is valid: SC New Delhi, Thu May 17 2012 Indian Express

www.preservearticles.com/.../short-notes-on-the-value-of-dying-decl.. Dying declaration should be recorded by the executive magistrate and police officer to record the dying declaration only if condition of the deceased was so precarious that no other alternative was left Under the old CrPC, there was no distinction between the Executive and Judicial Magistrates; some states still follow the old CrPC, e.g. Nagaland; there, the Collector is also the head of the judicial branch of the district and can pass sentences, including capital punishment, under IPC.

85. Inquest not present in Indian court : A. Magistrate inquest

49

B. C. D. E.

Medical examiners system Coroner inquest Police inquest Trial by jury

Ans: BCE [Ref: Reddy 27th/ 5; Parikh 6th/1.3-1.7 ]

Two types of inquests are held in India: the police inquest & the magistrates inquest. CORONERS INQUEST : This is type of inquest done in U.K., some States in U.S.A., and some other countries, but not in India. MEDICAL EXAMINERS SYSTEM : This is a type of inquest conducted in most of the states in the United States of America. JURY : Trial by jury has been abolished in India.

86. True about Incised looking wound: A. B. C. D. E. Type of split laceration wound Avulsion laceration wound with blunt object Produced by blunt object Incised wound Commonly seen on Scalp

Ans: ACE [Ref: Reddy 27th/ 165-66 ]

Type of Lacerations Reddy 27th/ 165-66 1. Split laceration: with excessive crushing & without excessive crushing (Incised

like or Incised-looking Wounds) 2. 3. 4. Stretch laceration Avulsion(Shearing laceration) Tears

50

5.

Cut laceration

87. False statement(s) about postmortem staining is/are: A. B. C. D. Occur immediately after death Common in dependent part Disappear with rigor mortis Surface elevated

E. Not found in internal organ

. Ans: A (Immedi..), C ( Disappear..),D(Surf..) & E (Not..) [Ref: Reddy 27th/136-39; Modis Medical Jurisprudence & Toxicology 22nd/226] PM staining persists until putrefaction sets in- Reddy 27th/137 PM staining does not appear elevated above the surface, but has sharply defined edges- Modis Medical Jurisprudence & Toxicology 23nd/429

88. True about Cadaveric spasm : A. B. C. D. E. Seen in voluntary muscle Some particular group of muscles are involved Disappear with Rigor mortis Occur 2-3 hour after death Occur immediately after birth

Ans: ABCE [Ref: Reddy 27th/143 ; Parikh 6th/3.18-3.19 ]

Cadaveric spasm: This is usually limited to a single group of voluntary muscles & frequently involves the hand. Occasionally, the whole body is affected as seen in soldiers, shot in battle. No other condition simulates cadaveric spasm & it cannot be produced by any method after death. It passes without interruption into normal rigor
51

mortis & disappears when rigor disappears- Reddy 27th/143

89. In India law and punishment is in accordance with: A. B. C. D. E. Indian panel code Consumer Protection Act Criminal Procedure Code Indian Evidence Act Coroners Act

Ans: ABCD [Ref: Reddy 27th/5 ; Parikh 6th/ 1.5 ] Coroners Act 1871: in Maharshtra is likely to be repealed soon & the cononers court in Mumbai will then be abolished(It was practice in High Courts of Calcutta and Bombay)- Parikh 6th/ 1.5 CORONERS INQUEST: This is type of inquest done in U.K., some States in U.S.A., and some other countries, but not in India - Reddy 27th/5

Legal Procedure Reddy 27th/5,49 Indian Penal Code(I.P.C) 1860 Criminal Procedure Code(Cr.P.C) 1973 Indian Evidence Act(I.E.A) 1872 Consumer Protection Act(CPA/COPRA)1986 (amended in 2002)

90. As per who protocol, ATT drug C/I in pregnancy : A. B. C. D. E. Rifampicin Pyrazinamide Ethambutol Streptomycin INH

52

Ans: D [Ref: KDT 6th/ 748-49;Park 21st/ 175 ] T.B Treament during pregnancy Park 21st/ 175 During pregnancy, streptomycin can cause permanent deafness in the baby, so ethambutol should be used instead of streptomycin. Isoniazid, rifampicin, pyrazinamide & ethambutol are safe to use. Second-line drugs such as fluoroquinolones,ethionamide & protionamide are tertogenic are tertogenic & should not be used

T.B Treament during pregnancy KDT 6th/ 748-49 The WHO & British Thoracic Society consider H, R & Z to be safe to the foetus & recommended the standard 6 month (2HRZ+4HR) regimen for pregnant women with T.B. E can be added during late but not early pregnancy. S is contraindicated

91. A female of 45 years has taken treatment of category I (DOTS) for 6 months, yet she is AFB positive. According to DOTS, continuation phase of new treatment regimen should continue for: A. B. C. D. E. 4 months 5 months 6 months 7 months 8 months

Ans: B(5 month) [Ref: KDT 6th/ 747-48; Park 21st/ 173 ] Any patient treated with category I or category III who has a positive smear at 5,6,7 months of treatment should be considered a failure & started on Category II treatment, afresh- Park 21st/ 173

Category II treatment: 2(HRZES)3 + 1(HRZE)3 Continuation - 5(HRE)3

53

92. Which ATT is/are safe in chronic liver disease patients : A. B. C. D. E. INH Rifampicin Pyrazinamide Ethambutol Streptomycin

Ans: DE [Ref: KDT 6th/ 740-45;Park 21st/ 171;Katzung 10th/773-76]

Three drugs can induce hepatitis: Pyrazinamide, INH and Rifampicin (in decreasing order of frequency). Pyrazinamide is C/I in patients with liver disease- KDT 6th/ 742 Rifampin imparts a harmless orange color to urine, sweat, tears, and contact lenses (soft lenses may be permanently stained). Occasional adverse effects include rashes, thrombocytopenia, and nephritis. It may cause cholestatic jaundice and occasionally hepatitis.- Katzung 10th/774 Ethionamide is also hepatotoxic. Neurologic symptoms may be alleviated by pyridoxine- Katzung 10th/776 Streptomycin is ototoxic and nephrotoxic- Katzung 10th/775

93. Larvae which travel through lung during its life cycle : A. B. C. Strongyloides stercoralis Ascaris lumbricoides Necator Americanus
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D. E.

Trichuris trichiura Wuchereria bancrofti microfilarae

Ans:ABC [Ref :Panikar 6th/ 159 ] Trichuris trichiura larva pass trough caecum(not lung)- Panikar 6th/167

Confusion about option E Wuchereria bancrofti microfilarae?? In Tropical Pulmonary Eosinophilia(occult filariasis), microfilariae and parasite antigens are rapidly cleared from the bloodstream by the lungs. The clinical symptoms result from allergic and inflammatory reactions elicited by the cleared parasites-Harrison Tropical Pulmonary Eosinophilia(occult filariasis): Microfilariae are not usually detectable in blood, but lung biopsies have shown microfilarae in some cases. It has been suggested that in these cases, there is failure in the suppression of immune response to microfilarae antigens, so that microfilarae are filtered out & destroyed in the lungs, with allergic inflammatory reactions- Panikar 6th/204

Larvae that pass through lung during its life cycle Ascaris lumbricoides Panikar 6th/190 A.duodenale Panikar 6th/179 Necator Americanus Panikar 6th/180 Echinococcus (Lung acts as 2nd filter) Panikar 6th/151 Schistosoma hematobium(Lung acts as 2nd filter) Panikar 6th/119 Paragonimus westermani(Lung flukes) Panikar 6th/135 Strongyloides Stercoralis Panikar 6th/171

94. Arthropod borne disease is/are: A. Brucellosis

55

B. C. D. E.

Lyme disease Borrelia recurrentis Malaria Plague

Ans:BCDE [Ref : Ananthanarayan 8th/343 ; Park 21st/708]

Brucellosis is transmitted through ingestion, contact, inhalation or accidental inoculation- Ananthanarayan 8th/343 Lyme disease(Borrelia burgdorferi) is transmitted by bite of Ixodid ticksAnanthanarayan 8th/381

95. Tick is a vector for : A. B. C. D. E. Crimean Congo fever Rocky Mountain spotted fever Epidemic typhus Endemic typhus Scrub typhus

Ans:AB [Ref : Ananthanarayan 8th/406; Park 21st/720-21] Crimean congo fever is transmitted by tick- Ananthanarayan 8th/514

96. Diseases caused by cat reading is/are: A. B. C. D. Bartonella hansellae Bartonella bacilliformis Pasteurella multocida Bartonella vinsoni
56

E.

Yersinia pestis

Ans:ACE [Ref : Ananthanarayan 8th/ 324,326,411-12;Harrison 18th/ 1314 ]

B. bacilliformis is transmitted by Sandfly bite- Harrison 18th/ 1314

Bartonella vinsoni sub-species arupensis reservoir :Mice Harrison 18th/ 1314 Bartonella vinsoni sub-species berkhoffii reservoir :Domestic dogs, coyotes, gray foxes Harrison 18th/ 1314

97. Bacillary Angiomatosis occur due to: A. B. C. D. E. Mycoplasma Gardenella Bartonella bacilliformis Hemophilus influenza No relation with any above organism

Ans:E

[Ref : Ananthanarayan 8th/ 411-1;Harrison 18th/ 1314 -19 ] Bacillary angiomatosis is caused by B. henselae & B. quintana- Harrison 18th/ 1318 Bartonellosis, or Carrin's disease, is caused by B. bacilliformis. The disease is characterized by two distinct phases: (1) an acute febrile hematic phase, known as Oroya fever; and (2) an eruptive phase manifested by cutaneous lesions, known as verruga peruana- Harrison 18th/ 1319

98. Single gene disorder(s) is/are: A. Colon cancer

57

B. C. D. E.

Huntingtions disease DMD - thalassemia Type II DM

Ans: ABCD

[Ref: Robbins 7th/ 150-160,170,181 ,287 ; Harrison 18th/499-505 ]

Diabetes mellitus II is Multifactorial Disorders Single Gene Disorders are of two types: (i) that follow classical mendelian

principles of inheritance &(ii) that follow Nonclassic Inheritance Classical Type: Mutations involving single genes typically follow one of three

patterns of inheritance: autosomal dominant, autosomal recessive, and X-linked. The general rules that govern the transmission of single-gene disorders are well known and are not repeated here.

99. Increased Prothrombin time is/are seen in: A. B. C. D. E. Pt on oral anticoagulant Pt with liver disease Factor X deficiency Factor VII deficiency Vit. K deficiency

Ans: All

Prothrombin Time (PT) Robbins 7th/649 This assay tests the extrinsicQ & common coagulation pathways

A prolonged PT can results from deficiency or dysfunction of factor V, factor VII, factor X, prothrombin or fibrinogen

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100. Both B and T cell defect presents in : A. B. C. D. E. SCID Common Variable immunodeficiency Wiskot-Aldrich syndrome X-linked Agammaglobulinemia Chronic mucocutaneous candidiasis

Ans: AC

[Ref: Ananthanarayan 8th/156]

Combined immunodeficiency(& T cell defect): Nezelof Syndrome, Ataxia Telangiectasia, Wiskott-Aldrich syndrome & Severe Combined Immunodeficiency (SCID) Ananthanarayan 8th/156

101. True about Adult polycystic kidney disease : A. B. C. D. E. Autosomal dominant pattern of inheritance Most common pattern is One gene mutation Most common pattern is two gene mutation Somatic mutation can also occurs Loss of heterozygosity may occur

Ans:ACDE

[Ref : Harrison 18th/2355-57; CMDT 06/928;Robbins 7th/962-964] At least two genes account for this disorder: AD PKD-1 gene on short arm of chromosome 16 (85-90%) & ADPKD-2 gene on chromosome 4 (10-15%). Other sporadic cases without these mutations have also been recognized-CMDT 06/928 Genetic Considerations Harrison 18th/2355 Over 90% of cases are inherited as an autosomal dominant trait, with the remainder likely representing spontaneous mutations. Mutations in the PKD-1 gene on chromosome 16 (ADPKD-1) account for 85% of cases, whereas mutations in the
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PKD-2 gene on chromosome 4 (ADPKD-2) represent the remainder. A few families appear to have a defect at a site that is different from either of these loci. Direct mutation analysis of isolated cysts suggests there is loss of heterozygosity, whereby a somatic mutation in the normal "wild-type" allele of a small number of tubular epithelial cells leads to unregulated clonal proliferation of the cells that ultimately form the cyst lining

102. Autosomal Dominant pattern of renal cyst is/are seen in: A. B. C. D. E. Cystic renal dysplasia Simple renal cyst Adult polycystic kidney disease Medullary cystic kidney disease Acquired renal cyst

Ans: CD

[Ref : Harrison 18th/ 2356, 17th/1797-1799; Robbins 7th/962-964] The medullary cystic kidney diseases (MCKD) generally present in young adults. Two genetic loci have been defined, both with autosomal dominant transmission Harrison 18th/ 2359 CYSTIC RENAL DYSPLASIA Robbins 7th/962 This sporadic disorder is due to an abnormality in metanephric differentiation

ACQUIRED (DIALYSIS-ASSOCIATED) CYSTIC DISEASE Robbins 7th/966

SIMPLE CYSTS Robbins 7th/966 These occur as multiple or single, usually cortical, cystic spaces that vary widely in diameter. They are commonly 1 to 5 cm but may reach 10 cm or more in size.

103. Superior vena cava syndrome is/are commonly seen in : A. B. C. D. Small cell lung carcinoma Squamous cell lung carcinoma Lymphoma Multiple myeloma
60

E.

Scleroderma

Ans: ABC

[Ref: Swartz 8th/562;Robbins 7th/ 544,615,762 ; Harrison 18th/ 742,226667,2762;CMDT06/267,302,475 ] Superior mediastinal tumors such as adenocarcinoma of lung, lymphoma, thyroid carcinoma, thymoma, teratom, synovial cell sarcoma or andiosarcoma accounts for over 80% of cases of SVC syndrome- CMDT06/475 Malignant tumors, such as lung cancer, lymphoma, and metastatic tumors, are responsible for the majority of SVCS cases. With the expanding use of intravascular devices (e.g., permanent central venous access catheters, pacemaker/defibrillator leads), the prevalence of benign causes of SVCS is increasing. Lung cancer, particularly of small cell and squamous cell histologies, accounts for approximately 85% of all cases of malignant origin. In young adults, malignant lymphoma is a leading cause of SVCS. Hodgkin's lymphoma involves the mediastinum more commonly than other lymphomas but rarely causes SVCS- Harrison 18th/ 2266

104. CHARGE in CHARGE syndrome stands for : A. C-Choanal atresia B. H-Heart defects C. A-Atrial septal defect D. R-Retardation of growth E. G- gonadal anomalies

Ans:BD [Ref :O.P.Ghai 337] CHARGE : The letters stand forC- coloboma of the eye, H- heart defects, A-atresia of the nasal choanae(i,e choanal atresia),
61

R- retardation of growth and/or development, G- genital and/or urinary abnormalities(genitourinary defect), and E- ear abnormalities and deafness.

105. VACTERAL stands for : A. V-Vestibular anomalies B. A-Anal anomalies C. C-cardiac anomalies D. TE-tracheaoesophageal anomalies E. R- Rectal anomalies

Ans:BCD [Ref : L & B 25th/ 579 ;Nelson 18th/1543 ]

VACTERAL stands for L & B 25th/ 579 en.wikipedia.org/wiki/ V - Vertebral anomalies A - Anal atresia/anus C - Cardiovascular anomalies TE - Tracheoesophageal fistula/trachea R - Renal (Kidney) and/or radial anomalies L - Limb defects/limb buds VATER/VACTERL (vertebral, anorectal, [cardiac], tracheal, esophageal, renal, radial, [limb]) syndrome-Nelson 18th/1543

106. In Hypothyroidism following are seen: A. Menorrhagia B. Constipation C. Warm & moist skin D. Silky hair
62

E. Hirsutism

Ans:ABDE [Ref : L & B 25th/ 775 ; Harrison 18th/2919-25;Sabiston 18th/ 926 ]

Warm & moist skin occurs in hyperthyroidism

Adult Hypothyroidism L & B 25th/ 775 The signs of thyroid deficiency are: bradycardia; cold extremities; dry skin and hair; periorbital puffiness; hoarse voice; bradykinesis, slow movements; delayed relaxation phase of ankle jerks. The symptoms are: tiredness; mental lethargy; cold intolerance; weight gain; constipation; menstrual disturbance(menorrhagia) carpal tunnel syndrome.

107. Skin tags is/are seen in : A. Pregnancy B. Obesity C. Endocrine disorder D. Lichen planus E. DLE

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Ans:ABC [Ref : Roxburg 17th/ 283; Neena Khanna 3rd/302-03;Harrison 18th/391,412,248788; www.emedicinehealth.com/skin_tags/article] Etiology of skin tags is unknown, but skin tags may be: Familial ,Associated with obesity- Neena Khanna 3rd/302

People with diabetes and pregnant women tend to be more prone to skin tags.www.medicalnewstoday.com/articles/67317.php Skin Tags Studies have shown existence of low-risk HPV 6 and 11 in skin tags hinting at a possible role in its pathogenesis. Acrochorda have been reported to have an incidence of 46% in the general population. A causal genetic component is thought to exist.[6] They also are more common in women than men. Rarely, they can be associated with the Birt-Hogg-Dub syndrome, Acromegaly and polycystic ovary syndrome. Risk factors - a risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2. Skin tags are more common in:People who are overweight and obese,Pregnant women - most likely because of the hormones secreted,Individuals with diabetes.People with the human papilloma virus (low-risk HPV 6 and 11). & Illegal steroid use - they interfere with the body and muscles, causing the collagen fibers in the skin to bond, allowing skin tags to be formed.

108. A 6 yr old child has midline neck cystic swelling. D/D of this condition does NOT includes: A. Branchial cyst B. Thyroglossal cyst C. Lymphnode enlargement D. Cystic hygroma E. Carotid body tumor
64

Ans:ADC

[Ref : S.Das 5th/619;L & B 25th/ 726-29]

Midline cystic swelling: Thyroglossal cyst, enlarged submental LN, Goitre of thyroid isthmus, Ludwig angina

Lateral Swelling Carotid triangle: Carotid body tumor, branchial cyst, thyroid swelling Posterior triangle:Cystic hygroma

109. Catgut is generally prepared from submucosa of : A. Cat B. Sheep C. Human D. Rabbit E. Wild boar

Ans:B [Ref : L & B 25th/ 238 ; Sabiston 18th/271 ; CSDT11th/94 ]

Sheep or cattle: L & B 25th/ 238 Sheep & beef- Sabiston 18th/271 Bovine: CSDT11th/94

110. True bout Typhlitis : A. Perforation common

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B. Most common site is ileum C. CT scan is screening test of choice D. Bacteria can be isolated from intestine E. Neutrophil count decreases

Ans: ACDE [Ref : L & B 25th/ 1211 ;Harrison 18th/1335,2276-77,716 Sabiston 18th/ ; CSDT11th/ 750 ; Swartz 8th ]

Early diagnosis is provided by a high index of suspicion and the use of CT scanning Abdominal computed tomography (CT) scanning with oral and intravenous contrast is the preferred examination. The maximum normal colonic wall thickness on CT scan is 3 mm. When the colon is distended with stool, fluid, or oral contrast, the normal colonic wall is nearly imperceptible. Pericolonic fat should demonstrate homogeneous fat attenuation-

The cecum is almost always affected, and the process often extends into the ascending colon and terminal ileum Various bacterial and/or fungal organisms, including gram-negative rods, grampositive cocci, anaerobes (eg, Clostridium septicum), and Candida spp, are often seen infiltrating the bowel wall. Polymicrobial infection is frequent. Only rarely are inflammatory or leukemic infiltrates identified . Bacteremia or fungemia is also common, usually with enteric organisms such as Pseudomonas or yeasts such as Candida The mortality rate for caecitis can be as high as 40 to 50%, mostly because it is frequently associated with bowel perforation. Caecitis is diagnosed with a radiograph CT scan showing thickening of the caecum and "fat stranding"

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111. True about apocrine gland : A. Secrete odourless hypotonic fluid B. Provide odour to body C. Present in axilla & groin D. Present all over body E. Suppurative infection of gland cause Hidradenitis suppurativa

Ans: A(?)BCE [Ref: Neena Khanna 3rd/109,1st/97-98; L & B 25th/1266;Grays 40th/153;Nelson 18th/2652] Not confirmed about hypotonicity!!! Bacterial decomposition of apocrine sweat gland accounts for the unpleasant odour associated with perspiration- Nelson 18th/2652 The secretion is initially sterile & odourless, but it undergoes bacterial decomposition to generate potent odourous, musky compound- Grays 40th/153

In humans, apocrine sweat glands are found only in certain locations of the body: the axillae (armpits), the areola of the pages , and the genitoanal region. Specialized types of apocrine sweat glands present on the eyelids are called Moll's glands. Most of the human body contains eccrine sweat glands. Apocrine sweat glands secrete a milky, viscous, odourless fluid which only develops a strong odour when it comes into contact with bacteria on the skin surface.

An important distinction between an eccrine sweat gland and an apocrine sweat gland structure is that an apocrine sweat gland has a larger lumen. Another distinction is that apocrine sweat glands secrete a more viscous fluid.

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112. Tube thoracostomy is indicated in : A. Pneumothorax B. Hemothorax C. Surgical emphysema D. Pneumo-hemothorax E. Pulmonary contusion

Ans:ABD [Ref : L & B 25th/ ; Sabiston 18th/ 1666-67,495,1672,1669 ; CSDT11th/ ] Surgical emphysema (subcutaneous trapped air) is a complication of chest drain insertion, or sometimes of the pneumothorax itself. Surgical emphysema can form because of poor technique during drain insertion or because of displacement of the drain such that a side hole near the end of the drain lies within the subcutaneous tissues. Surgical emphysema has the clinical characteristic of feeling like 'rice crispies' or 'bubble wrap' on palpation. Pulmonary contusion :Management is directed toward maintaining good oxygenation and adequate pulmonary toilette. Judicious crystalloid infusion is important to avoid fluid overload and pulmonary edema; however, intravascular volume depletion should also be avoided to decrease the risk for global ischemia and multiple organ failure. Patients with persistently low PaO2 who do not respond to supplemental oxygen, pulmonary toilette, and pain control should be intubated and mechanically ventilated- Sabiston 18th/495

A chest tube (chest drain or tube thoracostomy in British medicine or intercostal drain) is a flexible plastic tube that is inserted through the side of the chest into the pleural space. It is used to remove air (pneumothorax) or fluid (pleural effusion,blood, chyle), or pus (empyema) from the intrathoracic space. It is also known as a Blau drain or an intercostal catheter

Indications
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 Pneumothorax: accumulation of air in the pleural space Pleural effusion: accumulation of fluid in the pleural space Chylothorax: a collection of lymphatic fluid in the pleural space Empyema: a pyogenic infection of the pleural space Hemothorax: accumulation of blood in the pleural space Hydrothorax: accumulation of serous fluid in the pleural space Postoperative: for example, thoracotomy, oesophagectomy, cardiac surgery

113. Flail chest means fracture of : A. 2 Ribs on same side B. 2 Ribs on 2 side C. 4 Ribs on 2 sides D. Cervical or first rib on one side E. Multiple ribs on both side

Ans:CE [Ref : L & B 25th/ 343 ; Sabiston 18th/ 496 ; Schwartz 8th ; CSDT11th/ ] It is usually results from blunt trauma associated with multiple rib fracture i,e three or more ribs fractured in two or more places- L & B 25th/ 343 Flail chest occurs when four or more ribs are fractured in at least two locations. Paradoxical movement of this free-floating segment of chest wall may occasionally be sufficient to compromise ventilation. However, it is of greater physiologic importance that patients with flail chest frequently have an underlying pulmonary contusion-Schwartz 8th

Flail Chest By definition, a flail chest occurs in the presence of two or more fractures in three or more consecutive ribs and causes instability of the chest wall; however, it can also occur after costochondral separation ( Fig. 20-12 ). Flail chest is characterized by
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paradoxical motion of the chest wall (inward with inspiration and outward with expiration). Fractures can be located in the anterior, lateral, or posterior chest wall. Flail chest occurs in 10% to 15% of patients sustaining major chest trauma, and the chance of having an intrathoracic injury in this situation increases severalfold. Closed head injury is the most frequently associated extrathoracic injury, and it contributes to higher morbidity and mortality rates. Isolated flail chest carries a low mortality rate in younger patients- Sabiston 18th/ 496

114. Pulsus paradoxus is/are present in all except: A. Haemorrhagic shock B. Pulmonary embolism C. Right ventricular myocardial infarction D. Cardiac tamponade E. Severe COPD

Ans: C

[Ref: Harrison 18th/1972]

Paradoxical pulse occurs not only in cardiac tamponade but also in approximately one-third of patients with constrictive pericarditis . This physical finding is not pathognomonic of pericardial disease because it may be observed in some cases of hypovolemic shock, acute and chronic obstructive airways disease, and pulmonary embolus- Harrison 18th/1972 115. Loud S1 is /are present in: A. MS with pliable valve B. MS with calcified valve C. MR D. AS E. TR

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Ans: A [Ref: Harrison 18th/1826;Hurst 12th/261 ;PJM 15th/137]

MS with calcified valve, MR & TR cause soft S1

S1 is normal in AS-O.P.Ghai 7th/418 A loud, late M1 is the hallmark of hemodynamically significant mitral stenosis. When calcific fixation of the stenotic mitral valve occurs, M1 is soft, and the opening snap is absent AS: The cardiac impulse is heaving and sustained in character, and there may be a palpable fourth heart sound (S4). An aortic systolic thrill is often present at the base of the heart. In 80 to 90 percent of adult patients with severe AS, there is an S4 gallop sound, a midsystolic ejection murmur that peaks late in systole, and a single second heart sound (S2) because A2 and P2 are superimposed or A2 is absent or soft- Hurst 12th/261 Intensity of S1 The primary factors determining intensity of S1 are (1) integrity of valve closure, (2) mobility of the valve, (3) velocity of valve closure, (4) status of ventricular contraction, (5) transmission characteristics of the thoracic cavity and chest wall, and (6) physical characteristics of the vibrating structures.

INCOMPLETE QUESTIONS

1. Congenital ear disease classification: A. Morquis/Marqueate I, II B. Morquis I, II, III C. Corp I, II D. Corp I, II E. None of above

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2. Defect in 1st pharyngeal cleft results in : a.thyroglossal cyst b.Thyroglossal fistula c.branchial cyst d. Loss of sensation from posterior part of tongue e. Choanal atresia

Ans:

First branchial anomalies First branchial anomalies represent 1% of all branchial anomalies. Work reports the following 2 types[1] : A type I branchial anomaly is ectodermally derived and is a duplication of the external auditory canal (EAC). Type I branchial anomalies may manifest posteriorly, adjacent to the pinna and concha. They may terminate near a bony plate at the level of the mesotympanum. Type II branchial anomalies contain both ectoderm and mesoderm. They are more common and can originate along the EAC, middle ear cleft, or nasopharynx. Type II branchial anomalies often manifest with a fistula emanating from the concha, EAC, or neck, with a tract extending medially and inferiorly to the EAC. They may pass medial or lateral to the facial nerve and terminate at the level of the anterior border of the sternocleidomastoid muscle. Often an opening is found in the EAC as well as below the jaw. First branchial anomalies do not usually involve the middle ear or tympanic membrane. Patients with first branchial anomalies may present with unilateral facial paralysis. First branchial anomalies may be associated with hemifacial microsomia.

3. Host gene affect disease progression in: A. Hepatitis B B. Hepatitis B C. HCV

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D. HIV E. P

4. Significance of Biomarker: A. P B. C C. S D. I E. G

Provide options?? Ref: Harper

5. Which antiepilepties promotes growth hormone secretion : A. Phemytoin B. Valproate C. Carbamazepine D. Phenobarbitone E. Lacosamide

Lacosamide (INN, formerly known as erlosamide) is a medication developed by UCB for the adjunctive treatment of partial-onset seizures and diabetic neuropathic pain marketed under the trade name Vimpat. 6. Drug used for dementia in both disease parkinsonism & Alzeimers disease: A. Donazapril B. Revastigmine C. Galantinum D. Vincosentrin E. Tacrine F. Memantine

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7. Contrast used in MRI : A. Gadolinium B. I odine C. Myodinium D. Technitium E. Indium

Ans:A, other? [Ref ;Bhadury 2nd/177]

The contrast dye used in these MRI Scans is generally gadolinium as complications are rarer in comparison to the Iodine origin dye used for x-rays and CT scans

8. Hyperdense biconvex feature in CT seen in all except : A. Subdural hemorrhage B. Extradural hemorrahage C. Foreign body D. Intracerebral hemorrhage E. Hypertensive hemorrhage

9. Prophylactic cranial irradiation given in : A. AML B. ALL C. Small cell Ca of lung D. Glioblastoma multiforme E. NHL

10. True about Imaging in gallbladder: A. Cirrhosis:anteriorly shift B. Polysplenia:Left shift

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C. Never beyond superior surface D. Wandering of gallbladder

11. Increased density of corticospinal tract in T2 MRI seen in: A. Astrocytoma B. Amyotrophic lateral sclerosis C. Hemochondromatosis D. Wilson disease E. Vascular Infarction

Ans: B?

Cortical motor neurone loss and corticospinal tract (CST) degeneration are typical of amyotrophic lateral sclerosis (ALS). It is a matter of debate whether qualitative assessment of the CST by MRI is useful in the diagnosis. It is also an open question whether quantitative determination of the T2 relaxation times can improve its value. Signal intensity along the CST on 14 consecutive slices was assessed using arbitrary visual rating on double-echo T2-weighted and proton-density spin-echo images of 21 patients with ALS and 21 age- and sex-matched controls. T2 was determined quantitatively. On the T2-weighted images the patients' ratings did not differ from that of controls. The T2 of patients and controls showed no statistical difference in any slice. There was no correlation between T2 and patient age, duration of the disease, or predominant bulbar, lower or upper motor neurone signs. The only correlation between MRI findings and disease was on the proton-density images: all cases in which the CST was poorly seen were controls; a clearly highsignal CST was seen only in the patients. High conspicuity of the CST was thus specific but not sensitive for the diagnosis of ALS. T2-weighted images and measurement of T2 were not useful for diagnosis.
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12. Light bulb appearance in CT scan seen in: a. pheochromocytoma b.adrenal adenoma c.adrenal cortical tumor d. C e. M

Ans: [Ref : www.ajronline.org/content/194/6/1450.full]

MRI: Pheochromocytomas and other paragangliomas classically have a "light bulb" (very intense)

MRI:Typically hemangiomas are homogeneously hypointense relative to the liver on T1-weighted and markedly hyperintense (lightbulb sign) on T2-weighted images relative to the liver

Up to 70% of pheochromocytomas show relatively high signal intensity on T2weighted imagesa feature classically known as the light bulb sign, which was originally thought to be characteristic of pheochromocytoma [56, 69]. Currently, however, that description is not considered accurate, with at least 30% of pheochromocytomas showing moderate or low T2-weighted signal intensity and appearing similar to other adrenal diseases

13. Complete mole can be differentiated from partial mole by : A. P57kip2 B. P53 C. P16inkga D. P63
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E. PED

Ans: A

ajcp.ascpjournals.org/content/133/2/196.full

The p57(KIP2) gene ( CDKN1C ) is strongly paternally imprinted and expressed from the maternal allele. Because Complete Mole lacks a maternal genome, p57(KIP2) immunostaining is correspondingly absent, whereas hydropic abortuses and partial mole show positive staining

14. 70 yr female undergoing vaginal hysterectomy. The risk factor for post-op infection : A. Old age B. DM C. HTN D. Obesity E. Bacterial vaginosis

15. X-linked agammaglobinemia : A. 3 B. 3 C. 19 D. A E. T What was exact question??

16. Oncogene tyrosine kinase involves :

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A. PML-BRCA 1 B. BCR-ABL C. HAAJ D. JUN E. NJKKR,JNP

[Ref: Robbins 7th/ 98-100,296-97]

17. what is true about Kerala in relation to India : a. high literacy rate b. high doctor/ population ratio c. high growth rate d. older age of marriage e.

18. A 14 yr child restricted eye movements in all directions, ptosis, fatiguability of proximal muscle myopathy.What is most useful test diagnosis: A. C PK B. E MG C. Endrophonium test D. Biopsy E. D

Chronic progressive external ophthalmoplegia (CPEO), also known as progressive external ophthalmoplegia (PEO), is a type of eye movement disorder. It is often the only feature of mitochondrial disease, in which case the term CPEO may be given as the diagnosis. In other people suffering from mitochondrial disease, CPEO occurs as part of a syndrome involving more than one part of the body, such as Kearns-Sayre syndrome. Occasionally CPEO may be caused by conditions other than mitochondrial diseases. Diagnosis It is important to differentiate CPEO from other pathologies that may cause an
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ophthalmoplegia. There are specific therapies used for these pathologies. CPEO is diagnosed via muscle biopsy. On examination of muscle fibers stained with Gmri trichrome stain, one can see an accumulation of enlarged mitochondria. This produces a dark red staining of the muscle fibers given the name ragged red fibers. While ragged red fibers are seen in normal aging, amounts in excess of normal aging give a diagnosis of a mitochondrial myopathy.

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