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1. True about Nuclear bag fibers
a) Sense dynamic length of muscle
b) Involved in reciprocal innervation
c) Alpha motor neuron stimulation
d) Senses muscle tension
Answer: Sense dynamic length of muscle
Intrafusal fibers are a second category of muscle fibers found specifically within muscle spindles.
Intrafusal fibers are classified as nuclear bag fibers containing many nuclei in a dilated central area and
nuclear chain fibers lacking definitive bag. There are two subtypes of the nuclear bag fibers, dynamic and

Two types of sensory (afferent) nerves innervate intrafusal fibers:

Group Ia afferent nerves innervate both nuclear bag fibers and nuclear chain fibers, and transmit
information regarding the rate of change in muscle length (Dynamic response).

Group II afferent nerves mainly innervate nuclear chain fibers and do not innervate the dynamic nuclear
bag fibers.

The steady state activity of group Ia and II afferent provide information on steady state length of muscle
(Static response)

2. Human blood testis barrier

a) Tight junction between Sertoli cells
b) Absence of germ cells causes immune reaction
c) Formed before spermatogenesis
Answer: Tight junction between Sertoli cells
Tight junction between adjacent Sertoli cells near the basal lamina form a blood-testis barrier.
Blood-testis barrier prevents many large molecules from passing from the Interstial tissue and the part of
tubule near basal lamina (Basal compartment) to the region near tubular lumen (Ad-luminal compartment)
and the lumen.

3. Receptor of joint capsule and ligaments is

a) Slow adapting
b) Fast adapting
c) Different to slow and fast adapting
d) Non-adapting
Answer: Slow adapting
The receptors detect mechanical deformation within the capsule and ligaments:
There are four types of sensory endings that make up joint receptors; free nerve endings, Golgi type
endings, ruffini endings, and paciniform endings.

Slowly adapting receptors: Free nerve endings, Golgi type endings and ruffini endings
Fast adapting receptors: Paciniform endings
The rapidly adapting receptors produce generator potentials and action potential discharges that follow the
time-varying waveform of pressure changes produced by a vibrating stimulus.

In contrast, the slowing adapting receptors produce generator potentials and action potential discharges
that are sustained and unable to mimic the time-varying pattern of the stimulus.

Consequently, the responses of rapidly adapting 1 afferents are best suited for representing time varying
(e.g., vibrating or moving) stimuli, whereas slowly adapting 1 afferents better represent static stimuli (e.g.,
sustained pressure).

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MBBS Part: I
1, Which does not supply medulla?
a) Anterior spinal artery
b) Posterior spinal artery
c) Posterior inferior cerebellar artery
d) Superior cerebellar artery
Answer: Superior cerebellar artery
Four main arteries supply the medulla oblongata
1. Anterior spinal artery
2. Posterior spinal artery
3. Posterior inferior cerebellar artery
4. Bulbar branches of the vertebral artery
2. All extra-ocular muscles supplied by ipsi-lateral oculomotor complex nuclei except
a) Inferior rectus
b) Medial rectus
c) Superior rectus
d) Inferior oblique
Answer: Superior rectus
Extra-ocular Muscle Efferents
Three cranial motor nuclei provide efferent control of the extra-ocular muscles. Activation of the motor neurons
produces contraction of the innervated muscle.
The abducens nucleus sends its axons in the abducens (VI cranial) nerve controls the lateral rectus of the
ipsi-lateral eye.

The trochlear nucleus sends its axons in the trochlear (IV cranial) nerve controls the superior oblique of the
contra-lateral eye.

The oculomotor complex contains nuclei that send axons in the oculomotor (III cranial) nerve control the
superior levator in the eyelid of both eyes extra-ocular muscles, which include the medial rectus of the ipsi-
lateral eye, inferior oblique of the ipsi-lateral eye inferior rectus of the ipsi-lateral eye and superior rectus of
the contra-lateral eye.

3. All of the following glands have secreto-motor supply by facial nerve except
a) Nasal gland
b) Lacrimal gland
c) Submandibular gland
d) Parotid gland
Answer: Parotid gland
Facial nerve: Secreto-motor to all glands in head EXCEPT Parotid
Parotid gland:
Parasympathetic secreto-motor supply arises from the glosso-pharyngeal nerve. The nerves reach the gland
via the tympanic branch, the lesser petrosal nerve, the otic ganglion, and the Auriculo-temporal nerve.
Submandibular gland and Sublingual Gland:
Parasympathetic secreto-motor supply is from the facial nerve via the chorda tympani, and the submandibular
ganglion. The postganglionic fibers pass directly to the gland.
Nasal gland and lacrimal gland:
Parasympathetic secreto-motor supply is from the facial nerve via greater petrosal nerve.
4. Not content of meso-rectal fascia
a) Para rectal node
b) Inferior rectal veins
c) Superior rectal veins
d) Inferior mesenteric plexus
Answer:Inferior rectal veins
Meso-rectum is enclosed by meso-rectal fascia which is derived from the visceral peritoneum, and is also
known as visceral fascia of meso-rectum, fascia propria of rectum or pre-sacral wing of hypo-gastric sheath

Upper rectum is derived from the embryological hind gut and it is surrounded by meso-rectum and its
contents namely superior rectal artery and its branches, superior rectal vein and tributaries, lymphatic
vessels and nodes along superior rectal artery, branches from inferior mesenteric plexus to innervate
rectum and loose adipose connective tissue down to the level of levator ani.

5. Bucco-pharyngeal membrane made up of

a) Endoderm
b) Ectoderm
c) Endoderm, mesoderm
d) Ectoderm and endoderm
Answer: Ectoderm and endoderm
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The bucco-pharyngeal membrane forms the external upper membrane limit (cranial end) of the early
gastrointestinal tract (GIT).

This membrane region first develops in the tri-laminar embryo (week 3) during gastrulation.
The membrane quality comes from being composed of only ectoderm and endoderm, without a middle
layer of mesoderm.

6. A/E innervated by trigeminal nerve:

a) Lateral pterygoid
b) Medial pterygoid
c) Stylo-hyoid
d) Tensor veli palati
Answer: Stylo-hyoid
The trigeminal nerve is the largest and most complex of the 12 cranial nerves (CNs). It supplies sensations to
the face, mucous membranes, and other structures of the head. It is the motor nerve for the muscles of
mastication and contains propriaceptive fibers.
Components and Peripheral Distribution of CN V
Afferent general somatic: Sensory branches of the ophthalmic, maxillary, and mandibular nerves to skin,
mucous membranes of the face and head

Efferent special visceral: Branches to Temporalis, Masseter, pterygoid, mylohyoid, tensor tympani, and

Afferent propriaceptive: Sensory endings in muscles of mastication

1. Which vitamin deficiency causes circum-corneal vascularization?
a) Thiamine
b) Riboflavin
c) Vit E
d) Vit C
Answer: Riboflavin
Manifestations of riboflavin:
Magenta color tongue
Angular stomatitis
Circum-corneal vascularization
Proliferation of bulbar conjunctival capillaries
2. Enzyme replacement therapy is given successfully in
a) Fabrys disease
b) Gaucher disease
c) Sanfilippo syndrome
d) Pompe disease
Answer: Gaucher disease
Gaucher disease:
Gaucher disease is a lipid storage disease characterized by the deposition of glucocerebroside in cells of the
macrophage-monocyte system.
The disorder results from the deficiency of a specific lysosomal hydrolase, glucocerebrosidase.
Enzyme replacement therapy (ERT) for type 1 Gaucher disease is now available. Most patients receive the
recombinant enzyme. This preparation is highly effective in reversing the visceral and hematologic
manifestations of Gaucher disease.
Fabry disease:
Fabry disease is an X-linked lysosomal disorder that leads to excessive deposition of neutral
glycosphingolipids in the vascular endothelium of several organs and in epithelial and smooth muscle cells.
Deficiency of alpha-galactosidase-A activity leads to lysosomal accumulation of glycosphingolipids,
predominantly the cerebroside trihexosides.
Two enzymes, agalsidase-alpha and agalsidase-beta reportedly help in normalizing renal function, cardiac
function, and cerebro-vascular flow.
Pompe disease:
In some glycogen storage disorders, clinical trials have successfully used treatment involving replacement of
the enzymes that are deficient or not working normally. For example, in glycogen storage disorder type II
(Pompe disease), this treatment has been shown to help reverse the heart problems and muscle weakness
that can occur.
For the infantile form of Pompe disease, a recombinant enzyme replacement was approved by the FDA.
Sanfilippo syndrome:
Sanfilippo syndrome or Mucopolysaccharidosis III (MPS-III) is a rare autosomal recessive lysosomal storage
It is caused by a deficiency in one of the enzymes needed to break down the glycosaminoglycan heparan
sulfate (which is found in the extra-cellular matrix and on cell surface glyco-proteins).

No treatment for the underlying cause is available. Medical treatment is supportive and is directed toward
improving the patients quality of life.
3. Final electron goes to In ETC
a) 02
b) Cytochrome a
c) Cytochrome b1
d) FADH2
Answer: O2
The most common of final electron acceptors is molecular oxygen, O2, which combines with the spent
electrons of cellular respiration, along with protons, to generate what is known as metabolic water.
4. Not intermediate product of TCA cycle is
a) Alpha KG
b) Citric acid
c) Acetyl co-A
d) Succinyl co-A
Answer: Acetyl co-A
Intermediate products of TCA cycle:
Citrate Iso-citrate Alpha keto-glutarate Succinyl co-A Succinate Fumarate Malate Oxalo-
1.Cannabis is most commonly abused substance in India. Which form is not used in India as cannabis
a) Ganja
b) Charas
c) Bhang
d) Afeem
Answer: Afeem
Charas, ganja and bhang are obtained from the same plant called cannabis sativa.
Charas: Its a resin extract from the top leaves and unfertilized flower of the young female plant of cannabis
Ganja: Like charas, it is made of the top leaves and unfertilized flower of young female plant. The resin is not
extracted like charas. Leaves and flowers are dried and smoked in cigarettes, chillums and pipes.
Bhang: Large green leaves and flowering shoots of mainly the male plant but female too.
Afeem: A bitter, yellowish-brown, strongly addictive narcotic drug prepared from the dried juice of unripe pods
of the opium poppy and containing alkaloids such as morphine, codeine, and papaverine.
2. Viper bite
a) Musculo-toxic
b) Neuro-toxic
c) Histotoxic
d) Vasculotoxic
Answer: Vasculotoxic
Neurotoxins:Alfa-neurotoxins are a large group of postsynaptic toxins. Alfa -neurotoxins also attack
cholinergic neurons. They mimic the shape of the acetylcholine molecule and therefore fit into the receptors
they block the ACh flow feeling of numbness and paralysis. Snake examples: king cobra, sea snakes,
many-banded krait and cobras
Cardiotoxins are components that are specifically toxic to the heart. They bind to particular sites on the
surface of muscle cells and cause depolarization and prevent muscle contraction. These toxins may cause
the heart to beat irregularly or stop beating, causing death.Snake example: mambas, and some cobra
Hemotoxins cause hemolysis, the destruction of red blood cells (erythrocytes), or induce blood coagulation
(clotting). Snake example: most vipers and many cobra species.
3. Active component of a white oleander
a) Nerina
b) Nicotine
c) Abrine
d) Pilocarpine
Abrus precatorius- Abrins
Oleander: Oleandrin and nerioside, which are cardenolide glycosides
Nerine: A plant genus in the family Liliaceae which causes poisoning when eaten by cattle. The toxic agent is
lycorine, which causes salivation, vomiting and diarrhea.
4. In which poisoning, Burnt Rope odor is present
a) Hydrogen sulphide
b) Cyanide
c) Nitrobenzene
d) Cannabis
Answer: Cannabis
Rotten eggs odor: Hydrogen sulphide
Garlic odor: Arsenic poisoning
Fishy odor: Zn phosphide poisoning
Burnt rope odor: Cannabis
Bitter almond odor: Cyanide poisoning
1. Verocay body is seen in
a) Meningioma
b) Glioma
c) Schwannoma
d) Hemangioma
Answer: Schwannoma
Schwannoma is also known as neurilemoma. Encapsulated biphasic nerve sheath tumor derived from
Schwann cells.

Biphasic: compact hyper-cellular Antoni A areas and myxoid hypo-cellular Antoni B areas. Small tumors
may be all Antoni A.

Cells are narrow, elongate and wavy with tapered ends interspersed with collagen fibers
Nuclear palisading around fibrillary process (Verocay bodies) are often seen in cellular areas
Large irregularly spaced vessels are most prominent in Antoni B areas
2. Rossets are not seen in:
a) Retinoblastoma
b) Medulloblastoma
d) Neuro-cysticercosis
Answer: Neuro-cysticercosis
Rosettes are little round groupings of cells found in tumors. They usually consist of cells in a spoke-wheel or
halo arrangement surrounding a central, acellular region.
Homer Wright rosette:
1. This rosette is typically seen in neuroblastoma, Medulloblastoma, and primitive neuroectodermal tumors
2. It consists of a halo of tumor cells surrounding a central region containing neuropil (hence its association
with tumors of neuronal origin).
Flexner-Wintersteiner Rosette:
1. This rosette is characteristic of retinoblastomas. It consists of tumor cells surrounding a central lumen that
contains cytoplasmic extensions from the tumor cells.
True Ependymal Rosette:
1. This rosette is seen in ependymoma and consists of tumor cells surrounding an empty lumen.
Peri-vascular Pseudo-rosette:
1. This rosette consists of tumor cells collected around a blood vessel. Its called a pseudo-rosette because the
central structure isnt part of the tumor.
2. These rosettes are common in ependymomas, but also see in medulloblastoma, PNET, central
neurocytomas, and glioblastomas.
3. Not example of uni-parental disomy
a) Angelman syndrome
b) Prader-Willi syndrome
c) Bloom syndrome
d) Silver Russell syndrome
Answer: Bloom syndrome
Bloom syndrome (congenital telangiectatic erythema) is a rare autosomal recessive disorder characterized
by telangiectases and photosensitivity, growth deficiency of prenatal onset, variable degrees of
immunodeficiency, and increased susceptibility to neoplasms of many sites and types.

Uni-parental disomy (UPD) occurs when a person receives two copies of a chromosome or of part of a
chromosome, from one parent and no copies from the other parent.

The most well-known conditions:

Prader-Willi syndrome (UPD 15)
Angelman syndrome (UPD 15)
Beckwith-Wiedemann syndrome
Russell-Silver syndrome (UPD 7)
Transient neonatal diabetes (UPD 6)
UPD of chromosome 14
4. Morphogenetic and mitogen both is feature of
a) IGF
b) FGF
Answer: IGF
The IGFs (insulin-like growth factors) are mitogenic, stimulating the fetal metabolism and coordinating the
feto-placental metabolism. IGF-II regulates early embryonic development while IGF-I is responsible for the
growth of the newborn.

IGF-I signaling is an important mitogenic and morphogenetic regulator in hair follicle biology.
1. When was HIV virus discovered?
a) 1983
b) 1976
c) 1969
d) 1992
Answer: 1983
AIDS was first clinically observed in 1981 in the United States. The initial cases were a cluster of injection
drug users and gay men with no known cause of impaired immunity who showed symptoms of
Pneumocystis carinii pneumonia (PCP), a rare opportunistic infection that was known to occur in people
with very compromised immune systems.

In 1983, two separate research groups led by Robert Gallo and Luc Montagnier independently declared
that a novel retrovirus may have been infecting AIDS patients, and published their findings in the same
issue of the journal Science.

2. Malaria recrudescence is-

a) Resistant to treatment
b) Relapse of infection
c) Relapse in vivax and ovale
d) Re-appearance of asexual stage parasitaemia after treatment.
Answer: Re-appearance of asexual stage parasitaemia after treatment
In infections involving P. vivax and P. ovale there may be persistent hypnozoites in the liver. They are
responsible for relapses of those species for periods of up to 8 or 9 years.

The term for recurrence of infection with other species, P. falciparum, P. malariae and P. knowlesi, which
lack hypnozoites, is recrudescence, meaning that the infection has recurred from persistent blood stages
of the malaria parasite.

There are several studies to prove that recurrent P. falciparuminfection is caused by recrudescence of
chloroquine resistant parasites.

Recrudescence can also occur with P. vivax and P. ovale infections when such parasites have also
persisted in the blood.

Recrudescence can be due to (1) incomplete or inadequate treatment as a result of drug resistance or
improper choice of medication, (2) an antigenic variation, and (3) multiple infections by different strains.

3. Both DNA and RNA found in

a) Bacteria
b) Prion
c) Viriod
d) Plasmid
Answer: Bacteria
A plasmid is a small, circular, double-stranded DNA molecule that is distinct from a cells chromosomal
DNA. Plasmids naturally exist in bacterial cells, and they also occur in some eukaryotes.
Viroids are plant pathogens that consist of a short stretch of highly complementary, circular, single-
stranded RNA.
A prion is an infectious agent composed of protein in a mis-folded form. Prion diseases or transmissible
spongiform encephalopathies (TSEs) are a family of rare progressive neurodegenerative disorders that
affect both humans and animals.
1. Which of the following anti-Parkinson drug may cause peripheral vasospasm?
a) Ropinirole
b) Amantadine
c) Bromocriptine
d) Carbidopa
Answer: Bromocriptine
Bromocriptine is a dopamine receptors agonist that may cause peripheral vasospasm. It is contraindicated
in patients with peripheral vascular disease.

Ropinirole directly stimulate the dopamine receptors but it doesnt cause vasospasm.
Amantadine and Carbidopa do not act directly act on dopamine receptors.
2. Lithium should be stopped how many days before surgery
a) 1
b) 2
c) 3
d) 4
Answer: 2 days
Lithium is used to treat bipolar affective disorders. It may potentiate the effect of depolarizing and
competitive neuromuscular blocking agents. The clearance of lithium can be reduced and its toxicity
increased by factors that cause negative fluid balance, negative sodium balance, and decreased
glomerular filtration rate.

Lithium should be discontinued 2-3 days before major surgery and resumed when renal function and
electrolyte levels are stable.

If serum levels are not in a toxic range, renal function is normal, and fluid electrolyte status is stable, lithium
can be continued before minor surgery.

3. ATT side effects as hypothyroidism

a) INH
b) Pyrazinamide
c) Ethionamide
d) Streptomycin
Answer: Ethionamide
Ethionamide is second-line anti-tuberculosis medication. Ethionamide is administered at a dose of 1520
mg/kg/day (maximum 1 g/day) once or twice/day.

Ethionamide use is most commonly limited by gastrointestinal intolerance. Taking ethionamide at bedtime
or with food may improve tolerance.

Hypothyroidism is an important adverse event; therefore, thyroidstimulating hormone levels should be

measured at baseline and monthly while patients are receiving therapy.

Hepatotoxicity can also occur with ethionamide; therefore, baseline liver function tests should be obtained.
4. Methacholine agonist at
a) M2
b) M1
c) M4
d) M3
Answer: M2
Ganglionic and other neural muscarinic receptors (M1) are apparently involved in CNS transmission.
M3 muscarinic receptors on airway smooth muscle mediate broncho-constriction and pre-synaptic M2
muscarinic receptors inhibit acetylcholine release, causing broncho-dilation.

Tiotropium, a selective antagonist of M3 receptors has recently been approved for treatment of chronic
obstructive pulmonary disease (COPD). One of the advantages tiotropium is that it generally blocks only
postsynaptic M3 receptors (that promote broncho-constriction) but does not block pre-synaptic M2
receptors (That cause broncho-dilation).

Methacholine acts as M2-selective muscarinic receptor agonist to stimulate the parasympathetic nervous

It is most commonly used for diagnosing bronchial hyper-reactivity, using the bronchial challenge test.
Through this test, the drug causes broncho-constriction and people with pre-existing airway hyper-
reactivity, such as asthmatics, will react to lower doses of drug.

Agonist of muscarinic receptors:

M2- Methacholine
M3- Bethanechol
5. Frusemide acts on which part ofloop of Henle?
a) Ascending limb
b) Descending limb
c) PCT
d) DCT
Answer: Ascending limb
The diuretics are generally divided into four major classes, which are distinguished by the site at which they
impair sodium re-absorption:
Loop diuretics act in the thick ascending limb of the loop of Henle
Thiazide-type diuretics in the distal tubule and connecting segment
Potassium-sparing diuretics in the aldosterone-sensitive principal cells in the cortical collecting tubule
Acetazolamide and mannitol act at least in part in the proximal tubule.
6. Laxative use can lead to-
a) Hypo-magnesemia
b) Hypo-kalemia
c) Hypoglycemia
d) Spasm of colon
Answer: Hypo-kalemia
Laxatives are generally well tolerated and may be considered safe drugs. When taken at much higher than the
recommended doses (laxative abuse) some side effects may occur (e.g. hypo-kalemia, metabolic alkalosis,
renal tubular damage).
7. Which does not form active metabolites?
Which is not a pro-drug?
a) Diazepam
b) Cyclophosphamide
c) Lisinopril
d) Fluoxetine
Answer: Lisinopril
Captopril and Lisinopril are active drugs and other ACE inhibitors are inactive pro-drugs until metabolized in
the liver.

When hypertension or heart failure fails to respond adequately to a pro-drug ACE inhibitor, we should
consider a trial of Captopril or Lisinopril. Liver disease may impair activation of pro-drugs. This may apply to
liver congestion due to heart failure or hypertension.

8. Alpha 2 agonist causes a/e

a) Anxiolysis
b) Sedation
c) Analgesia
d) Hyperalgesia
Answer: Hyperalgesia
The alpha-2 (2) adrenergic receptor is a G protein-coupled receptor (GPCR). Catecholamines like nor-
epinephrine (nor-adrenaline) and epinephrine (adrenaline) signal through the 2-adrenergic receptor in the
central and peripheral nervous systems.

Alpha-2 agonists provide sedation, analgesia, muscle relaxation and anxiolysis.

9. Methadone related false statements-
a) Used in chronic treatment of pain
b) Mu agonist
c) Alpha agonist
Answer: Alpha agonist
Methadone is a synthetic opioid analgesic that is primarily a mu-opioid agonist. It has actions and uses
similar to those of morphine.

It also has a depressant action on the cough center and may be given to control intractable cough
associated with terminal lung cancer.

Methadone is also used as part of the treatment of dependence on opioid drugs, although prolonged use of
methadone itself may result in dependence.

Indications: For the treatment of dry cough, drug withdrawal syndrome, opioid type drug dependence, and

10. All true about midazolam except-

a) Antero-grade amnesia
b) Retrograde amnesia
c) Tachyphylaxis seen in patients receiving large doses
d) Less Cardiovascular risk in comparison to propofol
Answer: Retrograde amnesia
Midazolamis a short-acting but quickly effective benzodiazepine drug.
Midazolamhas very powerful anxiolytic (anti-anxiety), amnestic, hypnotic, anticonvulsant, skeletal muscle
relaxant, and sedative effects.

Because it is amnestic, rapidly reaches therapeutic plasma levels, and has a short half-life of only 2-6
hours midazolam is considered optimal for relieving anxiety, sedating patients and causing anterio-grade
amnesia in preoperative situations.

Midazolamis also sometimes used to induce and maintain anesthesia in surgeries, for short term treatment
of insomnia, and acute agitation management.

To sedate patients in the ICU, midazolam is commonly administered via titrated, continuous infusions.
Cardio-respiratory effects tend to be minimal; however, hypotension can occur in hypovolemic patients.

Tolerance and tachyphylaxis (an acute decrease in the response to a drug after its administration) may
occur, particularly with longer-term infusions.

Benzodiazepine withdrawal syndrome has also been associated with high dose/long-term midazolam

Compared with propofol infusions, midazolam infusions have been associated with a decreased
occurrence of hypotension.

Lorazepam is a more cost-effective choice for long-term sedation.

1. ITP due to vaccine-
a) MMR
b) Typhoid vaccine
c) Influenza vaccine
d) HIB
Answer: MMR
The MMR vaccine is an immunization vaccine against measles, mumps, and rubella (also called German
measles). It is a mixture of live attenuated viruses of the three diseases, administered via injection.

Rare side effects of the MMR vaccine:

Idiopathic thrombocytopenic purpura (ITP)
Allergic reaction
2. Which does not occur after a disaster?
a) Leptospirosis
b) Leishmania
d) Rickettsia
Answer: Leishmania
Diseases Associated with Natural Disasters:
Acute respiratory infections (ARI) are a significant contributor to death and disability after disasters, and
children less than five are affected disproportionately.

Waterborne diseases include diarrheal pathogens, hepatitis, and leptospirosis.

Important vector-borne diseases following disasters include malaria, dengue, J apanese encephalitis, and
yellow fever, all of which are transmitted by mosquitoes.

Direct contact diseases: Tetanus and coccidiomycosis

3. Father of Evidence Based Medicine is
a) David Lawrence Sackett
b) da Vinci
c) Hippocrates,
d) Tolstoy
Answer: David Lawrence Sackett
David Lawrence Sackett is a Canadian medical doctor and a pioneer in evidence-based medicine.
4. All of the following provisions are included in the primary health care according to the Alma Ata declaration
a) Adequate supply of safe drinking water
b) Provision of food supply
c) Provision of free medicines
d) Basic sanitation
Answer: Provision of free medicines
Provisions included in the primary health care according to the Alma Ata declaration:-Includes at
Education concerning prevailing health problems and the methods of preventing and controlling them; 1.
Promotion of food supply and proper nutrition; 2.
An adequate supply of safe water and basic sanitation; 3.
Maternal and child health care, including family planning; immunization against the major infectious
Prevention and control of locally endemic diseases; 5.
Appropriate treatment of common diseases and injuries; and 6.
Provision of essential drugs. 7.
5. Universal health coverage of India was recently approved by which committee-
a) Medical education health group
b) MPW in health and family planning
c) High level expert Group
d) Health survey and development committee
Answer: High level expert Group
The recommendations of the High Level Expert Group (HLEG) on Universal Health Coverage encompass the
area of health financing, health services norms, human resources for health, community participation and
citizen engagement, access to medicines, vaccines and technology and management and institutional reforms.
The main recommendations of the HLEG include:
a) Increase public expenditure on health to at least 2.5 percent of GDP by the end of the 12th Plan and to at
least 3% of GDP by 2022.
b) Ensure availability of free essential medicines by increasing public spending on drug procurement.
1. Micro-aneurysms in diabetic retinopathy occur in which layer?
a) Inner nuclear layer
b) Outer plexiform layer
c) Retinal pigment epithelium
d) Layer of rods and cones
Answer: Inner nuclear layer
Micro-aneurysms are the earliest clinical sign of diabetic retinopathy and occur secondary to capillary wall
out-pouching due to pericyte loss. They appear as small red dots in the superficial retinal layers, and there
is fibrin and red blood cell accumulation in the micro-aneurysm lumen. Micro-aneurysms are located within
the inner nuclear layer in capillaries linking the superficial and deep capillary network.

Hemorrhages Ruptured micro-aneurysms, capillaries and venules are all sources of intra-retinal
hemorrhages, which are mostly located within the outer plexiform and inner nuclear layers.

Hard Exudates Extracellular collections of macrophages within the outer plexiform layer, derived from
ingested leaked lipid & proteins from the abnormal vessels.

Retinal edema Fluid collects initially between the outer plexiform and inner nuclear layer; secondary
edema appear between the inner plexiform and nerve fibre layers.

2. Soft exudates deposits seen in which layer of retina?

a) Outer plexiform layer
b) Inner nuclear layer
c) Ganglionic layer
d) Rods and cones cell layer
Answer: Ganglionic layer
Cotton wool spots result from occlusion of retinal pre-capillary arterioles supplying the nerve fibre layer with
concomitant swelling of local nerve fibre axons. Also called soft exudatesor nerve fibre layer infarctions
they are white, fluffy lesions in the nerve fibre layer.

The retinal nerve fiber layer (RNFL) is formed by retinal ganglion cell axons and represents the innermost
layer of the fundus.

3. Critical angle of corneal-air interface is

a) 46
b) 66
c) 36
d) 56
Answer: 46
The challenge of visualizing the anterior chamber angle structures lies with the critical angle.
The critical angle for the cornea-air interface is approximately 46.
Corneal lenses or mirrors are needed to overcome the internal reflection of light. In direct gonioscopy, the
anterior curve of the contact lens is such that the critical angle is not reached, and the light rays are
refracted at the contact lens-air interface.

In indirect gonioscopy, the light rays are reflected by a mirror in the contact lens and leave the lens at
nearly a right angle to the contact lens-air interface.

4. Ex-press implant of glaucoma is made up of

a) Titanium
b) Silicon
c) Stainless steel
Answer: Stainless steel
The Ex-Press Mini Glaucoma Shunt is biocompatible device for implantation under the conjunctiva for
controlling intraocular pressure (IOP).

It is a non-valved, MRI compatible, stainless steel device with a 50 micron lumen. It has an external disc at
one end and a spur-like extension on the other to prevent extrusion.

5. Ascorbate and alpha tocopherol levels are maintained in the lens by

a) Glucose
b) Fatty acids
c) Glutathione
d) Glycoprotein
Answer: Glutathione
Ocular concentrations of glutathione are very high when compared with most other tissues and decreased
levels of glutathione are associated with both age related macular degeneration and cataract, and in
diabetic patients with similar conditions.

Glutathione is critical in maintaining the reduced state of sulfhydryl-containing proteins in the lens.
Glutathione normally functions to maintain ascorbate, alpha-tocopherol, and other cellular components in
reduced states.

6. Pt presents with chuna particles fallen into the eye. Which of the following should not be done?
a) Repeated irrigation of conjunctival sac with NS
b) Frequent instillation of Na citrate drops
c) Thorough slit lamp exam
d) Double eversion of lids and removal of chuna particles
Answer:Thorough slit lamp exam (?)
Kids have lost eyesight due to sudden bursting of packets of chuna or calcium hydroxide, an additive used
with chewing tobacco, and children are at the risk of irreversibly damaging their eyes in families where
this habit is prevalent.

Once chuna enters the eye, it sticks into the eye under the eyelid. Even thorough washing doesnt remove
all the particles. Chuna particles leach from under the eyelid and get into cornea, destroying its outer
covering called epithelium. The tear secretion system gets completely destroyed and the eye becomes dry.
It can lead to complete blindness.

The incidence of ulceration and perforation in the cornea of alkali-injured eyes is significantly reduced by
treatment with tri-sodium citrate or sodium ascorbate. Topical citrate reduces the inflammatory response in
the cornea by inhibiting polymorphonuclear leukocytes.

7. Which of the following organism causes corneal perforation in just 2 days?

a) Staphylococcus
b) Pseudomonas
c) Diphtheria
d) Aspergillus
Answer: Pseudomonas
Eighty percent of bacterial corneal ulcers are caused by Staphylococcus aureus, Streptococcus
pneumoniae and Pseudomonas species. Pseudomonas aeruginosa is the most frequent and the most
pathogenic ocular pathogen which can cause corneal perforation in just 2-3 days.

The most common organisms associated with contact lens related bacterial keratitis are Pseudomonas
aeruginosa and Staphylococci.

8. Gas used in retinopexy

a) Co2
b) SF6
c) Nitrous oxide
Answer: SF6
Pneumatic retinopexy (PR) is an alternative to scleral buckling for the surgical repair of selected retinal

A gas bubble is injected into the vitreous cavity, and the patient is positioned so that the bubble closes the
retinal break (s), allowing absorption of the sub-retinal fluid.

Cryotherapy or laser photocoagulation is applied around the retinal break(s) to form a permanent seal.
Sulfur hexafluoride (SF6) is the gas most frequently used for PR, followed by per-fluoro-propane (C3F8).
1. Size of the laryngeal mask airway (LMA) for normal adults
a) 2.5
b) 3
c) 1.5
d) 4
Answer: Size 4
The laryngeal mask airway (LMA) is an ingenious supra-glottic airway device that is designed to provide and
maintain a seal around the laryngeal inlet for spontaneous ventilation and allow controlled ventilation at modest
levels (up to 15 cm H2O) of positive pressure.
Ranges of patient laryngeal mask airway sizes:
Size 1: Neonates/infants up to 5 kg
Size 1.5: Infants 510 kg
Size 2: Infants/children 1020 kg
Size 2.5: Children 2030 kg
Size 3: Children/small adults over 30 kg
Size 4: Normal and large adults
Size 5: Large adults
2. Screening test to assess hearing loss in neonate
a) Audiometry
b) OAE
Answer: OAE
Tests used for screening newborns for hearing loss include Otoacoustic emissions (OAE) and automated
Auditory Brainstem Response audiometry (aABR). While OAE is cheap, quick, simple and reliable with a
sensitivity of 100% and specificity of 99 %, aABR has the additional advantage of identifying neonates with
auditory neuropathy unlike testing for OAE.

The most common sequence of tests is a two-step screening process in which OAEs are performed first,
followed by ABR in those newborns that do not pass the OAEs.

Diagnostic hearing test for infants:

The most common diagnostic hearing test for infants under 6 months of age is the diagnostic auditory
brainstem response test. It is similar to the aABR, but it provides more information and must be given by a

Brainstem-evoked response audiometry (BERA) is a special kind of electroencephalogram (EEG) a test

that measures electrical activity in the brain. It is also called the auditory brainstem responsetest (ABR).

Tests used to diagnose hearing impairment in older infants and children include: 1.Visual reinforcement
audiometry (VRA): This test is used in children between 6 months and 2 years of age. 2.Conditioned
play audiometry (CPA): Children between 2 and 4 years of age 3.Conventional audiometry: Children
ages 4 years and older

3. Which of the following part of cochlear implant is implanted during surgery?

a) Receiver stimulator
b) Transmitting coil
c) Microphone
d) Speech producer
Answer: Receiver stimulator
Parts of the cochlear implant:
The implant is surgically placed under the skin behind the ear. The basic parts of the device include:
One or more microphones which picks up sound from the environment 1.
A speech processor which selectively filters sound to prioritize audible speech, splits the sound into
channels and sends the electrical sound signals through a thin cable to the transmitter,
A transmitter, which is a coil, held in position by a magnet placed behind the external ear, and transmits
power and the processed sound signals across the skin to the internal device by electromagnetic induction,
A receiver and stimulator secured in bone beneath the skin, which converts the signals into electric
impulses and sends them through an internal cable to electrodes
An array of up to 22 electrodes wound through the cochlea, which send the impulses to the nerves in the
scala tympani and then directly to the brain through the auditory nerve system.
4. A patient presents with antrochoanal polyp arising from the medial wall of the maxilla. Which of the following
would be the best management for the patient?
a) FESS with polypectomy
b) Medial Maxillectomy
c) Caldwell Luc Operation
d) Intranasal polypectomy
Answer: FESS (Endoscopic sinus surgery)
Antrochoanal polyps are more common in children and young adults than in other age groups, with a
higher prevalence in children. They are more common in males than in females.
They nearly always are unilateral, solitary, benign polyps arising from the maxillary antrum. 2.
Computed tomography is an important radiological examination of choice for evaluation of antrochoanal
The treatment of choice is always surgical. Functional endoscopic sinus surgery (FESS) with polypectomy
has been the dominating surgical approach. Endoscopic treatment of antrochoanal polyp in children is safe
and effective.
Nasal steroids are used in the initial treatment and after the surgical management in order to prevent
5. BERA wave V seen in
a) Superior olivary nucleus
b) Cochlear nerve
c) Lateral lemniscus
d) Cochlear nucleus
Answer: Lateral lemniscus
In auditory brain stem evoked response audiometry (BERA), the impulses are generated by the brain stem.
These impulses contain a series of peaks and troughs.

The positive peaks (vortex positive) are referred to by the Roman numerals I VII.
These peaks are considered to originate from the following anatomical sites:
Cochlear nerves waves I and II 1.
Cochlear nucleus wave III 2.
Superior olivary complex wave IV 3.
Nulclei of lateral lemniscus wave V 4.
Inferior colliculus waves VI and VII 5.
6. Part spared in stapedectomy in otosclerosis
a) Anterior crus of stapes
b) Posterior crus stapes
c) Lenticular process of incus
d) Stapedius tendon
Answer: Lenticular process of incus
Using a hand burr a small fenestra about 0.6mm in diameter is made over the foot plate. The stability of the
incus is left intact because the stapedial tendon is not cut at this point. The stapedial tendon is cut after
making fenestra and the supra structure of the stapes (Stapedius tendon, Anterior crus of stapes and
Posterior crus stapes) is disarticulated and removed.

The prosthesis is placed in stapedectomy by inserting the device into the fenestra and leaning it against the
posterior surface of the incus, where it will remain standing by capillary attraction.

A right-angled pick is then used in one hand to lift the long process of the incus while a second pick slides
the bucket forward and under the lenticular process.

A few minor maneuvers may be necessary to place the well of the prosthesis beneath the lenticular
process of the incus.

1. Most common candidal species infecting neonates from caregivers hand:
a) C. tropicalis
b) C. parapsilosis
c) C. glabrata
d) C. albicans
Answer: C. parapsilosis
In the surgical ICU, C albicans accounts for about 50% of infections, C glabrata for about 25%, and a
mixture of other species for the remainder.

In the neonatal ICU, C albicans accounts for approximately two thirds of infections and C parapsilosis for
the remaining third.

Molecular epidemiology shows that the infecting strains of C albicans also colonize the mothers vaginal

The strains of C parapsilosis that infect infants are those found on the hands of healthcare workers in the
neonatal ICU.

2. In neonate with Erbs palsy, Moro reflex is

a) Absent
b) Symmetrical
c) Exaggerated
d) Asymmetrical
Erbs palsy is caused by damage to the brachial plexus during delivery of the neonate. This is mostly limited to
the 5th and 6th cervical nerves.
Infant is unable to abduct the arm from the shoulder, rotate the arm externally from the shoulder, and supinate
the forearm. This results in the classic porters tip or waiters tip appearance.
Clinical signs:
Characteristic position adduction and internal rotation of the arm with forearmpronated
Forearm extension normal
Biceps reflex absent
Moro reflex absent on affected side
Sensory impairment on outer aspect of arm (unusual)
Power of the forearm is normal (if impaired, suggests injury to lower part of plexus).
Hand-grasp normal unless lower part of plexus is also damaged.
3. Not a part of Kangaroo mother care
a) Skin to skin contact
b) Early discharge
c) Free nutritional supplements
d) Exclusive breastfeeding (?)
Answer: Free nutritional supplements
Kangaroo mother care (KMC) includes thermal care through continuous skin-to-skin contact, support for
exclusive breastfeeding or other appropriate feeding, early discharge from hospital and early
recognition/response to illness.
Individual component of kangaroo mother care:
Kangaroo position or skin to skin contact 1.
Kangaroo nutrition or exclusive breastfeeding or other appropriate feeding 2.
Kangaroo support 3.
Kangaroo discharge 4.
4. 4 years old girl presents with severe vomiting after viral fever of 6 days. She develops cerebral edema later
on. What would be the liver biopsy findings?
a) Centri-zonal hemorrhagic necrosis
b) Marked micro-vesicular steatosis
c) Ring granuloma
d) NASH(Nonalcoholic Steato-hepatitis)
Answer: Marked micro-vesicular steatosis
Reye syndrome, an extremely rare but serious illness that can affect the brain and liver, occurs most
commonly in children recovering from a viral infection.

The signs and symptoms of Reye syndrome are almost always preceded by a viral illness, such as an
upper respiratory tract infection (a cold, the flu, etc.) and a diarrheal illness.

Reye syndrome can occur from 1 day to 2 weeks after a viral infection.
Symptoms include: frequent vomiting, lethargy or sleepiness, irritability or aggressive behavior
In the later stages, a child may exhibit irrational behavior, confusion, severe muscle weakness, seizures,
and loss of consciousness. There is usually no fever.

Liver biopsy:
The major histopathological finding is diffuse micro-vesicular steatosis. In the typical case the hepatocytes are
swollen and packed with multiple small vacuoles.
5. A 7-year old boy presents with a right-sided hemangioma and left-sided focal seizures. The most likely
diagnosis is
a) Neurofibromatosis
b) Sturge-Weber disease
c) Hemangioma
Answer: Sturge-Weber disease
Sturge-Weber syndrome is a neuro-cutaneous disorder with angiomas that involve the lepto-meninges and
the skin of the face, typically in the ophthalmic (V1) and maxillary (V2) distributions of the trigeminal nerve.

In the majority of cases the naevus (Port-wine stain- facial cutaneous venous dilation) is unilateral and ipsi-
lateral to the intracranial abnormality. The most common clinical manifestation is with childhood seizures
that are often refractory to medical therapy.

1. A 45 year man is diagnosed with diabetes at his present visit for the first time. When should he visit an
a) On his 50th birthday
b) When dimness of vision starts
c) Before his 50th birthday
d) Immediately at time of diagnosis
Answer: Immediately at time of diagnosis
The ADA Clinical Practice Guidelines recommend ophthalmologic evaluation for all Type 1 diabetes that
have had diabetes for at least 3 years and in all patients with Type 2 diabetes.

A major difference between type 1 and type 2 diabetes mellitus is that many persons with type 2 diabetes
have had the disease for many years prior to diagnosis

Patients with type 2 diabetes, who generally have had years of undiagnosed diabetes and who have a
significant risk of prevalent diabetic retinopathy at time of diabetes diagnosis, should have an initial dilated
and comprehensive eye examination soon after diagnosis.

2. Lung biopsy of a HIV patient showed intra nuclear basophilic inclusion bodies with peri-nuclear halo. The
patients CD4 was 100 at the time of death. What is the probable cause of death?
a) CMV
b) MAC
c) Pneumocystis
d) TB
Answer: CMV
CMV infection characteristically is associated with owls-eye cells, which are large cells with basophilic
intra-nuclear inclusions and a surrounding clear Halo.

The presence of viral inclusions is diagnostic, although this method has low sensitivity. Therefore, absence
of inclusions does not always exclude infection or active disease.

3. Young male having pain with daily morning stiffness of spine for 30 minutes and reduced chest movements
a) Ankylosing Spondylitis
b) Rheumatoid Arthritis
c) Gouty Arthritis
d) Osteoarthritis
Answer: Ankylosing Spondylitis
Ankylosing spondylitis (AS) is a chronic disease of unknown cause. It mainly affects the spine and the
sacroiliac joints. Sometimes other joints and other parts of the body are affected.

Tendons and ligaments in various parts of the body (in addition to those attached to the vertebrae of the
lower spine) may become inflamed and painful where they attach to bones. Common examples are the
Achilles tendon where it attaches to the heel, and where chest muscles attach to the ribs.

New criteria to define inflammatory back pain have been proposed; when 2 of the 4 criteria are present,
they yield a sensitivity of 70.3% and specificity of 81.2%.These criteria includes the following:

Morning stiffness that lasts more than 30 minutes 1.

Improvement of back pain with exercise but not rest 2.
Nocturnal back pain during second half of the night only 3.
Alternating buttock pain 4.
4 . Evidence of decreased risk of cardiovascular disease is associated with all of the following except
a) Vitamin E supplementation
b) Low to moderate daily alcohol consumption
c) Regular physical activity
d) Potassium
Answer: Vitamin E supplementation
Research has shown that vitamin E does not have any overall benefit in lowering mortality or decreasing
the risk of heart death or stroke, and therefore should not be recommended for heart disease prevention.
Drinking moderate amounts of alcohol may have some benefits in terms of reducing the risk for cardiac
disease and death related to cardiac disease. While many previous studies have suggested there may be
heart benefits from drinking a moderate amount of red wine, the new study shows the findings hold with a
moderate intake of any type of alcohol.
K+is critical to the maintenance of cardiovascular disease health and the normokalemic state is vital to the
prevention of potentially serious sequelae, especially in the at-risk cardiovascular disease patient. So a diet
that includes potassium-rich fruits and vegetables is good for the heart.
5. True regarding multiple myeloma a/e
a) Plasmacytosis
b) Increased IgG
c) ANA Antibody
d) Increased M spikes
Answer: ANA Antibody
ANAs are found in patients with a number of different autoimmune diseases, such as systemic lupus
erythematosus, Sjgrens syndrome, rheumatoid arthritis, Polymyositis, scleroderma, Hashimotos
thyroiditis, juvenile diabetes mellitus, Addison disease, Vitiligo, pernicious anemia, Glomerulo-nephritis, and
pulmonary fibrosis.

ANAs can also be found in patients with conditions that are not considered classic autoimmune diseases,
such as chronic infections and cancer.

Diagnostic Tests:
The beta-2 micro-globulin (2-M) level is considered to be a standard measure of tumor burden (the extent
of disease).
Quantitive immunoglobulin (QIG) testing provides measurements of the levels of the different types of
immuno-globulins (antibodies)that is, IgG, IgA, and IgMthat are elevated and produced by myeloma
Serum protein electrophoresis (SPEP) detects the presence and level of various proteins in the blood,
including M protein. Higher levels of M protein indicate more extensive disease.
A bone marrow aspirate or biopsy shows that at least 10 percent of the cells are plasma cells
Criteria for diagnosis: The diagnosis of multiple myeloma requires the following:
A bone marrow aspirate or biopsy showing that at least 10 percent of the cells are plasma cells or the
presence of a plasma cell tumor (called a plasmacytoma), plus
M protein in the blood or urine, plus 2.
Evidence of damage to the body as a result of the plasma cell growth, such as destructive bone lesions,
kidney failure, anemia, or high calcium in the blood
6. False about blackout
a) Confused state
b) Antero-grade amnesia
c) Alcohol intake is reason
d) Remote memory intact
Answer: Confused state
Blackouts are caused by breakdown in the transfer of short-term memory into long-term storage and
subsequent retrieval primarily through dose-dependent disruption of hippocampal CA1 pyramidal cell

The exact mechanism is believed to involve potentiation of gamma-aminobutyric acid-alpha mediated

inhibition and interference with excitatory hippocampal N-methyl-d-aspartate [NMDA] receptor activation,
resulting in decreased long-term potentiation.

Alcohol primarily interferes with the ability to form new longterm memories, leaving intact previously
established longterm memories and the ability to keep new information active in memory for brief periods.

Blackouts represent episodes of amnesia, during which subjects are capable of participating even in
salient, emotionally charged eventsas well as more mundane eventsthat they later cannot remember.

Periods of amnesia are primarily antero-grade, meaning that alcohol impairs the ability to form new
memories while the person is intoxicated, but does not typically erase memories formed before intoxication.

7. Right atria chronic overload or acute overload is indicated by P wave of more than
a) 2.5
b) 3.5
c) 4.5
d) 5.5
Answer: 2.5
Right atrial enlargement is diagnosed by the presence of a P wave 2.5 millimeters or greater in height. This
increased voltage is caused by hypertrophy or acute strain of right atrial tissue.

Dilation or hypertrophy of the left atrium may increase the duration of the P wave. The P wave is normally
less than 0.11 msec.

The long or abnormally shaped P wave occurs because of delay in electrical activation of the enlarged left

A P wave longer than 0.11 milliseconds is diagnostic of left atrial enlargement

8. The v wave is larger than a wave in left atrium because
a) Left atrium has high pressure area
b) Left atrium is more compliant
c) Pressure from right atria left atria transferred to lungs
Answer: ?
The reasons for tall left atrial v waves are
V waves are passive atrial filling waves and a-wave is produced from the increased pressure during the
atrial contraction.

Left atrium is relatively thick, stiff, less compliant chamber.

Apart fromrelative thinness, right atrial volume is more; hence it can accommodate more volume without
raising its pressure.

The left atriumis decompressed by relatively stiff pulmonary veins cannot adequately dampen the refluxing
tides of v waves, while the low pressure vena cava of RA dampen the right atrial v waves with ease.

Further, the adjoining systemic left ventricle, adds up to the stiffness of left atrial filling.
1. Serious complication of sitting position technique
a) Dys-arrhythmia
b) Hypotension,
c) Nerve paralysis,
d) Venous Air embolism
Answer: Venous Air embolism
Venous Air embolism is most serious complication in sitting position technique in neurosurgery.
Intra-operative trans-esophageal echocardiography (TEE) is found to be the monitoring technique with the
highest sensitivity. The sitting position is a safe positioning technique if TEE monitoring is used.

2. Not related with CA colon?

b) C.myc
d) Micro satellite instability
Answer: EGFR mutation
Molecular genetics of sporadic colon cancer:
K-ras Oncogene
Mismatch repair genes
DCC (deleted in colon cancer) gene
C-myc Oncogene
Microsatellite instability (MSI) is the condition of genetic hyper-mutability that results from impaired DNA
Mismatch Repair.

Micro satellite instability (MSI) may result in colon cancer, gastric cancer, endometrium cancer, ovarian
cancer, hepato-biliary tract cancer, urinary tract cancer, brain cancer and skin cancers. MSI is most
prevalent in the cause of colon cancers.

EGFR over-expression (known as up-regulation) has been associated with a number of cancers, including
lung cancer, anal cancers and glioblastoma multiforme.

3. About neurogenic shock, true is:

a) Hypotension with bradycardia
b) Hypertension and bradycardia
c) Hypotension and tachycardia
d) Hypertension and tachycardia
Answer:Hypotension with bradycardia
In brain or spinal injury, the sympathetic trunk stops working and blood vessels dilate and result in blood
pooling away from the heart.

Patients are generally hypotensive with warm, dry skin. The loss of sympathetic tone may impair the ability
to redirect blood flow from the periphery to the core circulation leading to excessive heat loss and

Bradycardia is a characteristic finding of neurogenic shock; however, it is not universally present.

4. Most common viral cause of kidney transplant rejection
a) Polymyoma virus
b) HCV
c) HBV high risk
d) Herpes simplex type
Answer: Polymyoma virus
The polyomaviruses cause clinical disease among immuno-compromised patients.
BK virus and J C virus are the two most common polyomaviruses associated with human disease and the
only two associated with nephropathy.

The major diseases caused by BK virus are tubule-interstitial nephritis and ureteral stenosis in renal
transplant recipients, and hemorrhagic cystitis in bone marrow transplant recipients.

BK virus causes clinical disease of the genitourinary tract, due in part to its tropism for genitourinary

The J C virus causes a similar disease among kidney transplant recipients, but is far less common.
BK-induced nephropathy reportedly occurs in up to 10 percent of kidney allograft recipients. Overall, the
reported incidence of allograft failure ranges from15 to 50 percent of affected individuals.

5. Not a cause of pancreatitis

a) Hyperlipidemia
b) Islet cell hyperplasia
c) Abdominal trauma
d) Trypsinogen
Answer: Islet cell hyperplasia
Inflammation of the pancreas has various causes. Once the gland becomes inflamed, the condition can
progress to swelling of the gland and surrounding blood vessels, bleeding, infection, and damage to the
gland. There, digestive juices become trapped and start digestingthe pancreas itself.

A number of causes have been identified for acute pancreatitis and chronic pancreatitis,
including:Alcoholism, Gallstones, Abdominal surgery and during, ERCP procedure, certain medications,
Cigarette smoking, Cystic fibrosis, Family history of pancreatitis, Hyper-calcemia, Hyper-triglyceridemia,
Infection, Injury to the abdomen and Pancreatic cancer


1. Which drug is not given in pregnancy induced hypertension?
a) Alpha methyl dopa
b) Enalapril
c) Nifedipine
d) Labetalol
Answer: Enalapril
Commonly used antihypertensive medications in pregnancy:
Severe hypertension
Short-acting Nifedipine
Mild to moderate hypertension
Long-acting Nifedipine
Congenital malformations have been reported with the use of ACE inhibitors during the first trimester of
pregnancy, while fetal and neonatal toxicity, death, and congenital anomalies have been reported with the
use of ACE inhibitors during the second and third trimesters of pregnancy.

If the patient becomes pregnant, Enalapril should be discontinued as soon as possible. Enalapril is
considered contraindicated during pregnancy.

2. Diagnostic criteria for HELLP syndrome are A/E:

1) Hemolysis
2) Elevated liver enzyme
3) Low platelets <25000
4) Retro-peritoneal hemorrhages
Answer: Retro-peritoneal hemorrhages
The HELLP syndrome is a serious complication in pregnancy characterized by hemolysis, elevated liver
enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10-20% of cases with severe
Diagnostic criteria for HELLP syndrome
Elevated Liver Enzymes and
3. All are advantage of Hysteroscopic over open Myomectomy except
a) Less Pain
b) Early Ambulation
c) Less Blood loss
d) Recurrence
For women who are candidates for Hysteroscopic Myomectomy, this procedure is preferred over an abdominal
approach, particularly laparotomy, for the following reasons:
Outpatient procedure 1.
Minimal recovery time 2.
Decreased peri-operative morbidity 3.
Minimal or no scarring of myometrium 4.
Reduced the risk of postoperative adhesion formation 5.
Reduced postoperative pain 6.
Blood loss 7.
4. Not a criteria for diagnosis of superimposed preeclampsia in a pregnant lady with pre existing hypertension:
a) Increase in systolic BP by 30mm Hg and diastolic BP by 15mm Hg
b) Platelets less than 75000
c) New onset proteinuria
d) Nevo-vascular changes in retinal vessels
Answer: Nevo-vascular changes in retinal vessels
Preeclampsia is defined by the new onset of elevated blood pressure and proteinuria after 20 weeks of

Hypertension is defined as blood pressure equal to or greater than 140/90 mm Hg or an increase in mean
arterial pressure of 20 mm Hg. The use of an increase in blood pressure of 30/15 mm Hg over first-
trimester values is controversial.

Superimposed pre-eclampsia (on chronic hypertension)

New onset proteinuria in a woman with hypertension but no proteinuria before 20 weeks gestation
A sudden increase in proteinuria or blood pressure, or platelet count less than 100,000 in women with
hypertension and proteinuria before 20 weeks gestation

1. Which anesthetic doesnt interfere with CSF secretion?
a) N2O
b) Thiopentone
c) Halothane
d) Ketamine
Answer: N2O (Nitrous oxide)
Anesthetic agents
Halothane, ketamine increase CSF production
Thiopental decreases CSF production
Active transport inhibitors
Acetazolamide, Frusemide reduce CSF production
Angiotensin, vasopressin reduce CSF production
2. Most appropriate mode of ventilation for head injury patient?
c) AMV
d) CMV
Answer: CMV
Controlled mechanical ventilation (CMV): The ventilator delivers a preset number of breadths and tidal
volume, and makes no allowance for any effort by the patient.

This is used in heavily sedated and paralyzed or deeply unconscious patients.

Any respiratory attempt by the patient may lead to fighting the ventilator, resulting in hemodynamic
instability, coughing, restlessness, and raised ICP due to cerebral venous congestion.

3. Stage of surgical anesthesia during ether administration is

a) Loss of consciousness
b) Failure of circulation
c) Regular respiration to cessation of breathing
d) Loss of consciousness to beginning of regular respiration
Answer: Regular respiration to cessation of breathing
Stages of Anesthesia
Stage I (stage of analgesia or disorientation): from beginning of induction of general anesthesia to loss of
Stage II (stage of excitement or delirium): from loss of consciousness to onset of automatic breathing.
Stage III (stage of surgical anesthesia): from onset of automatic respiration to respiratory paralysis. It is divided
into four planes:
Plane I from onset of automatic respiration to cessation of eyeball movements.
Plane II from cessation of eyeball movements to beginning of paralysis of inter-costal muscles.
Plane III from beginning to completion of inter-costal muscle paralysis. Diaphragmatic respiration persists
but there is progressive inter-costal paralysis, pupils dilated and light reflex is abolished.

Plane IV from complete inter-costal paralysis to diaphragmatic paralysis (apnea).

Stage IV: from stoppage of respiration till death. Anesthetic overdose cause medullary paralysis with
respiratory arrest and vasomotor collapse. Pupils are widely dilated and muscles are relaxed.
1. Multiple, shiny, pinhead size papules on dorsal surface of hand forearm & penis in young boy
a) Scabies
b) Lichen planus
c) Lichen nitidus
d) Molluscum contagiosum
Ans: Lichen nitidus
Lichen nitidus is a relatively rare, chronic skin eruption that is flat-topped, skin-colored micro-papules.
Lichen nitidus mainly affects children and young adults.

The most common sites of involvement are the trunk, flexor aspects of upper extremities, dorsal aspects of
hands, and genitalia.

Lichen nitidus is usually an asymptomatic eruption; however, patients occasionally complain of pruritus.
2. 37 year female with itchy linear wheal, with itching for 30 minutes at site, diagnosis is
a)Dermatographic urticaria
b) Pressure urticaria
c) Acute urticaria
d) Chronic urticaria
Ans:Dermatographic urticaria
Pressure urticaria is an uncommon form of physical urticaria. Patients who have had urticaria for more than
6 weeks are given the diagnosis of chronic urticaria. A proportion of patients with chronic urticaria have
physical urticaria, which is urticaria incited by a physical stimulus, such as cold, vibration, or pressure.

The termdermographism (or dermatographism) literally means writing on the skin. It is the commonest
form of physical urticaria. Firm stroking of the skin produces a linear wheal. Whealing usually develops
within 5-10 minutes of stroking the skin and persists for 15-30 minutes.

3. Treatment of choice of comedone lesions on face trunk

a) Retinoids
b) Clindamycin
c) Retinoids plus oral doxycycline
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Answer: Retinoids plus oral doxycycline
Comedonal acne: It forms because a component of skin oil called sebum along with old skin cells block the
pores of the skin. Comedonal acne appears most often on the forehead, nose, and chin.

The most common treatment is retinoids with an oral antibiotic, such as doxycycline, tetracycline,
minocycline or erythromycin, which kills the bacteria that cause inflammation around the blocked pores.

Topical retinoids are comedolytic and anti-inflammatory. They normalize follicular hyper-proliferation and
hyper-keratinization. Topical retinoids reduce the numbers of micro-comedones, comedones, and
inflammatory lesions.

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