Sarp One Liners

1.
Pin index of oxygen is:

A. 0, 5
B. 1, 5
C. 2, 5
D. 3, 5
2. Anaesthesia agent with least analgesic property:
B. Halothane
A. N2O
C. Ethers
D. Propane
3. Used for IV Induction except:
A. Thiopentone Na
B. Ketamine
C. Etomidate
D. Bupivacine
4. Spinal Anesthesia should be injected into the space
between:
A. T12-L1
B. L3 L4
D. L5-S1
C. L1_ L2
5. Laughing gas is:
A. Nitrous oxide
C. Cyclopropane
B. Halothane
D. Entonox
14. M/C used in Brachytheraphy of Carcinoma cervix:

A. Radium-226
B. Cobalt-60
C. Gold-198
D. Caesiom-137
15. Filament in X-ray made of:
A. Tungsten filament
B. Chromium
C. Gallium
D. Selenium
16. Investigation of choice in a person brought with
traumatic paraplegia is:
A. MRI
B. CT
C. Myelography
D. USG
6. In carpel tunnel syndrome the nerve involved is:

A. Axillary nerve
B. Radial nerve
C. Ulnar nerve
D. Median nerve
17. Best method to diagnose pathology in terminal part of

CBD by:
A. USG
B. ERCP
C. PTC
D. CECT
7. Fibrous ankylosis is seen in:

A. Septic arthritis
B. TB arthritis
C. Psoriatic arthritis
D. Behcet's disease
18. Drug of choicc in depression in old person is:

A. Fluoxetine
B. Buspirone
C. Amitryptyline
D. Imipramine
8. Metacarpophalangeal joints are most common affected

in:
A. Osteoarthritis
B. Psoriasis
C. Rheumatic Arthritis
D. Pseudo gout
19. DOC in OCD

A. Sertraline
B. Alprazom
C. Chlorpromazine
D. Clomipramine
20. Prophvlactic maintenance scrum level of^ lithium is:
A. 0.2-0.8 mEq/1
B. 0.7-1.2 mEq/1
C. 1.2-2.0 mEq/1
D. 2.0-2.5 mEq/1
9. Hill - Sach's lesion seen in:

A. Anterior dislocation of hip
B. Posterior dislocation of hip
C. Recurrent dislocation of shoulder
D. Posterior dislocation of shoulder
10. Nerve damaged in the shaft of humerus fracture:
A. Median nerve
B. Radial nerve
C. Ulnar nerve
D. Axillary nerve
21. False perception without external stimulus is:

A. Illusion
B. Hallucination
C. Delirium
D. Delusion
22. Latest retinoid drug used in psoriasis:
A. Adapalene
B. Tretnoin
C. Calcipotriol
D. Tazarotene
11. Tinel's sign is seen in:

A. Regeneration
B. Degeneration
C. Both
D. None
12. Most radiosensitive tissue of the body is:
A. Bone marrow
B. Nervous Tissue
C. Connective Tissue
D. Fat Tissue
23. Alopecia, Hyper pigmentation, Hypogonadism

characteristic for deficiency of
A. Zinc
B. Magnesium
C. Selenium
D. Copper
13. Double bubble sign in Barium meal seen in:

A. Duodenal Atresia
B. Jejunal Atresia
C. lleocaecal kochs
D. Ulcerative colitis
24. Isomorphism not seen in:

A. Lichen planus
B. Warts
C. Psoriasis
D. Vitiligo
www.coaching.adrplexus.com
D. Malabsorption
25. Decrease number of melanocyte is seen in:
A. Albinism
B. Piebaldism
C. Ichthyosis
D. Chemical leucoderma
26. Not a cutaneous manifestation of TB:
A. Lupus pernio
B. Lupus vulgaris
C. Erythema nodosum
D. Scrofuloderma
27. Post exposure prophylaxis, for HIV patient minimum
for:
A. 6 weeks
B. 4 weeks
C. 12 weeks
D. 8 weeks
28. Dressler's syndrome is due to:
A. Autoimmune
B. Bacteria
C. Idiopathic
D. Virus
30. Most common cause of Intracerebral Bleeding is due

to:
A. Thrombocytopenia
B. Diabetes
C. Hypertension
D. Berry Aneurysm
31. Severity of Mitral stenosis is determined by:
A. Diastolic murmur Duration
B. Mid D.M
C. Opening Snap
D. Intensity of SI
32. 28 years old female presents complaints of tightness of
finger and dysphagia. Which of the following is probable
diagnosis?
A. Dermatomyositis
B. Scleroderma
C. Rheumatoid Arthritis
D. Polyarteritis Nodosa
33. 45 years old man complaints of back pain and joint
pain in X-ray b/1 sacroileitis diagnosis is:
A. Ankylosing spondylitis
B. Psoriatic arthritis
C. RA
D. Scleroderma
35. Tetany is not seen in:

A. Verapamil
B. Thyroid surgery
C. Hyperventilation
37. All are causes of flapping tremor except:

A. Hepatic encephalopathy
B. Uremic encephalopathy
C. Carbondioxide narcosis
D. Thyrotoxicosis
38.A 40-year-old male develops excessive hyperventilation
ABG reveals PH-7.5 Pco2 -24 mmHg Po2-88mmHg.
Diagnosis is:
A. Respiratory Alkalosis
B. Metabolic Alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
39. True about pancoast Tumor all except:
A. Lower lobe carcinoma
B. Squamous cell carcinoma
C. Causes Horner syndrome
D. Located in the Apex
29. Normal Anion gap acidosis seen in:

A. Uremia
B. OKA
C. Lactic Acidosis
D. Cholera
34. Morphine is given in:

A. LVF
B. Head Injury
C. Emphysema
D. Cor pulmonale
36. Which of the following is not a usual feature of right

middle cerebral artery territory infarct?
A. Aphasia
B. Hemiparesis
C. Facial weakness
D. Dysarthria
40. Most common CNS manifestation of HIV Infection is:

A. Acute Meningitis
B. Encephalopathy
C. Vacuolar myelopathy
D. Dementia
41. All are the risk factors for coronary artery disease
except:
A. LDL
B. HDL
C. Smoking
D. Hypertension
42. Lung carcinoma most common associated with:
A. Asbestosis
B. Silicosis
C. Byssinosis
D. Beryllium
43. Mixed connective tissue disease includes all the
following except:
A. Polymyositis
B. RA
C. Osteoarthritis
D. Systemic sclerosis
44. Microangiopathic Hemolytic anemia seen in:
A. HUS
B. HTN
C. SLE
D. All
45. "a" wave in JVP indicates:
A. Atrial systole
B. Ventricular systole
C. Atrial relaxation
D. Tricuspid regurgitation
46. Anti mitochondrial Ab seen typically in:
A. Primary Biliary cirrhosis
D. Tuberculosis
B. Hepatitis B
C. Hepatitis C
D. Hepatitis A
47. Hepatorenal syndrome characterised by all except:
A. No proteinuria
B. Normal intrinsic'kidney.
C. Liver failure
D. Urine osmolality less than plasma osmolality
48. In infant LRTI is MC caused by:
A. Streptococci
B. RSV Viruses
C. H. Influenza
D. Mycoplasma
58. Nephrocalcinosis is seen in all except:

A. Hyperparathyroidism
B. Multiple myeloma
C. Malignancy
D. Rickets
59. Hypotonia not seen in:
A. Hypokalemia
B. Deep sleep
C. LMNL
D. Parkinsonism
60. A sewer worker admitted with fever, Jaundice and
Renal failure the most appropriate diagnosis will be:
A. Shigella
B. Leptosporosis
C. Renal failure
D. Legionella
49. Megaloblastic anemia is caused by:

A. Diphyllobothrium latum
B. H-NaNa
C. Taenia saginata
D. Echinococcus granulosis
61. In Crohn's disease not seen:

A. Stricture
B. Fistula
C. Skip lesion
D. Pseudopolyp
50. Nephrocalcinosis is a feature of:

A. Primary Hyperparathyroidism
B. Medullary cystic kidney
C. Vitamin C Intoxication
D. Pseudohypoparathyroidism
51. Asymptomatic hypercalcemia in 30-year-old young
male is due to:
A. Occult Primary Malignancy
B. Primary Hyperparathyroidism
C. Familial Hypocalciuria
D. Hypernephroma
52. Carotid Massage is useful in:
A. Ventricularextrasystole
B. Atrial flutter
C. PSVT
D. Ventricular fibrillation
62. Differential diagnosis of chylous ascites are all except:

A. Tuberculosis
B. Hypothyroidism
C. Filariasis
D. Lymphoma
63. Exudate are seen in all except:
A. CHF
B. TB
C. Malignancy
D. Uremia
64. Pregnant lady presents with fulminate hepatitis, most
common cause is:
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
53. Zinc deficiency is seen in all except:

A. Inflammatory bowel disease
B. Malabsorption syndrome
C. Sickle cell anemia
D. T.B.
54. Most common cause of Hypovolemic shock is:
A. Haemorrhage
B. Gram -ve Bacteria
C. Tension Pneumothorax
D. Gram +ve
65. Painful tender and non reducible sac through inguinal

canal with absent cough reflexes you seen in:
A. Obstructed hernia
B. Strangulated hernia
C. Ricter's hernia
D. Incarcerated hernia
66. Most common mode of spread of Gall bladder
carcinoma:
A. Transcoeiemic spread.
B. Lymphogenic spread
C. Haematogenic spread
D. Direct spread.
55. Not a cause of Cor Pulmonale:

A. Mitral stenosis
B. Intermittent pulmonary embolism
C. COPD
D. Kyphoscoliosis
56. Pretibial myxoedema is seen in:
A. Thyrotoxicosis
B. Myxoedema
C. Follicular ca
D. Papillary ca thyroid
67. Thimble bladder is seen in:

A. Acute tuberculosis
B. Chronic tuberculosis
C. Neurogenic bladder
D. Schistosomiasis
57. Exudative pleural effusion seen in all except:

A. Acute Pancreatitis
B. SLE
C. CCF
68. Pott's puffy tumour is the:

A. Tuberculosis of spine
B. Bimaleoiar ankle fracture
D. Tumor of spleen
C. Osteomyelitis of skull
D. Bowen's disease
69. Migrating thrombophlebitis seen in:
A. Buerger's disease
B. Varicose vein
C. Intra venous infusion
D. Local bacterial infection
70. Sister Joseph's nodule is seen:
A. Rheumatoid arthritis
B. Umbilicus
C. Large size condylomata lata
D. Leprosy
80. A 45-year-man complain of vomiting with food mass

taken days before, foul smelling breath. Occasional
dysphagia to solid food. What is the diagnosis?
A. Zenker's diverticulum
B. Achalasia
C. Diabetic gastro paresis
D. Scleroderma
81. Most common type of Basal cell carcinoma
A. Cystic type
B. Morphea type
C. Noduloulcerative type
D. Pigmented type
71. Branham's sign is seen in:

A. Aneurysm of aorta
B. Varicose vein
C. A V- Fistula
D. Arterial occlusion
82. Collar - Stud abscess is seen in:

A. Actinomycosis
B. Tuberculosis
C. Syphilis
D. Sarcoidosis
72. Uvula vesicae is caused by which lobe of prostate:

A. Anterior lobe
B. Lateral lobe
C. Medial lobe
D. Posterior lobe
73. In pyogenic liver abscess commonest route of spread is:
A. Haematogenous through portal vein
B. Ascending infection through biliaiy tract
C. Hepatic artery
D. Local spread
74. For breast carcinoma which of the following is best
indicator of prognosis:
A. Estrogen receptor status
B. Lymphnode status
C. Metastasis
D. Size of tumor
75. Not a complication of pseudopancreatic cyst:
A. Hemorrhage into cyst
B. Rupture
C. Malignancy
D. Abscess formation
83. Spigelian hernia is seen in:

A. Lumbar triangle
B. Supra umbilical region
C. Arcuate line
D. Paraumbilical region
84. Calculus is most common in which salivary gland:
A. Sublingual
B. Parotid
C. Submandibulai
D. Sublingual
85. Most common organ ruptures in blunt trauma of
abdomen:
A. Diaphragm
B. Liver
C. Spleen
D. Kidney
86. Hirshsprung's disease most commonly involves:
A. Jejunum
B. llleo-colic junctions
C. Rectosigmoid junctions
D. Upper sigmoid part
76. Eczema like lesion with frequent bleed around areola is

seen in:
A. Eczema
B. Paget's disease
C. Tuberculosis
D. Inflammatory carcinoma
87. Dumping syndrome is characterized by all except:

A. Hyperglycemia
B. Tremor
C. Tachycardia
D. Diarrhoea Ans:
77. Treatment of paralytic ileus include all except:

A. Parasympathomimetics
B. Nasogastric aspirate
C. Electrolyte correction
D. Symphatomimetics
88. All are complication of Crohn's disease except:

A. Sclerosing cholangitis
B. Intestinal fistulas
C. Intestinal stricture
D. Toxic megacolon
78. Acute pancreatic causes all except:

A. Fat necrosis
B. Hypercalcemia
C. Increased amylase
D. Increased lipase.
89. Best marker to assess prognosis after colon surgery:

A. CA-125
B. CEA
C. CA-15.3
D. PSA
79. Grey turner sign is seen in:

A. Acute cholecystitis
B. Acute pancreatitis
C. Acute appendicitis
90. Amylase is increased in all except:

A. Acute appendicitis
B. Acute pancreatitis
C. Duodenal perforation
D. Intestinal obstruction
91. GERD (Gastro Esophageal Reflux Disease) is

Predisposed by:
A. Smoking
B. Defective gastric emptying
C. Truncal vagotomy
D. All
102. Down's syndrome is diagnosed in a pregnant women

by all except:
A. Decreased AFP
B. Increased HCG
C. Decreased I ICG
D. Estriol
92. Chronic cholecystitis is associated with all except:

A. Usually palpable
B. Common in women
C. Associated with Gallbladder stones
D. Rokitansky-Aschoff sinuses
103. In vagina, the type of epithelium is:

A. Columnar
B. Non-keratinised stratified squamous
C. Keratinised squamous
D. Cuboidal
93. All the following Lymphnodcs involved in breast

carcinoma except:
A. Axillary node
B. Pretracheal node
C. Parasternal node
D. Supraclavicular node
104. Exact no. of weeks between LMP and EDD:

A. 37 weeks
B. 38 weeks
C. 39 weeks
D. 40 weeks
94. All are precancerous state of penis except;

A. Hypospadias
B. Chronic balanoposthitis
C. Hpv infection
D. Paget's disease of penis
95. Perforation of typhoid ulcer usually occurs during
week:
A. 1st .week
B. 2nd week
C. 3rd week
D. 4th week
96. Not a malignant change in pleomorphic adenoma:
A. Facial nerve palsy
B. Trismus
C. Pain
D. Cervical lymphnode enlargement
97. The mass of 15 cm away from the anal orifice, the
treatment of choice is:
A. Colonoscopic removal
B. Hartman's operation
C. Anterior resection
D. Abdomino perineal resection
98. Complications of Duodenal ulcer, all except:
A. Malignancy
B. Perforation
C. Bleeding
D. Obstruction
99. A patient soon after 3rd stage of labour, placenta came
out fully, but there is heavy bleed, the Rx is:
A. IVF
B. Check for placenta in uterus
C. Check for Laceration of Labia
D. Massage and oxytocin
100. Gold standard for confirming the diagnosis of PID:
A. USG
B. Laparoscopy
C. Blood leucocyte count
D. Antichalmydial Ab.
101. Bacterial vaginosis can cause all except:
A. Abruptio placenta
B. Endometritis
C. Chorioamnionitis
D. Pre-term labour
105. A composite graphical record of cervical dilation and

descent of head against duration of labour in hours known
as:
A. Apgar score
B. Partogram
C. Bishop's score
D. Pearl index
106. Colposcopy used to visualize:
A. Cervix
B. Uterus
C. Fallopian tube
D. All of the above
107. LH: FSH ratio increased in:
A. Menopause
B. PCOD
C. Testicular feminization
D. Turners syndrome
108. M/c position in vertex presentation:
A. LOA
B. ROA
C. LOP
D. ROP
109. Investigation to be done in a girl presenting with
delayed puberty:
A. USG pelvis
B. FSH
C. Karyotyping
D. All above
110. Advantage of median episiotomy over mediolateral
are all except:
A. Hemorrhage is less
B. Healing is good
C. Extension of incision
D. Repair is easy
111. Bishop scoring system measures:
A. Cervical changes during delivery
B. To record the progress of labour
C. Intrauterine fetal well being.
D. For the uterine contraction
112. Ovulation coincides with:
A. FSH surge
B. LH surge
C. Peak of progesterone
D. Peak of oestrogen
124. 100% oxygen improves cyanosis in all except:

A. Tetralogy of fallot
B. Bronchial asthma
C. Eosinophilic pneumonia
D. Interstitial lung disease
113. Painless heavy bleed is seen in:

A. Ectopic pregnancy
B. Abruptio placenta
C. Placenta previa
D. Abortion
114. Most common site of ectopic pregnancy:
A. Isthmus
B. Fimbriae
C. Interstitium
D. Ampulla of tube
115.43 years lady complain of prolonged and heavy bleed
through vagina. On examination endometrial hyperplasia,
which is not atypical? What is the treatment?
A. Hysterectomy
B. Progestins
C. Radiotherapy
D. OCPs
116. The complication of hydramnios are all except:
A. Hemorrhage
B. Obstructed labour
C. Uterine inertia
D. Prematurity
117. 4-hour fluid requirement of a baby of 8 kg with severe

dehydration:
A. 1000 ml
B. 800 ml
C. 600 ml
D. 500 ml
125. Wide and Split S2 occurs in:

A. Coarctation of Aorta
B. VSD
C. ASD
D. MS
126. Prophylaxis to a child with RHD should be given
minimum till:
A. Atleast 5 years after onset
B. Life long
C. Till 17 years
D. Till 21 years
127. Skin test can't detect which hypersensitivity:
A. Type 1
B. Type 2
C. Type 3
D. Type 4
128. Nail involvement is not seen in:
A. Alopecia
B. Psoriasis
C. Acne
D. Lichen planus
129. MC skin manifestation of TB is:
A. Lupus vulgaris
B. Scrofuloderma
C. Erythema nodosum
D. None of the above
130. Scarring alopecia is seen in:
A. Alopecia areata
B. T. effluvium
C. Cicatricial alopecia
D. SLE
131. Miliaria is the involvement of:
A. Eccrine glands
B. Sebaceous gland
C. Apocrine gland
D. Endocrine gland
118. Delayed bone age is due to:

A. Hyperthyroidism
B. Hypothyroidism
C. Congenital adrenal hyperplasia
D. Cushing syndrome
132. Mucosa is involved in:

A. Lichen planus
B. Scabies
C. Psoriasis
D.
119. Physiological jaundice in a term baby is maximum at:

A. 5 days
B. 6 days
C. 7 days
D.9 days
120. Enuresis is normal until:
A. 2years
B. 10 years
C. 4 years
D. 5 years
121. Single oral dose for vitamin D prophylaxis:
A. 25000 IU
B. 50000 IU
C. 100000 IU
D. 200000 IU
122. For vesico ureteric reflex investigation of choice is:
A. X-Ray
B. MCU
C. CT-Scan
D. Antegrade orogram
123. Investigation of choice to diagnose Hirchsprung's
disease is:
A. Rectal manometry
B. Barium enema
C. Rectal biopsy
D. Laparotomy
133. Normal commensal of sebaceous gland:

A. P. acne
B. S. aureus
C. C. diphtheriae
D. Streptococci
134. Koilocytes are seen in infection with:
A. Herpes simplex
B. Molluscum contagiosum
C. CMV
D. Adenovirus
135. Most common site of Mongolian spot is:
A. Face
B. Arm
C. Chest
D. Lumbosacral area
136. Not seen in leprosy:
A. Anaesthetic patch
B. Thickened nerve
C. Hypopigmented lesion
D. Bullous lesion
137. Granuloma inguinale is caused by:
A. Calymrnatobacterium B. H. ducreyi
C. Chlamydia trachomatis D. Syphilis
138. True about use of Isotertionin in acne:
A. Flaring of acne initially
B. Prednisolone used to control flaring

C. Not used for nodulocystic acne
D. All of the above
152. Popcorn calcification is characteristic of:

A. Cystic hygroma
B. Pulmonary hamartoma
C. Lymphangioma
D. Teratoma
139. Scabies is transmitted by:

A. Mite
B. Tick
C. Louse
D. Flea
140. Patch test is used for:
A. Contact dermatitis
C. Seborrhic Dermatitis
B. Atopic dermatitis
141. Hoffman's elimination is for which drug:
A. Cis-atracurium
B. Mivacurium
C. Pancuronium
D. Succinylcholine
142. Which of the following is associated with acute
intermittent porphyria?
A. Thiopentone Sodium
B. Ketamine
C. Aspirin
D.Lithium
153 Most radiosensitive gonadal tumor is:

A. Choriocarcinoma
B. Seminoma
C. Melanoma
D. Teratoma
154. Best to detect pneumoperitoneum:
A. CXR
B. X-ray abdomen erect
C. Left lateral decubitus
D. X-ray abdomen supine
155. Which is seen in posterior mediastinum?
A. Thymoma
B. Pericardial cyst
C. Bochdalek hernia
D. Morgagnian Hernia
143. Non depolarizing blockade is potentiated by:

A. Hyperkalemia B. Hypomagnesemia
C. Alkalosis
D. Quinidine
156. Tram track appearance is seen in:

A. Optic nerve sheath meningioma
B. Optic nerve glioma
C. Retinoblastoma
D. Schwannoma
144. Which statement is true about ASA grading?

A. Grade 4 is moribund patient who can't survive
>24 hours with or without surgery
B. It tells about preoperatiave assessment
Of individual
C. It indicates post operative outcome
D. All of the above
157. Linear accelerator for treatment of cancer produces:

A. -rays
B. X-rays
C. b-rays
D. X-rays and gamma rays
145. Esophageal intubation is indicated earliest by:

A. Absence of air sound in bilateral chest
B. Absence of signal on capnography
C .Stomach distension
D. Gurgling sound in stomach
158. Drug which decreases relapse of alcohol drinking

are all except
A. Acamprosate
B. Disulfiram
C. Naltrexone
D. Fluoxetine
146. Which agent require ischaemic preconditioning?

A. Halothane
B. Enflurane
C. Sevoflurance
D. Isoflurane
159. Characteristic features of opioid withdrawal is:

A. Rhinorrhoea and lacrimation
B. Sedation
C. Tremors
D.Constipation
147. True about depolarizing block:

A. Train of 4 is seen in phase 1 block
B. Dual block
C. Anticholinesterase is used to overcome the block
D. All are true
160. Schneider's first rank symptoms are all except:

A. Thought withdrawal
B. Thought broadcast
C. Auditory hallucination
D. Persecutory delusion
148. Rapid sequence anaesthesia is used to prevent:

A. Aspiration
B. Asphyxia
C. Hypotension
161. Thought disorder with defective communication and

language is:
A. Thought broadcast
B. Thought echo
C. Thought withdrawal
D. Derailment
149. True about disposabale ET:

A. Size measured by external diameter
B. Uncuffed
C. Length is 22 mm for connection to ventilation circuits
D. All of the above
150. Soda lime has:
A. KOH
B. Ba(OH)2
C. AI(OH)3
D. All of the done
151. Calcification is best detected on:
A. CT
B. MRI
C. X-ray
D. USG
162. Clouding of consciousness is seen in:

A. Delirium
B. Dementia
C. Delusion
D. Hallucination
163. Complete suicide is seen in all except
A. Panic disorder
B. Depression
C. Borderline personality disorder
D. Mania
164. Which psychiatric disorder leads to loss of maximum
DALY?
A. Schizophrenia
B. Depression
C. Alcohol Dependence
D. Borderline personality disorder
B. MC cause- rupture of portal vein into biliary system

C. MR Angiography is the IOC
165. Drug of choice for prophylaxis of MDP:

A. Lithium
B. Carbamazepine
C. Fluoxetine
D. Clozapine
166. Drug of choice in rapid cyclers:
A. Carbamazepine
B. Valproate
C. Phenytoin
D. Lithium
167. Which is the following is not an impulse control
disorder?
A. Kleptomania
B. Pyromania
C. Erotomania
D. Trichotillomania
168. Tactile hallucinations is seen in:
A. Cocaine
B. Alcohol
C. Cannabis
D. Organophosphates
169. Magnus symptoms are seen with:
A. Opium
B. Cocaine
C. Cannabis
D. Heroine
170. Which of the following is Somatoform disorder?
A. Hypochondriasis
B. Depersonalization
C. Dissociataive disorder D. Delirium
171. Not a boundary of gastrinoma triangle:
A. Junction of 2nd and 3rd part of duodenum
B. Junction of 3rd and 4th part of duodenum
C. Junction of head with body of pancreas
D. Junction of cystic duct with common bile duct
172. Most common stones in ulcerative colitis:
A. Oxalate
B. Cysteine
C. Uric acid
D. Phosphate
173. What is true about Branchial cyst?
A. Present in anterior triangle of neck
B. Cauterization is done
C. Arises from 2nd cleft
D. Present in lower 3rd of neck
174. Best conduit for esophageal reconstruction:
A. Colon
B. Stomach
C. Appendix
D. Ileum
175. True about medullary carcinoma thyroid:
A. Good prognosis
B. Associated with MEN 1
C. Increased calcitonin is not associated with hypocalcemia
D. Treated by near total Thyroidectomy
176. Which of the following is not true?
A. Spleen is most commonly injured in the blunt trauma
B. Small Intestine is most commonly injured in penetrating
trauma
C. Thoracic duct injury needs urgent thoracotomy
D. Conservative treatment is preferred for solid organ injury.
177. True about cystic hygroma:
A. Present in anterior triangle of neck
B. Sclerosing agents are not useful
C. Pre operative MRI is crucial
D. Surgery is always indicataed
178. True regarding hemobila:
A. Triad of jaundice, pain, malena
179. Myocutaneous flap includes which tissues:

A. Muscle only
B. Muscle and vascular pedicle
C. Muscle and Skin
D. Skin, Muscle and vascular pedicle
180. Reddish swelling in the region of foramen caecum:
A. Lingual thyroid
B. Lingual tonsil
C. Ranula
D. Thyroglossal cyst
181. Asymptomatic hemangioma on ventral surface of the
tongue in 10 years old boy is treated by:
A. Watchful expectancy
B. Surgical Excision
C. Radiotherapy
D. Laser
182. True about superior sulcus tumor:
A. Anhidrosis in thoracic region
B. Pain in upper aspect of arm
C. Flexor atrophy
D. 2nd and 3rd rib erosion.
183. True about chylothorax:
A. Left side more common
B. Clear fluid
C. Immediate thoracotomy should be done
D. TOC is excision and iigation of thoracic duct
184. Peau- de-orange appearance is due to involvement of:
A. Subdermal Lymphatics
B. Ligament of cooper
C. Chest wall invasion
D. Pectoralis muscle
185. Which is used in CA Breast?
A. Daunorubicin
B. Doxorubicin
C. Cisplatin
D. Actionmycin D
186. Swiss cheese pattern is seen in:
A. Warthin's tumor
B. Adenoid cystic carcinoma
C. Pleomorphic adenoma
D. Mucoepidermoid carcinoma
187. Cylindroma is:
A. Appendage tumor
B. Acinic cell Carcinoma
C. Pleomorphic adenoma
D. Warthin's tumour
188. Which of the following is false about salivary
gland tumors?
A. Pleomorphic adenoma is MC tumor of parotid
B. Adenoid cystic carcinoma MC occurs in minor
salivary glands
C. Warthin's tumor is MC malignant tumor of salivary glands
D. Perineural invasion is seen is adenoid cystic carcinoma
189. Umbilical cord has:
A. 1 vein and 2 arteries
B. 2 veins and 2 arteries
C. 1 vein and 1 artery

D. 2 veins and 1 artery
190. Drug of choice for PCOD:

A. Metformin
B. Surgery
C. OCPs
D. Estrogen only
191. Side effects of OCPs are all except:
A. Irregular bleeding
B. Headache
C. Thrombosis
D. Ovarian cancer
192. Most common cause of hirsutism in females is:
A. PCOD
B. CAH
C. Adrenal tumor
D. Ovarian tumor
193. What doesn't contribute to active management of
third stage of labour?
A. Uterine massage
B. Early cord clamping
C. Controlled cord traction
D. Oxytocin
194. Which of the following cancer can't be staged only on
the imaging findings and need clinical parameters?
A. Ovarian
B. Cervical
C. Uterine
D. Vulva
195. Ampullary ectopic pregnancy stays till:
A. 2-4 weeks
B. 4-6 weeks
C. 6-8 weeks
D. 8-12 weeks
196. Absolute C/l of epidural anaesthesia in LSCS:
A. Placenta Previa
B. Aortic Stenosis
C. Previous spinal surgery
D. Poor left ventricular function
197. Germ cell tumor is:
A. Serous cystadenoma
B. Mucinous cystadenoma
C. Teratoma
D. Sertoli cell tumor
A. Anterior rotation followed by normal delivery

B. Deep Transverse Arrest
C. Persistent occipitoposterior position
D. Oblique posterior position
205. Treatment for stage 3b CA Cervix:
A. Radiotherapy
B. Chemotherapy
C. Surgery
D. Extended hysterectomy f/b RT
206. Not used to monitor progress of labour:
A. Uterine contraction
B. Station of descent
C. FHR
D. Cervical dilatation
207. MC cause of first trimester abortion:
A. Chromosomal anomaly
B. Cervical incompetence
C. Uterine anomaly
D. Infections
208. Anterior fontenalle closes by:
A. 2-3 years
B. 14-18 months
C. 3-6 months
D. 9-12 months
209. Congestive cardiac failure is not seen in:
A. VSD
B. ASD
C. PDA
D. TOF
210. At what age does the social smile appear earliest?
A. 8 weeks
B. 6 weeks
C. 12 weeks
D. 16 weeks
211. True about healthy breast fed neonate:
A. Watery stool with yellow pellets
B. Soft well formed stools
C. Hard Stools
D. Loose watery stool
198. Radio Therapy is the treatment of choice in all stages

of tumor:
A. Ca cervix
B. Ca Vulva
C. Ca ovary
D. Ca endometrium
212. Baby doubles its weight in:

A. 3 months
B. 5 months
C. 6 months
D. 1 year
199. MC cause of secondary PPH is:

A. Atonic uterus
B. Retained placenta
C. Iatrogenic injury
D. Medical diseases
213. Fat embolism is most commonly associated with:

A. Fracture ulna
B. Fracture radius
C. Fracture femur
D. Fracture tibia
200. Organism causing bacterial vaginosis which contain

meta chromatic granules is:
A. G. Vaginalis
B. C. diphtheriae
C. T. vaginalis
D. Chlamydia
214. Vertical striations in vertebrae is seen in:

A. Hemangioma
B. Paget's disease
C. Eosinophilic granuloma
D. Osteoid osteoma
201. Indication for stopping expectant treatment in

placenta praevia is all except
A. Fetal death
B. Onset of labour
C. Pre-maturity
D. Bleeding into the genital tract
202. Synthesis of hCG is by:
A. Syncytiotrophoblast
C. Corpus luteum
B. Cytotrophoblast
D. Ovary
203. Monitoring of MgS04 in eclampsia is done by all

except
A. RR
B. HR
C. Urine output
D. Knee jerk
204. MC outcome of occipitoposterior position:
215. TRUE about vertebral haemangioma are all

EXCEPT
A. Usually asymptomatic
B. Usually associated with liver haemangioma and carcinoma
C. Hyperindence in T1 image in MRI
D. Usually found in 2-5% of population
216. Mallet finger is:
A. Avulsion fracture of distal phalanx.due to sudden flexion
B. Fracture of 1st metacarpal
C. Fracture of 5th metacarpal
D. Fracture middle phalanx
217. MC benign bone tumor:
A. Osteoid Osteoma
B. Osteochondroma
C. Chondroblastoma
D. Osteosarcoma
D. Either of, temporal lobe involvement

218. Monteggia fracture is:
A. Fracture distal end of radius with dislocation of inf.
radioulnar joint
B. Fracture distal end of ulna with dislocation of inf.
radioulnar joint
C. Fracture proximal end of radius with dislocation of sup.
radioulnar joint
D. Fracture proximal end of ulna with dislocation of sup.
radioulnar joint
219. Avascular necrosis is MC associated with:
A. Subcapital fracature
B. Transcervical fracture
C. Intertrochanteric fracture
220. Carpal tunnel syndrome is due to:
A. Entrapment of median nerve
B. Entrapment of ulnar nerve
C. Entrapment of anterior interosseus nerve
D. Entrapment of radial nerve
221. Bamboo spine is seen in:
A. Ankylosing spondylitis
B. Rheumatoid arthritis
C. Osteoarthritis
D. Psoriasis
231. Most serious complication in Primary

Hyperparathyroidism is
A. Hypercalcemic parathyroid ism crisis
B. Peptic ulcer
C. Nephrocalcinosis
D. Osteoporosis
232. All are features of oesophageal rupture EXCEPT

A. Pain
B. Fever
C. Bradycardia
D.Low B.P.
233. Medical treatment of gall stone is NOT useful
A. Cholestrol stone
B. Pigmented stone
C. Size of stone less than 10 mm
D. Functioning of gall bladder
234. Major complication seen in peripheral venous
access
A. Venous thrombophelibitis
B. Migratory thrombophelibitis
C. Pulmonary embolism
D. Thrombosis
222. Perthes disease is:

A. Osteochondritis of vertebral body
B. Osteochondritis of femoral head
C. Osteochondritis of tibial tuberosity
D. Osteochondritis of calcaneum
235. Left atrial hypertrophy is seen in

A. MS
B. MR
C. AS
D. AR
236. Treatment of hypercalcemia is A/E
A. Thiazide
B. Steroid
C. Bisphosphonates
D. Calcitriol
223. Spina ventosa is:

A. Tenosynovitis of flexor tendon
B. Potts spine
C. Tubercular dactylitis
D. Syphilitic dactylitis
237. Lung carcinoma with worst prognosis is

A. Epidermoid
B. Small cell CA
C. Adenocarcinoma
D. Large cell CA
224. MC dislocation of hip joint is:

A. Anterior
B. Posterior
C. Central
D. Lateral
225. Best test for injuries of anterior cruciate ligament is:
A. Anterior drawer test
B. Posterior Drawer test
C. Lachman's test
D. Mc Murray's test
226. Ortolani's test is for:
A. CDH
B. Femoral neck fracture
C. Slipped capital femoral epiphysis
D. Intertrochanteric fracture
227. Cock up splint is used for:
A. Median nerve injury
C. Ulnar nerve injury
230. Prophylaxis of MI, by

A. Alpha blocker
B. NSAID
C. Prostacyclin
D. ACE-inhibitors
B. Radial nerve injury

D. Axillary nerve injury
238. Superficial cardiac dullness corresponds to

A. Right parasternal area
B. Left lower sternum
C. Right upper para ster num
239. True about Gaucher's disease are A/E
A. Glucocerebrosidase deficiency
B. No neurologic symptoms in adult form
C. Angiokeratomas
D. Autosomal dominant inheritance
240. TRUE in Kawasaki's disease are A/E
A. Fever
B. Occurs above 5 yrs age groups
C. Coronary artery aneurysm
D. Generally benign and self limited
228. Blood borne disease are A/E

A. Hepatitis B
B. Hepatitis C
C. Hepatitis D
D. Hepatitis E
229. Korasakoffs psychosis is due to involvement of
A. Nondominant cerebral hemisphere
B. Dominant hemisphere
C. Both
1. Ans: (C)
Pin Index system
This is safety mechanism so that one cylinder cannot be fitted
at other's position. The pins are so positioned that one
cylinder with corresponding hole can only be fitted. Some
imp. Pin index.
Oxygen 2,5
Nitrous Oxide3,5
Cyclopropane3,6
Air1,5
Nitrogen1,4
Entonox (50% 02 + 50% nitrous oxide) 7
Carbon dioxide (>7.5%)2,6
Carbondioxide (7.5%>1,6
2. Ans: (B)
Halothane is a potent anaesthetic but poor analgesic.
Remember
Maximum AnalgesicTrilene
Profound AnalgesicKetamine
Only AnalgesicN20
AnalgesicHalothane
Remember
Post spina! headache starts in 1st 3 days and last for
1-2 weeks. Most painful on IV injection -propofal
Gag reflex is through - 9th cranial nerve.
Atracurium is metabolized by Hoffmann
degradation.
Suxamethonium is metabolized in plasma by
pseudocholine esterase.
Suxamethonium increase intra cranial pressure &
intra ocular tension.
3. Ans: (D)
Commonly used IV induction
Thiopentone Propafol Ketamine Etomidate Midazolum Althesin - Methohexirone Some important
points ' IV Anaesthesia of choice in day care surgery
is - -propofol
Sodium Thiopentone is ultra short acting due to
rapid redistribution
Dissociative anaesthesia is seen in Ketamine
Post spinal headache is due toCSF Leak
Cone, of lidocaine used in spinal anaesthesia^ 5%
Lignocaine use in different concentration:
5% Spinal anaesthesia
4% Topically in eye
0.5% Epidural anesthesia
4. Ans: (B)
The LA is injected in the sub arachnoid space
betweera L2-L3 or L3-L4.
Spinal cord extends from medullk oblongata to
lower border of L, in adult.
Spinal; cord extends from medulla oblongata to
lower border of L3 in infant & neonate., (adult
level achieved at 2 years of age)
In infancy spinal; anesthesia given at L4-L5.
Level
In adult spinal araesthesia given at L3-L4 OR

L4rL5 space, (even at L2~L3)
In. adult usually spinal anesthesia given at l3-l4
level
Remember slruclmcs encountered during spinal
anesthesia
t-skin, 2-subcutaneous tissue, 3-supraspinous
ligament, 4-lnterspinous ligament, 5-ltgament flavum,
6-dura, 7-arachnoid.
5. Ans: (A)
Remember
Laughing gasNitrous oxide, name given by
Humphry dary.
Vomiting gas Chloropicrin.
Tear gasAceton, benzene bromide & xylol
- Suffocating gaschlorine, phosgen,
oxychlorocarban.
Sneezing gasdiphenylchlorasine.
Noble gashelium, neon, argon, krypton, xenon,
radon.
6. Ans: (D)
The median nerve is compressed in the carpel tunnel
syndrome
The ulnar nerve is compressed in the cubital tunnel
syndrome
The tibial nerve is compressed in the tarsal tunnel
syndrome
The causc of "Carpel tunnel syndrome" Mnemonics
*GRAMPIT* G Gout
R Rheumatoid arthritis A Acromegaly M
Myxoedema P Pregnancy I Idiopathic T
Trauma
Diagnosed by: Electromyography and nerve
conduction studies.
7. Ans: (B)
Ankylosis is 2 types:
1. Fibrous ankyIosis~Healing by fibrosis, limitation
or near complete loss of joint movement is known as
fibrous ankylosis.
2. Bony ankylosis > Destruction of articular
cartilage has occurs at the joint space is completely lost
and traversed by bony trabecular between the bones
forming the joint.
Fibrous ankylosis is the outcome of healed tuberculosis
except in spine where bony ankylosis occurs.
8. Ans: (C)
Rheumatoid arthritis: Metacarpophalangeal (MCP) Joint
especially of index linger, proximal interphalangeal joint,
wrist, elbow, knee, ankle. Distal interphalangeal is not
involved characteristically.
Osteoarthritis: Joint involved Proximal interphalangeal. Distal
interphalangeal, base of thumb
Sparing of wrist and metacarpophalangeal joint. Psoriasis:
Joint
involved
Proximal
interphalangeal.
Distal
interphalangeal wrist. Metacarpophalangeal joint.
9. Ans: (C)
Hil Sach's lesion and Bankarfs lesion causes recurrent
dislocation of shoulder
In previous year they asked about the Luxation Inferior
dislocation.
Most common Type of Shoulder dislocation anterior
dislocation of shoulder (sub-coracoid type) dislocation.
Surgeries for Recurrent dislocation of shoulder:
Bankart's operation
Puti platt's operation
Bristow's operation.
10. Ans: (B)
Most common nerve involved in:
Anterior dislocation of shoulder-Axillary nerve
#Surgical neck of Humems-Axillary nerve
# Shaft of Humerus-Radial nerve
#Supracondylar HumerusMedian nerve
Volkman's ischemic contracture-Median nerve
Dislocation of lunate-Median nerve.
11. Ans: (A)
Tinel's Sign:
On gently taping over the course of the nerve from
distal to proximal, a sensation of current or
hyperesthesia is felt in skin which supplied by the
involved nerve.
Tinel's sign and motor examination is the sign of
regeneration.
Motor Examination:
The muscle supplied nearest to the site of injury is 1 st to
recover. It is also known as MOTOR MARCH
Types of nerve injury:
Neuropraxia "it is the compression of any nerve, in which
physiological function is lost but anatomical nerve is
intact"
Axonotemesis "in which some of the axon are injured, but
nerve is intact".
Neurotemesis "in which the nerve is not intact, here nerve
is totally injured. So regeneration of the nerve is very
poor".
Neuroma: if any muscle tissue or any fibrous is takes place in
between the proximal and distal stamp of nerve injury site,
then Axonal sprouting from proximal stamp unable to go
distal stamp. So also sprouted axons will make formation of
neuroma, which is also known as Traumatic Neuroma.
Tinel's sign is +ve because of neuroma formation.
12. Ans: (A)
Remember
Least Radiosensitive Tissue of body nervous
tissue
Least Radio sensitive blood cellPlatelet
Most radio sensitive blood cellLymphocyte
Most radio resistant organVagina
Most common organ to be affected by radiation
Skin
13. Ans: (A)
Single bubble appearance is seen inPyloric stenosis.

Double bubble appearance is seen in Duodenal Artcsia,
Annular pancreas. Triple Bubble appearance is seen in
Jejunal Artesia
Multiple air fluid levels arc seen inIntestinal
obstruction.
Gas under diaphragm seen in Pneumoperitoneum
14. Ans: (D)
Brachytheraphy: Type of radiation in which radioactive
sources are placed in dose proximity to or directly into
tumors. Intestial
RT Needles Placed into Prostate/penis/other soft tissue.)
Intracavitary
eg. In urethra (m/c used csl37) M/C used source in
Brachytherapy - Irl 90. C.S.I. REMEMBER, some
commonly asked half life of ISOTOPES
Radium 2261620 years
Caesium- 13730 years
Cobalt 60 ------- 5.3 years
Iridium 19274.4years
Iodine 125 ------- 60 days
Phosphorus3214.3 days
Gold 1982.7 days
15. Ans: (A)
Please remember: Target is not Tungsten in mammography,
its made up off molybdenum.
16. Ans: (A)
All spinal imaging is done by MRI
MRI is safe in pregnancy Unit of MRI
is TESLA.
17. Ans: (B)
Undo radiological control the ampula of vater is cannulated
and the common bile duct or pancreatic duct can be entered
.Contrast medium can then be injected and the biliary or
pancreatic duct can be shown. It is method of choice for the
investigation of obstructive jaundice. It is also of great value
in the investigation of pancreatic disease.
18. Ans: (A)
Fluoxetine is devoid of anticholinergic, hypotensive and
sedative side effects, so safer with cardiac disease and BPH.
19. Ans: (D)
Other important Points
DOC for Attention Deficit Hyperactive Disorder
Methyl phenidate
DOC for delirium tremensdiazepam
Resistant case of schizophreniaclozapine
DOC for Gillesla Tourette's syndrome
Haloporidol
TOC for depression with suicidal tendency ECT
(electro convulsive therapy)
DOC for treatment of manic episode is Lithium
DOC in Nocturnal EnuresisImipramine
DOC in Rapid cycling bipolar disorderNaval
proate
20. Ans: (B)

Dose of Lithium should be remembered
Therapeutic level dose - 0.8-1.2 mEq/1for
Rx. of acute mania.
Prophylactic level -0.6-1.2 mEq/ for Rx. of
relapse prevention in bipolar disorder.
- Toxic level - >2 mEq/1
Life threatening intoxication3.5mEq/1
21. Ans: (B)
Remember these definitions they are important
IllusionIs misinterpretation of stimuli arising
from external object
Delusion -Is a false unshakable belief, which is
not amenable to reasoning and is in keeping the
patient with socio-cultural and educationa
background.
In shortfalse but firm belief.
DeliriumIs an acute confusion state
characterized by alteration in consciousness
orientation and perception.
22. Ans: (D)
- Tazarotene-vitamin-A agonist (retinoid) has also
come into clinical use recently. It tends not to induce
clearance and may cause irritation.
- Calcipotriol-It is a vit.D agonist. It tends to reduce
the thickness of the plaque and diminish the scaring.
Acne vulgaris use of retinoid -DAVIDSON 19th Ed.
Page No. 1082.
Studies of use of topical andsystemic retinoid in Acne
vulgaris have shown that:
1. Adapalene is more rapid in onset andbetter
tolerated than tretnoin in mild to moderate
acne.
2. Oral isotretnoin is clinically better and more cost
effective in moderate and severe acne. So adapaleneretinoid drug used in acne not in psoriasis.
23. Ans: (A)
The essential feature of Zinc deficiency.
1. A distinctive rash most often around the eyes, nose,
mouth, anus and distal parts called Acrodermatitis
Enteropathica.
2. Growth retardation in children.
3. Impaired wound healing
4. Hypogonadism with diminished reproductive
capacity.
5. Anorexia often accompanied by diarrhoea
6. Depressed mental function.
Other important disease
Selenium deficiency causes Keshan disease.
Copper deficiency causes Menke's disease.
24. Ans: (D)
Isomorphism or Koebner phenomenon-It means linear lesions
produced by scratching a primary lesion which results in new
lesions developing along the line of the scratch. Eg: Lichen
planus,vvarts and psoriasis. But koebner phenomenon is

characteristic for Lichen planus.
25. Ans: (B)
Piebaldism is a Autosomal dominant disease characterised by
patches of skin that lack melanin as a result of defect in
migration of melanoblasts from neural crest to skin.
Skin biopsy: Hypomelanotic area-few to no melanocytes.
Vitiligo: is an acquired disease and similar patch of loss of
melanin, but the loss develops after birth and progressive.
Albinism: Congenital inability to synthesize melanin.
26. Ans: (A)
Lupus pernio is a skin manifestation of Sarcoidosis.
Sarcoidosis does not involve kidney.
Sarcoidosis mimics like Berylliosis.
27. Ans: (B)
A combination of two nucleoside reverse transcriptase
inhibitor plus a protease inhibitors for 4 weeks.
Zidovudine + Lamivudine + Indinavir for 4 weeks.
28. Ans: (A)
Dressler's syndrome is a post myocardial infarction syndrome
is characterized by (3P) Pyrexia, Pancreatitis and Pleurisy
and is probably due to autoimmunity. The syndrome tends to
occur a few weeks or even months after the infarct and
subsides after a few days. Prolonged or severe symptom may
require treatment with high dose Aspirin, a non steroidal anti
inflammatory drug or even corticosteroid.
29. Ans: (D)
Anion gap is increased in:
Mnemonics "KUSSMAUL"
K-Ketosis with Diabetes, Alcoholism, malnutrition
U-Uraemia
SS-Salicylate Poisoning M-Methanol Poisoning UUraemia L-Lactic Acidosis
Normal Anion gap is seen in --> Diarrhoea and Renal
Tubular Acidosis Normal Anion gap in health range
from 8 to 14 mmol/ltr.
30. Ans: (C)
Remember these points by Heart: Intracerebral
(Parenchymatous Hemorrhage)
Most common type of Intra cranial Hemorrhage.
Most common cause is Hypertension causing
rapture of small of small perforating arteries or
Arterioles.
Most common site is putamen.
Subarachnoid Hemorrhage
Most common cause is spontaneous rupture of
saccular Aneurysm i.e. Berry Aneurysm.
Most common site of berry aneurysm is anterior
circulation of Willis.
31. Ans: (A)
Some important points on Mitral stenosis
S1Acccntuatcd (S1 is soft in calcified heart valve)
S2Normally split S2 with P2 component

accentuated
MurmurLow pitched rumbling, diastolic
murmur heard best at the apex in left lateral
recumbent position.
Opening snapBrief high pitched, early diastolic
sound. It is best heard at the lower left sternal border.
32. Ans: (B)
Diagnosis of this patient is suggested by:
Evidence of fibrosis of skin
Evidence of visceral involvement
Epidemiological characteristic
Tightness of lingers
Oesophageal motility or Dysphagia
Peak incidence of scleroderma is seen in women
during the 3rd to 5th decade.
33. Ans: (A)
Important point about Ankylosis spondylitis
It is associated with HLA B-27 Sacroileitis:
Histologically it is a chronic Synovitis causes
destruction of articular cartilage and bony
ankylosis especially in the sacroiliac joint.
The onset is usually insidious with recurrent
episodes of low back pain and stiffness sometimes
radiating
to
the
buttocks
or
thighs.
Characteristically the symptoms are worse in the
early morning and after inactivity.
Some characteristic features of ankylosing
spondylitis.
- Bamboospine
- Squaring of vertebrae
- Calcification of IV Disease.
- Enthesopathy.
Remember Osteoarthritis
Involvement of PIP, DIP and Is'carpometacarpal joint (base of
thumb), sparing of MCP and Wrist.
Rheumatoid Arthritis
Involvement of any small joints of hand i.e.PIP, MCP, Wrist,
Sparing of DIP.
Psoriatic arthritis
Involvement of PIP. DIP. MCP and wrist Sparing of any joint
or may not be present.
34. Ans: (A)
Morphine is given in ^cute left ventricular failure:
Morphine affords dramatic relief by
Reducing preload on heart due to vasodilatation and
peripheral pooling of blood.
Tending to shift blood from Pulmonary to systemic
circuit relieves pulmonary congestion and edema.
Cut down sympathetic stimulation by calming the
patient reduces cardiac work.
Morphine is contraindicated in
ICT
Asthma
Respiratory Insufficiency, emphysema, Pulmonary
fibrosis, corpulmonale
_ Head Injury
Undiagnosed acute abdominal pain
Note: Treatment of choice in Inferior wall MI/right
ventricular infarction is IV fluids.
35. Ans: (A)
Ca +ve channel blocker does not cause Tetany.
Tetany:
Low ionized calcium concentrations cause
increased excitability of peripheral nerves.
Latent Tetany may be present when sign of rest
tetany are lacking. It is best recognized by eliciting
Trousseau's sign.
A less specific sign of hypocalcaemia is that
described by Chvostek in which tapping on the
branches of the facial nerve as they emerge from the
parotid gland produces twitching of the facial muscles.
36. Ans: (A)
Aphasia is a manifestation of dominant parietal lobe
involvement. Dominant hemisphere in right handed persons is
left hemisphere and thus a right middle cerebral artery infarct
indicates non dominant parietal lobe involvement. Aphasia
will not be a manifestation because an infarction in middle
cerebral artery distribution on the right side will affect the non
dominant parietal lobe. (Left parietal lobe). - Clinical
manifestation of the middle cerebral Artery involvement:
Contralateral hemiplegia: Motor cortex
involvement
Contralateral hemianaesthesia: Sensory cortex
Involvement
Homonymous hemianopia: Optic radiation
Involvement
37. Ans: (D)
ASTEREX1S: Is the flapping tremor seen in metabolic
disturbances is as the result of intermittent failure of the
parietal mechanism which maintains posture. There is sudden
periods of cessation of muscle contraction best seen when the
patient arms are extended in front.
Causes of Asterexis
Renal/liver failure
Hypercapnia
Drug toxicity
Acute focal parietal or thalamic lesions.
38. Ans: (A)

There is Alkalosis (PH - 7.5) and Co2 is low (Alkalosis)
change in Co2 with change in PH and thus the primary cause
is Respiratory. The acid base disturbance is thus primary
respiratory Alkalosis.
39. Ans: (A)

Pan-coast tumor occurs in Association with Lung
cancer (Epidermoid or squamous cell carcinoma)
The tumor is usually located in the apex of lung,
grows locally to involve the brachial plexus.
Usually there is involvement of 8th cervical, 1st and
2nd thoracic nerves. This causes shoulder pain that

radiates in the ulnar distribution of the arm.
It also causes Horner's syndrome:
- Unilateral ptosis
- Miosis
- Ispilateral Anhydrosis
Remember
. Most common variety of Lung ca in India
Squamous cell carcinoma / Most common variety
in worldAdeno
carcinoma
I listological variety that cavitatesSquamous cell
carcinoma
Most common site for metastasis from ca lungliver, Variety most responsive to chemotherapy
Small cell carcinoma Variety with best prognosis
Squamous cell carcinoma
Most common variety with cushing syndrome Small cell
carcinoma / Most common endocrinal gland to be involved by
metastasis Adrenal carcinoma Ca which metastasize to
opposite lungAdeno carcinoma
Most common endocrinal gland to be involved by metastasis
Adrenal gland Remember:
Most common secondaries metastasize to Lymph node and
after that is liver.
40. Ans: (D)
HIV Encephalopathy also called HIV - Associated
dementia or AIDS dementia.
This is generally a late complication of HIV
infection, it can be seen patients with CD4 count
>350 cells.
HIV encephalopathy is a sub-cortical dementia while
. Alzheimer's is a cortical dementia
Alzheimer's disease is the most common cause of
dementia in elderly.
Most important risk factor for Alzheimer'^ disease is
age.
41. Ans: (B)
Some important risk factors for Atherosclerosis:
Fixed
Family history
Age
Sex (male) Modifiable
Smoking
Haemostatic variables
Hypertension
Sedentary life styles
Lipid disorders
Obesity
DM
Diet
Atherosclerotic vascular disease may manifest as coronary
heart disease, cerebrovascular disease or peripheral vascular
disease. Occult coronary artery disease is common in those
who present with other forms of atherosclerotic vascular
disease. So risk factors for atherosclerosis is also are the risk
factors for CAD.
42. Ans: (A)

Remember some important points.
Silicosiscurrently the most prevalent chronic
occupational disease in the world
Silicosis is associated with an increased
susceptibility to Tuberculosis. The radio logical
featureEGG SHELL calcification in the hilar
lymphnodes.
Berylliosis cause an interstitial granulomatous
disease similar to Sarcoidosis.
The most dangerous particles to cause
Pneumoconiosis from 1 to 5 micrometer in
diameter because they may reach in the terminal
small airways, air sacs and settle in their lining.
Cotton dust is associated with Byssinosis.
Sugarcane dust is associated with Bagassois
43. Ans: (C)
Mixed connective tissue diseases (MCTD) are sometimes
used to describe the disease seen in a group of patient who are
identified clinically by the coexistence of features suggestive
of SLE. Polymyositis, Rheumatoid arthritis and systemic
sclerosis and serologically by high titres of antibodies to RNP
Particle containing UI RNP. Two factors are important in
lending distinctiveness to MCTD are:
The paucity of renal disease.
Extremely good response to corticosteroid. Some
important points about connective tissue disorder:
Antinuclear antibodies in autoimmune disease.
Anti double stranded DNA-S (more specific
than anti SM antibody).
Anti Histone Antibodies-Z)rz/g induced lupus
erythrocytosis
Anti sm antibody> SLE
Anti DNA topoisornerasc antibody
sclerosis
Antibodies
of
Ribonucleoprotein
Antigen
containing ULRNP> Mixed connective tissue
disorder.
Antimitochondrial antibody>Primary biliary
cirrhosis.
44. Ans: (D)
Micro-angiopathic Hemolytic anemia occurs when red
blood cells are forccd to squeeze through abnormally
narrowed small vessels. Narrowing is most often
caused by fibrin deposition in association with DIC.
Other causes of micro-angiopathic hemolytic anemia
are:
Malignant hypertension
SLE
Thrombotic Thrombocytopenic purpura.
HUS
Disseminated cancer.
The common feature among all these disorders is a Micro
vascular Lesion that cause mechanical injury to circulating
Red blood cells. In blood smear in the form of red cell
fragments (schisocytes) burr cells, helmet cells and triangle
cells are seen. Some important Point:
Most common cause of Anemia in world is Iron

deficient Anemia.
Most sensitive and specific test for diagnosis of from
deficiency is serum ferritin levels.
Hyper segmented neutrophilis are a feature of
megaloblastic anemia and not iron deficient anemia.
Cause of microcytic hypochromic anemia Mnemonics:
Tiny CLIPS ' Iron deficient Anemia
Thaiassaemia
Sideroblastic anemia,
Lead poisoning
Anemia of chronic disease.
Pyridoxin deficit anemia.
45. Ans: (A)
A wave: Arc positive waves due to distention produced by
right atrial contraction Large a waves: Indicate atrium is
contracting against increased resistance tricuspid stenosis,
pulmonary stenosis, pulmonary hypertension. Cannon S
waves
Regularly: During junctional rhythm.
Irregularly: complete Heart Block.
Absent a waves: Atrial Fibrillation
46. Ans: (A)
Primary Biliary cirrhosis is a disease characterized by chronic
inflammation and fibrous obliteration of intrahepatic bile
duclioles due to an unknown (primary) stimulus. Etiology
PBC is believed to due to an autoimmune etiology as it is
often associated with other auto immune disorders such as
CRCST
syndrome:
Calcinosis,
Raynaud's
phenomena, Esophageal dysmotility, Sclerodactily. Telangiectasia
Sicca syndrome
Autoimmune thyroiditis
Renal tubular acidosis
Anti mitochondrial antibody (IgG is positive) Clinical
feature
Most patients arc asymptomatic.
Pruritis is commonest/earliest symptom
Jaundice
Deficiency of fat soluble vitamin due to
malabsorption leads to:
Vit D deficiency Bone painOsteomyelitis
Vit K deficiency- bleeding bruising
Vit A deficiency~Night Blindness IXanthelisma and
Xanthomas arc due to elevation of serum lipids. Lab
finding
Increased Serum alkaline phosphates. Positive
mitochondrial antibody sensitive and specific.
It occurs in advanced cirrhosis at most always and

ascites
Absence of proteinuria or abnormal urinary
sediment.
Urine sodium excretion below lOmmol/day.
Serum Na t- concentration < 130 m Eq/L?
Urinary osmolality greater than
plasma osmolality.
Urine volume < 500 ml/day.
48. Ans: (B)

RSV virus is m/c cause of bronchiolitis in Infants. DocRibavirin. Epiglottis is most commonly caused by H.
Influenzae.
Some Important points:
Encephalitis> is the Inflammation of the brain parenchyma
Meningitises an acute purulent infection with in the
subarachnoid space. The meninges, the subarachnoid space
and brain parenchyma are all frequently involved in the
inflammatory reaction with meningoencephalitis. The most
common cause of sporadic viral encephalitis HSV -I
The most common cause of Epidemic viral
encephalitis- Arbovirus
Japanese encephalitis virus is an arbovirus is one of
the most common causes of encephalitis outbreak.
The most common cause of viral meningitis is ->
Enterovirus
49. Ans: (A)
Habitat: Adult worm lives in small intestine (ileum or
jejunum) of man D. Latum is the longest tapeworm found in
man. Life cycle:
The worm passes its life cycle in one definitive host and Two
intermediate host. Definitive host: Man is the main definitive
host Intermediate host:
First intermediate host: Small copepods mainly of genra
Diaptomus and Cyclops Second intermediate host: Freshwater
Fishes. Humans become infected when they eat undercooked
raw or lightly salted meat or roe from infected freshwater
fishes.
Pathogenicity:
Most human infections arc caused by only one tape worm and
cause no or very vague ill effects.
Patient may develop fatigue, weakness, diarrhea and
numbness of extremities. Some Patient develops
mechanical obstruction. In few cases pernicious anemia
may develop due to B12 deficiency. D. Latum has been
shown to absorb as much as 80-100% of a single oral
dose of vit- B12 thereby competing with the host for
this important vitamin. Treatment of choice:
47. Ans: (D)

Renal failure consequent on liver failure can occur in
cirrhosis. The kidney's they are intrinsically normal
and renal failure is thought to result from altered
systemic blood flow including diminished renal blood
flow:
Niclosamide and praziquantel Important:

Vit B12 Absorb in the ILEUM.
Iron is absorbed in the Duodenum.
50. Ans: (A)
Most Important Point:

Patient with Hyperparathyroidism are asymptomatic.
Manifestation of Hyperparathyroidism involve primarily
the kidney and skeletal system.
Kidney involvement due to deposition of calcium in renal

parenchyma or to recurrent Nephrolithiasis.
Renal stones are usually composed of either calcium

oxalate with calcium phosphate.
Nephrocalcinosis may also cause decreased renal

function and phosphate retention.
Another Important Question
51. Ans: (B)
The most common presentation in a patient with Primary
hyperparathyroidism is asymptomatic hypercalcamia.
52. Ans: (C)
Other Important Point:
The most effective T/T of atrial flutter is D.C.
cardioversion.
Drug of choice in PSVT with adenosine.
Agent of second choice in PSVT is Beta Blockers.
Carotid massage is useful in PSVT and AV Nodal
Recurrent tachycardia.
53. Ans: (D)
Mild zinc deficiency has been described in many diseases
including diabetes mellitus. AIDS, Cirrhosis, Alcoholism,
Inflammatory bowel. Disease malabsorption syndrome and
sickle cell anemia.
T.B. is not mentioned in Harrison.
54. Ans: (A)
Hypovolumic shock:
This is most common form of shock results either from the
loss of red blood cells more and plasma from hemorrhage.
Classification of Shock
a. Hypovolumic shock
Loss of bloodHemorrhagic shock
Loss of plasma as in burns shock
Loss of fluiddehydration as in gastroenteritis.
b. Septic shock
M/c common due to gram -ve organism.
c. Cardiogenic shock
Due to pump failure as in myocardial infection,
pericardial effusion, pulmonary embolism.
d. Neurogenic shock
e. Anaphylactic shock
M/c due to penicillin drugs, toxin etc
55. Ans: (B)
Recurrent pulmonary thromboembolism is the cause
of cor pulmonale. Cor pulmonale is frequently
called as pulmonary Hypertensive Heart disease
consists of right ventricular hypertrophy.
Cor pulmonale may be acute or chronic
Acute cor pulmonale can follow massive pulmonary
embolism.
Chronic cor pulmonale usually implies right

ventricular hypertrophy and dilation secondary to
prolonged pressure overload caused by obstruction
of pulmonary arteries and arterioles.
There is long list of disorders predisposing for cor
pulmonale. But remember some important
conditions.
Disease of the pulmonary parenchyma.
COPD
Cystic fibrosis
Bronchiectasis
Disorders of the pulmonary vessels.
Recurrent pulmonary thromboembolism
Primary pulmonary hypertension.
Extensive pulmonary arteritis eg .
(Wegener's granulomatosis)
Drug: Toxin or radiation Induced
Vascular obstruction
Disorders affecting chest movement
Kyphoscoliosis
Marked obesity (pick wickian syndrome)
Neuromuscular disease.
56. Ans: (A)
Grave's disease consist of triad
1. Diffuse thyroid enlargement
2. Opthalmopathy
3. Pretibial myxoedema Thyrotoxicosis is a feature of
graves disease. Pretibial myxoedema is a misnomer. It
is not seen in myxoedema.
Antithyroid of choice in pregnancy is propylthiouracil.
57. Ans: (C)
Transudative effusion: Pleural fluid accumulates is a result
of increased hydrostatic pressure or decreased osmotic
pressure. Eg: Cardiac, liver and renal failure. Exudative
effusion: Due to increased microvascular permeability due to
disease of the pleural surface itself or injury.
Eg: Tuberculosis, malignant disease, pulmonary infarction.
Rheumatoid Disease. SLE. Acute Pancreatitis.
58. Ans: (D)
Almost all the I lypercalcemic conditions leads to
nephrocalcinosis.
The Hypercalccmic conditions arc: Hyperparathyroidism
Multiple myeloma. Vitamin D intoxication
Metastatic bone diseases.
Milk alkali syndrome.
Malignancy (eg. Lung, Breast, renal)
Thyrotoxicosis
So the vitamin deficiency (Rickets) doesn't leads to
hypercalcemia, only vitamin D intoxication causes
hypercalcemia.
59. Ans: (D)
Hypotonia is also known as Flaceidity.
Hypotonia is usually associated with Hypo- reflexia. Muscle
weakness and wasting
Cause of hypotonia:
LMN Lesion.
Posterior column lesion ( Tabes dorsalis )
Myopathy
Down's syndrome ^ Rickets y Deep sleep
Hypokalemia or hyperkalaemia ' Hypertonia is of two
types: Plasticity (pyramidal lesion) Rigidity (extra
pyramidal lesion) Hypertonia is seen in:
UMN lesion (Claspknife spasticity)

Extrapyramidal lesion except chorea (lead pipe or
cogwheel rigidity) eg: Parkinsonism.
Tetanus
Strychnine poisoning
Tetany
Decerebrate rigidity.
60. Ans: (B)
The patient in this question is a case of Weil's syndrome
or Leptospirosis or Ictar haemor- rhagicus fever. Clue to
diagnosis are:
a. Sewer worker
b. Jaundice
Sewer worker: l.eptosporosis is transmitted to human being
through water contaminated with urine of carrier animals.
Leptosplrae from this water enters the body through cuts or
abrasions on skin or through intact mucosa of Mouth, Nose or
Conjunctiva.
Characteristic features of weil's syndrome are:
* Fever
* Jaundice
* Renal failure
Serological test MAT (Microscopic agglutination Test)
is used for diagnosis.
61. Ans: (D)
Clonic involvement with ulcerative colitis is characterized by
extensive broad based ulceration of the mucosa in the distal
colon and through its length. Pseudopolyps are created by
bulging upwards of isolated islands of regenerating mucosa.
Pseudopolyps are a feature of ulcerative colitis.
62. Ans (B)
1. ChylousTurbid creamy or milky peritoneal

fluid due to presence of lymph. It shows sudden
standing fat globules and contain a large amount of
triglyceride. Ether dissolves the turbidity of chylous
ascites.
2. Chyliform ascitesTurbid due to large number
of Leucocyte, Degenerated cells or Tumor cells.
Addition of alkali clears the turbidity.
3. Pseudochylous AscitesTurbid fluid due to
increased amount of Lecthin, Globulin and Calcium
phosphate in the ascitic fluid.
Causes of Chylous ascites:
Tuberculosis
Filariasis
Trauma to the abdomen
Intra abdominal malignancy
Nephrotic syndrome
Congenital abnormality in the lymphatics or

obstruction to the thoracic duct.
These are the differential diagnosis of the chylous ascites.
63. Ans: (A)
64. Ans (B)
The most feared complication of viral hepatitis is
fulminate hepatitis (Massive hepatic necrosis).
Fulminate hepatitis is primarily seen in hepatitis B and D;
As well as in hepatitis E.
Rare fulminate cases of hepatitis^A occur primarily in
older adults in person with chronic liver disease.
Fulminate hepatitis is seen rarely in hepatitis
Hepatitis E can be complicated by fetal fulminate hepatitis
in 1-2% of all cases and in up to 20% of cases occurring
in pregnant women.
Hepatitis B accounts for >50% of fulminate hepatitis
cases.
Patients with simultaneous acute hepatitis B and I) do not
necessarily experience higher mortality rate than do
patients with acute hepatitis B alone.
Conclusion Fulminate hepatitis - Because of Hepatitis
A, is primarily in older and adult patients. So from the
choice it excluded.
Fulminate hepatitis is rarely seen in Hepatitis C but it is
the most common cause of chronic viral Hepatitis. So this
is also excluded from the choice.
Fulminate hepatitis because of Hepatitis E is strongly
associated with pregnant lady but in question Hepatitis E is
not in choice.
Hepatitis B accounts for more than 50% is of Fulminate
hepatitis.
Patients with simultaneous acute hepatitis B and D do
not necessarily experience higher mortality rate than do
patients with acute hepatitis B alone, so Hepatitis D also
excluded.
65. Ans: (B)
Stangulated hernia:
Irreducibility, obstruction and arrest of blood supply to the
contents. Accompanicd with pain and vomiting, obviously
there is no cough impulse.
Obstructed hernia:
Irreducibility and intestinal obstruction, obstruction due to
occlusion of lumen of the bowel.
Incarcerated hernia:
Often used as an alternative to obstructed hernia, but to the
precise if indicates that a portion of colon is the content of sac
and is blocked with feaces.
Ricter's hernia:
The content of sac is a portion of the circumference of the
intestine.
Littre's hernia:
When the content is mickel's diverticulum.
66. Ans: (D)
Gall bladder carcinoma: The main route of spread are:

> Direct infiltration
> Lymphatic spread
> Vascular spread
> Intraductal spread
Direct infiltration is the most common first mode of
involvement, second through lymphaticus.
Most common type of Gallbladder carcinoma
Serous adenocarcinoma. Most common site - Fundus
of Gallbladder.
67. Ans: (B)
When the tuberculosis involves the urinary bladder, it results
in FIBROSIS. So, it become small contracted, ineffectively
functioning. Storage capacity is lost resulting in intractable
frequency with few drops of urine. There is bleeding and
painful micturition which cailcd STRANGURY. There is also
severe pain in supra pubic region which referred to tip of
penis. Such a bladder is called thimble bladder. Treatment of
thimble bladder is ileocysto- plasty.
Remember Golf hole ureter is seen in Tuberculosis of bladder.
Putty kidney caseous material present In kidney because
orTuberculosis of parenchyma kidney.
Cement kidney when calcification of putty kidney takes
place, it is known as cement kidney; which on X-ray appears
as calculi (Pseudo calculi).
Scistosomiasia of the bladder:
S. Haematobium - affecting mainly the
bladder
S.Japanicum - affecting mainly the liver
aric small intestine.
S.Mansoni - affecting mainly the large
intestine
S.Haematobium infection leads to
granule matous heamaturia and later
granulomas calcify and develop a sandy
appearance.
If calcification is severe and it takes
place through out the bladder wall, On Xray film it appears as fetal head in pelvis.
Scistosomiasis also leads to

contraction the bladder.
It is a risk factor for bladder carcinoma. It is a
squamous cell carcinoma but not the Transi tional
cell carcinoma.
68. Ans:(C)
Pott's spine (Pott's disease) - Tuberculosisof spine.
Pott's paraplegia - Tuberculosis of spine with
neurological involvement. M ' Pott's puffy tumour
- Osteomyelitis of skull.
# Pott's fracture*- BimaReolar anklejraclure.
#Cotton's fracture - Trimallelar ankle fracture.
69. Ans: (A)
Migrating thrombophlebitis is seen in:
Buerger's disease
Carcinoma of pancreas (Visceral cancer)
Polycythemia
Polyarthritis
Varicose vein, Intravenous infusion and Local

bacterial infection are the causes of superficial
thrombophlebitis.
Try to remember - Homan's sign and Moses sign are
seen in deep vein thrombosis.
70. Ans: (B)
Sister Joseph's nodule is secondary carcinoma of the
umbilicus. The primary neoplasm is often situated in the
stomach, colon and ovary, but metastasis from breast
transmitted along the lymphaticus.
Condylomata lata seen in secondary syphilis.
Try to remember this also:
Adenoma of" umbilicus is called as Rasberry tumour.
71. Ans: (C)
Branham's sign also known as Nicoladani's sign.
Pressure on the artery proximal to the Fistula causes the
swelling to diminish in size, the thrill and bruit to cease, the
pulse rate to fall is known as Branham's sign.
AV-Fistula - congenital - Acquired - Penetrating
wound or sharp blow.
AV-l'istula also created surgically for Renal dialysis.
Features:
Increase pulse rate, Increase cardiac output, Pulse
pressure.
Overgrowth limb (congenital fistula)
Indolent ulcer
Left ventricular enlargement.
72. Ans: (C)
A slight elevation on the trigone immediately posterior
to the urethral orifice - produced by median lobe of the
prostrate is called as uvula vesicae.
The lobe for the carcinoma most commonly appears on
posterior lobe.
BPH most commonly appears on medianj- lobe.
73. Ans: (B)
In pyogenic liver abscess can reach liver in many ways:
a. Along the bile duct (most common route),
b. Via the Portal vein,
c. Via the Hepatic artery,
d. Along the Umbilical vein,
e. By direct extension
Most common organism: Streptococcus1 millieri, E-Coli.
74. Ans: (B)
Metastasis to ipsilateral axillary node predicts outcome after
surgical treatment more precisely than any other prognostic
factor.
75. Ans: (C)
Most common cyst of pancreas: Pseudocyst.
complications of pseudocysTare:
1. Abscess
2. Rupture into peritoneal cavity
3. Haemorrhage
4. Obstuction of Castro intestinal tract
The
5. Pseudoaneurysm associated with pseudocyst

(Lethal complication).
76. Ans: (B)
Paget's disease associated with intra-duct carcinoma. the tumor
cells spreading on the nipple. Clinical feature
Red eczamatous like lesion which erodes the nipple
- Eczema usually bilateral, itchy, doesrTt^
destroy the nipple. Treatment: Simple Mastectomy.
77. Ans: (D)
Paralytic is a dynamic intestinal obstruction.
Important sign:
Distension of abdomen, absent bowel sound |
and failure to pass flatus.
Most common cause arc post operative]
paralytic ileus.
Treatment:
> Nasogastric suction,
> Intravenous fluid administration,
> Correction of Elecrolyte Imbalance (Hypokalemia),
> Parasympathomimetics are used (Neostigmine).
78. Ans: (B)
l lypocalcemia is the feature of acute pancreatitis.
Increased serum lipase is diagnostic of acute
pancreatitis moreover the duration ofhyperlipasemia often exceeds that of Flyperamylasemia.
The complaints of acute pancreatitis are:
1. Shock and Acute renal failure.
2. Hyperglycemia, Hypocalcemia, Hypoxia.
3. Pancreatic abscess, Pseudocyst and Obstructions.
79. Ans: (B)
Grey turner sign: Discolouration of.yeHowish brown due to
ecchymosis of extravasated blood in the loin in acute
haemorrhagic pancreatitis. Collen sign: Discoloration of
periumbilical region in acute hemorrhagic pancreatitis.
80. Ans: (A)
Zenker's diverticulum (also known as
pharvngoesophageal diverticula).
It is the most common esophageal diverticula.
Age: patient older than 60 years.
Site: Diverticulum characteristically arises within
the inferior pharyngeal constrictor between the oblique
fibres and horizontal fibres, (at killians triangle).
Zenker's diverticulum is a pulsion diverticulum.
Symptoms: Dysphagia (Particularly for solid foods)
Regurgitation of food. Halitosis, Voice change. Retro
sternal pain and Respiratory obstruction.
Most common complication of Zenker's diverticulum is Lung
abscess due to Aspiration.
81. Ans: (C)
Basal cell carcinoma is commonest form of in cancer. / Called
as
Rodent ulcer.
Arises from basal cell layer of epidermis.
It is locally invasive, it does not spreads through
Lymphatics or blood stream.
Most common site, Inner canthus of eye. Most
common type Noduloulcerative type.
Most aggressive and high recurrence in morphea
type.
Treatment: Excision with healthy margin. It is
good radiosensitive tumour also.
82. Ans: (B)
Collar - Stud abscess - It is bi-locular abscess
with one locule deep to deep fascia and another
locule in superficial fascia.
They inter communicate through perforation in
deep fascia.
2 types:
Pyogenic > More often in Palmar fascia.
Tuberculous > More often in neck.
Cold abscesses:
It is not hot and red as Pyogenic abscesses.
Seen in tuberculosis. Actinomycosis. Gumma degeneration,
Leprosy .
83. Ans: (C)
Spegelian hernia is an Interparietal hernia, that
occurs at the level of Arcuate line, that is
subumbihcal region.
It is situated beneath Internal oblique, or
between the Internal and external oblique
muscles.
Diagnosis: CT or USG.
Para - umbilical hernia: Protrusion through
linea alba, just above or below the umbiicus.
84. Ans: (C)
> Eighty percent of all salivary gland stones occur
in the submandibular gland, 10% occur in the
parotid. 7% in the sublingual and remainder occurs
in minor salivary glands.
> Eight percent of submandibular stones arc
Radioopaque.
Majority of parotid gland stones are radio-lucent.
Remember
Most common benign salivary gland tumours Plemorphic adenoma.
Most common malignant salivary gland tumour Mucoepidermoid carcinoma.
The parotid gland tumour which spreads through
neural sheath - Adenoid cystic carcinoma
85. Ans: (C)
Splenic ruptures should be suspected after any trauma,
particularly any direct injury to left upper quadrant from any
angle.
86. Ans: (C)
10
In about two third of patients the rectum and lower

part of sigmoid colon are involved, but
involvement short segments of the lower rectum or
the whole intestinal tract have been described.
Tooth paste like stool is the classical finding.
Common complications are enterocolitis and
perforation of bowel.
87. Ans: (A)

> Dumping syndrome - following gastrectomy or vagotomy
Early and late dumping - different etilogies1 but common
features of rapid gastric emptying.
Early dumping symptoms: Epigastric fullness.
Sweating, Light headedness, Tachycardia.
Colic, diarrhoea.
Late dumping symptoms: you can see Reactive
Hypoglycemia not a hyperglycemia.
88. Ans: (D)
89. Ans: (B)
List of important markers:
- Medullary carcinoma of thyroid - Calcitonin, Neuron
specific enolase
- Carcinoid - 5-HIAA
- Stomach - Gastrin
- Pituitary - ACTH
- Bone - Alkaline phosphate
- Multiple myeloma - Ben Jone protein
- Prostate - PSA, Prostatic acid phosphate
- Liver -AFP, Carcino embryonic antigen (CEA)
- Ovary - CA-125, Beta-HCG
- Breast - CA-15.3,
- Testicle - AFP, Beta HCG, LDH
- ColonCEA.
90. Ans: (A)
Pancreatic disease causing elevated amylase level:
- Acute pancreatitis
- Pancreatic abscess
- Pancreatic pseudocyst
- Complication of pancreatitis
Some important non-pancreatic disorders are: Mumps
- Pregnancy
- Perforation peptic ulcer
- Ruptured ectopic pregnancy Intestinal obstruction
or infarction
- Cholecystitis
- Diabetic ketoacidosis
- Burn
91. Ans: (D)
GERD predisposing factors:
1. Dietary factors (alcohol, smoking, chocolate,
fat foods)
2. Defective esophageal clearance
3. Delayed gastric emptying
4. Increasing Intra abdominal pressure GERD is
mainly due to function loss of competence of
lower esophageal sphincter.
Gallbladder is not palpable, there is usually

right upper quadrant tenderness, and no
muscle guarding is there.
Rokitansky-Aschoff sinuses are found in 90%
case chronic cholecystitis.
Gallbladder stones are most commonly
associated with chronic cholecystitis.
Gallbladder stones are most commonly seen in
Fatty, Fertile, Flatulent, Females of fifty.
93. Ans: (B)
The lymphnodes involved in breast carcinoma are axillary.
Internal mammary, intraclavicular.
Supraclavicular and Parasternal node.
94. Ans: (A)
The precancerous states are:
Genital warts (Hpv infection)
Paget's disease of penis
Balanitis xerotica obliterans
Chronic balanoposthitis
Most common type of carcinoma in penis >
squamous cell carcinoma.
Most common site > Origin is Glanspenis.
Circumcision after birth decreases the risk of
carcinoma penis.
95. Ans: (C)
Typhoid is mainly medical disease, which caused
by salmonella typhi.
In this disease there is hyperplasia, Ulceration of
payer's patches of the intestine w hich present
antimesenteric border of ilium. Mesenteric
lymphadenopathy.
Confirmation diagnosis is obtained by culturing
S.Tvphi from blood or feaces or by finding a high
titre of agglutinins against the O and H antigens of
the organism.
Complication of the disease with which the
surgeon concerned with Intestinal haemorrhage
(10-20% cases) Intestinal perforation (2% eases)
which is during 3rd week
Perforation occurs through ulcerated^ Payer's
patches in the Terminal Ileum.
It must be Temembered that these ulcers are
Longitudinal.
Remember:
Tubercular ulcer, which are transverse because it

follows lymphatic channel. But amoebic ulcers are flask
shaped. Paralytic Ileus - Most common complication, It is
associated with distension of abdomen. Treatment:'
Conservative. Cholecystitis - When patient become carrier,
joints -Mild effusion. Bones - Makes typhoid osteomyelitis
(Rarely) Genitourinary complication - Typhoid pyelitis,
Cystitis, Epidermo-orchitis.
96. None of the above
92. Ans: (A)
11
Pleomorphic adenoma is the most common Benign Tumor

of salivary gland. In the parotid gland the commonest
location is the tail of the gland.
Symptom: The patient complain of painless swelling of the
side of the face.
Examination:
Shape - The" tumour tends to be Round or Oval when
it is small.
Surface - the surface is smooth.
Edge - The margins are quite distinct.
Fixing - It is neither adherent to the skin nor the
masseter muscle.
Involvement of facial nerve - Even when the
Tumor is huge the facial nerve is not involved and
remains free. Involvement of facial nerve
indicated by paralysis of involved Facial muscles.
Indicates carcinomatous change. Cervical
lymphnode - Though rare yet malignant
transformation of this tumor may occur in 3-5%
of
cases.
Malignant
transformation
is
apprehended when the tumor:
- Becomes painful. -- Starts
growing rapidly.
- Feels stony hard. Gets fixed to the masseter
deeply or to the skin superficially.
- Involves facial nerve is an important feature
of malignancy.
- Cervical lymphnode enlargement.
- Causes restriction of movement of the jaw.
Important:
Superficial parotidectomy is the treatment of choice
for Pleomorphic adenoma. This operation is also
known as Patey's operation. Trismus in para
pharyngeal abscess is due to spasm of Medial
pterygoid muscle.
97. Ans: (C)
Rectum is divided into 3 parts: Proximal third of
rectum Middle third of rectum Lower third of rectum
Operation of rectum are:
There are numerous procedures for treating rectal
carcinoma, out of these, most commonly asked in
exams arei
1. Anterior resection
2. Abdomino perineal resection
3. Hartman's procedure
> Anterior resection is a sphincter saving^ procedure
and it is done for the carcinoma in the proximal third
of the rectum and middle third of rectum. It is not
done for the carcinoma of rectum which are 7cm from
anal verge.
> Abdomino perineal resection - It is the treatment of the
choice of carcinoma of rectum which arc within the 7
cm from anal verge. Here sphincter is sacrificed and
permanent colostomy is performed. Note:
If you get the choice that carcinoma is 7 cm from
dentate line then the treatment of choice will be
anterior resection because you have to add 2.5 cm
because dentate line is 2.5 cm from anal verge, so the
length will be 7 + 2.5 = 9.5 cm. So the carcinoma of

the rectum is 9 cm from the anal verge. Treatment of
choice will be anterior resection.
98. Ans: (A)
Duodenal ulcer almost neveL_changes to
Malignancy. Incidence of Malignant changeln gastric" ulcer
is not very definitely know ulcer near the greater curvature
and near the lesser curvature below the angulus are more
prone to malignant change.
The common complication of peptic ulcer is:
1. Bleeding
2. Stenosis
3. Perforation
4. Gastric outlet obstruction.
Remember
The most common site of benign peptic ulcer is lesser
curvature near incisura Angularis. The most common
site of duodenal ulcer is 1st part of duodenum.
99. Ans: (D)
Here in this case there is no placenta left inside
the uterus, they had clearly mentioned the placenta
fully came out.
* So the best choice is to palpate the fundus,
massage and oxytocin
100. Ans: (B)
In acute PID laparoscopy is an excellent means of obtaining
cultures directly from the tube. Laparoscopy is still
considered the gold standard for conforming tlfc diagnosis of
PID, because it not only allows direct inspection of Fallopian
tubes and surrounding pelvic anatomy but also enables
microbiologic sampling from the upper genital tract (e.g.
fallopian tube, ovary and peritoneal fluid).
101. Ans: (A)
Bacterial vaginosis is nothing but gardenella vaginosis.
It is termed as vaginosis because a patient is associated with
alteration in normal vaginal flora. There is considerable
decrease in no. of bacilli with 100 fold growth of other
bacteria. Characteristics of vaginal discharge:
1. White milky discharge.
2. Ph > 4.5.
3. Fishy odour.
4. Clue cells and gardnella are seen.
The infection can cause PID. chroioamnionitis, premature
rupture of membrane, preterm labour.
Rx. DOC - Metronidazole
102. Ans: (C)
Triple test is combined biochemical test usually done at 15-18
weeks includes
a. MSAFP (Maternal serum -feto protein) is
decreased
b. HCG is increased
c. UE (unconjugated oestriol) is decreased
It is used for detection of down syndrome. Triple test
gives risk ratio (1:250) for confirmation of diagnosis by
12
amniocentesis. Test available for detection of down

syndrome are:,
.1. Noninvasive test 2. Invasive test
NONINVASIVE TEST
Maternal serum analysis

Maternal urinary analysis
Ultrasonography
INVASIVE TEST
, Chronic villous sampling (9-12 weeks)
Amniocentesis (15-18 weeks)
Noninvasive test are done when the pregnancy are not at
risk.
Invasive test are done when the pregnancy is at risk.
The Risk factors are:
> Advanced maternal age > 35 yrs (Risk 1- 10%)
> Parent with a balanced translocation (Risk
3-20%)
>
Previous child with down syndrome (1%)
103. Ans (B)
To remember:
Epithelial lining of:
Vagina - Non keratinised stratified squamous Cervix Columnar
Uterus - Ciliated columnar ,
Urinary bladder - Transitional
Oral cavity-Non keratinised stratified squamous Tonsil - Non
keratinised stratified squamous
Bartholin duct Serous
PCT - Broad based columnar cell.
DCT - Cuboidal epithelium
Loop of Henle
Descending
Upper part - Columnar epithelium Lower
part - Squamous epithelium
Ascending
Lower part - Squamous epithelium Upper
part - Cuboidal epithelium
104. Ans: (D)
Expected date of delivery is calculated by using Naegle's
formula by adding 9 calendar month and 7 days from the first
day of last menstruation (28 days cycle) period.
105. Ans: (B)
Apgar score: It is related to the status of oxygenation of the
fetus at or immediately after birth. Long-term neurological
correlation is obtained at the. 5 minute score which is of more
value. In cases where the score remains significantly
depressed at 5 minutes. It should be evaluated again after 15
minutes. This scoring is done in a newborn baby at 1 minute,
5 minutes and 15 minutes. In this scoring we see respiratory
effort, Heart rate, Muscle tone, Reflex irritability and Colour.
Total apgar score is 10
No depression is 7-10
Mild depression is 4-6
Severe depression is 0-3
Pa rtogra m: It is a composite graphical record of cervical

dilation and descent of he ad against duration of labour in
hours.
The component of a ponograph are: Patient identification
Time
Fetal heat rate
State of membranes and colour of liquor Cervical dilatation
and descent of the head Uterine contractions Drugs and
fluids
Blood pressure at every 2 hours and pulse at eveiy 30
minutes Oxytosin Urine analysis Temperature record
Bishops score: Bishop'spre-induction cervical scoring
system includes parameters like: y Dilatation of cen'ix
> Cervical length of cervix y
Consistency of cervix
> Position of cervix
Station of head
Total score = 13
Favourable score = 6-13
Unfavourable score = 0-5
Pearl index: The failure rate of any contraceptive is
calculated in terms of pregnancy rale per hundred women
years of use. It is calculated according to the following
formula: Pregnancy failure rate = Number of accidcntal
pregnancies * 1200/Number of patients observed * Months of
use.
When the pregnancy rate is below 10, the
effectiveness of the particular method is considered to
be high. If it is more than 20, it is said to be low.
Failure rate of contraceptive methods in first 12
months of use per 100 women are:
> Tuberectomy = 0.5
> Vasectomy -0.15
> Norplant ~ 0.1
> DMPA and NET injectables = 0.3
> Progestin only pill = 1
> Combined oral pill =0.1
> IUCD = 0.5-2
> Diaphragm = 20
> Condom (male) - 14
> Lactational amenorrhoea = 2
> Coitus inlerruptus =19
> Rhythm = 24
> No method = 80
106. Ans: (A)
Cervix is visualized by colposcopy with
Magnification to 40 times.
Colposcopy directed biopsy is the best one when
the lesion is not clinically detected.
Fallopian tube is visualized by salpingoscopy
(falloposcopy), Mainly used selection of patients for
IVF (In Vitro Fertilization).
Uterus is visualized by Hysteroscopy, used in
unresponsive uterine bleeding, Uterine Synechiae,
Congenital uterine septum Missing IIJD threads, etc.
Colpomicroscopy is used to see the structures at
cellular level (100 to, 300 times
13
magnification)
Culdoscopy - Optical instrument to visualize the pelvic
structure, through an incision in the pouch of Douglas.
107. Ans: (B)
LH: FSH ratio is > 3: l in PCOD (LH increased, FSH
decreased) PCOD is also known as Stein Leventhal
syndrome
Characteristic features:
Hirsutism
Obesity
' Oligomenorrhoea or Amenorrhoea
Infertility M/c cause of hirsutism and virilising
syndrome in young women.
Lab finding
Decreased FSH and progesterone (may be absent)
No ovulation - no progesterone
USG - Necklace appearance of ovaries
DOC: Clomiphene citrate
Turner's syndrome - Testicular feminization
menopause both LH and FSH are increased
108. Ans: (A)
Vertex occupying the left anterior quadrant of the
pelvis is the commonest one and called as left occipito
anterior. Presentation
Diameter of
Engagement
Vertex
Sub-occipito Brcgmatic
Brow
Vertico mental
Face
Submcnto-Bregmatic
Brecch
Bi-ischial
Shoulder
Bi-acromial
M/c - presentation is cephalic (96.5%) M/c - presenting
part of cephalic -vertex (96%) M/c - lie-longitudinal lie
(99.5%)
109. Ans: (D)
Here they didn't ask anything specifically. So you have to rule
out all the possible methods.
110. Ans: (C)
You can't extend the Incision as it may involve the
rectum. It is the major disadvantage of median
episiotomy.
To extent the incisionmediolateral episiotomy is
relatively safer, it is used commonly, but Dyspareunia
is comparatively more.
The other two type's episiotomy- lateral and J
shaped.
Relative merits and demerits of median and
mediolateral episiotomy:
Merits of median episiotomy:
> The muscles are not cut.
> Blood loss is least.
Repair is easy.
> Post operative comfort is maximum.
> Healing is superior.
> Wound disruption is rare.
> Dyspareunia is rare.
> Extension, if occurs, may involve the rectum.

> Not suitable for manipulative delivery or in
abnormal presentation or position. As such, its use
is selective.
Merits of mediolateral episiotomy:
> Relative safety from rectal involvement from
extension.
> If necessary, the incision can be extended.
Demerits of mediolateral episiotomy:
> Apposition of the tissue is not so good. >*
Blood loss is little more.
> Post operative discomfort is more.
> Relative increased incidence of wound disruption.
> Dyspareunia is comparatively more.
111. Ans: (A)
Follow the explanation of question no. 7 of obstetrics and
gynaecology.
112. Ans: (B)
Ovulation approximately occurs at 16-24 hrs after
the LH surge
The rupture of graffian follicule due to contraction
of micro muscle present over Theca externa. These
contraction brought by prostaglandin secreted
under the influence of LH.
The ovulation and maturation can be studied by
serial USG.
113. Ans: (C)
Placenta previaIt is when the placenta implanted
partially or completely over the lower uterine
segment
1. Features -painless, causeless, recurrent bleeding,
fresh bleed, placenta in lower segment/low lying.
2. Uterus soft and relaxed.
3. Diagnosed by: USG, FHS usually present.
4. Rx: PV examination is delayed upto 37 wk to avoid
premature labour, PV should be performed in OT
room.
Abruptio placenta
Painful, continuous bleeding with toxaemic
' features.
Concealed bleed (may be mixed)
Sign of fetal distress and shock
Associated with pre-eclampsia
Placenta in upper segment
Uterus is tense, tender and light
FHS usually be absent
Diagnosed clinically
Rx:
Correction of hypovolumic shock - 1st priority Give
dexamethasone and deliver the baby by induction.
114. Ans: (D)
- Most common site of ectopic pregnancy is ampullary part of
fallopian tube.
- Fallopian tube is 10 cm long which has 4 parts.
Demerits of median episiotomy:
14
Interstitial - narrowest part of fallopian

tube
Isthmus
Ampulla - widest part
Fimbria
- Most common cause of ectopic pregnancy is Pelvic
inflammatory disease (6 - 10 fold). The longest survival in
ectopic pregnancy of fallopian tube is in the Isthmus.
117. A. Ans: (C)

If the weight of child is known the amount of ORS solution
required for rehydration during the first four hours may be
calculated by setting the deficit at approximately 75 ml/kg. If
the child's weight is not known the approximate deficit may
be determined on the basis of age. So, weight of child is 8 kg.
Setting the deficit of approximately - 75 ml/kg
Then 8 x 75 - 600 ml
115. Ans: (B)
118. Ans: (B)

When bone age (Epiphyseal development) is less than the
chronological age. Then it is known as delayed bone age.
Markedly delayed: Hypothyroidism. Hypopitutrism.
Moderately delayed: Malnutrition, Chronic infection.
Mild delay: Constitutional delay.
Common causes of menorrhagia are DUB

or chronic pelvic infection.
Common causes of contact bleeding are
carcinoma cervix, cervical mucous polyp and
vascular erosion.
The endometrial pattern in DUB is
secretary in 60% and hyper plastic in about
30%.
There is no hormone therapy in
postmenopausal DUB.
In premenopausal (>40 years) patient
absence of any +ve finding, where bleeding
continues even after uterine curettage, cyclic
progestogen^ therapy may be employed
judiciously.
If in premenopausal patients have adenomatous or atypical endometrial hyperplasia
requires hysterectomy.
---------- --------------------------------In reproductive period (20-40 years), if patients
have irregular excessive cycle, we have to do
investigation by USG (TVS).
116. Ans: (B)

Polyhydramnios is a state where liquor amniotic fluid
exceeds 2000 ml.
Most common cause of polvhydraminosis are:
Fetal anomalies - anencephaly
- open spina bifida
- GIT Atresia
- hydrops fetalis
Placcnta
- chorioangioma
Multiple pregnancy
Maternal
- Diabetes
Complications:
Maternal during pregnancy:
Pre eclampsia
Malpresentation
Premature rupture of membrane
Flemorrhage
Maternal during labour:
' Early rupture of membrane
Cord prolapse
Uterine inertia.
Retained placenta
Postpartum hemorrhage
Fetal:
perinatal mortality (death are due to prematurity and
congenital abnormality
Boneage is in advance of the heightage

Familial short stature
Down syndrome
Turner syndrome
Chondrodystrophies
Intrauterine infection
Storage disorders
Boneage is an advance chronologic age
Precocious puberty
Thyrotoxicosis
119. Ans: (A)

Physiological Jaundice:
Appears after 24 hours
Intensifies in 5 days in term baby and 7 days in
preterm infant ( 12-15 mg/dl )
Total bilirubin < 15 mg/dl
After two weeks clinically not detachable, adult
values are attained
Pathological Jaundice:
Pathologic Jaundice appears in the first 24 hours
Total bilirubin >15 mg/dl (Hyperbilirubinemia)
Direct bilirubin >2.0 mg/dl
Persist more than 14 days.
120. Ans: (D)
Enuresis is defined as normal nearly complete evacuation of
the bladder at a wrong place and time atleast twice a month
after the Fifth year of life.
121. Ans: (C)
Daily requirements:
Adult - 2.5 meg (100 IU) Infants and children - 5.0 meg (200
IU) Pregnancy and Lactation - 10.0 meg (400 IU) (One IU of
Vitamin D is 0.025mg of Calciferol) For management of
Rickets - administration of15000 mg or 600000 IU of
Vitamin D3 orally or IM induces rapid healing.
122. Ans (B)
VUR - refers to retrograde flow of urine from the bladder to
the Upper urinary tract. Two techniques commonly used to
detect VUR, The radio contrast MCU is most commonly
15
used. Since in addition to showing VUR, it provides excellent

anatomical details. Isotope Radionuclide Cystography is
more Sensitive: For detecting VUR and causes Less radiation
exposure but provides less anatomical details. So, MCV is the
investigation of choice for VUR But Isqtope Radionuclide
Cystography is more sensitive.
123. Ans: (C)
Definitive diagnosis of Hirschprung's disease is made by:
Rectal biopsy - Absence of ganglion cells in Mcissner's
plexus, myenteric plexus and Hypertrophy of nerve
trunks.
Manometric study - Show a failure of relaxation of
internal sphincter following rectal distention. It is used as
screening test.
Barium enema also helpful in diagnosis, but not
Investigation of choice.
124. Ans: to (A)
02 therapy is helpful in V/Q Mismatch.
Airway disease (Asthma COPD)
Interstitial lung disease
Alveolar disease
Pulmonary vascular disease.
02 therapy is not helpful
AIveoiar collapse (Atelectasis)
lntra-alveolar filling - (Pneumonia, Pulmonary
edema)
Intracardiac shunt (R-L shunt)
Vascular shunt within lungs.
125. Ans: (C)
Wide fixed splitting of S2 with ejection systolic murmur in left
2nd intercostals space points towards the diagnosis of Arterial
septal defect.
Also know:
Paradoxical reverse splitting is seen in complete left bundle
branch block, Right ventricular pacemaker.
Most common type of ASD
Ostium Secundum
126. Ans: (A)
There is controversy over this question. Davidson says
that attacks of rheumatic fever are unusual after the age of
21 at which age treatment may be stopped.
I larrison say, that the risk of recurrence of RT is highest
during the first 5 years after the attack secondary
prophylaxis is always given for at least this period.
This is a controversial question. We will go with
Harrison.
Some Important points:
Endocarditis is unusual in sites with a small pressure
gracfient as in ASD. VSD is most common congenital
lesion to be complicated by infective endocarditis. Most
common valve involved in IV drug abusers is tricuspid
valve.
127. Answer is B (Type 2): Still searching
Skin test can't detect type 2 hypersensitivity.
128. Answer is C (Acne):
Nail involvement is not seen in Acne.
Pattern of Nail Involvement

Alopecia areata:
Diffuse, fine regular pitting or Thimble
pitting
Ridges
Onychodystrophy
Cross fissures
Lichen planus :
Pterygium
Anychia
Onychorrhexia
Pitting
Psoriasis :
Pitting of nail (mc change)
Nail discolouration (earliest change)
Oil drop nails
Onycholysis
Iron deficiency anaemia: Koilonychia
Arsenic poisoning : Mee's lines
129. Answer is A (Lupus vulgaris):
MC skin manifestation of TB is Lupus Vulgaris.
Scrofuloderma:
Contagious spread5 of TB, secondary to underlying lymph
node, joint, bone etc.
MC site is Cervical lymph node
Undermined ulcer with bluish edges
The resultant sinus and fistula heal with puckered scarring
MC skin TB in children
Lupus Vulgaris:
MC skin TB in adults
It is most common type of progressive cutaneous tuberculosis
occurring in people with moderate or high immunity
Lupus Vulgaris arises from normal skin but it can arise in a
scar of scrofuloderma
The initial lesion is a reddish brown, soft, gelatinous plaque
which increases in size and extends peripherally
Peripheral extension occur with resultant scarring
Diascopy reveals Apple jelly nodules in the periphery
Nasal mucosa can be involved leading to resultant
destruction of nasal septum
Rarely squamous cell carcinoma can occur
Erythema nodosum is not very common.
130. Answer is C (Cicatricial alopecia):
Cicatricial alopecia is also known as scarring alopecia.
Cicatricial (scarring) Alopecia:
Lichen planus
Leprosy
Lupus vulgaris
Linear scleroderma (morphea)
Sarcoid
Syphilitic gumma
Cutaneous metastasis
Favus and kerion
Traumatic alopecia
Injury, burn, Herpes Zoster, Pseudopellade
DLE, Dematomyositis
Non- cicatricial (non scarring) Alopecia:
Telogen effluvium
Anagen effluvium
16
Metabolic disorder
Trichotillomania
Alopecia areata
Androgenic alopecia
SLE
Remember: DLE is cause of scarring alopecia whereas SLE is
cause of non scarring alopecia.
131. Answer is A (Eccrine glands):
1. Eccrine sweat glands:
Eccrine sweat glands are present all over skin, particularly
palms and soles
These are situated in Dermis and absent in mucosa
These secrete Watery Hypotonic secretions, which contain
Chloride, Lactic acid and Fatty acid, urea, glycoprotein &
mucopolysaccharide
2. Apocrine glands:
Apocrine glands are vestigial remnants of Odoriferous glands
of lower animals, which are found in Axilla, anogenital area,
scalp and nipples.
These glands start functioning at puberty
Their secretion is sterile but because of bacterial action gives
unpleasant smell
Modified apocrine glands are: Mammary glands
: Mohl's glands in
eyelids
: Cerumin glands in ear
Canal
Obstruction of following structures lead to:
Pilosebaceous gland: Acne vulgaris
: Fordyce spot
Sweat gland: Crystalline miliaria
Apocrine gland: Fox Fordyce disease
Hair root: Boil
Remember: Fordyce spots (ectopic sebaceous gland) are
confused with Koplik's spots (pathognomic sign of
measles).These are differentiated by presence of erythematous
halo around koplik spot.
Fox Fordyee disease is a chronic itching popular eruption of
axilla and pubis due to obstruction of apocrine gland.
132. Answer is A (Lichen planus):
Mucosa is involved in Lichen planus.
Lichen Planus
It is self limiting papulosquamous inflammatory disorder of
skin of unknown origin
Typical lesion is pruritic, polygonal, purple, plain topped
papule & plaques which often has whitish lacy pattern on its
surface (Wickham's striae)
Skin lesions are most commonly present over the wrist, shins,
lower back and genitalia.
Mucous membrane is commonly involved (30:70%), most
commonly buccal mucosa and tongue.
Mucosal lesions are white lacy reticular eruptions
Koebners phenomenon is characteristic of lichen planus
Involvement of hair follicle is known as Lichen Piano Pilaris,
may lead to Cicatricial alopecia of scalp
It may lead to Squamous cell carcinoma.
Pterygium formation
Onychomedesis
Splitting of nail plate
Onychodystrophy
Skin biopsy:
Hyperkeratosis, hypergranulosis, epidermal hyperplasia
Max Joseph Cleft
Degeneration, necrosis & squmatization of basal
keratinocytes
Subepidermal lichenoid band
Pointed rete ridges (saw toothing)
Civatte /cytoid /colloid bodies
Topical steroids are mainstay of treatment.
Oral dapsone for oral LP & acute generalized LP.
133. Answer is A (P. acne):
Propionobacterium acne is normal commensal of sebaceous
gland.
In Acne vulgaris Propionibacterium acne5 (bacteria) and
Pityrosporum orbiculare5 (yeast) infects comedones.
134. Answer is A (Herpes simplex):
Koilocytes are seen in infection with Herpes simplex.
Though koilocytes are seen typically in infection of HPV
(Human papilloma virus) but it can be seen in infection with
herpes simplex.
Koilocytes can also observed in columnar cells in infection
with herpes simplex.
135. Answer is D (Lumbosacral area): Neena Khanna, 273
Most common site of Mongolian spot is lumbosacral area.
Mongolian spots:
Seen commonly in Mongoloid and Negroid infants
Bluish ill defined macule over Lumbosacral region
Regression by the age of 4 years
136. Answer is D (Bullous lesion):
Bullous lesion is not seen in leprosy.
Diagnosis of leprosy is made by
1. Clinical examination
Sensory testing
Peripheral nerve examination
2. Demonstration of acid fast bacilli
In skin smear prepared by slit 8i srape method
Nasal swabs by modified Ziehl-nelson method
3. Skin biopsy / FNAC:
Periappendigial lymphocytosis
Virchow (lepra/foam) cells are diagnostic
Useful in indeterminate leprosy & differentiating it from
other granulomatous lesion
4. Nerve biopsy
5. Foot pad culture (In mouse)
6. IgM antibodies to PGL-1 support diagnosis in lepromatous
patients not in tuberculoid leprosy
137. Answer is A (Calymmatobacterium):
Granuloma inguinale is caused by Calymmatobacterium.
Nail changes occurs in 10% of patients.
17
Donovanosis/Granuloma inguinale
Caused by Calymmatobacterium granulomatis
Bleeding (red granulation tissue), painless, indurated ulcer
mostly involving genitalia (90%), inguinal (10%) & anal (5%)
region
Pseudobubo is seen
Genital swelling especially of labia (pseudoelephantiasis) is
seen
Best diagnosed by microscopy by demonstrating Donovan
bodies & Safety pin appearance
Doc is Doxy/tetracycline
In pregnancy doc is azithromycin/erythromycin
138. Answer is A (Flaring of acne initially):
There is flaring of acne initially by use of isotretenoin in acne.
Isotretenoin:
Accutane (brand name for a kind of isotretenoin) one of the
most popular topical acne treatments ever invented.
Can be used for nodulocystic acne.
Associated with adverse effects like dryness of skin, acne
flare, skin peeling and in rare cases, inflammatory bowel
disease.
139. Answer is A (Mite):
Scabies is transmitted by mite Sarcoptes scabie.
Scabies
Causative agent is Sarcoptes scabie (itch mite)
More common in winters, incubation period is 3-6 weeks
Characteristic feature is severe nocturnal itching with
positive family history
Burrow is characteristic lesion, which is a tunnel made by
female mite in stratum corneum (s shaped burrow in stratum
corneum)
Other lesions are papule, vesicles, excoriations & crusted
lesions
Mostly involves interdigital space, anterior wrist & ulnar
border of hand. In adults scalp, face, palms & soles are
characteristically spared.
In infants involve penis, palm, sole, scalp, face & neck
Nodular scabies involve scrotum
Treatment:
Doc is Permethrin (1st) BHC (2nd)
Ivermectin is the only oral drug for scabies
Other drugs are Benzyl benzoate (25%), Crotamiton (10%)
Scabicides should be applied to the whole body (below jaw
line in adults) to all members of family whether symptomatic
or not.
140. Answer is A (Contact dermatitis):
Patch test is used for diagnosis of contact dermatitis.
Patch test: it is done to confirm disorder of skin resulting
from a delayed hypersensitivity (type IV)
eg contact dermatitis. It is read after 48 hours (2 days)
Test
Patch test
Early Fernandes
reaction
In TB, induration is seen
Read after
2 days
2 days
after
Skin doubling time in
4 days
psoriasis
Kveim's test
2 weeks
Late Mitsuda reaction
3 weeks
Normal skin doubling
4 weeks
time
Remember: Contact dermatitis is diagnosed by Patch test &
Atopic dermatitis is diagnosed by clinical examination
141. Answer is A (Cis atracurium):
Metaboiization of Muscle Relaxant
Metabolized by organ Atracurium Cisatracurium
independent- Hoffman
elimination, so can be
used in both hepatic &
renal failure
Totally excreted by
Gallamine Metocurine
kidney; so
contraindicated in renal
failure
Metabolized by
Succinylcholine (shortest
psedocholine esterase acting M.R.) Mivacurium
(shortest acting non
depolarizing M.R.)
142. Answer is A (Thiopentone sodium):
Porphyria is an absolute contraindication for the use of
Thiopentone sodium.
Porphyria: Thiopentone induces enzyme amino levulenic acid
synthetase which stimulates the.formation of porphyrin in
susceptible individuals. So it is contraindicated in acute
intermittent and variegate porphyria (can be used safely in
porphyria cutanea tarda)
143. Answer is D (Quinidine):
Non depolarizing blockade is potentiated by Quinidine.
Factors prolonging the neuromuscular blockade
a. Hypothermia
b. Hypocalcemia
c. Hypokalemia
d. Acidosis
e. Hypermagnesemia
f. Quinidine, Procainamide
144. Answer is B (It teils about preoperative assessment of
individual):
ASA grading tells about preoperative assessment of individual.
Based on physical status,the patient are classified into six
categories by American Society of Anasthesiologist.The
morbidity and mortality is highest in grade V patients and
minimum in grade I patients.
I: Normal healthy patient
II: Mild systemic disease not limiting functional activity
III: Severe systemic disease that limits the activity but not
incapacitating
IV: Incapacitating disease that is a constant threat to life
V: Moribund patient who is not going to survive for more than
24 hours with or
Without operation
VI: Brain dead patients (for organ donation)
3 days
18
145. Answer is B (Absence of signal on capnography): Ajay

Yadav 2nd/47 Esophageal intubation is indicated earliest by
absence of signal on capnography.
Capnography
Capnography is the continuous measurement of end tidal
carbon di oxide (ETC02) and its waveform.
Normal: 32 to 42 mmHg ( 3 to 4 mmHg less than arterial
pC02 which is 35 to 45 mmHg)
Principle: Infrared light is absorbed by carbon di oxide
Uses:
1.
2.
3.
4.
5.
6.
7.
8.
It is the surest confirmatory sign of correct intubation

(esophageal intubation will yield ETC02=0)
Intraoperative displacement of endotracheal tube
(ETC02 will become zero)
Diagnosing malignant hyperthermia (ETC02 may
rise to more than 100 mm Hg)
For detecting obstructions and disconnections of
endotracheal tubes (ETC02 will fall)
Diagnosing pulmonary embolism by air, fat or
thrombus (sudden fall of ETC02 occurs. It may
become zero if embolus is large enough to block total
pulmonary circulation)
Exhausted sodalime or defective valves of closed
circuit will show high ETC02 values.
To control level of hypocapnia during
hyperventilation in neurosurgery.
Indicator of cardiac output. In cardiac arrest ETCO2
is zero.
146. Answer is D (Isoflurane):

Isoflurane require ischemic preconditioning.
In coronary artery disease isoflurane should be avoided due to
coronary steal phenomenon.
In ischemia of cardiac muscle, selective vasodilation of vessels
of ischemic zone and maintained tone of non ischemic zone leads
to selective increase of blood supply to ischemic areas.
But in coronary steal phenomenon (Isoflurane & Dipyridamole)
there is dilation of vessels of non ischemic zone also there is
decrease of flow in ischemic zone. That is why isoflurane is
avoided in ischemic heart disease.
147. Answer is B (Dual block):

Answer of exclusion is dual block.
Effect Of
anticholinesterase
Depolarizing
Nondepolarizing
Block
block
Also called
Also called
Leptocurare
Pachycurare
Potentiation of Reversal of block
block
(anticholinestrase
also inhibit
pseudocholinester
ase)
Agent
Less blockade
Effect of non
More blockade
depolarizing
Blockade
Effect on single
Depression
Depression
twitch height
Train of four fade
Tetanic fade
Absent
Absent
Present
Present
Post titanic
Absent
Present
facilitation
148. Answer is A (Aspiration):

Rapid sequence anaesthesia is used to prevent aspiration.
For full stomach patient, if general anaesthesia is to be given,
it should be rapid sequence (crash) intubation while assistant
maintains the cricoid pressure (Sellick's manoeuvre).Cricoid
pressure compresses esophagus against vertebral column
preventing aspiration.
Rapid sequence (crash) intubation
In rapid sequence intubation after preoxygenation for 4 to 5
minutes (many clinicians consider 4 deep breaths with 100%
oxygen equally effective for denitrogenation, to
preoxygenation for 5 minutes) induction agent is given
followed immediately by succinylcholine.
Ventilation with bag and mask is not done because with bag
and mask ventilation the air leak into stomach can achieve
intragastric pressure>20 cm H20 (critical pressure for
aspiration) easily.
An assistant applies pressure over cricoid to prevent
regurgitation till the cuff of endotracheal tube is inflated.
149. Answer is C (Length is 22 mm for connection to
ventilation circuits): Still searching As suggested by SR
anaesthesia.
150. Answer is A (KOH): Ajay Yadav 2nd/28 Sodalime
contains KOH. Composition of Sodalime KOH.
Ca(OH)2 : 94%
NaOH : 5%
KOH : 1%
Indicator
Silica (to prevent dust formation)
151. Answer is A (CT): Sumer sethi 3rd/7 Calcification is best
detected on CT.
152. Answer is B (Pulmonary hamartoma):
Hamartoma produce noncavitating popcorn calcification.
Pulmonary hamartoma
a. Popcorn calcification
b. Presence of fat is diagnostic of hamartoma
153. Answer is B (Seminoma)
Seminoma is most radiosensitive gonadal tumour among the
provided options.
Radiosensitivity of different tumours
Highly sensitive
Seminoma
Myeloma
Lymphoma
Ewings sarcoma
Wilms tumour
Relatively resistant
Squamous cell
carcinoma of lung
Hypernephroma
Rectal carcinoma
Bladder carcinoma
Soft tissue sarcoma Cervical
cancer
Moderately sensitive
Small cell lung cancer Breast
cancer
Basal cell carcinoma
Medulloblastoma Teratoma
Ovarian cancer
Highly resistant
Melanoma Osteosarcoma
Pancreatic carcinoma
19
154. Answer is C (Left lateral decubitus)

Best projection to demonstrate pneumoperitoneum-CXR
Perforation:
Best projection to demonstrate pneumoperitoneum-CXR
If the patient cannot get into an erect position then Left
Lateral Decubitus Projection is required.
Patient should be in that position for 10 min at least for air to
rise up
By careful technique even 1 ml of air can be detected
155. Answer is C (Bochdalek hernia):
Mediastinum - is situated b/w the lungs in the center of the
thorax. It is divided into 3 compartments
1) Anterior or Anterosuperior
It lies in front of the anterior pericardium & trachea.
2) Middle mediastinum or Visceral compartment
It lies within the pericardial cavity including the trachea.
3) Posterior mediastinum or paravertebral sulci
It lies posterior to the post pericardium & trachea.
Locations of the Common Mediastinal Masses
Anterior
mediastinum
Thymoma (most
common in Ant.
Med.)
Lymphoma
Germ cell tumors
Thyroid &
parathyroid
masses
1. Aversion therapy: Apomorphine,.sub-threshold electric

shock
2. Psychotherapy
3. Group therapy
4. Deterrent agents: (Alcohol sensitizing drugs)
Disulfiram
Citrated calcium carbimide (CCC)
Metronidazole, Nitrafezole
Methyltetrazolethiol
Sulfonylureas (specially Chlorpropamide)
Cephalosporins (cefoperazone, moxalactam,
cefamandole).
5. Anticraving agents: (FAN)
Fluoxetine
Acamprosate
Naltrexone
Drug of choice in withdrawal syndrome
Opium
Middle Mediastinum Post. Mediastinum
Alcohol
Cysts (MC in Mid.
Med.)
- pleuropeicardial bronchogenic
- enterogenous
- neuroenteric
Vascular masses
(aneurysm)
Lymph node
enlargement (including
lymphoma)
Mesenchymal tumors
Pheochromocytoma
Neurogenic tumors
(MC overall)
Meningoceles
Gastroenteric cyst
Mesenchymal tumors
Pheochromocytoma
Lymphoma
Bochdalek hernia
156. Answer is A (Optic nerve sheath meningioma):

Tram track calcification is seen in Sturge weber syndrome &
Tram track appearance is seen in optic nerve sheath
meningioma.
159. Answer is A (Rhinorrhoea and lacrimation):

Characteristic feature of opioid withdrawal is Rhinorrhoea &
Lacrimation.
Withdrawal Syndromes
Substance
Opioid
Alcohol
(HIS
Delirium)
Optic nerve sheath meningioma

Arise from the cap cells of arachnoid around the intraorbital
portion of optic nerve
Early visual loss with small degree of proptosis later
Limitation of ocular movements particularly upwards,
swollen or atrophic disc
Occurs predominantly in middle aged women
Presence of opticociliary shunt is pathognomonic of nerve
sheath meningioma
CT confirms the origin of tumor (Investugation of choice)
157. Answer is B (X-rays and gamma rays):
Linear accelerators or Co-60 machines are used commonly for
external beam radiation therapy.
Three main types of radiation that are used in radiation therapy
-gamma rays, X-rays and electron beams.
Methadone (1st choice)

Clonidine (2nd choice)
Chlordiazepoxide (1st choice)
Diazepam (2nd choice)
Cocaine
Features
Yawning, Insomnia, Dysphoric
mood
Water loss from different orifices
(Lacrimation, sweating, diarrhea,
vomiting, rhinorrhea)
Increased vitals (BP, Pulse, RR,
Temperature)
Pupilary dilation, piloerection
Hang over (mc)
Hallucinations (usually auditory) &
illusions
Insomnia
Seizures (Alcoholic seizures/Rum
fits)
Delirium tremens:
-Occurs within 5 days of complete or
significant abstinence from from
heavy alcohol drinking
-Recovery occurs within 7 days
-Characteristic features are clouding
of consciousness, disorientation,
hallucinations (mostly visual &
auditory), illusion, autonomic
disturbances, agitation & insomnia.
Increased or decreased
- Sleep (hypersomnia or insomnia)
-Psychomotor activity
Vivid unpleasant dreams
Increased apetite & fatigue
158. Answer is B (Disulfiram):

Disulfiram doesn't decrease relapse of alcohol drinking. It is
deterrent agent, also k/a alcohol sensitizing drug.
160. Answer is D (Persecutory delusion):

Persecutory delusions are not included in Schneider's first rank
symptoms.
Treatment of Alcohol Dependence
Schizophrenia:
-Dementia precox was coined by Emil Kraepelin.
20
-Schizophrenia was coined by Eugen Bleuier.

Schizophrenia
Schneider's first rank
symptoms
1. Hallucinations
a. Audible thoughts
b. Voices heard arguing
c. Voices commenting on
ones action
Bleuler's "4A"
1. Ambivalence (confusion)
2. Autism (withdrawal into
self)
3. Affect disturbances
4. Association disturbance
2. Delusional perception
3. Thought alientation
phenomenon
a. Thought withdrawal
b. Thought insertion
c. Thought
diffusion/broadcasting
4. Passivity phenomenon
a. Made feeling (affect)
b. Made impulses
c. Made volition or acts
d. Somatic passivity
Schizophrenia
Type
Feature
1. Catatonic -Best prognosis, late onset
-Mutism, rigidity, waxy flexibility,
negativism, echolalia, echopraxia,
mannerism, grimacing, automatic
obedience, ambitendency, verbigeration,
Lethal catatonia or Pernicious catatonia
2. Paranoid -Most common type
-Amphetamine causes similar syndrome
-Worst prognosis -Most difficult
diagnosis
-Schizophrenia in presence of mental
4. Ptropf
retardation
-Early onset and bad prognosis -Senseless
5.
Hebephrenic giggling & mirror gazing
6.
Undifferenti
ated
3. Simple
Remember: The delusions included in 1st rank symptoms of

schizophrenia are primary delusions also k/a autoconthous
delusions0. These are characteristic of schizophrenia.
161. Answer is D (Derailment):
Thought disorder with defective communication and language
is Derailment.
Derailment
Gradual or sudden deviation in train of thought
without blocking; sometimes used synonymously with
loosening of association.
162. Answer is A (Delirium):
Clouding of consciousness is seen in Delirium.
Delirium
Acute confusional state occurring in various medical,
surgical, metabolic, toxic & post
operative conditions.
Characteristic features:
Clouding of consciousness (ie decreased awareness
and decreased ability to respond to environmental
stimuli)
Disorientation (in time>place>person)
Hallucinations (mostly visual) & illusions
Autonomic dysfunctions agitation, insomnia
Carphologia/floccilation (picking movements at
clothes or coversheets) & occupational delirium
(pantomimes as if continuing the usual occupation in
hospital bed)
In delirium, the EEG characteristically shows a
generalized slowing of activity, which is useful in
differentiating it from depression or psychosis.
163. Answer is C (Borderline personality disorder):

Complete suicide is not seen in Borderline Personality
Disorder.
Recurrent suicidal threats (not the complete suicide),
suicidal behavior or gesture or self mutilating behavior is
seen in Borderline Personality Disorder.
Niraj Ahuja says "A liability to become involved in intense
and unstable relationship may cause repeated emotional crises
and may be associated with excessive efforts to avoid
abandonment and a series of Suicidal Threats or acts of self
harm.
Diagnostic criteria of Personality Disorder
Markedly disharmonious attitude and behavior, involving
usually several areas of functioning
Behavior is long lasting not limited to episodes of mental
illness
Behavior is pervasive & clearly maladaptive
Always appear in childhood or adolescence & continue in
adulthood
Disorder leads to personal distress, problems in social &
occupational performance
Remember: Personality disorders are ego syntonic (acceptable
to ego) & alloplastic ((can adopt to alter to the external
environment), whereas OCD is ego dystonic.
Borderline Personality Pisoder
It is an instability of interpersonal relationship, self image &
affects (feeling) and marked impulsivity. Diagnosis by 5 or
more of these:
1. Instability of interpersonal relationships
2. Instable self image
3. Instable affect (Mood/feelings)
4. Inappropriate, intense anger
5. Frantic effort to avoid real or imagined abandonment
6. Impulsivity in at least two areas that are potentially self
damaging (ex-sex, spending, reckless driving or binge
eating)
7. Recurrent suicidal threats, behavior or gesture or self
mutilating behavior
8. Chronic feeling of emptiness
9. Transient stress related paranoid ideas or dissociative
symptoms
164. Answer is C (Alcohol Dependence)
Alcohol dependence leads to loss of maximum DALY.
Two schools of thoughts are there.
21
- One group says depression is very common psychiatric

disorder and leads to loss of maximum DALY.
- Other group says alcohol dependence is more common than
depression and leads to loss of maximum DALY. I favour
second one, you choose your own option.
165. Answer is A (Lithium):
Lithium is DOC for prophylaxis of MDP.
Drugs used in treatment of MDP
1. Lithium:
DOC for Acute Mania
DOC for Prophylaxis of MDP (bipolar disorder)
2. Valproate:
DOC (1st line drug) for Rapid Cyclers
3. Carbamazepine:
2nd line drug for Rapid cyclers, used in patients refractory to
lithium or valproate
4. Levothyroxine
5. Nimodipine, Verapamil, Clonidine
5. Bupropion, Olanzapine
166. Answer is B (Valproate):
169. Answer is B (Cocaine):

Magnus symptoms are seen with Cocaine.
170. Answer is A (Hypochondriasis):
Hypochondriasis is a somatoform disorder.
Somatoform disorders are various disorders in which there
are physical symptoms without adequate physical basis.
Types of somatoform
disorder
1. Hypochondriasis
-Preoccupation with fear or belief of having

serious disease based on own interpretation
-May agree regarding the possibility of his
aggregation of disease -Belief persists even after
showing normal reports
2. Somatization
disorder
-4 pain symptoms of different areas

-2 gastrointestinal, 1 sexual, 1
pseudoneurological
symptoms
-1 or more symptom/sign affecting voluntary
motor or sensory function or convulsions
without autonomic system involvement
-Preceded by conflicts or stressors
-Not intentionally produced or feigned (as in
factitious disorder for obtaining medical
attention; or in malingering, for some
recognized motive)
3. Conversion
disorder
(Hysteria)
167. Answer is C (Erotomania): Erotomania is not an impulse

control disorder.
Erotomania or Clerembaults syndrome: Content of delusion
is erotic, occurring most often in women, there is an erotic
conviction that a person with higher status is in love with the
patient.
Habit and Impulse Disorders
In these disorders heterogenous groups are characterized by
impulsive behavior, which the patient can not resist or control.
There may be feeling of relief of release of tension by doing
the act and feeling of guilt after the act is over.
This category includes the following disorders:
1. Pathological gambling
2. Pyromania (Pathological fire setting)
3. Kleptomania (Pathological stealing)
4. Trichotillomania (Compulsive hair pulling)
5. Intermittent explosive disorder
6. Oniomania (Compulsive buying)
Features
4. Body dismorphic
disorder
-Preoccupation with an imagined defect in

appearance. If slight anomaly is present, the
persons concern is markedly excessive.
5. Factitious disorder -Simulate fake disease for sole purpose of

obtaining medical attention & there is no other
(Munchausen
recognized motive (differentiating feature from
syndrome)
malingering)
-Distort clinical histories, physical signs (by self
inflicted injuries, & infection), lab test reports,
& even facts about their lives (Pseudologia
fantastica)
-Are manipulative, convincing liars, have
superficial knowledge of medical terms
-Evidence of earlier treatment eg. multiple
scars ie grid abdomen
-Often move out LAMA (left against medical
advice)
6. Somatoform pain
disorder
-Pain that does not vary in intensity & is

insensitive to emotional, cognitive, attentional &
situational influence
168. Answer is A (Cocaine):

Tactile hallucinations are seen with Cocaine.
Substance
Cocaine
Cannabis
Alcohol
LSD
Characteristic features
Magnus symptom
(cocaine bugs or Tactile
hallucination)
-Run amok
-Amotivation syndrome
-Flash backs
-Mc-Evan's sign
-Morbid jealousy
-Bad trips
-Flash backs
Amphetamin Paranoid hallucinatory syndrome
(like paranoid schizophrenia)
e
Phencyclidin Dissociative anaesthesia
e
(Angel dust)
171. Answer is B (Junction of 3rd and 4th part of duodenum):

Bailey & Love 24th/1132 Junction of 3rd and 4th part of
duodenum is not a boundary of gastrinoma triangle.
Boundaries of Gastrinoma Triangle: (90% of gastrinomas are
found in this triangle)
Superiorly, confluence of cystic duct and common bile duct
Inferiorly, junction of the second and third parts of the
duodenum
Medially, junction of neck and body of pancreas
172. Answer is A (Oxalate):
Most common stones in Ulcerative colitis are Oxalate stones.
Calculi: Calcium oxalate stones are seen due to hyperoxaluria
which occurs because increased absorption of dietary oxalates
in colon0. In patients with ileal dysfunction, fatty acids are
unabsorbed and they chelate calcium leaving oxalate unbound.
22
Calculi: Calcium oxalate stones are seen due to hyperoxaluria

which occurs because increased absorption of dietary oxalates
in colon0. In patients with ileal dysfunction, fatty acids are
unabsorbed and they chelate calcium leaving oxalate unbound.
173. Answer is C (Arises from 2nd cleft):
Branchial cyst arises from 2nd cleft.
Branchial cysts: are characteristically found anterior and deep
to the upper third of the sternocleidomastoid muscle.
Branchial fistulas: (those derived from 2nd branchial cleft)
open externally in the lower third of neck, near the anterior
border of sternocleidomastoid. Its internal orifice is located in
the tonsillar fossa.
f.
carcinoma thyroid makes family surveillance

advisable)
Hypocalcemia is associated: These cancers are
associated with Hypocalcemia because Calcitonin
is secreted.
Diagnosis:
I131 scan is of no use as tumors are TSH independent.
Calcitonin is raised in almost all cases of medullary
carcinoma and is tumor marker.
Treatment: Total thyroidectomy + Resection of involved
nodes with radical or
modified radical neck dissection.
174. Answer is B (Stomach): Sabiston 17th/1136, Maingot's

10th/872 Best conduit for esophageal reconstruction is
Stomach.
Follow up: Level of Calcitonin falls after resection and is

raises again in cases of
recurrence, hence used for follow up.
Stomach is best fonduit for esophageal reconstruction because

of:
Ease in mobilization
Ample vascular supply
Medullary carcinoma thyroid is seen as:

a. Sporadic: 80%
b. Familial: 20% (Non MEN setting/ MEN IIa / MEN IIb
"After a portion of esophagus is removed or after complete

esophagectomy, a conduit must be established for alimentary
continuity. The stomach, colon and jejunum have all been
successfully used as esophageal substitutes, but the stomach
appears to be the conduit of choice because of ease in
mobilization and its ample vascular supply.
Maingot's says "The stomach is the most widely used and
preferred organ for esophageal replacement after
esophgectomy for cancer.
175. Answer is (None of the above):
Medullary Carcinoma Thyroid:
Associated with poor prognosis
Associated with MEN Ha / MEN lib
Increased Calcitonin is associated with hypocalcemia
Treated by Total thyroidectomy + Resection of
involved nodes with radical or modified radical neck
dissection
None of the given options is correct. (Most probably Not is a
printing mistake in option (C)
Medullary Carcinoma Thyroid
It is a neuroendocrine carcinoma arising from
parafollicular VC' cells of thyroid.
Parafollicular 'C' cells are derived from neural crest
and secrete Calcitonin.
MCT is associated with poor prognosis. (Papillary
carcinoma is associated with good prognosis)
Medullary carcinoma should be suspected whenever:
a. High level of serum Calcitonin are discovered.
b. Cervical lymph nodes are discovered at time of
presentation.
Involvement of lymph nodes occurs early.
Thyroid and blood borne metastases occurs
early.
c. Diarrhea is a presentation.
d. Amyloid is present in stroma histologically.
e. MEN setting: Evidence of
Pheochromocytoma/Hyperparathyroidism/Thyroi
d cancer in family. (Discovery of medullary
176. Answer is C (Thoracic duct injury needs urgent

thoracotomy):
Thoracic duct injury doesn't need urgent thoracotomy. If the
damage is recognized during an operation, the proximal end of
the duct must be ligated.
Thoracic Duct injury
Wounds to the thoracic duct are most often occur in
association with dissection of lymph nodes in the left
supraclavicular fossa.
Treatment
If the damage is recognized during an operation, the
proximal end of the duct must be ligated.
Ligation of the duct is not harmful because there are
a number of anastomotic channels between the
lymphatics and venous systems in the lower neck.
If undetected, chyle usually starts to discharge from
the neck wound within 24 hours of the operation. On
occasions, firm pressure from a pad and bandage to
the lower neck may stop the leaking. It is best to reexplore the wound and locate and ligate the damaged
duct
177. Answer is C (Preoperative MRI is crucial):
Pre-operative MRI is crucial in Cystic hygroma.
Cystic hygroma
Cystic hygroma is a swelling usually occurring in the
lower third of the neck.
It is most commonly seen in posterior triangle of
the neck, but may also occur in axilla, groin &
mediastinum.
It results due to sequestration of a portion of the
jugular lymph sac from the lymphatic system.
It usually manifests in the neonate or in early infancy
(occasionally present at birth).
Turner's syndrome is associated with cystic
hygroma.
The swelling is soft and partially compressible and
invariably increases in size when the child coughs or
cries.
23
The characteristic that distinguishes it from all other

neck swellings is that it is brilliantly translucent.
The cysts are filled with clear lymph and are lined by
endothelium.
Mostly these are multiple cysts but occasionally they
can be unilocular.
It may show spontaneous regression.
Definitive t/t is by excision of the cyst.
178. Answer is A (Triad of jaundice, pain, malena):

Hemobilia is triad of jaundice, pain, malena.
Hemobilia is defined as bleeding into the biliary tree from an
abnormal communication between a blood vessel and bile
duct. Hemobilia is characterized by a classic triad of:
1. Biliary colic
2. Obstructive jaundice
3. Malena or occult blood in stool
179. Answer is D (Skin, muscle and vascular pedicle): Online
medical dictionary Myocutaneous flap includes skin, muscle
and vascular pedicle.
Myocutaneous flap: A pedicle skin flap, often an island flap,
with an attached subjacent, muscle and its investments and
blood supply.
180. Answer is A (Lingual thyroid):
Reddish swelling in the region of foramen caecum is Lingual
thyroid.
Lingual Thyroid
Forms a rounded swelling at the back of tongue at the
foramen caecum
It may represent the only thyroid tissue present
May cause dysphasia, impairment of speech, respiratory
obstruction or hemorrhage
Treated by replacement thyroxine when it should get smaller
181. Answer is A (Watchful expectancy):
Asymptomatic hemangioma on ventral surface of the tongue in
10 years old boy is treated by watchful expectancy.
Hemangioma:
Mucosal hemangiomas can occur in oral cavity or
oropharynx.
Mostly seen in children
When hemangiomas are present at birth or in
young children, they should be only observed for
some period as spontaneous regression can occur.
182. Answer is D (2nd and 3rd rib erosion): Harrison 16th/508
2nd and 3rd rib erosion is seen in superior sulcus tumor.
Pancoast Tumor (Superior Sulcus Tumor)
Pancoast's (or superior sulcus tumor) syndrome results from
local extension of a tumor growing in the apex of the lung
with involvement of eighth cervical and first and second
thoracic nerves, with shoulder pain characteristically
radiates in the ulnar distribution of the arm, often with
radiologic destruction of first and second ribs.
Often Horner's syndrome and Pancoast's syndrome co-exist
Treatment is preoperative RT followed by En bloc resection
of lung and chest wall with consideration of postoperative RT
or intra operative brachytherapy.
183. Aswer is D (TOC is excision and ligation of thoracic

duct): Bailey & Love 24th/772 In chylothorax, TOC is
excision and ligation of thoracic duct. See Q.no.170
184. Answer is A (Subdermal lymphatics): Bailey & Love
24th/837 Peau-de-orange appearance is due to involvement of
subdermal lymphatics.
Phenomenon resulting from lymphatic obstruction in
advanced breast cancer
1. Peau d' orange:
Peau d orange is due to cutaneous lymphatic
edema, where the infiltrated skin is tethered by sweat
ducts, it can not swell, leading to an appearance like
orange skin.
Occasionally, it may be seen in chronic abscess
2. Cancer-en-cuirasse
3. Lympangiosarcoma:
It's a rare complication of lymphoedema with an onset many
years following the treatment.
It takes the form of multiple subcutaneous nodules in the
upper limb and must be distinguished from recurrent
carcinoma of the breast.
185. Answer is B (Doxorubicin):
Doxorubicin is used in CA breast.
Two regimens are used CMF & CAF.
186. Answer is B (Adenoid cystic carcinoma):
Swiss cheese pattern is seen in Adenoid cystic carcinoma.
Adenoid Cystic Carcinoma
Relatively uncommon tumor, which in approximately
50% cases are found in the minor salivary glands
(in particular the palate)
Among the major salivary glands, the parotid and
submandibular glands are the most common locations
Propensity for neural invasion and is second most
common salivary gland malignancy in adults
Skip lesions along nerves are common and can lead
to treatment failures because of difficulty in treating
full extent of invasion
High incidence of distant metastasis but display
indolent growth
187. Answer is A (Appendage tumor):

Appendage tumor is also k/a cylindroma.
Cylindroma (Turban tumor)
An appendage tumor with apocrine differentiation, usually
occurs on forehead and scalp
Coalescence of nodules with time may produce a hat like
growth (turban tumor)
188. Answer is C (Warthin's tumor is MC malignant tumor of
salivary glands):
Warthin's tumor is NOT the MC malignant tumor of salivary
glands.
Remember
MC neoplasm of salivary
gland
MC malignant tumor of
salivary gland
The parotid tumor which
spreads through
Pleomorphic
adenoma
Mucoepidermoid
carcinoma
Adenoid cystic
carcinoma
24
neural sheath
Best diagnostic modality for
parotid swelling
FNAC
Ovarian cancer (40%)

Colorectal cancer (40%)
Open incisional biopsy is contraindicated due to tumor cell

implantation and formation of parotid fistula
192. Answer is A (PCOD):

Most common cause of hirsutism in females is PCOD.
189. Answer is A (1 vein and 2 arteries):

Umbilical tord has 1 vein and 2 arteries.
193. Answer is A (Uterine massage):

Early cord clamping doesn't contribute to active management
of third stage of labour.
Umbilical Cord
Initially there are 4 vessels- 2 arteries & 2 veins
Of the two umbilical veins, right one disappears by the 4th
month, leaving behind one vein (left vein is left)
Presence of single umbilical artery is often associated with
fetal congenital abnormalities
Single Umbilical Artery
Present in 1-2% cases, due to failure of development of one
artery or due to its atrophy in later months
More common in twins and in babies born to diabetic
mothers or in polyhydramnios
Frequently associated with congenital malformation of
the fetus (10-20%)
Renal and genital anomalies, Trisomy 18 are common
There is increased chance of abortion, prematurity, IUGR
and increased perinatal
190. Answer is A (Metformin):
Drug of choice for PCOD is metformin.
Although clomiphene is drug of choice for anovulation in
PCOD but Metformin is useful for both short term aiding of
infertility treatments and in prevention of long term sequelae
for patients with PCOD.
Role of Metformin in PCOD:
Hyperinsulinemia is believed to be a key link in the enigmatic
generation of the symptoms of polycystic ovarian syndrome,
which includes anovulatory infertility and the skin stigmata
induced by hyperandrogenism. Regression of these symptoms
may be achieved by reducing hyperinsulinelia. Metformin, an
insulin sensitizing agent, has been proven to be of clinical
usefulness both in the short- term aiding of infertility
treatments and potentially, in the prevention of the
longterm sequelae for patients of PCOD.
191. Answer is D (Ovarian cancer):
Ovarian cancer is not a side effect of OCPs. It prevents ovarian
malignancy.
Non-Contraceptive benefits of OCPs.
Improvement of menstrual abnormalities
Regulation of menstrual cycle
Reduction of dysmenorrhoea (40%), menorrhagia (50%)
Reduction of Pre-menstrual tension syndrome and
Mittelschmerz syndrome
Protection against iron deficiency anemia
Protection against health disorders
Pelvic inflammatory disease (thick cervical mucus),
Ectopic pregnancy, Endometriosis
Fibroid uterus, Hirsutism &. acne, Functional ovarian cyst,
Benign breast disease
Osteopenia & post-menopausal osteoporotic fractures
Autoimmune disorders of thyroid, Rheumatoid arthritis
Prevention of malignancies
Endometrial cancer (50%)
Management of third stage of labour

Active management
Expectant management
Administration of
Waiting for the signs of
prophylactic uterotonic at separation of the placenta
or after delivery like
and its spontaneous
oxytocin
delivery
Early cord clamping
Late cord clamping,
and cutting
clamping the umbilical
Controlled cord traction cord when cord pulsation
has ceased
to deliver the placenta
194. Answer is B (Cervical):

The staging of cervical carcinoma is essentially based on
clinical findings: Chest radiograph, IVP, cystoscopy,
proctoscopy are permitted.
Pelvic lymph nodes are involved in 5% in stage IB, 15% in
stage II, 25% in stage III. Para-aortic nodes are infiltrated in
advanced cases.
195. Answer is D (8-12 weeks):
Ampullary ectopic pregnancy stays till 8-12 weeks.
Tubal Rupture (MC in isthmic implantation)
Isthmic rupture- 6-8 weeks (earliest)
Ampullary rupture- 8-12 weeks
Interstitial rupture- 4 months (Longest survival in
interstitial part of fallopian tube)
196. Answer is B (Aortic stenosis):
Aortic stenosis is absolute C/I of epidural anaesthesia in LSCS.
Aortic Stenosis
Most cases of AS are congenital
Normal aortic valve area is 3-4 cm2, when it is reduced to <1
cm2, stenosis is significant
Maternal mortality of significant AS is 15-20%, with
prenatal loss of 30%.
Epidural anaesthesia is contraindicated
197. Answer is C (Teratoma):
Teratoma is germ cell tumor.
Germ cell tumor
Dysgerminoma
Endodermal sinus tumor
Embryonal carcinoma
Polyembryoma
Choriocarcinoma
Teratoma
198. Answer is A (Ca cervix):
Radiotherapy is the treatment of choice in all stages of tumor
of Ca cervix.
25
Radiotherapy is applicable to all stages between stage IB to

IV.
Expectant treatment carried upto 37 weeks i.e. Baby becomes

mature
Management (Carcinoma cervix)

If cancer cervix is detected remote from term, Werthiem's
hysterectomy with or without radiotherapy is desirable.
If pregnancy is approaching term, it may be prudent to wait
until the fetus is viable.
Elective Classical caesarean delivery is followed 4 weeks
later by surgery or
radiotherapy as in a non-pregnant
state.
Treatment of invasive cancer
Stage IA1: cone or simple hysterectomy. Lifelong follow up
is necessary.
Stage IA2, IB, IIA: Radical hysterectomy with bilateral
pelvic
lymphadenectomy (Werthiem's operation, Schauta's radical
vaginal hysterectomy, Mitra's modification of the Schauta's
operation) radiotherapy or combined therapy.
Stage IIB, III and IV: Radiation therapy or combination
with chemotherapy.
Recurrent or persistent disease: Radical hysterectomy,
pelvic extenteration
Premature termination of expectant t/t may be done

1. Recurrence of brisk hemorrhage
2. Fetus is dead
3. Fetus is found congenially malformed on investigations
199. Answer is B (Retained placenta):

MC cause of secondary PPH is Retained placenta.
Secondary Postpartum Hemorrhage
Bleeding usually occurs between 8th to 14th day of delivery.
Causes:
Retained bit of cotyledons or membranes (commonest)
Infection and separation of slough over a deep cervicovaginal laceration
Endometritis and subinvolution of the placental site-due to
delayed healing process
Secondary hemorrhage from caesarean section wound usually
occurs between 10-14 days
- Ultrasonography is useful in detecting the bits of placenta
inside the uterine cavity.
- As the commonest cause is due to retained bits of cotyledon
or membranes, it is preferable to explore the uterus urgently
under general anaesthesia
- The commonest cause of retention of non-seperated
placenta is atonic uterus.
200. Answer is A (G. vaginalis):
Organism causing bacterial vaginosis, which contain
metachromatic granules is G. vaginalis.
G. vaginalis is a small, gram negative, pleomorphic rod
which shows metachromatic granules.
201. Answer is C (Prematurity):
Prematurity is not an indication for stopping expectant
treatment in placenta praevia.
Expectant Management for Placenta Praevia
Suitable cases for expectant management
1. Mother is in good condition, patient not in labour & should
be hemodynamically stable
2. Hb 10 gm% or more
3. Pregnancy <37 weeks
4. FHS: good
5. Active bleeding absent
6. Initial bout of bleeding <600 ml
202. Answer is A (Syncytiotrophoblast):

Synthesis of hCG is by syncytiotrophoblast.
Human Chorionic Gonadotrophin
hCG is a glycoprotein
It consists of a hormone non-specific a and a hormone
specific subunit
It is chemically and functionally similar to pituitary
leutenising hormone
The a subunit is biochemically similar to LH, FSH and TSH
whereas p subunit is relatively unique to hCG
Have highest carbohydrate content (30%) of any human
hormone
Functions:
1. Rescue and maintenance of corpus luteum till 6 weeks of
pregnancy (major biological function)
2. Stimulates Leydig cells of the male fetus to produce
testosterone in conjunction with fetal pituitary gonadotrophins
3. Immunosuppressive activity which may inhibit the
maternal process of immunorejection of the fetus as the
homograft
4. Stimulates both adrenal and placental steroidogenesis'
Stimulates maternal thyroid because of its thyrotrophic
activity
Levels of hCG:
Production by syncytiotrophoblast
Half life=24 hours, Doubling time=48 hours (2 days)
By radio immunoassay detected in maternal serum or
urine as early as 8-9 days following ovulation
Maximum blood and urine level 100-200 IU/ml between
60-70 days of pregnancy
Disappears from circulation within 2 weeks following
delivery
High levels of hCG is detected in:
1. Multiple pregnancy
2. Hydatiform mole or Choriocarcinoma
3. Down's syndrome
4. Erythroblastosis fetalis0 resulting from maternal D-Ag
isoimmunisation
hCG is decreased in Ectopic pregnancy & Impending
spontaneous abortion.
203. Answer is B (HR):
Answer after all except is Heart rate.
Magnesium Sulphate-DOC for eclampsia
Repeat injections are given only if
Knee jerks are present
Urine output exceeds 30 ml/hour
Respiration rate is more than 12/min
Therapeutic level of serum magnesium is 4-7 mEQ/L.
26
204. Answer is A (Anterior rotation followed by normal

delivery):
MC outcome of occipitoposterior position is anterior rotation
followed by normal delivery.
MC outcome of occipitoposterior position is Anterior
rotation of the occiput (90%) followed by spontaneous,
ventouse or forceps delivery.
205. Answer is A (Radiotherapy):
Treatment for stage 3b CA cervix is radiotherapy.
206. Answer is C (FHR): Still searching
FHR is not used to monitor progress of labour.
207. Answer is A (Chromosomal anomaly
MC cause of first trimester abortion is Chromosomal anomaly.
Majority (50%) of early miscarriages are due to
chromosomal abnormality in the conceptus.
Autosomal trisomy is the commonest (50%) cytogenetic
abnormality. The most common trisomy is trisomy 16 (30%).
Monosomy constitutes 20% of all abortuses. Commonest is
monosomy X (45X)
208. Answer is B (14-18 months):

Anterior fontanel closes by 14-18 months.
Posterior fontanel usually closed by the 2nd or 3rd month
of life.
Anterior fontanel closes between 12th to 18th months of
life
209. Answer is D (TOF):
Congestive cardiac failure is not seen in TOF.
CCF occurs generally in L/R shunt, not in right to left
shunt until heart is decompensated.
The ventricular septal defect of TOF is large enough to
allow free exit to the right to left shunt. Since the right
ventricle is effectively decompressed by the ventricular
septal defect, congestive failure never occurs in TOF.
The exceptions to this rule are:
1. Anaemia
2. Infective endocarditis
3. Systemic hypertension
4. Unrelated myocarditis complicating TOF
5. Aortic or Pulmonary valve regurgitation
210. Answer is B (6 weeks):
Social smile appear earliest at 6 weeks.
The first social smile may appear as early as 6 weeks.
211. Answer is B (Soft well formed stools):
Healthy breast fed neonate passes soft well formed stools.
Breast fed infants
Infants fed naturally generally experience almost no bouts with
constipation compared to their formula fed counterparts.
Breast fed babies generally have bowel movements after every
feeding and the stools are mostly soft, well formed and
slightly runny. Healthy baby poop is usually rich yellow to
bright orange in color but may contain white 'seed like" specs.
212. Answer is B (5 months):
Baby doubles its weight in 5 months.
Normal Growth
Weight
The average birth weight of neonates is about 3 kg.
Most full term infants regain their birth weight by the age of
10 days.
An infant usually doubles his birth weight by the age of 5
months.
Thejbirth weight trebles at 1 year and is four times at 2
years of age.
Length or height
The baby measures 50 cm at birth, 60 cm at 3 months, 70 cm
at 9 months and 75 cm at 1 year of age.
The Indian child is 100 cm tall at the age of 4 Vi years.
Thereafter, the child gains about 5 cm in height every
year until the age of 10 years.
Head circumference
Birth=35 cm; 3 months=40 cm; 12 months=45 cm; 2 years=
48 cm; 12 years= 52 cm.
If the head growth exceeds 1 cm in 2 weeks during the
first 3 months, hydrocephalus should be suspected.
Crown rump length is always less than the head
circumference during the first year of life.
Chest circumference
The circumference of chest is about 3 cm less than the
head circumference at birth.
The circumference of head and chest are almost equal by the
age of 1 year. Thereafter, the chest circumference exceeds the
head circumference.
213. Answer is C (Fracture femur):
Fat embolism is most commonly associated with fracture
femur.
Fat embolism is a common phenomenon, more commonly
seen in multiple fractures (involving lower limbs especially
femur)
Fat embolism syndrome
Pathophysiology
Fat embolism is a common phenomenon, more commonly
seen in multiple fracture and in fractures involving lower
limbs especially femur.
Circulating fat globules>10 m in diameter occur in most
adults after close fracture of long bones and histological
traces of fat can be found in the lungs and other internal
organs.
Clinical presentation
It usually manifests itself within 24-48 hours.
Early warning signs (within 72 hours of injury) are a alight
rise in temperature (pyrexia) and pulse rate (tachycardia)
In more pronounced cases there is breathlessness, mild mental
confusion or restlessness, petechiae on chest, axillae, retina
& conjunctival folds; progressive to marked respiratory
distress & coma in serve cases.
Management
Supportive pulmonary care, definitive fracture management
and effective treatment of shock are the corner stones of
current fat embolism management.
Respiratory
support
Treatment of shock
Fracture
stabilization
27
Ranges from oxygen

administration to full
respiratory siioDort
with
mechanical
ventilation (Oxygen
is the only
therapeutic tool of
proven use)
Maintain adequate
intravascular volume
Aggressive fluid
resuscitation should
be instituted to
restore intravascular
volume
Appropriate
monitoring (CVP)
should
be used to avoid
fluid overload.
Albumin has been
suggested for fluid
resuscitation along
with a balanced
electrolyte solution
because it not only
restores blood
volume but also
binds free fatty
acids.
Since movement
at the fracture site
has been shown to
increase the fat
emboli in
circulation, early
immobilization of
lower extremity
fractures is
advocated
Additional therapies
Steroids: Prophylactic corticosteroids benefit high risk patients
Heparin: Increase serum lipase activity and decrease number of
circulating fat globules
Dextran: To reduce red cell aggregation, expand plasma volume,
decrease blood viscosity and reduce platelet adherence
Hypertonic glucose: Metabolically decrease production of free
fatty acids
Aprotinin: Decrease platelet aggregation and serotonin release
Alcohol: Reduces serum lipase activity
214. Answer is A (Hemangioma):

Vertical striations in vertebra, is seen in Hemangioma.
Hemangioma of the bone

Benign tumor of hemangiomatous origin, commonly
affecting vertebrae and the skull. (Spine>skull &
pelvis)
Common presenting symptoms are persistent pain and
features of cord compression.
Typically one of the lumbar vertebrae is affected.
Radiologically, it appears as loss of horizontal
striations and prominence of vertical striations of the
affected vertebral body.
Treatment is by Radiotherapy
215. [D] (Usually found in 2-5% of population):
216. Answer is A (Avulsion fracture of distal phalanx due to

sudden flexion):
Mallet finger is avulsion fracture of distal phalanx due to
sudden flexion.
Mallet finger (Baseball finger)
Avulsion of extensor tendon of the distal interphalangeal
joint from its insertion at the base of distal phalanx.
It results from sudden passive flexion of the distal
interphalangeal joint
Patient usually presents with slight flexion of the distal
interphalangeal joint
X-ray remains normal because there is no bony injury
Osteochondroma is MC benign bone tumor.

Bone tumors
MC bone lesion- Fibrous cortical defect (non ossifying
fibroma)
MC bone tumor- Secondaries
MC site for secondaries- Vertebra
MC benign bone tumor- Osteochondroma
MC true bone tumor- Osteoid osteoma
MC primary malignant tumor- Multiple myeloma
218. Answer is D (Fracture proximal end of ulna with
dislocation of sup. radioulnar joint):
Monteggia fracture is fracture proximal end of ulna with
dislocation of superior radioulnar joint.
Monteggia Fracture
Fracture of upper third of the ulna with dislocation of the
head of the radius
Caused by fall on outstretched hand with the forearm forced
into excessive pronation (Hyperpronation injury)
Extension type is commoner than flexion type
In extension type, ulna fracture angulates anteriorly (extends)
and the radial head dislocates anteriorly
Rigid anatomical fixation by plating is the method of
choice
Galeazzi Fracture
Fracture of the of the lower third of third of the radius with
dislocation or subluxation of the distal radio-ulnar joint
It commonly results from a fall on outstretched hand
Rigid anatomical fixation by plating is the treatment of
choice in adults.
Remember: In Monteggia, medial side of bone (ulna) is
fractured.
219. Answer is A (Subcapital fracture):
Avascular necrosis is MC associated with subcapital fracture.
Fracture neck of femur
Chances of avascular necrosis (AVN) and nonunion
increases, as the fracture site becomes more proximal
The more proximal the fracture located, the worse the
prognosis.
Chances of AVN & nonunion (Or worseness of prognosis)
in decreasing order is
- Subcapital >Transcervical > Basal > Intertrochanteric
220. Answer is A (Entrapment of median nerve):
Carpal tunnel syndrome is due to entrapment of median nerve.
Nerve Entrapment Syndromes
Entrapment syndrome results from entrapment and compression of
nerves wherever
peripheral nerves traverse fibroosseous tunnels.
Common sites
Carpal tunnel
Supra scapular notch
Median nerve (Carpal tunnel

syndrome)
Ulnar nerve (Cubital tunnel
syndrome)
Posterior tibial nerve (Tarsal tunnel
syndrome)
Lateral cutaneous nerve of thigh
(Meralgia
paraesthetica)
Suprascapular nerve
Neck of fibula
Common peroneal nerve
Cubital tunnel
Tarsal tunnel
Inguinal ligament
Treatment: An acute mallet finger should be splinted with

the joint ion extension for 8 weeks.
217. Answer is B (Osteochondroma
28
Thoracic outlet
Roots of brachial plexus posterior
Arcade of Frohse
Interosseous nerve (Posterior
(Proximal edge of Supinator) interosseous syndrome)
Guyon's canal
Morton's
metatarsalgia
Ulnar nerve (Guyon's canal

syndrome)
Interdigital nerve compression
(Usually 3rd ,4th toe)
221. Answer is A (Ankylosing spondylitis):

Bamboo spine is seen in Ankylosing spondylitis.
Ankylosing Spondyiitis/Marie-Strumpell or Bchtrew's
disease
Radiological Examination: The following changes may be
seen on an X-ray of the pelvis
Haziness of sacro-iliac joints
Irregular subchondral erosions in SI joints
Sclerosis of the articulating surfaces of SI joints
Widening of sacro-iliac joint space
Bony ankylosis of the sacro-iliac joints
Calcification of the sacro-iliac ligaments and sacro-tuberous
ligaments
Evidence of enthesopathy- Calcification at the attachment
of the muscles, tendons and ligaments, particularly around the
pelvis and around the heel.
X-ray of Lumbar spine:
Squaring of vertebra: The normal anterior concavity of the
vertebral body is lost because of calcification of the anterior
longitudinal ligament
Loss of lumbar lordosis
Bridging osteophytes (syndesmophytes)
Bamboo spine appearance d/t syndesmophytes &
paravertebral ossification
222. Answer is B (Osteochondritis of femoral head):
Perthes disease is Osteochondritis of femoral head.
Common Osteochondritis
Name
Site affected
Perthes disease
Femoral head (MC)
Panner's disease
Capitulum
Kienbobock's disease
Lunate
Osgood-Sclatter's disease
Tibial tubercle
Sever's disease
Calcaneal tuberosity
Kohler's disease
Navicular bone
Freiberg's disease
Metatarsal head
Scheurmann's disease
Ring epiphysis of vertebrae
Calve's disease
Central bony nucleus of

vertebral body
223. Answer is C (Tubercular dactylitis):

Spina ventosa is tubercular dactylitis.
Spina Ventosa (Tubercular dactylitis)
Spindle shaped expansion of short tubular bones, caused
by tuberculosis
Affected phalanx swells like a balloon
An X-ray characteristically shows a lytic lesion
distending the phalanx, and a lot of new bone formation
224. Answer is B (Posterior):
MC dislocation of hip joint is posterior.

Posterior Dislocation Of Hip
It is the most common type of hip dislocation in adults and
children
Also known as Dashboard injury
Clinical features
The patient presents with history of severe trauma followed
by pain, swelling and deformity (Flexion, adduction and
internal rotation)
One may able to feel the head of femur in the gluteal region
Vascular sign of Narath is positive
Radiological features
The femoral head is out of the acetabulum
The thigh is internally rotated so that the lesser trochanter
becomes less prominent compared to that on opposite side
Shenton's line is broken
Treatment
Reduce the hip by manipulation under GA in most cases
Open reduction may be required in cases where closed
reduction fails, if there is intra-articular loose fragment not
allowing concentric reduction, if the acetabular fragment is
large and is from the weight-bearing part of the acetabulum
Complications
Injury to Sciatic nerve: More commonly, if the dislocation
is associated with a large bony fragment from the lip of
acetabulum, displaced posteriorly.
Avascular necrosis of femoral head: In 15-20% cases, the
femoral head undergoes avascular necrosis. The changes of
avascular necrosis, appears on X-ray generally 1-2 years after
the injury.
Osteoarthritis: This is a late complication.
Myositis ossificans: This occurs few weeks to months after
injury
225. Answer is C (Lachman's test):
Best test for injuries of anterior cruciate ligament is Lachman's
test.
Lachman's test is the most sensitive test for anterior
cruciate ligament tears. It is done with the knee flexed at 20.
So it can be done in acute as well as chronic injuries. (Because
in acute cases with hemarthrosis more flexion is usually not
possible, so performing anterior drawer test is difficult)
Test for ACL in decreasing order of sensitivity &
specificity: Lachman's test >Flexion-rotation drawer test
>Anterior drawer test >Pivot shift test
Test for Ligamentous Instability
Anterior
Cruciate
Posterior
Cruciate
Ligament
Ligament
Lachman's
Test
Posterior drawer Mc Murray's

test
test
Flexion
Rotation
Drawer
Test
Posterior tibial
sag
Menisci
Collateral
Ligaments
Valgus/Varus
stress test
Apley's
grinding test
Reverse
Pivot shift
test
29
Quadriceps active
test
Anterior
drawer
test
Pivot shift
test
226. Answer is A (CDH):

Ortolani's test is for CDH.
Barlow's test, Ortolani's test and Galeazzi's sign help to
diagnose CDH.
227. Answer is B (Radial nerve injury):
Cock up splint is used for radial nerve injury.
Plaster casts and their uses
Name of the cast
Use
Minerva cast
Risser's cast
Turn-buckle cast
Shoulder spica
Cervical spine disease

Scoliosis
Scoliosis
Shoulder immobilization
U-slab
Hanging cast
Colle's cast
Hip spica
Cylinder cast
Patellar-tendon
bearing cast
Fracture of the humerus

Fracture of the humerus
Colle's fracture
Fracture of the femur
Fracture of the patella
Fracture of the tibia
228.
[D] (Hepatitis-E)
229.
[D] (Either of temporal lobe involvement):
Korsakoff's psychosis - an amnestic state with impairment in
recent memory and learning may become more apparent.
It is frequently persist, the residual mental state is
characterized by gaps in memory, confabulation and
disordered temporal sequencing.
230.
[C] (Prostacyclin):
Secondary prevention/prophylaxis
Long term treatment with an antiplatelet agent
(usually Aspirin) after STEM I is associated with a
25% reduction in the risk of recurrent infarction,
stroke or cardiovascular mortality.
An alternative antiplatelet agent that may be used for
secondary prevention in patients intolerant of aspirin is the
ADP receptor antagonist Clopidogrel (75 mg 00)
ACE inhibitors should be used indefinitely by patients
with clinically evident heart failure, a moderate
decrease in global ejection fraction or a large regional
wall motion abnormality to prevent late ventricular
remodeling and recurrent ischemic attacks.
The chronic use of oral b-adrenoceptor blockers for at
least 2 years after STEMI - reduction in the rates of total
mortality sudden death and in some instances,
reinfarction.
231.
[A) (Hypercalcemic parathyroid ism crisis):
Severe calcium elevations are not typical, and the presence
of such suggests a concomitant disease such as
hyperparathyroidism. Usually, the diagnosis is obvious but

the signs of hyperthyroidism may occasionally be occult,
particularly in the elderly.
If the serum calcium level rises rapidly, clouding of
sensorium renalfailure, and rapid precipitation of
calcium throughout the soft tissues occurs
232.
[C] (Brady cardia):
233.
[B] (Pigmented stone):
Medical treatment of Gall bladder stone
UDCA (Ursodeoxy cholic acid) - decreasing cholesterol
saturation of bile and also appears to produce a lamellar liquid
crystalline phase in bile that allow a dispersion of cholesterol
from stone by physiochemical means
Retards cholesterol crystal nucleation
*in carefully selecting patients with functioning GB and with
radiolucent stone < 10 mm in diameter
complete dissolution can be achieved in about 50% of patients
within 6 months to 2 years with UDCA at a dose of 8-1 0
mg/Kg per day
The highest success rate (i.e. > 70%) occurs in patients with
small 5 mm) floating radiolucent gall stone
234. [C] (Pulmonary embolism):
Pulmonny embolism - Deep vein thrombosis is the most common
source of the pulmonary thromboemboli
More unusual causes are fat embolism from multiple
trauma, tumour embolus (renal carcinoma) and
amniotic fluid, Atrial myxoma
235. [A] (MS): Mitral stenosis - ECG findings are

In MS and sinus rhythm, the P wave usually suggests LA
enlargement.
When severe pulmonary hypertension or TS complicates
MS and RA enlargement occurs
The QRS complex is usually normal. However with severe
pulmonary hypertension, right axis deviation and R VH are
often present.
Normally patients of MS never has LVH if LVH occurs
suspect
Associated MI, AS, or AR
Hypertension due to renal embolism
IHD due to coronary embolism
Cardiomyopathy
Mitral regurgitation - In patients with sinus rhythm there is
evidence 0 LA enlargement, but RA enlargement also may be
present.
Sign of LV hypertrophy are present
236. [D] (Calcitriol): Therapy for severe hypercalcemia
Most useful therapy
Hydration with saline
Forced diuresis saline plus loop diuretic
Biphosphonates (etidronate, pamidronate, zolendronate)
Calcitonin
Special use therapies
Phosphate
Glucocorticoids
Dialysis
237.
[B] (Small cell carcinoma):
Histologic type
Frequency Age-
5-year
30
Adenocarcinoma
(and all subtypes)
Squamous cell
(epidermoid)
carcinoma
Small cell (oat
cell) carcinoma
Large cell
carcinoma
(%)
adjusted
rate
* 32
17
survival
rate (all
stages)
17
29
15
15
18
5*
11
Corticosteroid are used by some in refractory diseases.

Warfarin is indicated for management of coronary artery
aneurysm.
238.
[B] (Left lower sternum):
Differences between Pericardial rub and Murmur
Pericardial
Murmurs
1. Cardiac cycle Does not
Coincides
coincide with
with systole
systole or
diastole
Blowing,
2. Character
Creaking,
rumbling or
scratchy
musical
rasping or
leathery
3.
4.
Conduction
Variability
None
Present
May be present
Absent
5.
Audibility
Sounds
superficial
Sounds deeper
6.
Pressure of
stethoscope
Alters the
intensity of the
rub
Does not alter

the intensity
239.
[D] (Autosomal dominant disorder):
GAUCHER DISEASE - is an autosomal recessive
disorder that results from defective activity of acid f3glucosidase
Type I Gaucher disease is a non neuronopathic disease that
can present in childhood to adulthood with slowly to
rapidly progressive visceral disease.
Type II is rare severe CNS disease that leads to death by 2
years of age.
Type III gaucher disease has high variable manifestations
in the CNS and viscera
Angiokeratomas and acroparesthesia may appear in
childhood and lead to early diagnosis in Fabry disease
240.
[B] (Occurs above 5 years age group):
KA WASAKI DISEASE - (Mucocutaneous lymph node
syndrome) is an acute febrile, mulisystem disease of children,
some 80% of cases occur prior to the age of 5, with the peak
incidence occurring at :s; 2 years.
Characterised by - non supprative cervical adenitis and
changes in the skin and mucous membranes as edema.
Although the disease is generally benign and self-limited.
It is associated with coronary artery aneurysm in
approximately 25%.
Others manifestations include pericarditis, myocarditis, MI
and cardiomegaly.
Treatment - High doses intravenous y-globulin with aspirin is
treatment of choice.
Plasmapheresis may be useful in the upto 10% of cases
that are unresponsive to immune globulin.
31

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1.

Pin index of oxygen is:

14. M/C used in Brachytheraphy of Carcinoma cervix:

6. In carpel tunnel syndrome the nerve involved is:

17. Best method to diagnose pathology in terminal part of

7. Fibrous ankylosis is seen in:

18. Drug of choicc in depression in old person is:

8. Metacarpophalangeal joints are most common affected

19. DOC in OCD

9. Hill - Sach's lesion seen in:

21. False perception without external stimulus is:

11. Tinel's sign is seen in:

23. Alopecia, Hyper pigmentation, Hypogonadism

13. Double bubble sign in Barium meal seen in:

24. Isomorphism not seen in:

30. Most common cause of Intracerebral Bleeding is due

35. Tetany is not seen in:

37. All are causes of flapping tremor except:

29. Normal Anion gap acidosis seen in:

34. Morphine is given in:

36. Which of the following is not a usual feature of right

40. Most common CNS manifestation of HIV Infection is:

58. Nephrocalcinosis is seen in all except:

49. Megaloblastic anemia is caused by:

61. In Crohn's disease not seen:

50. Nephrocalcinosis is a feature of:

62. Differential diagnosis of chylous ascites are all except:

53. Zinc deficiency is seen in all except:

65. Painful tender and non reducible sac through inguinal

55. Not a cause of Cor Pulmonale:

67. Thimble bladder is seen in:

57. Exudative pleural effusion seen in all except:

68. Pott's puffy tumour is the:

80. A 45-year-man complain of vomiting with food mass

71. Branham's sign is seen in:

82. Collar - Stud abscess is seen in:

72. Uvula vesicae is caused by which lobe of prostate:

83. Spigelian hernia is seen in:

76. Eczema like lesion with frequent bleed around areola is

87. Dumping syndrome is characterized by all except:

77. Treatment of paralytic ileus include all except:

88. All are complication of Crohn's disease except:

78. Acute pancreatic causes all except:

89. Best marker to assess prognosis after colon surgery:

79. Grey turner sign is seen in:

90. Amylase is increased in all except:

91. GERD (Gastro Esophageal Reflux Disease) is

102. Down's syndrome is diagnosed in a pregnant women

92. Chronic cholecystitis is associated with all except:

103. In vagina, the type of epithelium is:

93. All the following Lymphnodcs involved in breast

104. Exact no. of weeks between LMP and EDD:

94. All are precancerous state of penis except;

105. A composite graphical record of cervical dilation and

124. 100% oxygen improves cyanosis in all except:

113. Painless heavy bleed is seen in:

117. 4-hour fluid requirement of a baby of 8 kg with severe

125. Wide and Split S2 occurs in:

118. Delayed bone age is due to:

132. Mucosa is involved in:

119. Physiological jaundice in a term baby is maximum at:

133. Normal commensal of sebaceous gland:

B. Prednisolone used to control flaring

152. Popcorn calcification is characteristic of: