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(1) What type of fracture of this?

(a.) Bennetts fracture


(b.) Rolandos fracture
(c.) Fractures of the metacarpals
(d.) Fractures of the phalanges
(1) Ans: a.
Exp. Bennetts fracture

Intraarticular Fractures of the First Metacarpal Base (A). An intraarticular fracture at the base of the first metacarpal with radial and
proximal displacement is a Bennett's fracture (B). A comminuted intraarticular fracture at the base of the first metacarpal is a
Rolando's fracture (C).
It is an oblique intra-articular fracture of the base of the first metacarpal with subluxation or dislocation of the metacarpal. It is
sustained as a result of a longitudinal force applied to the thumb.
Treatment: Accurate reduction and restoration of the smooth joint surface is important. This is because, being an intra-articular
fracture, if not reduced accurately, it will lead to incongruity of the articular surfaces. This would increase the chances of developing
osteoarthritis. The following methods of treatment are used:
a. Closed reduction and percutaneous K-wire fixation under an image intensifier, is a good technique. K-wire is used and
incorporated in a plaster cast.
b. Open reduction and internal fixation with a K-wire or a screw may be necessary in some cases.

(2.) What type of traction is this?

(a.) Gallows
(c.) Russells
(2.) Ans: c.
Exp. Russells

(b.) Bryants
(d.) Bucks

It is a type of traction that is used for trochanteric fractures.

(3.) What is the diagnosis?

(a.) Optic nerve sheath meningioma


(b.) Optic nerve glioma
(c.) Caroticocavernous fistula
(d.) Cavernous hemangioma
(3.) Ans: a.
Exp. Optic nerve sheath meningioma
Optic nerve sheath meningioma with classic tram tract appearance on T1 weighted contrast enhanced MRI.

Optic nerve meningiomas account from approximately a third of all optic nerve neoplasms; optic nerve gliomas are the most
common entity. Unlike optic nerve gliomaswhich occur primarily in children, optic nerve meningiomas are usually seen in adults
(mean age at presentation 40 years), however up to 25% present in children, in which case they tend to be more aggressive
Similar to meningiomas elsewhere there is a female predilection
The vast majority of cases are sporadic, although patients with neurofibromatosis type II(NF2) are at increased risk.
On axial or oblique sagittal imaging the enhancing tumour surrounding the non-enhancing optic nerve results in the so-called tramtrack sign. This is most evident in tumours with tubular growth pattern.

(4.) What is most probable age of this child?

(a.) 7 months
(b.) 10 months
(c.) 13 months
(d.) 15 months
(4.) Ans: b.
Exp. 10 months
Diagonal localization of the sources of sound occurs at 10 months

(5.) The below given abnormality is seen in which condition?

(a.) Fanconi anemia


(b.) Dyskeratosis congenita
(c.) Ehler Danlos syndrome
(d.) Pseudo hypoparathyroid

(5.) Ans: a.
Exp. Fanconi anemia
This is radial ray defects seen in Fanconi anemia. It present in a wide spectrum they include absent or hypoplastic thumbs. The
thenar hypoplasia may be missed unless carefully examined.

(6.) The cells shown in the figure with arrow is found in which condition?

(a.) Thalassemia
(c.) B12 deficiency

(b.) CRF
(d.) Aplastic anemia

(6.) Ans: b.
Exp. CRF
The red blood cells in uremia may acquire numerous, regularly spaced, small spiny projections. Such cells, called burr cells or
echinocytes, are readily distinguishable from irregularly spiculated acanthocytes or spur cells.
(7.) The . Given in picture may help to manage a shoulder dystocia during vaginal delivery-

(a.) Woods' screw maneuver


(b.) Zavanelli maneuver
(c.) McRoberts maneuver
(d.) None
(7.) Ans: c.
Exp. McRoberts maneuver
The McRoberts maneuver is named after William A. McRoberts, Jr. It is employed in case of shoulder dystocia during childbirth and
involves hyperflexing the mother's legs tightly to her abdomen. It is effective due to the increased mobility at the sacroiliac joint
during pregnancy, allowing rotation of the pelvis and facilitating the release of the fetal shoulder. If this maneuver does not succeed,
an assistant applies pressure on the lower abdomen (suprapubic pressure), and the delivered head is also gently pulled. The
technique is effective in about 42% of cases.
(8.) The following abnormality an angiography is seen in which condition?

(a.) Takayasu
(b.) Giant cell arteritis
(c.) PAN
(d.) Wageners granulomatosis
(8.) Ans: A.
Exp. Takayasu
RAS occur in Takayasus and atherosclerosis.
Angiogram illustrating high-grade renal artery stenosis affecting the left kidney. This lesion is often part of widespread
atherosclerosis and sometimes is an extension of aortic plaque. This lesion develops in older individuals with preexisting
atherosclerotic risk factors.
(9.) What is your diagnosis?

(a.) Intestinal perforation


(b.) Toxic megacolon
(c.) Volvulus
(d.) Gastric dilatation
(9.) Ans: c.
Exp. Volvulus
Sigmoid volvulus with the characteristic radiologic appearance of a "bent inner tube."

10. What is your diagnosis of the following peripheral smear?

A. Sickle cell anemia

B. Iron deficiency anemia


C. Hemolytic anemia
D. Thalassemia
10. Ans. C. Hemolytic anemia
Fragmentation hemolysis
1. Microangiopathic hemolytic anemia (MAHA) is a microangiopathic subgroup of hemolytic anemia (loss of red blood cells
through destruction) caused by factors in the small blood vessels.
2. It is identified by the finding of anemia, schistocytes & fragmented RBCs on microscopy of the blood film.
Presentation
1. In diseases such as hemolytic uremic syndrome, disseminated intravascular coagulation, thrombotic thrombocytopenic
purpura, and malignant hypertension, the endothelial layer of small vessels is damaged with resulting fibrin deposition and
platelet aggregation.
2. As red blood cells travel through these damaged vessels, they are fragmented resulting in intravascular hemolysis.
3. The resulting schistocytes (red cell fragments) are also increasingly targeted for destruction by the reticuloendothelial
system in the spleen, due to their narrow passage through obstructed vessel lumina.
4. It is seen in systemic lupus erythematosus because the immune complex aggregates with platelets, which creates
intravascular thrombi. Microangiopathic hemolytic anemia is also seen with cancer
11. What is the diagnosis of the patient having following condition?

(A). Herpes zoster


(C). Pemphigus

(B). Herpes simplex


(D). Molluscum contagiosum

11. Ans. (D). Molluscum contagiosum


a. Molluscum contagiosum is a cutaneous poxvirus infection characterized by multiple umbilicated flesh-colored or
hypopigmented papules.
b. Molluscum contagiosum lesions are flesh-colored, dome-shaped, and pearly in appearance. They are often 15 millimeters
in diameter, with a dimpled center.
c. They are generally not painful, but they may itch or become irritated
d. In a process called autoinoculation, the virus may spread to neighboring skin areas.
e. Children are particularly susceptible to autoinoculation, and may have widespread clusters of lesions.

12. What is the osmolarity at point X in the diagram below if ADH is present?

A) Hypertonic
B) Hypotonic
C) Isotonic
D) Hypertonic if aldosterone is also present

12. The answer is A. hypertonic


If ADH is present CD becomes permeable to water via Aquaporin 2 and cause water reabsorption resulting in hypertonic fluid in CD
and also hypertonic urine. In absence of ADH i.e DI, there would be hypotonic fluid.
13. In the figure below, The tip of probe passes into the opening of which vessel?

A. Left coronary artery


C. Right coronary artery

B. Left marginal artery


D. Right marginal artery

13. Ans. C) Right coronary artery


The specimen is a superior view of the cadaver heart showing the two great vessels of heart in direct view. The ascending aorta
(held by the forceps) is seen on the right side of the pulmonary trunk
The right coronary artery (RCA) originates above the right cusp of the aortic valve. It travels down the right atrioventricular groove,
towards the crux of the heart.
At the origin of the RCA is the conus artery.
In addition to supplying blood to the right ventricle (RV), the RCA supplies 25% to 35% of the left ventricle (LV).
In 65% of population, the RCA gives off the posterior interventricular artery (PIVA) right cardiac dominance.
In 10% of cases, the PIVA is given off by the left circumflex artery left dominance.
25 % people have co-dominance, where multiple PIVA(s) are found, arising from both the coronary arteries.

PIVA is also called as PDA (posterior descending artery). The PDA supplies the inferior wall, ventricular septum, and the
posteromedial papillary muscle.
14. What is the your diagnosis of the following examination of the fundus?

(A) Diabetes retinopathy.


(B) Optic atrophy
(C) CRAO
(D) Retinal detachment
14. Ans. (D) Retinal detachment
It is a cause of retinal detachment appears as an elevated sheet of retinal tissue with folds. In this patient the fovea was spared, so
acuity was normal, but a superior detachment produced an inferior scotoma.
Retinal Detachment
This produces symptoms of floaters, flashing lights, and a scotoma in the peripheral visual field corresponding to the detachment. If
the detachment includes the fovea, there is an afferent pupil defect and the visual acuity is reduced. In most eyes, retinal
detachment starts with a hole, flap, or tear in the peripheral retina (rhegmatogenous retinal detachment). Patients with peripheral
retinal thinning (lattice degeneration) are particularly vulnerable to this process. Once a break has developed in the retina, liquefied
vitreous is free to enter the subretinal space, separating the retina from the pigment epithelium. The combination of vitreous
traction on the retinal surface and passage of fluid behind the retina leads inexorably to detachment. Patients with a history of
myopia, trauma, or prior cataract extraction are at greatest risk for retinal detachment. The diagnosis is confirmed by
ophthalmoscopic examination of the dilated eye.
15. What is treatment of choice of the classical sign shown in the fundus photo given below:

(A) Control of systemic disease


(B) Laser
(C) Vitrectomy
(D) Enucleation

15. Ans. (B) Laser


It is a case of diabetic retinopathy. Best treatment for this is LASER.
Lasers In Ophthalmology
Argon laser
- It is absorbed by Hemoglobin
- Used for PDR, neovascular glaucoma, capillary hemangioma
Nd: YAG laser
- For posterior capsulotomy, iridectomies, iridotomies, cutting vitreous bands (vibriolysis)
Sec. Glaucoma, after cataract, tumors
Excimer / UV laser
- In refractive surgeries like LASIK
(For T/t of Myopia, Astigmatism and Hypermetropia)
Also used for photorefractive keratectomy (in Band Keratoplasty)
Diode laser
- Retinal photocoagulation, for glaucoma drainage
Argon Laser is used in
- RD
Retinal Vein Occlusion
Eale's ds
Lasers used for retinal photocoagulation are---Diode laser, krypton red laser, double frequency Nd: YAG
16. A 2-year-old child (A) presents with a four-day history of a rash limited to the feet and ankles. The papular rash is both pruritic
and erythematous. The 3-month-old sibling of this patient (B) has similar lesions also involving the head and neck. Appropriate
treatment for this condition includes (See Fig)

(A). Coal-tar soap


(B). Permethrin
(C). Hydrocortisone cream (D). Emollients

16. Ans. (A). Coal-tar soap


When the clinical signs of constricted pupils, bradycardia, and muscle fasciculations are associated with the sudden onset of
neurologic symptoms, progressive respiratory distress, diaphoresis, diarrhea, and overabundant salivation, a diagnosis of
organophosphate poisoning should be suspected. Intake of organophosphate agents can occur by ingestion, inhalation, or
absorption through skin or mucosa. Organophosphates inhibit carboxylic esterase enzymes, including acetylcholinesterase and
pseudocholinesterase; toxicity depends primarily on the inactivation or inhibition of acetylcholinesterase.
Treatment consists of gastric lavage, if the poison has been ingested, or decontamination of the skin, if exposure has been through
contact. Maintenance of adequate ventilation and fluid and electrolyte balance also is indicated. All symptomatic children should
receive atropine and, if severely affected, cholinesterase-reactivating oximes as well. Cholinesterase-reactivating oximes quickly
restore consciousness by inhibiting muscarine- and nicotine-like synaptic actions of acetylcholine. Cholinesterase-reactivating
oximes include pralidoxime chloride or obidoxime.

17. A 1-week-old black infant presents to you for the first time with a large, fairly well-defined, purple lesion over the buttocks
bilaterally, as shown in the photograph. The lesion is not palpable, and it is not warm or tender. The mother denies trauma and
reports that the lesion has been present since birth. This otherwise well-appearing infant is growing and developing normally and
appears normal upon physical examination. The most likely diagnosis in this infant is (See Fig)

(A). Child abuse


(B). Mongolian spot
(C). Subcutaneous fat necrosis
(D). Vitamin K deficiency
17. Ans. (B). Mongolian spot
(Behrman, 16/e, pp 455, 1970.)
Mongolian spots are bluish-gray lesions located over the buttocks, lower back, and occasionally, the extensor surfaces of the
extremities. They are common in blacks, Asians, and Latin Americans. They tend to disappear by 1 to 2 years of age, although those
on the extremities may not fully resolve. Child abuse is unlikely to present with bruises alone; children frequently present with more
extensive injuries. Subcutaneous fat necrosis is usually found as a sharply demarcated, hard lesion on the cheeks, buttocks, and
limbs. The lesion usually is red. Hemophilia and vitamin K deficiency rarely present with subcutaneous lesions as described and are
more likely to present as a bleeding episode.

18. If you could histologically examine the spinal cord of a patient who had experienced a viral illness 10 years before in which
only the neurons of the area shown below in diagram were destroyed, what findings would you expect?
(See Color Atlas, Figure 10)

(A) The corticospinal tract would be completely degenerated


(B) The rubrospinal tract would show an increased number of axons
(C) The corticospinal tract would be about one-third depleted of axons
(D) The alpha motor neurons would be atrophic
18. The answer is C. The corticospinal tract would be about one-third depleted of axons

The area damaged is primary motor cortex, area 4. The neurons of the primary motor cortex contribute about one-third of the
axons that make up the corticospinal tract. Other tracts, such as the rubrospinal, do not sprout additional axons. The alpha motor
neurons do not atrophy if deprived of corticospinal input.

19. Which of the following most likely cause of the color photo given below.

(A)N. gonorrhoeae
(B) Fungal infection
(C) Adenovirus
(D) E. Coli
19. Ans. A. N. gonorrhoeae
N. gonorrhoeae causes conjunctivitis, pharyngitis, proctitis or urethritis, prostatitis and orchitis.
Conjunctivitis is common in neonates (newborns), and silver nitrate or antibiotics are often applied to their eyes as a preventive
measure against gonorrhoea. Neonatal gonorrheal conjunctivitis is contracted when the infant is exposed to N. gonorrhoeae in
the birth canal and can lead to corneal scarring or perforation, resulting in blindness in the neonate.

20. What is your diagnosis of the color photo given below:

(A) Retinoblastoma

(B) Cataract
(C) PHPV
(D) Coats disease
20. Ans. (B) Cataract
This is the case of congenital cataract.
Classification of cataract by etiology
Age-related cataract
Cortical senile cataract
Immature senile cataract (IMSC): partially opaque lens, disc view hazy
Mature senile cataract (MSC): completely opaque lens, no disc view
Hypermature senile cataract (HMSC): liquefied cortical matter: Morgagnian cataract
Senile nuclear cataract
Cataracta brunescens
Cataracta nigra
Cataracta rubra
Congenital cataract
Sutural cataract
Lamellar cataract
Zonular cataract
Total cataract
Secondary cataract
Drug-induced cataract (e.g. corticosteroids)
Traumatic cataract
Blunt trauma (capsule usually intact)
Penetrating trauma (capsular rupture and leakage of lens materialcalls for an emergency surgery for extraction of
lens and leaked material to minimize further damage)

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