1. Most common nerve injured in supracondylar fracture humerus? a. Median b. Radial c. Ulnar d.

Anterior interosseus nerve Ans: D I would not like to discuss much on this question since it has already been disc ussed in detail previously...The Mnemonic for the order of nerves injured in Sup racondylar fracture is AMRU That is: Ant . Interosseus Nerve> Median > Radial >Ulnar 2. Earliest symptom of GERD in an infant is? A. Respiratory distress answer B. Upper GI bleed C. regurgitation D.obstruction Ans: C REGURGITATION.... Reference from Nelson Pediatrics Infantile reflux manifests more often with regurgitation (especially postprandia lly), signs of esophagitis (irritability, arching, choking, gagging, feeding ave rsion), and resulting failure to thrive; symptoms resolve spontaneously in the m ajority by 12 24 mo. Older children, in contrast, may have regurgitation during th e preschool years; complaints of abdominal and chest pain supervene in later chi ldhood and adolescence. Occasional children present with neck contortions (archi ng, turning of head) designated Sandifer syndrome. The respiratory presentations are also age dependent: GERD in infants may manifest as obstructive apnea or as stridor or lower airway disease in which reflux complicates primary airway dise ase such as laryngomalacia or bronchopulmonary dysplasia. Otitis media, sinusiti s, lymphoid hyperplasia, hoarseness, vocal cord nodules, and laryngeal edema hav e all been associated with GERD. In contrast, airway manifestations in older chi ldren are more frequently related to asthma or to otolaryngologic dis ease such as laryngitis or sinusitis. 3. Basal metabolic rate is closely associated with? A. Lean body mass B. Body surface area C. Body mass index D. Body weight Ans: A Lean Body mass (REPEAT...shall not spend much time on repeats) 4. A girl presented with recurrent occipital headache associated with ataxia and vertigo. Mother also has similar complaints. Most probable diagnosis is? A. Vestibular neuronitis B. Basillar migraine C. TIA D. Ans: b Basilar migraine(REPEAT) 5. Drug of choice for central Diabetes Insipidus is? a. Desmopressin b. Leuperolide c. Thiazide diuretics d. Ans: A Desmopressin Reference: Harrispn 17th ed The signs and symptoms of uncomplicated pituitary DI can be eliminated completel y by treatment with desmopressin (DDAVP), a synthetic analogue of AVP (Fig. 3341). It acts selectively at V2 receptors to increase urine concentration and decr

ease urine flow in a dose-dependent manner (Fig. 334-4). It is also more resista nt to degradation than AVP and has a three- to fourfold longer duration of actio n. Desmopressin (DDAVP) can be given by IV or SC injection, nasal inhalation, or oral tablet. 6. A 32 year old mountaineer has a hematocrit of 70%. What is the possible expla nation? A. Polycythemia with relative dehydration B. High altitude cerebral oedema C. High altitude pulmonary oedema D. Hemodilution Ans.A Polycythemia and relative dehydration Reference:Harrison 17th ed Polycythemia can be spurious (related to a decrease in plasma volume; Gaisbock's syndrome), primary, or secondary in origin. The secondary causes are all associ ated with increases in EPO levels: either a physiologically adapted appropriate elevation based on tissue hypoxia (lung disease, high altitude, CO poisoning, hi gh-affinity hemoglobinopathy) or an abnormal overproduction (renal cysts, renal artery stenosis, tumors with ectopic EPO production). A rare familial form of po lycythemia is associated with normal EPO levels but hyperresponsive EPO receptor s due to mutations

7. Tetracycline is used in the prophylaxis of which of the following diseases? a. Cholera b. Brucellosis c. Leptospirosis d. Meningitis Ans: a Cholera Reference:Goodman Gilman and Harrison 17th ed Doxycycline (300 mg as a single dose) is effective in reducing stool volume and eradicating Vibrio cholerae from the stool within 48 hours. Antimicrobial agents , however, are not substitutes for fluid and electrolyte replacement in this dis ease. In addition, some strains of V. cholerae are resistant to tetracyclines. 8. A 7 month old child has bouts of cough ending with a whoop. What is the best way to confirm the diagnosis? A. Nasophayngeal swab B. Cough plate culture C. Tracheal aspirate D. Ans: a Nasopharyngeal swab Harrison 17th ed The diagnosis is Pertusis and we have to find the best specimen to confirm the d iagnosis. Culture of nasopharyngeal secretions remains the gold standard of diagnosis, alt hough DNA detection by polymerase chain reaction (PCR) is replacing culture in m any laboratories because of increased sensitivity and quicker results. The best specimen is collected by nasopharyngeal aspiration, in which a fine flexible pla stic catheter attached to a 10-mL syringe is passed into the nasopharynx and wit hdrawn while gentle suction is applied. 9. A. B. C. Aflatoxin is produced by? Aspergillus flavus Aspergillus niger Candida

D. Ans: a Aspergillus Flavus MYCOTOXINS Many fungi produce poisonous substances called mycotoxins that can cause acute o r chronic intoxication and damage. The mycotoxins are secondary metabolites, and their effects are not dependent on fungal infection or viability. A variety of mycotoxins are produced by mushrooms (eg, amanita species), and their ingestion results in a dose-related disease called mycetismus. Cooking has little effect o n the potency of these toxins, which may cause severe or fatal damage to the liv er and kidney. Other fungi produce mutagenic and carcinogenic compounds that can be extremely toxic for experimental animals. One of the most potent is aflatoxi n, which is elaborated by Aspergillus flavus and related molds and is a frequent contaminant of peanuts, corn, grains, and other foods. 10. Most important prognostic factor in congenital diaphragmatic hernia? A. Pulmonary hypertension B. Timing of surgery C. Size of defect D. Ans: A Pulmonary hypertension Reference: Nelson 18th ed Overall survival of live-born infants is 67%. The incidence of spontaneous fetal demise with CDH diagnosis is 7 10%. Relative predictors of a poor prognosis inclu de an associated major anomaly, symptoms before 24 hr of age, severe pulmonary h ypoplasia, herniation to the contralateral lung, and the need for ECMO. Serious sequelae include pulmonary function changes, neurodevelopmental delays, and growth retardation. Pulmonary problems continue to be a source of morbidity for long-term survivors of CDH. Children receiving CDH repair studied at 6 11 yr o f age demonstrate significant decreases in forced expiratory flow at 50% of vita l capacity and decreased peak expiratory flow. Both obstructive and restrictive patterns can occur. Those without severe pulmonary hypertension and barotrauma d o the best. Those at highest risk include children who required ECMO and patch r epair, but the data clearly show that non-ECMO CDH survivors also require freque nt attention to pulmonary issues. At discharge, up to 20% of infants require oxy gen, but only 1 2% require it past 1 yr of age. 11. A surgeon removed the part of liver to the left of the falciform ligament. W hich segments have been removed? A. 1 & 4a B. 2 & 3 C. 1 & 4b D. 5 & 6 Ans: B 2 & 3(REPEAT) Reference: Sabiston 18th ed Resection of segments II and III is a commonly performed sublobar resection and is often referred to as a left lateral segmentectomy and left lateral sectionect omy or left lobectomy.Left lobe is that part of liver to the left of the falcifo rm ligament. 12. Punnett square is used for a. Finding genotype of offspring b. Statistical analysis c. d. Ans:a Finding the genotype of the offspring

Reference: The Tennessee Gateway Science Punnett square is a Diagram used to identify possible combinations of recessive and dominant alleles in OFFSPRING.To create a punnette square divide a suare int o 4 parts and write the letters that represent the alleles of one parent on top of the suare and the alleles of the other parent on the side of the square..Just like we make a 2X2 table for statistics questions.Combine the allele of one par ent with the other and work out the 4 possible combinations.The punnett square d oes not give the exact information about the offspring but instead gives the pro bability. Have a look at this diagram...its a simple concept that we all have been practis ing since childhood but may not have been aware of the name of this method... 13. Cavitation is seen in? A. Mycolplasma pneumonia B. Tuberculous pneumonia C. Streptococcal pneumonia D.Staphylococcus pneumonia Ans: D Staphylococcal Pneumonia(REPEAT) 14. In PSUDOHYPOPARATHYROIDISM true is?(NEED FINETUNING OF STEM) a. Decreased cAMP b. Decreased IP3 c. Increased gtpas activity/Gain of function mutation in GTPase d.--Ans:a Decreased cAMP Reference: Harrisson 17th ed Individuals with Pseudohypoparathyroidism 1, the most common of the disorders, s how a deficient urinary cyclic AMP response to administration of exogenous PTH. Patients with PHP-I are divided into type a, with AHO and reduced amounts of Gs in in vitro assays with erythrocytes, and type b, lacking AHO and with normal am ounts of Gs in erythrocytes. There is a third type (PHP-Ic, reported in a few pa tients) that differs from PHP-Ia only in having normal erythrocyte levels of Gs despite having AHO, hypocalcemia, and decreased urinary cyclic AMP responses to PTH (presumably with a post-Gs defect in adenyl cyclase stimulation). 15. Difference between follicular carcinoma and follicular adenoma is? A. Vascular invasion B. Mitosis C. Nuclear pleomorphism D. Tubule formation Ans: a Vacular invasion (REPEAT) 16. Antidepressant drug that can be used in nocturnal eneuresis? A. Imipramine B. Fluoxamine C. D. Ans: A Imipramine Reference: Kaplan Saddock Psychiatry Imipramine (Tofranil) is efficacious and has been approved for use in treating c hildhood enuresis, primarily on a short-term basis. Initially, up to 30 percent of patients with enuresis stay dry, and up to 85 percent wet less frequently tha n before treatment. The success often does not last, however, and tolerance can develop after 6 weeks of therapy. Once the drug is discontinued, relapse and enu resis at former frequencies usually occur within a few months. The drug's advers e effects, which include cardiotoxicity, are also a serious problem. 17. A female patient presented with depressed mood, loss of appetite and no inte

rest in surroundings. There is associated insomnia. The onset of depression was preceeded by a history of business loss. What is the line of management? A. No treatment is necessary as it is due to business loss B. SSRI is the most efficacious of the available drugs C. Start SSRI treatment based on side effect profile D. Combination therapy of 2 anti depressant drugs Ans:C Treatment is started based on the side effect profile Reference:Kaplan and Saddock Initial Medication Selection The available antidepressants do not differ in overall efficacy, speed of respon se, or long-term effectiveness. Antidepressants, however, do differ in their pha rmacology, drug drug interactions, short- and long-term side effects, likelihood of discontinuation symptoms, and ease of dose adjustment. Failure to tolerate or to respond to one medication does not imply that other medications will also fail. Selection of the initial treatment depends on the chronicity of the condition, course of illness (a recurrent or chronic course is associated with increased li kelihood of subsequent depressive symptoms without treatment), family history of illness and treatment response, symptom severity, concurrent general medical or other psychiatric conditions, prior treatment responses to other acute phase tr eatments, potential drug drug interactions, and patient preference. In general, appr oximately 45 to 60 percent of all outpatients with uncomplicated (i.e., minimal psychiatric and general medical comorbidity), nonchronic, nonpsychotic major dep ressive disorder who begin treatment with medication respond (i.e., achieve at l east a 50 percent reduction in baseline symptoms); however, only 35 to 50 percen t achieve remission (i.e., the virtual absence of depressive symptoms). 18. An Infant is brought to casualty with reports of violent shaking by parents. Most characteristic injury is? A. Long bone fracture answer B. Ruptured spleen C. Subdural hematoma D. Skull bone fracture Ans: Subdural hematoma Reference: Forensic Medicine By Reddy Under the Topic Battered Baby syndrome Reddy talks about SUBDURAL HEMATOMA being the MOST CHARACTERISTIC FEATURE of violent shaking of an infant by the Parent.. .Its called INFANTILE WHIPLASH SYNDROME....In Battered baby syndrome multiple Lo ng bone fractures at various stages of healing may be seen and not in infantile whiplash syndrome.. 19. Gun powder on clothing can be visualized by? A. Magnifying lens B. UV rays C. Infrared rays D. Dye Ans: B UV Rays (REPEAT) 20. Capsular antibody protection is seen in all except? A. Neisseria meningitidis B. Pneumococcus C. Bordetella pertussis D. Haemophilus influenza Ans: C Bordetella pertusis

Reference: Harrison 17th ed Pathogenetic factors in Bordetella : B. pertussis produces a wide array of toxins and biologically active products th at are important in its pathogenesis and in immunity. Most of these virulence fa ctors are under the control of a single genetic locus that regulates their produ ction, resulting in antigenic modulation and phase variation. Although these pro cesses occur both in vitro and in vivo, their importance in the pathobiology of the organism is unknown; they may play a role in intracellular persistence and p erson-to-person spread. The organism's most important virulence factor is pertus sis toxin, which is composed of a B oligomer binding subunit and an enzymatically active A protomer that ADP-ribosylates a guanine nucleotide-binding regulatory p rotein (G protein) in target cells, producing a variety of biologic effects. Per tussis toxin has important mitogenic activity, affects the circulation of lympho cytes, and serves as an adhesin for bacterial binding to respiratory ciliated ce lls. Other important virulence factors and adhesins are filamentous hemagglutini n, a component of the cell wall, and pertactin, an outer-membrane protein. Fimbr iae, bacterial appendages that play a role in bacterial attachment, are the majo r antigens against which agglutinating antibodies are directed. These agglutinat ing antibodies have historically been the primary means of serotyping B. pertuss is strains. Other virulence factors include tracheal cytotoxin, which causes res piratory epithelial damage; adenylate cyclase toxin, which impairs host immune-c ell function; dermonecrotic toxin, which may contribute to respiratory mucosal d amage; and lipooligosaccharide, which has properties similar to those of other g ram-negative bacterial endotoxins. Immunity against Bordetella: Both humoral and cell-mediated immunity are thought to be important in pertussis . Antibodies to pertussis toxin, filamentous hemagglutinin, pertactin, and fimbr iae are all protective in animal models. Pertussis agglutinins were correlated w ith protection in early studies of whole-cell pertussis vaccines. Serologic corr elates of protection conferred by acellular pertussis vaccines have not been est ablished, although antibody to pertactin, fimbriae, and (to a lesser degree) per tussis toxin correlated best with protection in two efficacy trials. The duratio n of immunity after whole-cell pertussis vaccination is short-lived, with little protection remaining after 10 12 years. After a three-dose infant primary series of acellular pertussis vaccine, protection persists for at least 5 6 years; the du ration of immunity after a four- or five-dose schedule is not yet known. Althoug h immunity after natural infection has been said to be lifelong, seroepidemiolog ic evidence suggests that it may not be and that subsequent episodes of clinical pertussis are prevented by intermittent subclinical infection. Clinical Manifestations 21. Signature fracture refers to? A. Depressed skull fracture B. Suture displacement fracture C. Contrecoup injury D. Fracture at foramen magnum Ans: Depressed fracture (REPEAT) I don t think the question needs an explanation 22. Which among the following is most frequently seen in anti phospholipid antib ody syndrome?(Pls CORRECT Q) A. Beta 2 microglobulin antibody B. Anti nuclear antibody C. Anti centromere antibody D. Anti beta 2 glycoprotein antibody Ans: D Anti beta 2 GP Ab The antiphospholipid antibody syndrome (APS) may be defined as the occurrence of arterial or venous thrombosis or recurrent miscarriage in association with labo ratory evidence of persistent antiphospholipid antibody. The antibody may manife st itself as either a lupus anticoagulant detected by clotting tests or an antic ardiolipin antibody (ACA) detected by immunoassay. The syndrome may be associate

d with an autoimmune disorder, especially SLE (secondary), or may occur independ ently of other autoimmune disorders (primary). A large proportion of antiphospho lipid antibodies are actually directed against complexes of phospholipid with pr otein, most notably beta-2-glycoprotein I. The ACA immunoassay detects both thes e clinically significant antibodies and antibodies directed purely against cardi olipin and not beta-2-glycoprotein I. The latter antibodies are transient, and a re often associated with infection but not thrombosis. A positive anti-b2 GPI as say is evidence in favor of APS, once persistence is demonstrated by repeating t he assay after eight weeks. 23. What factor is responsible for deciding whether an antibody will remain memb rane bound or get secreted? A. RNA splicing B. Class switching C. Differential RNA processing D. Allelic exclusion Ans: C Differential RNA Processing(REPEAT) 24. Blood Chimerism is associated with? A. Monochorionic monoamniotic twins B. Monochorionic diamniotic twins C. Singleton pregnancy D. Vanishing twin Ans: B Monochorionic diamniotic twins (no doubt if these were the options) Explanation: Reference: Journal Ref: Blood Chimerism in a Dizygotic Dichorionic Pregnancy Blood chimerism in monochorionic twins conceived by induced ovulation: Case repor t Journal says Blood chimerism is more common in monochorionic dizygotic(MCDZ)twins and rare in dichorionic twins Cases in which a monochorionic placenta occurs in a twin pregnancy,vascular ansto mosis is well described and can lead to blood chimerism as well as twin twin tra nsfusion syndrome.In contrast interplacental vascular communications occur only with very rare exceptions in a dichorionic placenta 25. In expectant management of placenta praevia, all are done except? A. Cervical encirclage B. Anti D C. Corticosteroids D. Blood transfusion Ans: a Cervical encirclage Reference: Williams Obstetrics The treatment of classical cervical incompetence is cerclage. The operation is p erformed to surgically reinforce the weak cervix by some type of purse-string suturing. Bleeding, uterine contrac tions, or ruptured membranes are usually contraindications for cerclage. 26. Which drug is not used during delivery in a woman with rheumatic heart disea se ? A. Methylergometrine B. Carboprost C. Syntocin D. Misoprostol Ans: A Methylergometrine(REPEAT) 27. Which is not an autoimmune disease? A. SLE B. Grave's disease C. Myasthenia gravis D. Sickle cell disease Ans: D Sickle Cell Disease(I don t think an explanation is needed..Sickle cell ds is a hemoglobinopathy and not an autoimmune ds) 28. All are true regarding selective estrogen receptor downregulator (SERD),fulv estrant except?

A. Used for breast cancer B. Is a selective oestrogen antagonist C. Is slower acting, safer, LESS effective than SERM D. Given as once a month im dose Ans: C Its slower acting and less efficacious than SERM Reference:This Question has been taken line to line from Goodman Gilman Pharmaco logy as u will see below: Fulvestrant Fulvestrant (FASLODEX) is the first FDA approved agent in the new class of estro gen-receptor downregulators, which were hypothesized to have an improved safety profile, faster onset, and longer duration of action than the SERMs due to their pure ER antagonist activity (Robertson, 2002). Fulvestrant was approved in 2002 for postmenopausal women with hormone receptor-positive metastatic breast cance r that has progressed despite antiestrogen therapy. Mechanism of Action Fulvestrant is a steroidal antiestrogen that binds to the ER with an affinity mo re than 100 times that of tamoxifen, inhibits its dimerization, and increases it s degradation. Preclinical studies suggest that as a consequence of this ER "downregulation," E R-mediated transcription is abolished, completely suppressing the expression of estrogen-dependent genes (Howell et al., 2004b). This difference in the activity of fulvestrant likely explains why fulvestrant demonstrates efficacy against ta moxifen-resistant breast cancer. However, the hypothesis that fulvestrant provides more effective antiestrogen ac tivity than tamoxifen was not confirmed by a clinical trial comparing fulvestran t (250 mg intramuscularly monthly) with tamoxifen (20 mg orally daily) as firstline therapy in metastatic breast cancer (Howell et al., 2004a). Absorption, Fate, and Excretion Maximum plasma concentrations are reached about 7 days after intramuscular admin istration of fulvestrant and are maintained over a period of 1 month. The plasma half-life is approximately 40 days. Steady-state concentrations are reached aft er 3 to 6 monthly injections. There is extensive and rapid distribution, predomi nantly to the extravascular compartment. Various pathways, similar to those of steroid metabolism including oxidation, ar omatic hydroxylation, and conjugation, extensively metabolize fulvestrant. CYP3A 4 appears to be the only CYP isoenzyme involved in the oxidation of fulvestrant. Several preclinical and clinical studies have confirmed that fulvestrant is not subject to CYP3A4 interactions that might affect the safety or efficacy of the drug. The putative metabolites possess no estrogenic activity and only the 17-ke to compound demonstrates a level of antiestrogenic activity about 4.5 times less than that of fulvestrant. The major route of excretion is via the feces, with l ess than 1% being excreted in the urine (Robertson and Harrison, 2004). Therapeutic Uses Fulvestrant typically is administered as a 250-mg intramuscular injection at mon thly intervals. It is used in postmenopausal women as antiestrogen therapy of ho rmone receptor-positive metastatic breast cancer after progression on first-line antiestrogen therapy such as tamoxifen (Strasser-Weippl and Goss, 2004). Fulves trant is at least as effective in this setting as the third-generation aromatase inhibitor anastrozole. Fulvestrant 250 mg (administered as a once-monthly 5-ml intramuscular injection) also has been compared with tamoxifen 20 mg (orally once daily) in a trial of p ostmenopausal women with ER-positive and/or progesterone receptor (PR)-positive or ER/PR-unknown metastatic breast cancer who had not previously received endocr ine or chemotherapy. There was no difference between fulvestrant and tamoxifen i n time to disease progression in either the entire study population or the subse t of patients with ER- and/or PR-positive disease. Observed differences in other efficacy endpoints favored tamoxifen, and fulvestrant equivalence was not demon strated (Vergote and Robertson, 2004). The long time to steady-state plasma leve ls for fulvestrant has brought into question the results of existing studies, an d trials are in progress to test the relative efficacy of giving an initial load

ing dose followed by regular monthly injections. Clinical Toxicity Fulvestrant generally is well tolerated with the most common adverse events bein g nausea, asthenia, pain, vasodilation (hot flushes), and headache. Injection si te reactions, seen in about 7% of patients, are reduced by giving the injection slowly. In the study comparing anastrozole and fulvestrant, quality-of-life outc ome measures were maintained over time with no significant difference between th e drugs . 29. A farmer developed a swelling in the inguinal region which later ulcerated. What stain can be used to detect bipolar stained organisms? A. Albert's stain B. Waysons stain C. Ziehl neelsen stain D. Nigrosin stain Ans: B Wayson stain(REPEAT) 30. An 8 year old boy completed 8 out of 10 day course of cefaclor. Now he devel oped a generalized erythmatic rash which is mildly pruritic and lymphadenopathy. Diagnosis is? A. Kawasaki disease B. Type 3 hypersensitivity C. Anaphylaxis D. Infectious mononucleosis Ans: B Type 3 Hypersensitivity(REPEAT) 31. Rave drug is? A. Cannabis B. Cocaine C. Heroin D. Amphetamine Ans: D Amphetamine(MDMA) MDMA is also called Rave drug and ecstasy 32. How to differentiate ASD from VSD in X-ray? A. Enlarged Left atrium B. Normal left atrium C. Pulmonary congestion D. Aortic shadow Ans: B Normal LA size LA remains normal in ASD despite volume overload since it can decompress through 2 outlets that is into RA and into LV.So LA enlargement is not seen in ASD wher as it is seen in VSD 33. Regarding an imbecile, all are true except? A. IQ is 50-60 B. Intellectual capacity equivalent to a child of 3-7 years of ag e C. Not able to take care of themselves D. Condition is congenital or acquired at an early age Ans: A IQ is 50-60 Reference: Kaplan and saddock Q Range Classification 70-80 Borderline deficiency 50-69 Moron 20-49 Imbecile below 20 Idiot 34. Which is not true regarding diet modification recommended in high cardiovasc ular risk group? A. Cholesterol less then 100 mg/1000kcal/day B. Avoid alcohol C. Fat intake 10% of total calories D. Salt limitation to less than 5 gm Ans: C Fat intake <10% of total calories

Reference: American Heart association 2006 guidelines These guidelines confirm the options 1/2/4...regarding option 3....it is the sat urated fat content which should be less that 10%.the total fat intake should be less than 30% of the overall calorie intake. IF THE OPTION 3 WAS....Saturated Fat intake less than 10% then the answer shall become Avoid alcohol...as AHA guidelines say upto 2-3 drink per day is fine.... 35. Maintenance dose of which of the following drugs is used worldwide for opioi d dependence? A. Naltrexone B. Methadone C. lmipramine D. Disulfiram Ans: B Methadone Reference: Kaplan and saddock Methadone is a synthetic narcotic (an opioid) that substitutes for heroin and ca n be taken orally. When given to addicts to replace their usual substance of abu se, the drug suppresses withdrawal symptoms. A daily dosage of 20 to 80 mg suffi ces to stabilize a patient, although daily doses of up to 120 mg have been used. The duration of action for methadone exceeds 24 hours; thus, once-daily dosing is adequate. Methadone maintenance is continued until the patient can be withdra wn from methadone, which itself causes dependence. An abstinence syndrome occurs with methadone withdrawal, but patients are detoxified from methadone more easi ly than from heroin. Clonidine (0.1 to 0.3 mg three to four times a day) is usua lly given during the detoxification period. Methadone maintenance has several advantages. First, it frees persons with opioi d dependence from using injectable heroin and, thus, reduces the chance of sprea ding HIV through contaminated needles. Second, methadone produces minimal euphor ia and rarely causes drowsiness or depression when taken for a long time. Third, methadone allows patients to engage in gainful employment instead of criminal a ctivity. The major disadvantage of methadone use is that patients remain depende nt on a narcotic. 36. Best test/Gold standard test for assesing HCG function/action? A. Radioimmunoassay B. ELISA C. Latex test D. Bioassay Ans: D Bioassay(OPEN TO SCRUTINY......CHALLENGING REFERENCES INVITED) My explanation....Though Radioimmunoassay is more sensitive than Bioassay for qu atifying an antigen ,Bioassay only can asses an harmone both quantitatively and qualitatively....THE Question SPECIFICALLY asked about the BEST TEST OF FUNCTION which can be assessed by BIOASSAY and not Radioimmunoassay. 37. Vitamin K is involved in the posttranswerlational modification of? A. Glutamate B. Aspartate C. -D. Ans: A Glutamate(REPEAT) 38. Spinal anaesthesia is given at which level? A. L1-2 B. L2-4 C. S1 D. Midline thoracic segments Ans: B L2-4 Reference: Miller anesthesia(Procedureconsult) Spinal anesthetics have their effects at the spinal cord, which originates at th e foramen magnum of the skull and the brainstem and extends caudally to the conu s medullaris. The distal termination varies from about the level of the 3rd lumb ar vertebrae (L3) in infants to the lower border of L1 in adults. The spinal cor d is surrounded by three membranes (from central to peripheral): the pia mater, arachnoid mater, and dura mater. It is believed that the arachnoid mater is resp

onsible for up to 90% of the resistance to drug migration in and out of the CSF. Inside the subarachnoid space are the CSF, spinal nerves, a network of trabecul ae between the two membranes, and blood vessels supplying the spinal cord. Altho ugh the spinal cord ends at about L1 in adults, the subarachnoid space continues to about the second sacral vertebrae (S2). Posterior to the epidural space is the ligamentum flavum, which extends from the foramen magnum to the sacral hiatus. Immediately posterior to the ligamentum fl avum are the lamina and spinous processes of the vertebral bodies or the intersp inous ligaments. Posterior to these structures is the supraspinous ligament, whi ch joins the vertebral spines. Anatomic landmarks most important to performance of spinal anesthesia are the il iac crests, the midline of the back, and the vertebral spinous processes. Palpat ion of the midline of the back identifies the spinous processes and vertebral in terspaces in most patients but may be difficult in obese patients. A line drawn between the upper borders of the iliac crests across the midline of the back ide ntifies the approximate level of L4 or the L4-L5 interspace. Spinal anesthesia is usually performed at the level of the L3 or L4 vertebrae in the adult patient, because the spinal needle is introduced below the level at w hich the spinal cord ends. 39. a child presented with mild fever little breathlessness..... was treated and she improved over 4 days and later deteriorated again with fever and more breat hlessness. x ray showed hyperlucency. diagnosis? 1.bronchiolitis obliterans 2.alveolar proteinosois 3.bronchitis 4. AsthmA Ans: a bronchiolitis obliterans(REPEAT) 40. Which of the following passes through foramen magnum? A. Internal Carotid Artery B. Sympathetic chain C. Hypoglossal Nerve D. Vertebral Artery Ans: D Vertebral artery(REPEAT) 41. McKeon's theory on reduced prevalence of TB? A. Increased awareness and knowledge B. Medical advancement answer C. Behavioural modification D. Social and environmental factor Ans: D Social and environmental factor Reference: McKeown and the Idea That Social Conditions Are Fundamental Causes of Disease Bruce G. Link, PhD and Jo C. Phelan, PhD THE MCKEOWN THESIS STATES that the enormous increase in population and dramatic improvements in health that humans have experienced over the past 2 centuries ow e more to changes in broad economic and social conditions than to specific medic al advances or public health initiatives.1 The thesis gives center stage to soci al conditions as root causes of the health of populations. On the basis of new d ata and numerous revisitations, however, Colgrove2 tells us that the thesis has been overturned and the theory discredited. Whither, then, the idea that social cond itions require prominence in any complete understanding of the health of populat ions? When we turn away from the thesis, do we accept an antithesis asserting that t he role of social conditions is insignificant? 42. Which among the following is not a cause of fasting hypoglycemia? A. Glucagon excess B. Glucose 6 phospatase deficiency C. Ureamia D. Glycogen synthase deficiency Ans: A Glucagon excess Explanation: I am not quoting any book...But i will explain...if anyone has a co ntradictory reference pls post... Glucose 6 phosphatase def leads to inability to mobilize glucose and hence can c

ause Glycogen synthase def leads to glycogen deficiency and hence during fasting pati ent goes hypo In uremia liver metabolism is hampered and hence hypo is possible In glucagon excess there is HYPERglycemia and hence the answer. 43. Mineralocorticoid receptor is not present in? A. Liver B. Colon C. Hippocampus D. Kidney Ans:Liver(REPEAT) 44. Prolonged treatment with INH leads to deficiency of? A. Pyridoxine B. Thiamine C. Pantothenic acid D. Niacin Ans: A Pyridoxine Reference: Harrison 17th ed table of vitamins Vitamin B6 Defeciency symptoms: Seborrhea, glossitis convulsions, neuropathy, depression, c onfusion, microcytic anemia RDA:<0.2 mg Factors contributing to deficiency:Alcoh olism, isoniazid 45. Which is the most reliable objective sign of identifying pulmonary plethora in chest X-ray? A. Diameter of the main pulmonay artery >16mm B. Diameter of the lt pulmonay artery >16mm C. Diameter of the decending Rt pulmonay artery >16mm D. Diameter of the decending Lt pulmonay artery >16mm Ans: C(REPEAT) 46. Necrotizing lymphadenitis is seen in? A. Kimura disease B. Kikuchi disease C. Hodgkin disease D. Castelma Ans: B Kikuchi disease (a type of Modified REPEAT) Reference:Harrison 17th ed and eMEDICINE Kikuchi disease, also called histiocytic necrotizing lymphadenitis or Kikuchi-Fu jimoto disease The most common clinical manifestation of Kikuchi disease is cervical lymphadeno pathy Kimura disease is a chronic inflammatory disorder of unknown etiology that most commonly presents as painless, unilateral cervical lymphadenopathy or subcutaneo us masses in the head or neck region. The disorder received its current name in 1948, when Kimura et al2 noted the vascular component and referred to it as an " unusual granulation combined with hyperplastic changes in lymphoid tissue." Lymph-Node Tuberculosis (Tuberculous Lymphadenitis) from Harrison 17th ed: The most common presentation of extrapulmonary tuberculosis (>40% of cases in th e United States in recent series), lymph-node disease is particularly frequent a mong HIV-infected patients. In the United States, children and women (particular ly non-Caucasians) also seem to be especially susceptible. Once caused mainly by M. bovis, tuberculous lymphadenitis is today due largely to M. tuberculosis. Ly mph-node tuberculosis presents as painless swelling of the lymph nodes, most com monly at posterior cervical and supraclavicular sites (a condition historically referred to as scrofula). Lymph nodes are usually discrete and nontender in earl y disease but may be inflamed and have a fistulous tract draining caseous materi al. Associated pulmonary disease is seen in >40% of cases. Systemic symptoms are usually limited to HIV-infected patients. The diagnosis is established only by fine-needle aspiration or surgical biopsy. AFB are seen in up to 50% of cases, c ultures are positive in 70 80%, and histologic examination shows granulomatous les

ions. Among HIV-infected patients, granulomas usually are not seen. Differential diagnosis includes a variety of infectious conditions, neoplastic diseases such as lymphomas or metastatic carcinomas, and rare disorders like Kikuchi disease (necrotizing histiocytic lymphadenitis), Kimura's disease, and Castleman's disea se. 47. NARP syndrome is seen in? A. Mitochondrial function disorder B. Glycogen storage disorder C. Lysosomal storage disorder D. Lipid storage disorder Ans: A Mitochondrial disorder(REPEAT) 48. A 65 yrs old lady presented with a swollen and painful knee. On examination, she was found to have grade III osteoarthritic changes. What is the BEST COURSE OF ACTION ? A. Conservative management B. Arthroscopic washing C. Partial knee replacement D. Total knee replacement Ans: D Total knee replacement THIS QUESTION IS NOT A REPEAT FROM MAY AIIMS.... This question has been adequately discussed in the institute classes and the ans wer is TKR....Whatever be the case they are asking the BEST course of action and so no point in going for a conservative approach... 49. Causes of primary amenorrhoea are all except? A. Rokintasky syndrome B. Kallaman syndrome C. Sheehan syndrome D.Turner syndrome Ans: C Sheehan syndrome(REPEAT) 50. Integrase inhibitor approved for treatment of HIV is? A. Raltegravir B. Indinavir C. Lopinavir D. Elvitegravir Ans: A Raltegravir Reference: Pasting a net reference since the texts don t have thedrug....anyway Ra lteravir and maraviroc are given in Sparsh Pharmac Raltegravir (MK-0518, brand name Isentress) is an antiretroviral drug produced b y Merck & Co., used to treat HIV infection.[1] It received approval by theU.S. F ood and Drug Administration (FDA) in October 2007, the first of a new class of H IV drugs, the integrase inhibitors, to receive such approval. 51. Deoxygenated blood is not seen in a. Pulmonary artery b. Umbilical artery c. Umbilical vein d. Renal vein Ans: C Umbilical vein(No explanation needed) 52. All of the following are pneumatic bones except? A. Frontal B. Ethmoid C. Mandible D. Maxilla Ans: C Mandible (No explanation needed) 53. Which of the following is not a contraindication for pregnancy? A. WPW syndrome B. Pulmonary hypertension C. Eisenmenger syndrome D. Marfan syndrome with aortic root dilatation Ans: A WPW syndrome(REPEAT) 54. Which of the following antihypertensive drugs is contraindicated in a patien

t on Lithium in order to prevent toxicity? A. Clonidine B. Beta blockers C. Calcium channel blockers D. Diuretics Ans: D Diuretics Reference: goodman and gilman Most of the renal tubular reabsorption of Li+ occurs in the proximal tubule. Nev ertheless, Li+ retention can be increased by any diuretic that leads to depletio n of Na+, particularly the thiazides (see Chapter 28) (Siegel et al., 1998). Ren al excretion can be increased by administration of osmotic diuretics, acetazolam ide, or aminophylline, although they are of little help in the management of Li+ intoxication. Triamterene may increase excretion of Li+, suggesting that some r eabsorption of the ion may occur in the distal nephron. However, spironolactone does not increase the excretion of Li+. Some nonsteroidal antiinflammatory agent s can facilitate renal proximal tubular resorption of Li+ and thereby increase c oncentrations in plasma to toxic levels 55. Superior vena caval syndrome is most commonly caused by? A. Lymphoma B. Small cell lung ca C. Non small cell lung ca D. Secondary tumours Ans: B Small cell carcinoma(REPEAT) 56. Which of the following is not an adverse effect of thalidomide? A. Diarrhoea B. Teratogenicity C. DVT D. Peripheral neuropathy Ans: A Diarrhea Reference: Goodman and Gilman The most common adverse effects reported in cancer patients are sedation and con stipation (Franks et al., 2004), while the most serious one is treatment-emergen t peripheral sensory neuropathy, which occurs in 10% to 30% of patients with MM or other malignancies in a dose- and time-dependent manner (Richardson et al., 2 004). Thalidomide-related neuropathy is an asymmetric, painful, peripheral pares thesia with sensory loss, commonly presenting with numbness of toes and feet, mu scle cramps, weakness, signs of pyramidal tract involvement, and carpal tunnel s yndrome. The incidence of peripheral neuropathy increases with higher cumulative doses of thalidomide, especially in elderly patients. Although clinical improve ment typically occurs upon prompt drug discontinuation, long-standing residual s ensory loss can occur. Particular caution should be applied in cancer patients w ith preexisting neuropathy (e.g., related to diabetes) or prior exposure to drug s that can cause peripheral neuropathy (e.g., vinca alkaloids or bortezomib), es pecially since there has been little progress in defining effective strategies t o alleviate neuropathic symptoms. An increasing incidence of thromboembolic even ts in thalidomide-treated patients has been reported, but mostly in the context of thalidomide combinations with other drugs, including steroids and particularl y anthracycline-based chemotherapy (Zangari et al., 2001), and with very low inc idence with single-agent thalidomide treatment. 57. Blount s disease is: A. Genu valgum B. Genu varum C. Genu recurvatum D. Menisceal injury Ans: B Genu varum Reference:eMEDICINE(don t have the orthobook with me right now) Blount disease is an uncommon growth disorder characterized by disordered ossifi cation of the medial aspect of the proximal tibial physis, epiphysis, and metaph ysis. This progressive deformity is manifested by varus angulation and internal rotation of the tibia in the proximal metaphyseal region immediately below the k

nee 58. A teenaged girl complains of pain in knee on climbing stairs and on getting up after sitting for a long time. What is the probable diagnosis? A. Chondromalacia patellae B. Plica syndrome C. Bipartite patella D. Patello-femoral osteoarthritis Ans: A Chondromalacia patellae Reference: Current Orthopedic Diagnosis and management. Bilateral knee pain and stiffness in a teenage girl is suggestive of a few condi tions of which Chondromalacia patellae is one. 59. Which of the following is not included in parenteral nutrition? A. Fat B. Carbohydrate C. Fibre D. Micronutrients Ans: C Fibre 60. Sparrow marks are seen in? A. Gunshot injuries B. Stab injury of face C. Vitriolage D. Windshield glass injury Ans: D Winshield glass injury Reference: Forensic pathology by David.J.Williams The occupants of the first row seats in a motor vehicle accident may demonstrate facial injuries due to contact with windshield glass called sparrow s foot. 61. Amphotericin B causes deficiency of? A. Na B. Ca C. K D. Mg Ans: C Potassium Reference: Goodman and Gilman Renal tubular acidosis and renal wasting of K+ and Mg2+ also may be seen during and for several weeks after therapy. Supplemental K+ is required in one-third of patients on prolonged therapy. 62. All are seen in injury to common peroneal nerve except? A. Loss of sensation over sole B. Foot drop C. Injury to neck of fibula D. Loss of dorsiflexion of toe Ans: A loss of sensation over the sole(No explanation needed) 63. Cause of premature death in schizophrenia? A. Homicide B. Suicide C. Toxicity of antipsychotic drug D. Hospital acquired infection Ans:B Suicide Reference:Kaplan and saddock(A STAIGHT LINE TO LINE FROM THE TEXT) Suicide

Suicide is the single leading cause of premature death among people with schizop hrenia. Suicide attempts are made by 20 to 50 percent of the patients, with long -term rates of suicide estimated to be 10 to 13 percent. These numbers reflect a n approximately 20-fold increase over the suicide rate in the general population . Often, suicide in schizophrenia seems to occur out of the blue, without prior warni gs or expressions of verbal intent. The most important factor is the presence of a major depressive episode. Epidemiological studies indicate that up to 80 perc ent of schizophrenia patients may have a major depressive episode at some time i

n their lives. Some data suggest that those patients with the best prognosis (fe w negative symptoms, preservation of capacity to experience affects, better abst ract thinking) can paradoxically also be at highest risk for suicide. The profil e of the patient at greatest risk is a young man 64. Epileptic potential is present in A. Desflurane B. Halothane C. Sevoflurane D. Ether Ans: Sevoflurane(No explanation needed) 65. Which of the following anesthetic drugs is contraindicated in a patient with hypertension? A. Ketamine B. Propofol C. Etomidate D. Diazepam Ans: Ketamine(Ketamine is known to increase the BP...no explanation needed 66. All of the following decrease bone resorption in osteoporosis except? A. Alendronate B. Etidronate C. Strontium D. Teriparatide Ans: D Teripartide Reference: Goodman and Gilman Parathyroid Hormone (PTH) Continuous administration of PTH or high circulating PTH levels achieved in prim ary hyperparathyroidism causes bone demineralization and osteopenia. However, in termittent PTH administration promotes bone growth. Selye first described the an abolic action of PTH some 80 years ago, but this observation was largely ignored and generally forgotten. Beginning in the 1970s, studies focused on the anaboli c action of PTH, culminating with FDA approval of synthetic human 34-amino-acid amino-terminal PTH fragment [hPTH(1 34), teriparatide] for use in treating severe osteoporosis (Hodsman et al., 2005). Full-length PTH(1 84) is likely to be approve d in the near future; its benefits over PTH(1 34) are unclear. Absorption, Fate, and Excretion Pharmacokinetics and systemic actions of teriparatide on mineral metabolism are the same as for PTH. Teriparatide is administered by once-daily subcutaneous inj ection of 20 g into the thigh or abdomen. With this regimen, serum PTH concentra tions peak at 30 minutes after the injection and decline to undetectable concent rations within 3 hours, whereas the serum calcium concentration peaks at 4 to 6 hours after administration. Based on aggregate data from different dosing regime ns, teriparatide bioavailability averages 95%. Teriparatide clearance averages 6 2 L/hour in women and 94 L/hour in men, which exceeds normal liver plasma flow, consistent with both hepatic and extrahepatic PTH removal. The serum half-life o f teriparatide is approximately 1 hour when administered subcutaneously versus 5 minutes when administered intravenously. The longer half-life following subcuta neous administration reflects the time required for absorption from the injectio n site. The elimination of PTH(1 34) and full-length PTH proceeds by nonspecific e nzymatic mechanisms in the liver, followed by renal excretion. Clinical Effects In postmenopausal women with osteoporosis, teriparatide increases BMD and reduce s the risk of vertebral and nonvertebral fractures. Several laboratories have ex amined the effects of intermittent PTH on BMD in patients with osteoporosis. In these studies, teriparatide increased axial bone mineral, although initial repor ts of effects on cortical bone were disappointing. Coadministration of hPTH(1 34) with estrogen or synthetic androgen led to impressive gains in vertebral bone ma ss or trabecular bone. However, in some early studies there was only maintenance or even loss of cortical bone. Vitamin D insufficiency in patients at baseline or pharmacokinetic differences involving bioavailability or circulating half-lif e may have contributed to observed differences on cortical bone. The most compre

hensive studies to date established the value of daily hPTH(1 34) administration o n total BMD, with significant elevations of BMD in lumbar spine and femoral neck and with significant reductions of vertebral and nonvertebral fracture risk in osteoporotic women (Neer et al., 2001) and men (Finkelstein et al., 2003). Candidates for teriparatide treatment include women who have a history of osteop orotic fracture, who have multiple risk factors for fracture, or who failed or a re intolerant of previous osteoporosis therapy. Adverse Effects In rats, teriparatide increased the incidence of bone tumors, including osteosar coma (Vahle et al., 2004). The clinical relevance of this finding is unclear, es pecially since patients with primary hyperparathyroidism have considerably highe r elevations of serum PTH without a greater incidence of osteosarcoma. Nonethele ss, teriparatide should not be used in patients who are at increased baseline ri sk for osteosarcoma (including those with Paget's disease of bone, unexplained e levations of alkaline phosphatase, open epiphyses, or prior radiation therapy in volving the skeleton). Full-length PTH(1 84), which is in clinical trials, has not been associated with osteosarcomas. Other adverse effects have included exacerb ation of nephrolithiasis and elevation of serum uric acid levels. 67.Ondoni cells and Haller cells are associated with the following structures re spectively? A. Optic nerve and Orbital floor answer B. Optic nerve and Internal carotid artery C. Internal carotid artery and Optic nerve D. Orbital floor and Internal carotid artery Ans: Optic nerve and Orbital floor(REPEAT) 68. Pain sensation from the ethmoid sinus is carried by : A. Frontal nerve B. Lacrimal nerve C. Nasociliary nerve D. Infraorbital nerve Ans: C Nasociliary nerve which divides into the ethmoidal branches to supply the ethmoidal sinus 69. 28-Which among the following is not used to treat alcohol dependence? A. Flumazenil B. Acamprosate C. Naltrexone D. Disulfiram Ans: A Flumazenil(a MODIFIED REPEAT......last time this question came with Diaze pam in the options) 70. A 40yr old patient has a single kidney with an exophytic mass of 4 cm size a t it s lower pole. Which among the following is the best course of action? A. Partial nephrectomy B. Radical nephrectomy with dialysis C. Radical nephrectomy with immediate renal transwerplant D. Observation Ans: A Partial nephrectomy since it is the current method of choice for tumors l ess than or equal to 4cm and at poles.

71. 29-Which among the following is the most common fungal infection seen in imm uno competent patients? A. Aspergillus

B. Candida C. Cryptococcus D. Mucor Ans: A Aspergillus Reference: Harrison 17th ed The required size of the infecting inoculum is uncertain; however, only intense exposures (e.g., during construction work, handling of moldy bark or hay, or com posting) are sufficient to cause disease in healthy immunocompetent individuals. An increasing incidence of invasive aspergillosis in medical intensive care unit s suggests that, in patients who are not immunocompromised, temporary abrogation of protective responses as a result of glucocorticoid use or a general anti-inf lammatory state is a significant risk factor. 72. All are seen in Argyl Robertson pupil except? A. Near reflex normal B. Direct reflex absent C. Consensual reflex normal D. Vision normal Ans: C Consensual reflex is normal Argyll Robertson pupil This is caused by neurosyphilis and is characterised by the following: Involvement is usually bilateral but asymmetrical The pupils arc small and irregular. Light-near dissociation. The pupils are very difficult to dilate. 73. 31-A 5 year old boy while having dinner suddenly becomes aphonic and is brou ght to the casulty for the complaint of respiratory distress. What should be the appropriate management? A. Cricothyroidotomy B. Emergency tracheostomy C. Humidified oxygen D. Heimlich maneuver Ans: D Heimlich manoeveure(please read the explanation carefully) This is the AHA guidelines for management of any conscious choking patient....Th e question in the exam had a conscious,aphonic patient in respiratory distress.. .Now how to manage.....Most of the discussions in the forum give other answer fe eling that Heimlich has to be performed at the site only...lets C the guidelines and find the answer... 1. Recognise signs of choking 2. Call for help 3. Use Heimlich manoeveure until the patient recovers OR LOSES CONSCIOSNESS 4. Place the victim in a supine position ..open the mouth and perform a finger s weep 5. Open the airway and attempt to ventilate 6. If unsuccessful give upto 5 heimlich manoeveures 7. Repeat 5 and 6 8. If expert has arrived he has to perform a laryngoscopy and try to remove the foreign body if not already removed 9. FAILING ALL ATTEMPTS ONLY CRICOTHYOTOMY SHOULD BE PERFORMED.

74.Which among the following is a branch from the trunk of brachial plexus? A. Subscapular nerve

B. Long thoracic nerve C. Anterior thoracic nerve D. Nerve to subclavius Ans:D Nerve to subclavius.......If i am sure suprascapular nerve was not at all there in the options....so the answer is clear.... 75.Orthotolidine test is used for detecting: A. Chlorine B. Nitrites C. Nitrates D. Ammonia Ans: A Chlorine(No explanation needed) 76. Which among the following is the most common tumour associated with neurofib romatosis in a child? A. Juvenile myelomonocytic leukemia B.Acute lymphoblastic leukemia C. Acute monocytic leukemia D. Acute myeloid leukemia Ans: Juvenile myelomonocytic leukemia Reference: Nelson 18th ed Juvenile Chronic Myelogenous Leukemia Juvenile chronic myelogenous leukemia (JCML), also known as juvenile myelomonocy tic leukemia, is a clonal proliferation of hematopoietic stem cells that typical ly affects children <2 yr of age. Patients with this disease do not have the Phi ladelphia chromosome that is characteristic of CML. Patients with JCML present w ith rashes, lymphadenopathy, and splenomegaly. Analysis of the peripheral blood often shows an elevated leukocyte count and also may show thrombocytopenia and t he presence of erythroblasts. The bone marrow shows a myelodysplastic pattern, w ith blasts accounting for <30% of cells. No distinctive cytogenetic abnormalitie s are seen. JCML is rare, constituting <2% of all cases of childhood leukemia. T herapeutic reports are largely anecdotal. Patients with neurofibromatosis type 1 have a predilection for this type of leukemia. Stem cell transplantation offers the best opportunity for cure, but much less so than for classic CML. 77. Diaphragm develops from all except: A. Septum transwerversum B. Dorsal mesocardium C. Pleuroperitoneal membrane D. Cervical myotomes Ans: D Cervical myotomes Reference: Langman Embryology gives text confirming the options A/D ....now rega rding options B and D is the confusion....Langman says the nerve supply alone de velops from the level of the cervical myotomes but not the diaphragm....so i pre fer the answer cervical myotomes> dorsal mesocardium 78. Erythema nodosum is seen in all except: A. Pregnancy B. Tuberculosis C. SLE D. Chronic pancreatitis Ans: D Chronic pancreatitis Causes Currently, the most common cause of erythema nodosum is streptococcal infection in children and streptococcal infection and sarcoidosis in adults.3 Numerous oth

er causes have been reported.4 The causes reported most often in the literature are as follows: Bacterial infections: Streptococcal infections are one of the most common causes of erythema nodosum. Tuberculosis was an important cause in the past, but it ha s decreased dramatically as a cause for erythema nodosum; however, it still must be excluded, especially in developing countries.5,6 Yersinia enterocolitica is a gram-negative bacillus that causes acute diarrhea and abdominal pain; it is a common cause of erythema nodosum in France and Finland.7,8,9 Mycoplasma pneumoni ae infection may cause erythema nodosum. Erythema nodosum leprosum clinically re sembles erythema nodosum, but the histologic picture is that of leukocytoclastic vasculitis. Lymphogranuloma venereum may cause erythema nodosum. Salmonella inf ection may cause erythema nodosum. Campylobacter infection may cause erythema no dosum. Fungal infections: Coccidioidomycosis (San Joaquin Valley fever) is the most com mon cause of erythema nodosum in the American Southwest. In approximately 4% of males and 10% of females, the primary fungal infection (which may be asymptomati c or involve symptoms of upper respiratory infection) is followed by the develop ment of erythema nodosum. Lesions appear 3 days to 3 weeks after the end of the fever caused by the fungal infection. Histoplasmosis may cause erythema nodosum. Blastomycosis may cause erythema nodosum. Drugs: Sulfonamides and halide agents are an important cause of erythema nodosum . Drugs more recently described to cause erythema nodosum include gold and sulfo nylureas. Oral contraceptive pills are implicated in an increasing number of rep orts. Enteropathies: Ulcerative colitis and Crohn disease may trigger erythema nodosum . Erythema nodosum associated with enteropathies correlates with flares of the d isease. The mean duration of chronic ulcerative colitis before the onset of eryt hema nodosum is 5 years, and erythema nodosum is controlled with adequate therap y of the colitis. Erythema nodosum is the most frequent dermatologic symptom ini nflammatory bowel diseases, and it is strongly associated with Crohn disease.10 Hodgkin disease and lymphoma: Erythema nodosum associated with non-Hodgkin lymph oma may precede the diagnosis of lymphoma by months. Reports of erythema nodosum preceding the onset of acute myelogenous leukemia have been published.11 Sarcoidosis: The most common cutaneous manifestation of sarcoidosis is erythema nodosum. A characteristic form of acute sarcoidosis involves the association of erythema nodosum, hilar lymphadenopathy, fever, arthritis, and uveitis, which ha s been termed Lfgren syndrome. This presentation has a good prognosis, with compl ete resolution within several months in most patients. HLA-DRB1*03 is associated with Lfgren syndrome. Most DRB1*03-positive patients have resolution of their sy mptoms within 2 years; however, nearly half of DRB1*03-negative patients have an unremitting course.12 Behet disease (associated with erythema nodosum) Pregnancy: Some patients develop erythema nodosum during pregnancy, most frequen tly during the second trimester. Repeated episodes occur with subsequent pregnan cies or with the use of oral contraceptives. 79. Posterior relations of head of pancreas are all except? A. Common bile duct B. First part of duodenum C. Aorta D. Inferior vena cava Ans: B First part of Duodenum(NO Explanation needed) 80. Multiple sebaceous cysts seen in: A. Gardner s syndrome B. Turcot syndrome C. Muir Torre syndrome D. Cowden syndrome Ans:C Muir torre syndrome Reference:Sabiston 18th ed table in chapter of GI neoplasia Muir-Torre variant: sebaceous adenomas, keratoacanthomas, sebaceous epitheliomas

, and basal cell epitheliomas 81. Which among the following is the hallmark of acute inflammation? A. Vasoconstriction B. Stasis C. Vasodilation and increase in permeability D. Leukocyte margination Ans: C Vasodilatation and increased vascular permeability(REPEAT) 82.True about epidural opioids are all except? A. Acts on dorsal horn substantia gelatinosa B. Can cause Itching C. Function of the intestines are not affected D. Can cause respiratory depression Ans: C Function of the intestine is not affected Reference: Pharmacology By KATZUNG(THE QUESTION HAS BEEN TAKEN LINE TO LINE FROM TEXT---READ BELOW) Because of their direct action on the superficial neurons of the spinal cord dor sal horn, opioids can also be used as regional analgesics by administration into the epidural or subarachnoid spaces of the spinal column. A number of studies h ave demonstrated that long-lasting analgesia with minimal adverse effects can be achieved by epidural administration of 3 5 mg of morphine, followed by slow infus ion through a catheter placed in the epidural space. It was initially assumed th at the epidural application of opioids might selectively produce analgesia witho ut impairment of motor, autonomic, or sensory functions other than pain. However , respiratory depression can occur after the drug is injected into the epidural space and may require reversal with naloxone. Effects such as pruritus and nause a and vomiting are common after epidural and subarachnoid administration of opio ids and may also be reversed with naloxone if necessary. Currently, the epidural route is favored because adverse effects are less common. 82. Which among the following does not cause hyperpyrexia? A. MAOI B. Alcohol C. atropine D. Amphetamine Ans: B Alcohol Reference:Harisson 17th ed Alcohol(ethanol) causes hypothermia and not hyperthermia 83. All are true about neuronal tumors except? A. 90% are malignant B. 95% occur in the abdomen C. They secrete catecholamines D. They arise from sympathetic ganglions Ans: A 90% are malignant...as per the rule of 10...only 10% are malignant Reference:Harrison 17th ed Epidemiology Pheochromocytoma is estimated to occur in 2 8 out of 1 million persons per year, a nd about 0.1% of hypertensive patients harbor a pheochromocytoma. Autopsy series reveal prevalence figures of 0.2%. The mean age at diagnosis is about 40 years, although the tumors can occur from early childhood until late in life. The "rul e of tens" for pheochromocytomas states that about 10% are bilateral, 10% are ex traadrenal, and 10% are malignant. However, these percentages are higher in the inherited syndromes.

84. Campylobacter jejuni false is-(contributions from Dr.confident) a.commonest cause of campylobacteriosis b.polutry source of infection c.humans are reservoir d.associated with GBS Answer:C humans are the only reservoir[REPEAT AIIMS09] 85. Which of the following does not cause indoor air pollution? (dr.confident co ntribution) A. CO B. Nitrogen dioxide C. Radon D. Mercury vapor 86. Most important and potential agent that can be used in bioterrorism: A. Plague B. Small pox C. TB D. Clostridium botulinum YET TO SOLVE 88. Most common site of obstruction after TURP? A. Navicullar foss B. Bulb C. Prostatic membranous urethra D. Bladder neck YET TO SOLVE 89. Intraoperative myocardial infarction is best diagnosed by: A. ECG B. Invasive arterial pressure C. Central venous pressure D. Transwer esophageal echo Ans:D TEE(REPEAT) Reference awaited 90. Pseudoisomorphic phenomenon seen in A. Psoriasis B. Lichen planus C. Vitiligo D. Plane warts Ans:D Plane warts(reference awiated) 91. Campylobacter jejuni false isa.commonest cause of campylobacteriosis b.polutry source of infection c.humans are reservoir d.associated with GBS ans : C. as animals are reservoirs of Camplyobacter 92. Some antigen was injected into a rabbit. What antibody will it produce initi ally?

A. IgG B. IgM C. IgE D. IgD Ans: B IgM(IS this question any trick or just a question asking for the primary immune respose) 91. A fire breaks out during laser vocal cord surgery. What is not to be done? A. Pouring sterile water into the oral cavity B. Removing endotracheal tube C. 100% oxygen after discontinuing anesthetic gases D. Treatment with steroid & antibiotic Ans: Reference: Could not get a Text reference....a journal paper on Management of Ai rway fire during Microlaryngeal surgery provides some light Managing fire Remove source of fire and extinguish with water Stop ventilation, turn off O2 Mask ventilate with air, then 100% O2 once fire is extinguished Laryngoscopy and rigid bronchoscopy to remove debris Lavage and fibreoptic bronchoscopy if indicated by airway injury Common pattern is worst injury at the surgical site and little distal injury If severe injury Maintain ventilation Consider low tracheostomy IV corticosteroids may be helpful CXR, ABG with co-oximetry for smoke inhalation assessment Option B is correct... Option A not sure... Option C is TRICKY......we should Discontinue the oxygen first that itself will extinguish the fire....once the fire is gone then ventilate with 100% O2.... OptionD is correct Answer should be A/C depends on the exact wordings of the option C Current answer: C 92. Some antigen was injected into a rabbit. What antibody will it produce initi ally? A. IgG B. IgM .answer C. IgE D. IgD 93. Which insect among the following is not resistant to DDT? A. Musca domestica B. Phlebotomus ..answer C. Culex D. Anopheles stephensi 94. Which virus among the following is least likely to cross placenta? A. Rubella B. Herpes simplex C. HIV D. HBV 95. About yaws all are true except: A. Caused by Treponema pertenue

B. Transwermitted non-venerally C. Secondary yaws can involve bones D. Last stages involve heart and nerves Ans: D Late stages involve heart and nerves Reference:Harrison 17th ed Yaws Also known as pian, framboesia, or bouba, yaws is caused by T. pallidum subspeci es pertenue and is characterized by the development of one or several primary le sions ("mother yaw"), which is followed by