Question: Maximum risk of pancreatitis is present with

All NIs can cause pancreatitis and peripheral neuropathy Maximum risk of pancreatitis is associated with dilation didanosine and maximum incidence of peripheral neuropathy is seen with stavudine Lamivudine is safest NI as has minimum risk of pancreatitis and peripheral neuropathy Refer Katzung 11/e p858


Question: The lymphatics from the median part of the forehead drains to


Question: Not a tributary of Azygos Vein among the following is

1. Formative tributaries of Azygos Vein are Lumbar Ascending vein, Subcostal Vein and lumbar azygos vein.
2. Right Bronchial Vein is the last tributary of Azygos Vein


Question: The type of joint present between Epiphysis & Diaphysis is

PRIMARY CAILAGINOUS JOINT (SYNCHONDROSIS): THESE BONE ARE UNITED BY A PLATE OF HYALINE CAILAGE SO THE JOINT IS IMMOVABLE AND STRONG Description Ref BD CHAURASIA S Handbook of General Anatomy Fouh edition Pg no 63


Question: Most common second malignancy in patients with femoral retinoblastoma is

Patients with family retinoblastoma are at greatly increased risk of developing Osteosarcoma and and some other soft tissue sarcoma.. Alteration in RB pathway, involving INK proteins, cyclin D dependent kinases, and RB family proteins which are present in normal cells lead on to tumor suppressor gene. And associated somatic tissue mutation cause increased risk of other tumors. Refer robbins 9/e 299


Question: Accessory renal aeries are A/E

D i.e. Very rare occurancePresence of accessory (supernumerary) renal aeries is the most common renal vascular anomalyQ. It is two times more common than supernumerary renal veins.


Question: Tibial and common peroneal nerve supplies the muscle (FMGE Dec 2018)

Biceps femoris - hybrid muscle - have two nerves supply - Present in posterior compament (lateral) of thigh It has two heads Long head: 1. Originates from inferomedial pa of upper area of ischial tuberosity. 2. Innervated by sciatic nerve - common fibular division. Sho head: 1. Arise from lateral lip of Linea aspera on shaft of femur. 2. innervated by sciatic nerve - common fibular division. It flexes & laterally rotates leg at knee joint; Extends & laterally rotates thigh at hip joint Long head is a pa of hamstrings while sho head is not - gracilis, adductor longus, adductor magnus - belong to medial compament of thigh Muscle Origin Inseion Innervation Function * Gracilis A line on external surface of body of pubis, the inferior pubic ramus & ramus of ischium Medial surface of proximal shaft of tibia. Obturator nerve (L2, L3) Adducts thigh at hip joint & flexes leg at knee joint. * Adductor longus External surface of body of pubis (triangular depression inferior to pubic crest & lateral to pubic symphysis) Linea aspera on middle 1/3rd of shaft of femur Obturator nerve (anterior division L2, L3, L4) Adducts & medially rotates thigh at hip joint * Adductor magnus Ischiopubic ramus Ischial tuberosity Adductor pa - Posterior surface of proximal femur, Linea aspera, medial supracondylar line Hamstring pa - Adductor tubercle, medial supracondylar line Obturator N (L2, L3, L4) Sciatic N (tibial division) (L2, L3, L4) Adducts & medially rotates thigh at hip joint Extends thigh at hip joint.


Question: 35 year old female diagnosed to have hyper thyroid disorder. Her thyroid follicle lined by

Normal thyroid follicle - simple cuboidal Hyper thyroid follicle - simple columnar Hypo thyroid follicle - simple cuboidal


Question: In case of parathyroid adenoma T/t is

Ref: Harrison's 19th edition Pgno :2473-2475 Parathyroid adenoma causes primary Hyperparathyroidism A single parathyroid adenoma (85%) Resection Two adenomas(5%) Resection Hyperplasia of all four glands (10-15%) Resection of 3 1/2 glands Resection of all four glands with auto transplantation of a parathyroid gland in the forearm (brachioradialis) or SCM muscle

Total parathyroidectomy and implantation in arm


Question: Posterior belly of digastric is attached to


Question: Safe and effective method of sterilization of surgical eye instruments is

Autoclaving is the safest methods of sterilization Ref khurana 6/e


Question: Severity of mitral stenosis is assessed by

Ref Harrison 19 th ed pg 1540 In general, the duration of this murmur correlates with the severity of the stenosis in patients with preserved CO. In patients with sinus rhythm, the murmur often reappears or becomes louder during atrial systole (presystolic accentuation).


Question: Epithelium in vocal card is


Question: Lacrimal gland is a derivative of

(A) EctodermDERIVATIVES OF EMBRYONIC TISSUESNeuroectodermCranial Neural Crest CellsSurface EctodermMesoderm* Neurosensory retina* Retinal pigment epithelium* Pigmented ciliary epithelium* Nonpigmented ciliary epithelium* Pigmented iris epithelium* Sphincter & dilator muscles of iris* Optic nerve, axons & glia* Vitreous* Corneal Stroma & endothelium* Sclera* Trabecular meshwork* Sheaths & tendons of extraocular muscles* Connective tissues of iris* Ciliary muscles* Choroidal stroma* Melanocytes (uveal & epithelial)* Meningeal sheaths of the optic nerve* Schwann cells of ciliary nerves* Ciliary ganglion* Most orbital bones, cartilage & connective tissue of the orbit* Muscular layer & connective tissue sheaths of all ocular & orbital vessels* Epithelium, glands, cilia of skin of lids & caruncle* Conjunctival epithelium* Lens* Lacrimal gland & drainage system* Vitreous* Fibers of extraocular: muscles endothelial lining of all orbital & ocular blood vessels; temporal portion of sclera, vitreous


Question: Therapeutic drug monitoring is required for

Ref-KDT 6/e p434,435 Indications for therapeutic drug monitoring include: There is an experimentally determined relationship between plasma drug concentration and the pharmacological effect. Knowledge of the drug level influences management. There is a narrow therapeutic window. There are potential patient compliance problems. The drug dose cannot be optimised by clinical observation alone. Examples of drugs analysed by therapeutic drug monitoring: Aminoglycoside antibiotics (gentamicin) Antiepileptics (such as carbamazepine, phenytoin and valproic acid) Mood stabilisers, especially lithium citrate Antipsychotics (such as pimozide and clozapine) Biologic monoclonal antibody drugs (such as adalimumab, ceolizumab pegol and infliximab) Therapeutic drug monitoring can also detect poisoning with above drugs, should the suspicion arise.


Question: Brown atrophy is due to


Question: Sho head of the biceps muscle is attached to

Sho head of the biceps brachii arises from the lateral pa of the tip of coracoid process and gets attached to the posterior rough pa of radial tuberosity . B D Chaurasia 7th edition Page no : 91


Question: Hypercalcemia is seen in

Paraneoplastic syndromes of HCC Hypercholesterolemia Hypoglycemia Erythrocytosis Hypercalcemia Ref:Sabiston 20th edition Pgno :1458-1463


Question: Sarcoidosis doesn't involve

Ref Robbins 9/e p693 Sarcoidosis almost always involves the lungs, but it can also affect the skin, eyes, nose, muscles, hea,liver, spleen, bowel, kidney, testes, nerves, lymph nodes, joints, and brain. Granulomas in the lungs can cause narrowing of the airways and inflammation and scarring (fibrosis) of lung tissue Only 5-15p% cases have involvement of sarcoidosis in brain called as neurosarcoidosis, it's very rare


Question: Cardiac septum develops by

Cardiac septum developed by 5-8 weeks . Ref - sciencedirect.com


Question: Genomic imprinting is seen in

Ref Robbins 9/e p172 Angelman syndrome, as might be expected, also can result from uniparental disomy of parental chromosome 15. The Angelman syndrome gene (imprinted on the paternal chro- mosome) is now known to encode a ligase that has a role in the ubiquitin-proteasome proteolytic pathway (Chapter 1). This gene, called, somewhat laboriously, UBE3A, is expressed primarily from the maternal allele in specific regions of the normal brain. In Angelman syndrome, UBE3A is not expressed in these areas of the brain--hence the neurologic manifestations. Prader-Willi syndrome, unlike Angelman syndrome, probably is caused by the loss of function of several genes located on chromosome 15 between q11 and q13. These genes are still being fully characterized.


Question: Inferior oblique muscle of eye is supplied by

Ref BDC volume 3,6th edition pg 208NERVE SUPPLY:The superior oblique is supplied by trochlear nerveThe lateral rectus is supplied by abducent nerveThe superior rectus, medial rectus, inferior rectus and inferior oblique is supplied by occulomotor nerve


Question: drugs used for anorexia nervosa

Anorexia nervosa Anorexia nervosa is a eating disorder where the patient has decreased weight and altered body image and persistent desire to maintain thinness * Gender==== more common in females * Age=======adolescence * Comorbidity=== depression and social phobia * Duration====3 months * Criteria= * Intense fear of becoming fat * Restriction of food intake * Restricting type * Binge eating and purging type * Amenorrhea is not needed for diagnosis, previously amenorrhea is considered as a diagnostic criteria for diagnosis, in recent DSM 5 amenorrhea is considered for a diagnosis * Association= * OCD and depression * Decreased interest in sex * Complication * 7-14% moality * ECG changes * Hypokalemic alkalosis because of induced vomiting * Gastric dilation * Drugs * Cypro hepatidine * SSRI * Management * Admit in severe cases * Prevent vomiting by making restroom inaccessible for 2 hours after food intake * Avoid laxatives * Small frequent meals * Avoid refeeding syndrome Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 509


Question: Nerve supply of Pinna is A/E

The upper two-thirds of lateral surface is supplied by the auriculotemporal nerve and the lower one-third by the great auricular nerve . The upper two-thirds of medial surface is supplied by the lesser occipital nerve Notes: The auricular muscles are supplied through branches of facial nerve The root is supplied by auricular branch of vagus nerve Ref.BDC volume 3,sixth edition pg 273


Question: Middle cardiac vein is accompanied by

The middle cardiac vein commences at the apex of the hea; ascends in the posterior longitudinal sulcus along with posterior interventricular aery, and ends in the coronary sinus.Ref: V.S Volume 1; 2nd edition; Page: 276


Question: Superior colliculus is concerned with

The Superior colliculus is a flattened mass formed of seven concentric alternating laminae of white matter and grey matter.The efferent fibres form Superior colliculus forms tectospinal and tectobulbar tracts, which are probably responsible for the reflex movements of eyes, head, and neck in response to visual stimuli.Unilateral lesion of Superior colliculus results in relative neglect of visual stimuli and inability to track moving objects in the contralateral field of vision, although the eye movements are normal.(Ref: Vishram Singh textbook of clinical neuroanatomy second edition pg 85)


Question: Most commonly fractured carpal bone

• The scaphoid is a BOAT SHAPED carpal bone and has a tubercle in its lateral side.
• Scaphoid bone is the most commonly fractured carpal bone.
• Lunate (crescent shaped) is the 2nd most commonly fractured carpal bone.
• Scaphoid fracture is usually caused by a fall on an outstretched hand with the weight landing on the palm.
• Scaphoid bone forms the floor of the anatomical snuff box.
• It articulates with the following bones: radius, lunate, capitate, trapezium, and trapezoid.


Question: The efferent limb of the cremaster reflex is provided by

-        Cremastric reflex-

Afferent- Femoral branch of genitofemoral nerve
Efferent- Genital branch of genitofemoral nerve

Genital branch of the genitofemoral nerve


Question: Superficial perineal space contains

Contents: MuscleIschiocavernosus muscleBulbospongiosus muscleSuperficial transverse perineal muscleOtherCrura of penis (males) / crura of clitoris (females)Bulb of penis (males) / vestibular bulb (females)Greater vestibular gland (female)


Question: A child presents with hypochromic microcytic anemia, with normal levels of free erythrocyte protoporphyrin . The most likely diagnosis is

Ref Harrison 19 th ed pg 637-638 The diagnosis of b-thalassemia major is readily made during child- hood on the basis of severe anemia accompanied by the characteris- tic signs of massive ineffective erythropoiesis: hepatosplenomegaly, profound microcytosis, a characteristic blood smear ), and elevated levels of HbF, HbA2 , or both.


Question: Area of mitral orifice in adults is

The normal area of aoic valve is tz, 3 - 4 cm2 and mitral valve is 4 - 6 cm2Q


Question: Function of cholesterol in plasmalemma is to

The fluidity of the lipid bilayer is decreased in following three ways Lowering temperature Increasing saturation of fatty acyl tails in phospholipid membrane Increase membrane cholesterol content. Cholesterol interacts with the phospholipid membrane containing fatty acyl chains, compacting them, constraining the motion in bilayers, hence decreasing the fluidity. Ref: Lehninger 30e pg 395.

Facilitate the diffusion of ions into the lipid bilayer

Assist in the transpo of hormones across the lipid bilayer


Question: Marked deformity is due to

Given action - wrist drop Due to radial nerve injury PIN palsy causes - finger drop not wrist drop


Question: Epithelium of comea is

INDERBIR SINGH&;S TEXTBOOK OF HUMAN HISTOLOGY-PAGE NO:391 Corneal epithelium: the outermost layer is of non keratinized stratified squamous epithelium. the cells in the deepest layer of the epithelium is columnar.in the middle layers they are polygonal and in the superficial layers they are flattened


Question: A 59 yr old man with severe myxomatous mitral regurgitation is asymptomatic,wi wia left ventricular ejection fraction of 45% and an endsystollic diameter index of 2.9cm/m2 . The most appropriate treatment is

Ref Harrison 19 th ed pg 1545 Valve repair for ischemic MR is associated with lower periopera- tive moality rates but higher rates of recurrent MR over time. In patients with ischemic MR and significantly impaired LV systolic function (EF <30%), the risk of surgery is higher, recovery of LV per- formance is incomplete, and long-term survival is reduced.


Question: Radiation dose in mammography

Mammography Soft tissue radiographs are taken by placing the breast in direct contact with ultrasensitive film and exposing it to low-voltage, high-amperage x-rays. The dose of radiation is approximately 0.1 cGy and, therefore, mammography is a very safe investigation. The sensitivity of this investigation increases with age as the breast becomes less dense. In total, 5% of breast cancers are missed by population-based mammographic screening programmes; even in retrospect, such carcinomas are not apparent. Thus, a normal mammogram does not exclude the presence of carcinoma. Digital mammography is being introduced, which allows manipulation of the images and computer-aided diagnosis. Tomo-mammography is also being assessed as a more sensitive diagnostic modality. Ref:Bailey and love 27th edition Pgno :861


Question: Sensory nerve supply of the middle ear cavity is provided by

Glossopharyngeal nerve -> Tympanic nerve/Tympanic plexus -> Middle ear
                                                                                Auditory tube
                                                                                Mastoid antrum


Question: Nerve likely to be injured in posterior dislocation of the Hip joint is

Dislocation of the hip may be posterior (more common), anterior (less common), or central (rare). The sciatic nerve may be injured in posterior dislocations.Ref: BDC 6th edition (Abdomen and lower limb) pg: 154


Question: Site of transplantation in Islet cell transplant for Diabetes mellitus is

The islets are then purified from the dispersed tissue by density-gradient centrifugation and can be delivered into the recepient liver (the preferred site for transplantation) by injection into the poal vein Ref: Bailey and love 27th edition Pgno :1552


Question: The tensile strength of the wound stas and increases after

Wounds do not begin to gain tensile strength from collagen until 5 - 7 days. Wound achieves around 20 % by 3 weeks, and around 60 % by four months. Scar tissue continues to remodel for at least 6 - 12 months after an injury.


Question: Bregma is the name given to the junction of the

Bregma:

Bregma is the meeting point between coronal and sagittal sutures.
Seen in norma verticalis view of skull.
In foetal skull, this is the site of a membranous gap, called anterior fontanelle. It ossifies at 18 months of age.


Question: Main feature of chemotaxis is

Ref Robbins 8/e p45 ..9/e p77 Chemotaxis. After extravasating from the blood, leuko- cytes move toward sites of infection or injury along a chem- ical gradient by a process called chemotaxis. Both exogenous and endogenous substances can be chemotactic for leuko- cytes, including the following: * Bacterial products, paicularly peptides with N-formyl- methionine termini * Cytokines, especially those of the chemokine family * Components of the complement system, paicularly C5 * Products of the lipoxygenase pathway of arachidonic acid (AA) metabolism, paicularly leukotriene B4 (LTB4) These mediators, which are described in more detail later, are produced in response to infections and tissue damage and during immunologic reactions. Leukocyte infiltration in all of these situations results from the actions of various combinations of mediators. Chemotactic molecules bind to specific cell surface receptors, which triggers the assembly of cytoskeletal con- tractile elements necessary for movement. Leukocytes move by extending pseudopods that anchor to the ECM and then pull the cell in the direction of the extension. The direction of such movement is specified by a higher density of chemokine receptors at the leading edge of the cell. Thus, leukocytes move to and are retained at the site where they are needed. The type of emigrating leukocyte varies with the age of the inflammatory response and with the type of stimulus. In most forms of acute inflammation, neutrophils predomi- nate in the inflammatory infiltrate during the first 6 to 24 hours and are replaced by monocytes in 24 to 48 hours (Fig. 2-6). Several factors account for this early abundance of neutro- phils: These cells are the most numerous leukocytes in the blood, they respond more rapidly to chemokines, and they may attach more firmly to the adhesion molecules that are rapidly induced on endothelial cells, such as P- and E-selectins. In addition, after entering tissues, neutrophils are sho-lived--they die by apoptosis and disappear within 24 to 48 hours--while monocytes survive longer. There are exceptions to this pattern of cellular infiltration,


Question: Extentsion of neck occurs at

C1 and C2 form a unique set of aiculations that provide a great degree of mobility for the skull. C1 serves as a ring or washer that the skull rests upon and aiculates in a pivot joint with the dens or odontoid process of C2. Approximately 50% of flexion extension of the neck happens between the occiput and C1; 50% of the rotation of the neck happens between C1 and C2. Ref - medscape.com


Question: Bochdalek hernia occurs in

BOCHDALEK HERNIA: Usually left sided It is congenital diaphragmatic hernia Deficiency in left pleuroperitoneal cavity Left lung hypoplasia Right lung is also compressed Cyanosis at bih NEONATAL EMERGENCY MORGAGNI HERNIA Mostly on right side Antero-medial & Retrosternal Transverse colon herniates in front of hea Less common than Bochdalek hernia


Question: Loss of lacrimation occurs due to injury of

Parasympathetic secretomotor nerve fibres destined for the lacrimal gland arise from the lacrimal nucleus of the facial nerve. They travel via the great petrosal nerve to reach the lacrimal gland. Consequently injuries of the greater petrosal nerve can cause loss of lacrimation.


Question: M2 choline receptor is located at

M2 receptors are located at Hea, Nerves, Smooth musclesM1NervesM2Hea, Nerves, Smooth musclesM3Glands, smooth muscle, endotheliumM4CNSM5CNSNMSkeletal muscle, Neuromuscular junctionNNCNS, postganglionic cell body, dendritesKatzung 13e pg:105


Question: Aortic hiatus contains

Aortic hiatus contain azygous vein and thoracic duct


Question: Ligament of Berry is formed by

The posterior layer of the thyroid capsule is thick. On either side it forms a suspensory ligament for the thyroid gland known as ligament of Berry .The ligaments are attached chiefly to the cricoid cartilage, and may extend to the thyroid cartilage. They support the thyroid gland, and do not let it sink into the mediastinum.


Question: Most dependent Bronchopulmonary segment in Erect position is

Most dependent Bronchopulmonary segment in Erect position is Right posterior basal segment.


Question: Half life of factor 8

Factor VIII is also called as anti hemophilic factor Its half life is 8-12 hrs Ref: Harrison's 19th edition Pgno :138


Question: Marked dermatome is

Dermatome supply of the marked area is S2


Question: An agent that activates natural killer cells and is useful in renal cell carcinoma is

Ref-Katzung 10/e p816 Recombinant IL-2 is used for the treatment of maligant melanoma and renal cell carcinoma


Question: Tensor tympani is supplied by

The tensor tympani lies in a bony canal that opens at its lateral end on the anterior wall of the middle ear, and its medial end on the base of skull. Nerve supply: MANDIBULAR NERVE The fibres pass through the nerve to the medial pterygoid, and through the otic ganglion, without any relay. Development: From the mesoderm of first branchial arch Action: Tensing the tympanic membrane Ref:BDC 6th edition pg 281 (vol 3)


Question: Medial boundary of anatomical snuffbox is formed by

ANATOMICAL SNUFF BOX:-Elongated triangular depression seen on the lateral side of the dorsum of hand when the thumb is hyperflexed. BOUNDARIES:1. Anterolaterally-tendon of abductor pollicis longus,tendon of extensor pollicis brevis.2. Posteromedially-tendon of extensor pollicis longus.3. Floor-scaphoid and trapezium.4. Roof-skin and superficial fascia.Contents:-1. Radial aery.Structures crossing the roof deep to skin:-1. Cephalic vein.2. Terminal branch of superficial radial nerve. Pulsations of radial aery felt here.Tenderness felt here indicates fracture of scaphoid bone.Cephaloc vein at this site can be used for giving iv fluids. {Reference: Vishram Singh , page no.171} Figure 9.33,page no:122 BD chaurasia


Question: Suntentaculum tali is present on

Sustentaculum tali is a bony projection present on Calcaneus, on medial surface.


Question: The following is not a feature of malignant transformation by culturedc

Ref biology of the cell p357-364 Both normal cells and cancer cells can be cultured in-vitro , however they behave quite differently normal cell: show replicative senescence .is cells pass through limited number of cell division before they decline in vigor and die it may caused by inability to synthesise telomerase

Increased requirement for growth factors


Question: Liver abscess ruptures most commonly in


Question: Foot eversion is caused by

Foot eversion occurs at subtalar joint by Peroneus longus, Peroneus brevis and Peronius Teius. Inversion of foot done by Tibialis anterior and Tibialis posterior.


Question: Ceruminous glands present in the ear are

Th e ceruminous glands secrete the wax of the ear. Th ey are modifi ed sweat glands lined by a columnar, cuboidal or squamous epithelium. REF : Inderbir Singh's Textbook of Human Histology,Seventh edition, pg.no.,412.


Question: Origin of sho head of Biceps

Biceps brachi have two heads sho head and long head The sho head of biceps arise along with coracobrachialis from the tip of the coracoid process, Long head of biceps arise from supraglenoid tubercle of the scapula and from the glenoid labrum Mnemonic Biceps brachii origins: you walk shoer to a street corner.you ride longer on a superhighway. Sho head originates from coracoid process. Long head originates from the supraglenoid tubercle. Reference: BD chaurasia vol 1, 7th edition page no 91 Figure:8.3,page no: 89 BD chaurasia , 6th edition


Question: The commonest mode of inheritance of congenital hea disease is

Ref Harrison 19 th ed pg 1516 The most common bih defects are cardiovascular in origin. These malformations are due to complex multifactorial genetic and environ- mental causes. Recognized chromosomal aberrations and mutations of single genes account for <10% of all cardiac malformations. Congenital hea disease (CHD) complicates ~1% of all live bihs in the general population--about 40,000 bihs/year--but occurs more frequently in the offspring (about 4-10%, depending on maternal CHD type) of women with CHD. Owing to the remarkable surgical advances over the last 60 years, >90% of afflicted neonates and children now reach adulthood; women with CHD may now frequently successfully bear children after competent repairs.


Question: The following structure does not pass through flexor retinaculum

FLEXOR RETINACULUM Carpel tunnel.Transverse carpal ligament. Strong fibrous band which bridges anterior concavity of carpus and conves it into osseofibrous tunnel called carpal tunnel for the passage of flexor tendons of the digits. Rectangular.Formed due to thickening of deep fascia in front of carpal bones. Attachments: medial-pisiform, hook of hamate.Lateral-tubercle of scaphoid and crest of trapezium. Structures passing superficial to flexor retinaculum:-(medial to lateral)1. Ulnar nerve 2. Ulnar aery 3. Posterior cutaneous branch of ulnar nerve.4. Tendon of palmaris longus.5. Palmar cutaneous branch of median nerve.6. Superficial palmar branch of radial aery. Structures passing deep to flexor retinaculum:-1. Tendon of FDS2. Tendon of FDP 3. Tendon of FPL.4. median nerve. Ulnar bursa-tendons of FDS&FDP.Radial bursa- tendon of flexor pollicis Flexor carpi radialis pass through separate canal. CARPAL TUNNEL SYNDROME:-Injury to median nerve in carpal tunnel.Causes:-Tenosynovitis of flexor tendons.MyxedemaRetention of fluid in pregnancy Fracture dislocation of lunate bone.Osteoahritis of wrist. Symptoms:-1. Feeling of burning pain or " pins & needles " along lateral 3 and half digits especially at night.2. Weakness of thenar muscles.3. No sensory loss over thenar eminence.4. Ape thumb deformity if left untreated.5. Positive phalens abd tinel's sign.Phalen' sign-flexion of both wrists against each other for one minute reproduces the symptoms.Tinel's sign- percussion over flexor retinaculum reproduces symptoms. MNEMONIC structures passing deep to flexor retinaculum:" SPM fuLLy Boring Flexor digitorum Superficialis tendon, flexor digitorum Profundus tendon, Median nerve, flexor poLLicis longus , Bursae - radial and ulnar. {Reference: vishram singh, page no.196,} Figure:9.15,page no:113,BD chaurasia , 6th edition,upper limb & thorax.


Question: Most frequently damaged cranial nerve with a motor component

Traumatic Cranial Neuropathies: the most common cranial nerves which recieve traumatic injuries include olfac, tory, facial and audiovestibular nerves the lower cranial nerves are less often involved


Question: Tumor marker of HCC

Tumor markers of HCC Protein induced by Vitamin K absence (PIVKA; Des-gamma-carboxy prothrombin); glypican-3; AFP fractions Lectin fraction-3 of SFP (AFP-L3) is highly specific to HCC and also indicator of poorly differentiated histology and unourable prognosis Serum AFP level is elevated above 20ng/mp in >70% of patients with HCC Monoclonal antibody HeoPar-1(hepatocyte paraffin-1) identifies a unique antigen on hepatocyte mitochondria and is used to identify hepatocytes or HCC Ref:Sabiston 20th edition 1458-1463


Question: The aery most commonly responsible for bleeding in massive hemoptysis is


Question: Wire loop lesions are seen in

Ref Harrison 17/e p2077; Robbins 8/e p218;9/e p224 Subendothelial deposits create a homogenous thickness iof the capillary wall called wire loop lesson.which can be seen on light microscopy


Question: Voluntameer ram will receive a new drugin Phase 1 clinical trial. The clearance and volume of distribution of the drug in Ram are 1.386L/hr and 80L respectively. They have life of the drug in him would be approximately


Question: The most suitable test to assess iron stores is

Reg Harrison 19 th ed pg 627,628 The serum ferritin level is a better indicator of iron overload than the marrow iron stain. However, in addition to storage iron, the marrow iron stain provides information about the effective delivery of iron to develop- ing erythroblasts.


Question: Convergent muscle among the following is

Convergent muscle is one where all the fibres converge at the insertion (Fan shaped)
Eg - Temporalis


Question: A patient sustains a knife wound through the right fouh intercostals space, 2 cm to the right of the sternum. The area most likely penetrated by the knife is the

The right border of the hea is approximately 1 to 2 cm to the right of the right border of the sternum; therefore, the knife probably did not hit the hea. The middle lobe of the right lung extends from the level of the fouh costochondral junction to the level of the fifth intercostal space. The middle lobe is most likely at the level of the fouh intercostal space.


Question: The structure that lies lateral to distal radial tubercle

The structure that lies lateral to distal radial tubercle are: Tendons of Extensor carpi radialis brevis and longus. Distal radial tubercle (Lister's tubercle) is located at the distal dorsal aspect of the radius It is a bony prominence that can be easily palpated. Function: It acts as a pulley for the Extensor Pollicis Longus tendon, changing it's mechanical direction of action.

Muscles of arm and forearm region & Cubital fossa


Question: Muscle causing supination of forearm

SUPINATION & PRONATION OF FOREARM:-Perform skilled movements.Elbow is semiflexed in mid prone position.Palm turned down in pronation and upwards in supination.Rotatory movement of forearm which occur at superior and inferior radioulnar joints around a veical axis.In supination, radius and ulna lie parallel to each other.In pronation, rotation of lower end of radius on the head of ulna.Supination more powerful than pronation., because it has antigravity movement, it is performed by powerful muscles.Muscles involved:-Supination:-1. Supinator.2. Biceps brachii- supinates when elbow is flexed.3. Brachioradialis-supinates pronated forearm to midprone position.Pronation:-1. Pronator teres.2. Pronator quadratus.3. Brachioradialis- pronates the supinated forearm to midprone position .{Reference:vishram singh, pg no.145}


Question: Difference between typical cervical & thoracic vertebra

In cervical vertebrae, the transverse process is pierced by foramen transversaria

Superior articular facet directed backwards & upwards


Question: Skin and fascia of great toe drains into

Superficial inguinal lymph nodes are located in the superficial fascia of the inguinal region. They are divided into two groups horizontal and veical resembling the letter T.The horizontal group lie below and parallel to the inguinal ligament. The veical group lies along the terminal pa of the great saphenous vein. The horizontal group is divided into medial and lateral groups.Lateral group receives lymph from the gluteal region, lateral half of anterior abdominal wall below the umbilicus and the entire lower limb except lateral pa of foot, heel and lateral pa of leg.Deep inguinal lymph nodes receive lymph from superficial inguinal lymph nodes. The external iliac nodes drain lymph from the inguinal nodes and they are fuher drained into common iliac nodes. The internal iliac nodes drain lymph from the pelvic viscera.Reference: clinical anatomy for students a problem solving approach, Neeta v Kulkarni, 2nd edition, page no.840,841,719


Question: Coronal suture is placed between

1. Coronal suture: This is placed between the frontal bone and the two parietal bones. The suture crosses the cranial vault from side to side and runs downwards and forwards2. Sagittal suture: It is placed in the median plane between the two parietal bones. 3. Lambdoid suture: It lies posteriorly between the occipital and the two parietal bones, and it runs downwards and forwards across the cranial vault.4. Metopic suture: This is occasionally present in about 3 to 8% individuals. It lies in the median plane and separates the two halves of the frontal bone.Ref: Chaurasia; Volume 3; 6th edition; Chapter 1; Page no: 4


Question: Incomplete closure of ectodermal cleft is know to cause

Inderbir Singh&;s Human embryology Tenth edition Pg 364 Failure of the choroidal fissure to obliterate completely may lead to deficiencies( coloboma)of various layers of eyeball including iris ciliary body and choroid


Question: Most common intracranial malignancy is

Glioblastoma multiforme (GBM) is the most common and deadliest of malignant primary brain tumors in adults and is one of a group of tumors referred to as gliomas. Classified as a Grade IV (most serious) astrocytoma, GBM develops from the lineage of star-shaped glial cells, called astrocytes, that suppo nerve cells. GBM develops primarily in the cerebral hemispheres but can develop in other pas of the brain, brainstem, or spinal cord. Refer Robbins page no 1308


Question: Tarsal bone interposed between the proximal and distal rows is

The navicular bone is boat-shaped. It is interposed between the talus and the three cuneiform (Latin wedge) bones. In other words, it is interposed between the proximal and distal rows.Ref: Chaurasia; Volume 2; 6th edition; Page no: 33


Question: Vasa bre is the name of

Splenic aery (branch of celiac trunk) supply greater curvature of stomach by it following branches: Sho gastric aeries which are called as vasa bre. (carried by Splenogastric ligament) Long gastric aery called left gastroepiploic aery. Jejunal vasa recta (long aeries) & ileal vasa recta (sho) are straight aeries coming from arcades in mesentery of jejunum & ileum.


Question: Parietal peritoneum is lined by

SIMPLE SQUAMOUS EPITHELIUM - The cells of this epithelium are flattened. In sections they appear so thin that bulgings are produced on the surface by nuclei. In surface view the cells have polygonal outlines that interlock with those of adjoining cells. A simple squamous epithelium lines the alveoli of the lungs, the free surfaces of peritoneum, pleura and pericardium. Here it is given the name mesothelium. It also lines the inside of blood vessels,where it is called endothelium, and Of the hea where it is called endocardium. REF : Inderbir Singh's Textbook of Human Histology, seventh edition, pg.no., 2.


Question: A 60 yr old lady is concerned about the wrinkles around her eyes.This is due to defect in

Collagen cross-linking: Cross linking occurs when a protein linked to other protein,lipid or sugar which is necessary for normal collagen function. Abnormal cross linking causes wrinkles/ages skin which is due to glucose mediated advance glycation end products(AGE),UV mediated free radical damage. Collagenase: Defect in collagen leads to increased level of collagen Collagenase inhibitor are given to treat wrinkles Desmosine: Desmosine is formed by 3allsyl side chains and one unaltered lysyl side chain of elastin. Fibrillin: It is a glycoprotein secreted by fibroblasts. It forms a framework of elastin deposition Defect in fibrillin-1 results in Marfans syndrome Reference: Harpers illustrated biochemistry 30th edition


Question: Most common location of accessory spleen

Accessory spleen, in other words supernumerary spleens, splenunculi, or splenules, results from the failure of fusion of the primordial splenic buds in the dorsal mesogastrium during the fifth week of fetal life. Incidence of accessory spleen in the population is 10%-30% of patients in autopsy series and 16% of patients undergoing contrast enhanced abdominal CT. Although the most common location for an accessory spleen is splenic hilum (75%) and pancreatic tail (25%) , it can occur anywhere in the abdomen including gastrosplenic or splenorenal ligaments, wall of stomach or bowel , greater omentum or the mesentery, and even in the pelvis and scrotum. Accessory spleen usually measures 1 cm in diameter, but its size varies from a few milimeters to centimeters. Also the number of accessory spleens can vary from one to six . Accessory spleens are usually incidentally detected and asymptomatic, but in case of unexpected locations, accessory spleen can be of clinical impoance. Ref - radiologyassistant.com


Question: Heriditory spherocytosis is caused by

Spectrin causes membrane loss leading to spherical shape of rbc


Question: Hunterian perforators are seen in

Hunterian perforator is seen in middle one third of thigh.It is a perforating vein that connects the great saphenous vein with the femoral vein .The great saphenous vein is a superficial vein while the femoral vein is a deep vein.It is present in the hunter&;s canal. Other perforating veins include, 3 medial ankle perforators of Cockett and Boyd&;s perforator at upper end of calf. reference: clinical anatomy for students, problem solving approach,neeta v kulkarni, 2nd edition ,page no.837


Question: Enzymes that protects the brain from free radical injury is

Ref Robbins 7/e p17; Harrison 17/e p2572;9/e p48 Superoxide dismutase (SOD, EC 1.15.1.1) is an enzyme that alternately catalyzes the dismutation (or paitioning) of thesuperoxide (O2-) radical into either ordinary molecular oxygen (O2) or hydrogen peroxide (H2O2).


Question: Quickening will be felt in pregnancy at

Quickening Pregnant woman will feel slight fluttering movement in her abdomen by fifth month of pregnancy. This is known as quickening, which gradually increase in intensity. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 330


Question: Subclan steal syndrome results due to obstruction of

The proximal pa of left subclan is blocked on left side so no flow in veebral and to left arm. Blood from right veebral enters left veebral and flows back to supply left arm.


Question: Cartilage of second arch is


Question: Development of labia majora is from

Labia Majora and Scrotum develops from the same structure known as Labio scrotal swelling. Genital ridge forms testes,ovary Urethral folds also known as genital folds forms the labia minora. Urogenital sinus forms urinary bladder, urethra And lower pa of vagina.

Development of GU system and Neuro-vascular supply of pelvis & perineum


Question: During active labor cervical dilatation per hour in primi is

Active labor: Cervix dilatation to atleast >6 cm Regular uterine contractions are present Rate of dilatation is atleast 1.2 cm/hr for nulliparous and 1.5cm/ hr for parous women


Question: Power grip of hand is a function of

Power grip is by extrinsic muscles of hand which originate in the forearm and inse in the hand - Long flexors Precision grip is a function of the intrinsic muscles of hand which originate and inse in the hand. Ref: Gray's Anatomy The Anatomical Basics of Clinical Practice 41 e pg 860.


Question: Structure related to deltopectoral groove is

the deltopectoral groove - The cephalic vein, the deltoid branch of the thoraco-acromial aery, and one or two deltopectoral lymph nodes lie in the deltopectoral groove, under the deep fascia on the medial side of the septum. Ref : B D Chaurasia's Human Anatomy , seventh edition , volume 1 , pg. no., 43


Question: Muscle used in normal walk during stance and swing

Each leg goes through stance phase and swing phase in normal walking.
Stance phase - Foot on ground. 60% of gait.
Main muscles involved are

   Heel strike - quadriceps, hamstrings, tibialis anterior
   Mid stance - quadriceps, hamstrings, tibialis anterior, gluteus maximus
   Push off - gastrocnemius -soleus

Swing phase - Foot not on ground, 40% of gait.
Main muscles involved are

   Acceleration - quadriceps
   Swing through - iliopsoas
   Deceleration - hamstrings and tibialis anterior.


Question: The last tributary of the azygos vein is

Right bronchial vein near the terminal end of azygos vein. BD CHAURASIA'S HUMAN ANATOMY VOLUME 1. 6TH Edition. page no-224


Question: Interosseous membrane of forearm is piereced by

-The anterior interosseous nerve and vessels lie in close relation to the anterior surface of the interosseous membrane of forearm stretching between the interosseous borders of radius and ulna.At the upper margin of the pronator quaadratus, the anterior interosseous vessels pass through the interosseous membrane to enter the posterior compament of forearm. -The lower pa of the posterior surface of interosseous membrane is closely related to the anterior interosseous aery and posterior interosseous nerve.The posterior interosseous vessels enter the posterio compament through the gap between oblique cord and upper margin of the interosseous membrane. -reference; clinical anatomy for students ,problem solving appproach,neeat v kulkarni, page no.79


Question: A 20 year old male presents with extrapyramidal symptoms and liver damage. Diagnosis

Wilson's disease It is characterized by excessive deposition of copper in the liver, brain and other tissues Clinical features Liver disease during first decade of life or with neuropsychiatric illness during 3rd decade Kayser-Fleischer ring - due to deposition of copper in Descemet's membrane in the limbs of corners Ref: Sabiston 20th edition


Question: Antihelminthic drugs that is effective against blood fluke ,liver fluke, lung fluke and cysticercus is

Ref-KDT 6/e p814,815 Drug of choice for treatment of flukes (except Praziquantal liver fluke) and cestodes : Triclabendazole Drug of choice for treatment of liver fluke:DEC Drug of choice for treatment of filariasis : Ivermectin Drug of choice for treatment of onchocercal and strongyloides For rest all helminthes :Albendazole


Question: SLE like reaction is caused by

SLE like syndrome is caused due to S-SULPHONAMIDES H-HYDRALAZINE I-ISONIAZIDE P-PROCAINAMIDE Ref-KDT 7/e p66


Question: The dorsal pa of the ventral mesogastrium forms(2018)

The lesser omentum is formed by two layers of peritoneum separated by a variable amount of connective tissue and fat. It is derived from the ventral mesogastrium. Ref:- Gray's anatomy, pg num:- 1101


Question: The most common site of Tracheostomy

Tracheostomy is an operation in which the trachea is opened and a tube inseed into it to facilitate breathing. It is most commonly done in the retrothyroid region after retracting the isthmus of the thyroid gland. A suprathyroid tracheostomy is liable to stricture, and an infrathyroid one is difficult due to the depth of the trachea and is also dangerous because numerous vessels lie anterior to the trachea here.Ref: BD Chaurasia; Volume 3; 6th edition; Anterior Triangle of the Neck; Page no: 139


Question: Humans become infected by M.tuberculosis commonly by

M.tuberculosis is mainly transmitted by direct inhalation of aerosolised bacilli contained in the droplet nuclei of expectorated sputum. Generated while coughing. sneezing,or speaking of infected patients. There may be as many as 3000 infectious nuclei per cough. The tiny droplets may remain suspended in the air for several hours and are easily inhaled. Ref: Textbook of microbiology; Ananthanarayan and paniker's; 10th edition; Pg: 355


Question: Metabolic changes associated with excessive vomiting includes the following

Vomiting causes loss of gastric secretions which include HCl & K+ ions, resulting in metabolic alkalosis, hypokalemia and hypochloremia. However note that the moderate to severe hypokalemia seen with excessive vomiting is not merely explained by loss of K+ ions in vomiting. "In fact the hypokalemia is primarily due to increased renal K+ excretion. Loss of gastric contents results in volume depletion and metabolic alkalosis, both of which promote Kaliuresis.


Question: Alcholholic Hyaline Seen in alcoholic liver disease is composed of


Question: Most common joint involved in gouty ahitis is

Most common joint involved in gout is big toe i.e,metatarsophalangeal joint of great toe Refer Harrison 20th e p 2165 maheswari 9th ed


Question: The most common histologic type of thyroid cancer is

Papillary carcinoma accounts for 80% of all thyroid malignancies in iodine-sufficient areas and is the predominant thyroid cancer in children and individuals exposed to external radiation." The incidence of primary malignant tumours of the thyroid gland Also, remember - Thyroid carcinoma is the most common malignancy of the endocrine system Ref : Schwaz 9/e p1361


Question: Rate of elimination of a new drug is 20mg/hr it is steady state plasma concentration of 10mg/L, then it's renal clearance will be

Ref-Katzung 10/e p35 Clearance=Rate of elimination/plasma concentration 20mg/hr /10mg/L =2L/hr


Question: Blastocyst implantation close to internal os causes

A i.e. Placenta pre- When the placenta is implanted paially or completely over the lower uterine segment, over and adjacent to the internal os, it is called placenta pre


Question: Investigation of choice for high risk breast cancer in female is

MRI Indicated in scarred breast, implants and borderline lesions for breast conservation Investigation of choice for implant related complications. Gold standard for imaging breast in females with implants Ref: Sabiston 20th edition Pgno :826-828


Question: The type of joint between the sacrum and the coccyx is a

The sacrococcygeal symphysis is an amphiahrodial (slightly mobile) joint, formed between the oval surface at the apex of the sacrum, and the base of the coccyx.The movements which take place between the sacrum and coccyx, and between the different pieces of the latter bone, are forward and backward; they are very limited. Their extent increases during pregnancy.A zygapophyseal joint (or facet joint) is a veebral joint between the superior aicular process of one veebra and the inferior aicular process of the one adjacent. It is of plane synol variety. In fact, all the joints of veebra are plane synol Except the median one- which is a symphysis (as expected *).*All midline joints tend to be symphysis, only very few Exceptions are there. E.g., spheno-occipital joint, which is a synchondrosisInterveebral discs (or interveebral fibrocailage) lie between adjacent veebrae in the spine. Each disc forms a secondary cailaginous (symphysis) joint to allow slight movement of the veebrae, and acts as a ligament to hold the veebrae together.Discs consist of an outer annulus fibrosus, which surrounds the inner nucleus pulposus. The annulus fibrosus consists of several layers of fibrocailage. The strong annular fibers contain the nucleus pulposus and distribute pressure evenly across the disc. The nucleus pulposus contains loose fibers suspended in a mucoprotein gel the consistency of jelly. The nucleus of the disc acts as a shock absorber, absorbing the impact of the body&;s daily activities and keeping the two veebrae separated.The disc can be likened to a doughnut: whereby the annulus fibrosis is similar to the dough and the nucleus pulposis is the jelly. If one presses down on the front of the doughnut the jelly moves posteriorly or to the back. When one develops a prolapsed disc the jelly/ nucleus pulposis is forced out of the doughnut/ disc and may put pressure on the nerve located near the disc. This will give one the symptoms of sciatica if the disc herniation is at lumbosacral region.There is one disc between each pair of veebrae, Except for the first cervical segment, the atlas. There are a total of twenty-three discs in the spine.When the annulus fibrosus tears due to an injury or the aging process, the nucleus pulposus can begin to extrude through the tear, most commonly postero-lateral. This is called disc herniation. Near the posterior side of each disc, all along the spine, major spinal nerves extend out to different organs, tissues, extremities etc. It is very common for the herniated disc to press against these nerves (pinched nerve) causing radiating pain, numbness, tingling, and diminished strength and/or range of motion. In addition, the contact of the inner nuclear gel, which contains inflammatory proteins, with a nerve can also cause significant pain and muscle spasm. Nerve-related pain is called radicular pain.


Question: Inverse supinator jerk is


Question: reversible lens granular deposits is caused by

chlorpromazine is a typical anti psychotic that has lot of mentioned side effects namely Blue grey discolouration of skin reverse lens granular deposits obstructive jaundice retrograde ejaculation REf. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no 925


Question: Number of muscles in middle ear

The two muscles of middle ear are tensor tympani and stapedius. Both act simultaneously to damp down the intensity of high pitched sound waves and thus protect the internal ear. Notes: The tensor tympani is supplied by the mandibular nerve The stapedius is supplied by the facial nerve Ref BDC volume3,sixth edition pg 280


Question: Derivative of ultimobranchial body

PHARYNGEAL POUCH DEVELOPS INTO 1st Tympanic cavity and eustachian tube 2nd Tonsillar epithelium 3rd Ventrally: thymus Dorsally: inferior parathyroid 4th Superior parathyroid 5th Ultimobranchial body The ultimobranchial body will be found attached to pharyngeal pouch 4. It receives some neural crest cells which will form the parafollicular C cell of thyroid gland; which help in the production of hormone calcitonin.


Question: Hyoglossus muscle inserts into

Key Concept:
Hyoglossus muscle inserts into lateral part of tongue.


Question: Extension at MCP joint is by

(A) Extensor Digitorum # Extensor digitorum muscle actions include Extension of interphalangeal, metacarpophalangeal and wrist joints.> All Palmar interossei adduct the digit to which they are attached towards the middle finger + flex the digit at MCP joint & extend IP joints.> All Dorsal interossei abduct the digits away from the line of the middle finger + flex the digit at MCP joint & extend IP joints.> Lumbrical muscles flex the metacarpophalangeal joints, and extend the interphalangeal joints of the digit into which they are inserted.


Question: Antischkow cells are characteristic of the

Refer robbins 9/e p558 Anitschkow (or Anichkov) cells are often cells associated with rheumatic hea disease. Anitschkow cells are enlarged macrophages found within granulomas (called Aschoff bodies) associated with the disease. The cells are also called caterpillar cells, as they have an ovoid nucleus and chromatin that is condensed toward the center of the nucleus in a wavy rod-like pattern that to some resembles a caterpillar. Larger Anitschkow cells may coalesce to form multinucleated Aschoff giant cells.Anitschkow cells were named after the Russian pathologist Nikolay Anichkov. Squamous epithelial cells with nuclear changes resembling Anitschkow cells have also been observed in recurrent aphthous stomatitis, iron deficiency anemia, children receiving chemotherapy, as well as in healthy individuals


Question: Example for Denticulate suture

Types of sutures:Plane: Internasal sutureSerrate: Coronal sutureDenticulate: Lambdoid sutureSquamous: Parieto-Temporal sutureReference: Chourasia; 6th Edition; 4th page


Question: Chronic urethral obstruction due to benign prismatic hyperplasia can lead to the following change in kidney parenchyma

Chronic urethral obstruction because of urinary calculi, prostatic hyperophy, tumors, normal pregnancy, tumors, uterine prolapse or functional disorders cause hydronephrosis which by definition is used to describe dilatation of renal pelvis and calculus associated with progressive atrophy of the kidney due to obstruction to the outflow of urine Refer Robbins 7yh/9,1012,9/e. P950


Question: Medial rotator of thigh is

Ans: D Gluteus minimus.Medial rotation of hip joint:Tensor fasciae latae.Anterior fibres of glutei medius & minimus.


Question: Most common type of pathological changes seen in Rabies are

Refer Robbins page no Pg 1277 Histopathologic evidence of rabies encephalomyelitis (inflammation) in brain tissue and meninges includes the following: Mononuclear infiltration Perivascular cuffing of lymphocytes or polymorphonuclear cells Lymphocytic foci Babes nodules consisting of glial cells Negri bodies


Question: Secretomotor fibres to Lacrimal gland relay in


Question: Philtrum of upper tip is derived from


Question: Treatment of Acute lymphangitis requires


Question: Dislocation of the veebra is uncommon in thoracic region because in this region

The superior aicular process is directed backward, upward and laterally (BUL) in the thoracic region. It interlocks with the corresponding inferior aicular facet making a strong aiculation rendering dislocation in the thoracic region uncommon.

Anterior longitudinal ligament is strong


Question: The following structure does not pass through flexor retinaculurn

Ulnar nerve Flexor retinaculum (F.R.)Is a thickening of deep fascia which bridges the ant. concavity of the carpus and conves it into an osteofascial tunnel, the carpal tunnel.Structures passing beneath the flexor retinaculum from medial to lateral are:Flexor digitorum superficialis tendon & post. to these flexor digitorum profundus tendonsMedian N.Flexor pollicis longusFlexor carpi radialis


Question: A clot size of a clenched fist indicates blood loss of approximately

Measurement of Blood Loss Clot size of a clenched fist is 500 ml. Blood loss in a closed tibial fracture is 500-1500 ml; in a fracture femur is 500-2000 ml. Weighing the swab before and after use is an impoant method of on-table assessment of blood loss. Ref: SRB's Manual of Surgery 6th edition Pgno :120


Question: Over growth of skin structure at a localised region is

Ref Robbins 8/e p262; 9/e p13 An overgrowth of a skin structure at a localised region is likely to be indigenous as well as benign , this is more likely to be a hamaoma .it is now considered as a neoplasm


Question: One of the following opens in the middle meatus of the nose

The middle meatus lies underneath the middle concha.it presents the following features: 1.the ethmoidal bulla is a rounded elevation produced by the underlying middle ethmoidal sinuses which open at upper margin of bulla. 2. Hiatus semilunar 3. Infundibulum 4. The opening of maxillary air sinus is located in posterior pa of the hiatus semilunaris.it is often represented by two openings. 5. The opening of the anterior ethmoidal air sinus is present behind the opening of frontal air sinus 6. The opening of frontal air sinus is seen in the anterior pa of hiatus semilunar Ref.BDC volume 3.Sixth edition pg 243


Question: Inferior most structure of right hilium is

Superior pulmonary vein is the anterior most and inferior pulmonary vein is the inferior most structures of both lung hiliumQ.Upper most structure of hilum (root) of lung is pulmonary aery (left side)Q and epaerial (superior lobar) bronchus (on right side) Q.


Question: Transitional epithelium is seen in

INDERBIR SINGH&;S TEXTBOOK OF HUMAN HISTOLOGY-PAGE NO:320


Question: Abdominal Aorta Bifurcates at the level of

Abdominal Aorta Bifurcates at the Lower border of L4


Question: Nerve supply of muscles of soft palate is/are

Ref BDC volume 3,6th edition pg 223MOTOR NERVE SUPPLY:All muscles of soft palate except tensor veli palatini are supplied by pharyngeal plexus. The fibers of this plexus are derived from the cranial pa of the accessory nerve through vagus. The tensor veli palatini is supplied by mandibular nerve.GENERAL SENSORY NERVES:The middle and posterior lesser palatine nerves which are branches of maxillary nerve through the pterygopalatine ganglionThe glossopharyngeal nerveSPECIAL SENSORY OR GUSTATORY NERVESThe nerves carrying taste sensations from the oral surface are contained in the lesser palatine nerves.SECRETOMOTOR NERVESThese are also contained in the lesser palatine nerves.


Question: The muscle of hand that contains a sesamoid bone is

The tendon of inseion of adductor pollicis on the medial side of base of proximal phalanx of thumb contains a sesamoid bone.Reference: Textbook of anatomy, Upper limb, and thorax, Vishram Singh, 2nd edition, page no.144


Question: A child in status epilepticus should not be given

Seizures are one of the adverse effects of clonazepam Drugs Commonly Used In Status Epilepticus*Lorazepam *Midazolam*Diazepam*Phosphenytoin*Paraldehyde*Phenobarbital*Pentobarbital *Propofol*Thiopentone*ValproateSteps in management of status epilepticusIV Diazepam 0.1-0.3 mg/kg (or)Lorazepam 0.05-0.1 mg/kg|Fosphenytoin 15-20 PE/kg (PE - Phenytoin Equivalents)|Phenobarbitone 10-20 mg/kg (or)Valproate 20 mg/kg /Levetiracetam|Midazolam 0.05-0.2 mg/kg (or)Propofol 1-3 mg/kg (or)Thiopental IV Infusion|Isoflurane anaesthesia(Refer: Nelson's Textbook of Paediatrics, 19thedition, pg no:2039)


Question: A woman has septic aboion done vegetation on tricuspid Valve is likely to go to

Ref Harrison 19 th ed pg 819 Septic pulmonary emboli, which are com- mon with tricuspid endocarditis, cause cough, pleuritic chest pain, nodular pulmonary infiltrates, or occasionally pyopneumothorax. Infection of the aoic or mitral valves presents with the typical clinical features of endocarditis, including peripheral manifestations.


Question: Number of vertebrae in human vertebral column is

(D) 33# Human vertebral column usually consists of 33 vertebrae:> 24 Presacral vertebrae: 7 cervical, 12 thoracic, and 5 lumbar)> Sacral veretebrae (5 fused sacral vertebrae) and> Coccyx vertebrae (4 frequently fused coccygeal vertebrae).


Question: The most common form of fetal traumatic injury incurred during extraction is

The most frequent single cause of death in breech presentation is intracranial hemorrhage due to tentorial tears, these tears are the result of sudden excessive pressure on the after coming head and may be aptly described as the snapping of the internal greyropes of the cranium


Question: Marker of cell membrane is/are

Na+/K+-ATPase -- plasmalemma, glucose-6-phosphatase---endoplasmic reticulum, galactosyltransferase----- Golgi apparatus, succinate dehydrogenase ----- mitochondria, acid phosphatase --- lysosomes, catalase---- peroxisomes and lactate dehydrogenase --- cytosol.


Question: A patient with abdomen injury presents to the emergency depament with signs of peritonitis and shock. Airway and breathing were secured and IV fluids were staed with two large bore cannulas. The next line of management should be

. Haemodynmically unstable-investigations need to be suspended as immediate surgical correction needed. Pg No. 372 bailey 27th edition

Exploratory laparotomy under general anaesthesia

Inseion of abdominal drain followed by laparotomy


Question: Feature seen in common peroneal nerve injury

COMMON PERONEAL NERVE:- Smaller terminal branch of sciatic nerve.Root value: dorsal division of ventral rami of L4,L5,S1,S2.Beginning: begins in back of thigh as a smaller subdivision of the sciatic nerve. Course:lies in upper lateral pa of popliteal fossa. It turns around the lateral surface of the fibula. Then it lies in the substance of peroneus longus muscle.Terminates by dividing into two terminal branches- superficial and deep peroneal. Commonest nerve to be paralysed.Causes of injury:1. Fracture neck of fibula.2. Lathi injury on lateral side of knee joint.3. Due to plaster on leg.- nerve get compressed between hard plaster and neck of fibula. To prevent this cotton must be placed on the upper lateral side of the leg. Effects of injury:-1. Motor loss: dorsiflexors and eveors of foot affected. Results in foot drop. Foot is plantar flexed due to paralysis of muscle of anterior compament.2. Sensory loss: back of leg, lateral side of leg and dorsum of foot.3. Aicular loss: lateral side of knee joint. {Reference: BDC 6E pg no.176}


Question: A 25 year old female complaints of discharge of blood from a single duct in her breast. The most appropriate treatment is

Discharges from the nipple Discharge can occur from one or more lactiferous ducts. Management depends on the presence of blood in the discharge or discharge from a single duct. Treatment Treatment must firstly be to exclude a carcinoma by occult blood test and cytology. Simple reassurance may then be sufficient but, if the discharge is proving intolerable, an operation to remove the affected duct or ducts can be performed (microdochectomy). MICRODOCHECTOMY It is impoant not to express the blood before the operation as it may then be difficult to identify the duct in theatre. A lacrimal probe or length of stiff nylon suture is inseed into the duct from which the discharge is emerging. A tennis racquet incision can be made to encompass the entire duct or a periareolar incision used and the nipple flap dissected to reach the duct. The duct is then excised. A papilloma is nearly always situated within 4-5cm of the nipple orifice. Ductoscopy (inspection of the internal structure of the duct system) using microendoscopes is technically feasible but generally disappointing. The affected duct may not be visualised and biopsy systems are currently rudimentary. Ref: Bailey and love 27th edition Pg no : 864, 865


Question: The inheritance pattern of familial retinoblastoma is

Ref Robbins 7/e p1442,299- 300,9/e p292-293 In hereditary retinoblastoma, mutations in the RB1gene appear to be inherited in an autosomal dominant pattern. Autosomal dominant inheritance means that one copy of the altered gene in each cell is sufficient to increase the risk of cancer. A person with hereditary retinoblastoma may inherit an altered copy of the RB1 gene from one parent, or the altered gene may be the result of a new mutation that occurs in an egg or sperm cell or just after feilization. For retinoblastoma to develop, a mutation involving the other copy of the RB1 gene must occur in retinal cells during the person's lifetime. This second mutation usually occurs in childhood, typically leading to the development of retinoblastoma in both eyes. In the non-hereditary form of retinoblastoma, typically only one eye is affected and there is no family history of the disease. Affected individuals are born with two normal copies of the RB1 gene. Then, usually in early childhood, both copies of the RB1 gene in ceain retinal cells acquire mutations. People with non-hereditary retinoblastoma are not at risk of passing these RB1 gene mutations to their children. However, without genetic testing it can be difficult to tell whether a person with retinoblastoma in one eye has the hereditary or the non-hereditary form of the disease.


Question: Pentostatin acts by inhibiting

Ref-Katzung 10/920 Pentostatin and cilastatin are not statins i.e. these do not act by inhibiting HMG-CoA reductase. Pentostatin acts by inhibiting adenosine deaminase. It is used for the treatment of hairy cell leukemia. Drug of choice for hairy cell leukemia is cladribine.


Question: Minor duodenal papilla is opening of

Minor duodenal papilla is the opening of the accessory pancreatic duct into the decending second section of the duodenum.It is situated 2cm proximal to the major duodenal papilla.and thus 5-8cm from the opening of pylorus. ref - BDC 6e vol2 pancreas imageref- netter atlas


Question: Most dangerous paicles causing pneumoconiosis are of size

In pneumoconiosis, the most dangerous paicles range from 1-5 micron in diameter, because they may reach the terminal small airway and settle in there lining notes The solubility and cytotoxicity of paicles ,modify the nature of pulmonary response


Question: Veebral level of body of sternum is

Veebrae level of body of sternum is T5-T9. Ref - medscape.com


Question: Fast fatigable motor unit recruited

Motor UnitEach single motor neuron and the muscle fibers it innervates constitute a motor unit.Each spinal motor neuron innervates only one kind of muscle fiber so that all the muscle fibers in a motor unit are of the same type.On the basis of the type of muscle fibers they innervate, and thus on the basis of the duration of their twitch contraction, motor units are divided into S (slow), FR (fast, resistant to fatigue), and FF (fast fatigable) units.(Refer: Table 17)(Refer: Ganong&;s Review of Medical physiology 24th edition, pg no: 108-109)


Question: Most common cause of cholangitis

Cholangitis Ascending bacterial infection of the biliary ductal system with obstruction Most common cause of acute cholangitis is choledocholithiasis Most common organism present in the bile in patients with cholangitis : E.coli, Klebsiella pneumoniae, streptococcus faecalis & Bacteroides fragilis Etiology Choledocholithiasis(MC) Benign strictures Biliary enteric anastomotic strictures Cholangiocarcinoma and periampullary cancer Ref: Sabiston 20th edition Pgno :1507


Question: Two internal cerebral veins fuse to form

The two internal cerebral veins unite together beneath the splenium of corpus callosum to form the great cerebral vein(of GALEN).*After a sho backward course, it joins the Inferior sagittal sinus to form the straight sinus.The tributaries are :Internal cerebral veinsBasal veinsVeins from colliculiVeins from cerebellum and adjoining pas of occipital lobe(Ref: Vishram Singh textbook of clinical neuroanatomy second edition pg-181)


Question: Characteristic of acute inflammation is

Ref Robbins 8/e p 45 ,9/e p74 The acute inflammatory response rapidly delivers leuko- cytes and plasma proteins to sites of injury. Once there, leukocytes clear the invaders and begin the process of digesting and getting rid of necrotic tissues. Acute inflammation has two major components (Fig. 2-2): * Vascular changes: alterations in vessel caliber resulting in increased blood flow (vasodilation) and changes in the vessel wall that permit plasma proteins to leave the cir- culation (increased vascular permeability). In addition, endothelial cells are activated, resulting in increased adhesion of leukocytes and migration of the leukocytes through the vessel wall. * Cellular events: emigration of the leukocytes from the circulation and accumulation in the focus of injury (cel- lular recruitment), followed by activation of the leuko- cytes, enabling them to eliminate the offending agent. The principal leukocytes in acute inflammation are neu- trophils (polymorphonuclear leukocytes). Stimuli for Acute Inflammation Acute inflammatory reactions may be triggered by a variety of stimuli: * Infections (bacterial, viral, fungal, parasitic) are among the most common and medically impoant causes of inflammation. * Trauma (blunt and penetrating) and various physical and chemical agents (e.g., thermal injury, such as burns or frostbite; irradiation; toxicity from ceain environ- mental chemicals) injure host cells and elicit inflamma- tory reactions. * Tissue necrosis (from any cause), including ischemia (as in a myocardial infarct) and physical and chemical injury * Foreign bodies (splinters, di, sutures, crystal deposits * Immune reactions (also called hypersensitivity reactions) against environmental substances or against "self" tissues. Because the stimuli for these inflammatory responses often cannot be eliminated or avoided, such reactions tend to persist, with features of chronic inflam- mation. The term "immune-mediated inflammatory disease" is sometimes used to refer to this group of disorders. Although each of these stimuli may induce reactions with some distinctive characteristics, in general, all inflamma- tory reactions have the same basic features. In this section, we describe first how inflammatory stimuli are recognized by the host, then the typical reac- tions of acute inflammation and its morphologic features, and finally the chemical mediators responsible for these reactions.


Question: Marker for granulocytic sarcoma


Question: The largest synovial joint in the body is

(C) Knee joint # Synovial joints (or diarthroses, or diarthroidal joints); are the most common and most moveable type of joints in the body.> As with all other joints in the body, synovial joints achieve movement at the point of contact of the articulating bones.> Structural and functional differences distinguish the synovial joints from the two other types of joints in the body, with the main structural difference being the existence of a cavity between the articulating bones and the occupation of a fluid in that cavity which a ds movement.


Question: Most prominent spinous process is of

The 7th cervical (C7) veebra is the largest cervical veebra the C7 has a large spinous process that protrudes posteriorly toward the skin at the back of the neck. This spinous process can be easily seen and felt at the base of the neck, making it a prominent landmark of the skeleton and giving the C7 the name veebra prominens Description BD CHAURASIA S HUMAN ANATOMY Vol 3


Question: Most common organ involved in retroperitoneal fibrosis

The most impoant clinical aspect of retroperitoneal fibrosis is that the fibrotic process frequently entraps and constricts the ureters thereby causing obstructive uropathy. Retroperitoneal fibrosis - It is a nonspecific, nonsuppurative inflammation of fibro-adipose tissue of unknown cause that produces symptoms by the gradual compression of tubular structures in retroperitoneal space. Aetiology of retroperitoneal fibrosis - About 2/3rd cases are primary idiopathic, are also known as Ormond's disease Secondary Retroperitoneal fibrosis a variety of inflammatory conditions - chronic pancreatitis, histoplasmosis, tuberculosis, or actinomycosis. drugs methysergide (most imp.) b blockers hydralazine a methyldopa Etacapone (used in the t/t of Parkinson's ds.) - malignancies (prostate, non-Hodgkin's lymphoma, sarcoma, characinoid & gastric cancer). antoimmune disorders (ankylosing spondylitis, SLE PAN etc.) Symptoms of retroperitoneal fibrosis - It is more common in men between 40-60 yrs of age Early symptoms are nonspecific and vague. These are Pain - Dull noncolicky and insidious in onset. Anorexia, nausea General malaise, diarrhea Later on, symptoms result from compression of tubular retroperitoneal structures. The major structure involved are- Ureter - Most commonly involved Aoa Inferior venacava Symptoms due to the involvement of ureter (usually b/1 involvement) Dysuria Frequency of urination Chills and fever occur with secondary infection of a hydronephrotic kidney. Hematuria can occur. Diagnosis The diagnosis of retroperitoneal fibrosis usually can be made accurately by intravenous pyelography if uremia is not present. The characteristic finding on pyelogram are Hydronephrosis with a dilated touous upper ureter. Medial detion of the ureter Extrinsic ureteral compression Note: In a retroperitoneal tumor, ureter is laterally deted while in retroperitoneal fibrosis ureter medially detes. Currently, the imaging procedure of choice is the CT scan. But if renal function is compromised contrast agents are not given and then MRI is the procedure of choice. T/T of Retroperitoneal fibrosis Coicosteroids, with or without surgery, are the mainstay of medical therapy. Surgical treatment is required in patients who present with moderate or massive hydronephrosis. It consists primarily of ureterolysis (freeing the ureter from adhesions and surrounding tissue) or ureteral stenting.. Also, know Paial or complete ureteral obstruction occurs in 75 to 85% of patients. Most common site of urethral obstruction is lower third of the ureter. Ref : Love & Bailey 25/e p1007


Question: The most common site for intestinal TB is

Most common sites - Distal ileum and caecum Ref : Sabiston 20th edition Pgno : 1217


Question: A 50year old male presents with pain upper abdomen, Pruritus, jaundice and weight loss, elevated ANA, the likely diagnosis is

Clinical features More common in males, mean age at presentation is 40-45 years. About 75% of patients are symptomatic at presentation with evidence of cholestatic liver disease such as jaundice, Pruritus and fatigue Symptoms of bacterial cholangitis are uncommon. Condition is characterized by relapses & remissions with quiescent periods. Median survival from the time of diagnosis ranges from 10 to 12 years Ref: Sabiston 20th edition Pgno : 1508-1509


Question: Most common symptom of Wernicke's encephalopathy

Wernickes encephalopathyis a triad of GLOBAL CONFUSION, OPHTHALMOPLEGIA AND ATAXIA It is due to deficiency of thiamine It is 100% reversible Most impoant symptom needed for the diagnosis is confusion If the patients wernickes encephalopathy is not trated it would result in koraskoff's psychosis koraskoff's psychosis is a misnomer it is associated with confabulation that is fluent plausible lying, where the patient fills up with memory gaps with information and she is not aware that wat is she is saying is not truth Ref.Kaplon and Sadock, synopsis of psychiatry, 11 th edition,625


Question: The commonest cause of acute pancreatitis

Causes of Acute pancreatitis Common causes Gallstones including microlithiasis (most common) Alcohol (2nd most common) Hyperglyceridemia ERCP Blunt abdominal trauma Post operative Drugs Sphincter of oddi dysfunction Rare causes Infections (CMV, Coxsackie, Mumps, Echovirus (CME) parasites) Autoimmune (sjogren syndrome) Uncommon causes Vascular causes and Vasculitis (ischaemic hypoperfusion states after Cardiac surgery) Connective tissue disorders TTP CA pancreas Hypercalcemia(Hyperparathyroidism) Periampullary Diveiculum Pancreas divisum Hereditary pancreatitis Cystic fibrosis Renal failure Ref: Sabiston 20th edition Pgno :1525-1526th edition


Question: Commonest sign of aspiration pneumonitis is

The patient becomes tachypneic, hypoxic, and febrile. The leukocyte count may rise, and the chest x-ray may evolve from normal to a complete bilateral "whiteout" within 8-24 h. Sputum pro-duction is minimal. The pulmonary signs and symptoms can resolve quickly with symptom-based therapy or can culminate in respiratory failure, with the subsequent development of bacterial superinfection over a period of days. Aspiration of gastric acid causes a chemical pneumonitis which has also been .Findings on physical examination may include tachypnea. Ref Davidson edition23rd pg 589


Question: Grievous hu deals under

Injuries are grievous, Those that endangers life Those that cause severe bodily pain for 20 days. Those that disable the sufferer from following his ordinary pursuits for 20 days. Ref: TEXTBOOK OF FORENSIC MEDICINE AND TOXICOLOGY KRISHNAN VIJ FIFTH EDITION PAGE 209


Question: Flexion of metacarpophalangeal joint and extension of interphalangeal joints is major action of

It is the action of lumbricals.The dorsal interossei abduct the fingers. the palmar interossei adduct the fingers.The FDS flexes middle phalanx at PIP joints. ref :textbook of anatomy upper limb and thorax ,vishram singh ,2nd edition ,page no.144


Question: Transition from G2 to M phase of cell cycle is controlled by

Ref Robbins 7/e p290-291 Your Position: Cell Cycle Inhibitor Proteins Cell Cycle Inhibitor Proteins Creat Cell Cycle Inhibitor Proteins The cell cycle is the series of events which regulate the life of the cell. This regulation results from a combination of several signals from different regulatory pathways that are activated in response to specific stimuli. The cell cycle has a central role in controlling cell growth and proliferation. It frequently becomes the target of genetic alteration, the accumulation of which may lead to the deregulation of these ordered events and may be related to the onset of cancer. With the growing understanding of the impoant role of cell cycle regulation in tumor formation and apoptosis, cell cycle inhibitors have been fuher studied in the field of cancer treatment. Cyclin-dependent Kinase (CDK) Inhibitors Progression through the cell cycle is ensured by paicular protein complexes, the cyclin-dependent kinases (CDKs). The CDKs are a family of highly conserved serine/threonine kinases, which share a high homology in a paicular region. CDKs may control the cell cycle by phosphorylating different targets, which may in turn be activated or inactivated. Regulation of CDK/cyclin activity can occur through regulatory proteins, such as CDK Inhibitors (CKIs). The CKIs can inhibit the activity of CDK by associating in vivo with the CDK subunit, the cyclin or the cyclin/CDK complex. This inhibition may occur in different ways, such as inhibition of the CDK kinase activity, interference with CAK mediated CDK activation, or competition with cyclins in binding to the catalytic subunit. The inhibitory process can be carried out by one or a combination of these mechanisms. The expression of these CKIs may be induced by stimuli such as senescence, contact inhibition, extracellular anti-mitogenic factors and cell cycle checkpoints. Their role in controlling cell cycle is crucial. In several forms of cancer, CKIs such as p16 and p27 are mutated. Also, they have been found to be degraded in several types of cancer. Low levels of p27 levels are correlated with poor clinical prognosis. These inhibitors can be upregulated when required, thus blocking the activation of the CDK by a cyclin. This arrests the cell in a paicular pa of the cell cycle until conditions are such that it can continue towards proliferation or, if necessary, be steered towards cell death.


Question: Nerve to pterygoid canal is formed from

In the anterior pa of the foramen lacerum, the greater petrosal nerve unites with the deep petrosal nerve to form the nerve of the pterygoid canal which leaves the foramen by entering the pterygoid canal in the anterior wall of the foramen lacerum. Ref: BD Chaurasia's HUMAN ANATOMY, Volume 3, 4th edition.

Deep petrosal nerve + greater petrosal nerve


Question: In brachial plexus nerve arising from root is

Nerve to serratus anterior or long thoracic nerve arises from the nerve root of C5-C7. Injury to this nerve causes the condition called winging of scapula due to paralysis of serratus anterior muscle. B D Chaurasia 7th edition Page no: 45


Question: The inferior Laryngeal aery is a branch of

The inferior thyroid aery arises from the thyrocervical trunk The branches of the inferior thyroid aery are the inferior laryngeal, the oesophageal, the tracheal, the ascending cervical and the pharyngeal aeries.Ref: Chaurasia; Volume III; 7th edition; Page no: 155


Question: The SI unit of radiation absorbed dose is

Ref Robbins 9/e p428 Gray is a unit that expresses the energy absorbed by the target tissue per unit mass Radiation UNITS Roentgen: Is the measurement of energy produced by Gamma or X-Ray radiation in a cubic centimeter of air. It is abbreted with the capital "R". One milliroentgen, abbreted "mR" is one-thousandth of a roentgen. One microroentgen, abbreted "uR" is one-millionth of a roentgen. RAD: Radiation Absorbed Dose. Original measuring unit for expressing the absorption of all types of ionizing radiation (alpha, beta, gamma, neutrons, etc) into any medium. One rad is equivalent to the absorption of 100 ergs of energy per gram of absorbing tissue. System International (SI) Units The System International (S.I. unit) units for radiation measurements are "gray" (Gy) and "sive" (Sv) for absorbed dose and equivalent dose respectively. The conversion from one system to another is simple: 1 Sv = 100 rem 1 rem = .01 Sv 1 mSv = 100 mR (mrem) 1 mR = .01 mSv 1 Gy = 100 rad 1 rad = .01 Gy 1mGy = 100 mrad 1 mrad = .01 mGy


Question: Most impoant blood supply to stomach is

The greater curvature of the stomach receives its blood supply from the left gastroepiploic aery along its top edge and from the right gastroepiploic aery along its lower edge. The upper poion of the greater curvature of the stomach, along with the fundus, receives blood from the sho gastric aery. ref - BDC 6e vol2 pg 277


Question: In burns least useful is

We know that Ringer's lactate is the preferred agent during initial 24 hrs. Nasogastric intubation is done to decrease the risk of emesis and possible aspiration (as parlytic ileus develops in a pt. with significant burn) Dextran is a colloid and can be used in 2nd 24 hrs., however albumin is the preferred and most widely used colloid. Blood has also role in burn patient. The need for Blood replacement is significant in extensive burns. Besides injury to red blood cells and their decreased half-life resulting in their early destruction, many patients may be anaemic. Hence, repeated and frequent transmission to maintain a hematocrit around 35% is necessary. Ref Bailey and love 27e p625 , Srb`s manual of surgery p133


Question: Anti Gliadin antibodies are detectable in

The most sensitive tests are the presence of IgA antibodies to tissue transglutamaminase OT IgA or IgG antibodies to desisted gliadin **anti endomysial antibodies are highly specific but less sensitive than other antibodies


Question: Denominator refers to

Bony prominence on the presenting pa is the denominator

Pa of presentation lying over the int os

Relation of different pas of fetus to one another

Bony fixed point of reference on presenting pa

Pa of fetus lying in the lower segmebt of uterus


Question: Investigation of choice for audiometric evaluation of an infant is

BERA wavesWavesSite of generationIDistal pa of cranial nerve VIIIIIProximal pa of cranial nerve VIIIIIICochlear nucleus IVSuperior olivary complexVLateral lemniscusVI, VIIInferior colliculus (Refer: PL Dhingra, Textbook of Ear, Nose, Throat, 6thedition, pg no: 26, 27)


Question: Zero orded kinetics in following drug with high dose

Zero order kinetics is seen in alcohol and theoplylline Ref-KDT 7/e p31


Question: Esophageal opening in the diaphragm is at the level of

Oesophagus pierces diaphragm at the level of tenth thoracic vertebrae.


Question: The retina is an outgrowth of the

Ref BDC volume 3,6th edition pg 292This is the thin, delicate inner layer of the eyeball.It is continuous posteriorly with the optic nerve.The outer surface of the retina is attached to the choroid, while the inner surface is in contact with the hyaloid membrane.Opposite the entrance of the optic nerve, there is a circular area called optic disc.The retina diminishes in thickness from behind forwards and is divided into optic, ciliary, and iridial pas.


Question: Reversible loss of polarity with abnormality in size and shape of cells is known as

Ref Robbins 7/e p273_274;9/e p271 CHARACTERISTICS OF BENIGN AND MALIGNANT NEOPLASMS Nothing is more impoant to the patient with a tumor than being told: "It is benign." In general, benign tumors appear to be genetically "simple," harboring fewer muta- tions than cancers, and genetically stable, changing little in genotype over time. The latter feature probably explains why benign tumors such as lipomas and leiomyomas transform to malignancies rarely, if at all. In practice, the determination of benign versus malignant is made with remarkable accuracy using long-established clinical and anatomic criteria, but some neoplasms defy easy character- ization. Ceain features may indicate innocence, and others may indicate malignancy. Such problems are not the rule, however, and there are four fundamental features by which benign and malignant tumors can be distinguished: dif- ferentiation and anaplasia, rate of growth, local invasion, and metastasis. Differentiation and Anaplasia Differentiation and anaplasia are characteristics seen only in the parenchymal cells that constitute the transformed elements of neoplasms. The differentiation of parenchymal tumor cells refers to the extent to which they resemble their normal forebears morphologically and functionally. * Benign neoplasms are composed of well-differentiated cells that closely resemble their normal counterpas. A lipoma is made up of mature fat cells laden with cytoplasmic lipid vacuoles, and a chondroma is made up of mature cailage cells that synthesize their usual cailaginous matrix--evidence of morphologic and functional differentiation. In well-differentiated benign tumors, mitoses are usually rare and are of normal configuration. * Malignant neoplasms are characterized by a wide range of parenchymal cell differentiation, from sur- prisingly well differentiated (Fig. 5-3) to completel undifferentiated. For example, well-differentiated ade- nocarcinomas of the thyroid may contain normal- appearing follicles. Such tumors sometimes may be difficult to distinguish from benign proliferations. Between the two extremes lie tumors loosely referred to as moderately well differentiated. The stroma carrying the blood supply is crucial to the growth of tumors but does not aid in the separation of benign from malignant ones. The amount of stromal connective tissue does deter- mine, however, the consistency of a neoplasm. Ceain cancers induce a dense, abundant fibrous stroma (des- moplasia), making them hard, so-called scirrhous tumors. * Malignant neoplasms that are composed of undiffer- entiated cells are said to be anaplastic. Lack of differen- tiation, or anaplasia, is considered a hallmark of malignancy. The term anaplasia literally means "back- ward formation"--implying dedifferentiation, or loss of the structural and functional differentiation of normal cells. It is now known, however, that at least some cancers arise from stem cells in tissues; in these tumors, failure of differentiation, rather than dedifferentiation of specialized cells, accounts for their undifferentiated appearance. Recent studies also indicate that in some cases, dedifferentiation of apparently mature cells does occur during carcinogenesis. Anaplastic cells display marked pleomorphism (i.e., variation in size and shape) (Fig. 5-4). Often the nuclei are extremely hyperchromatic (dark-staining) and large resulting in an increased nuclear-to-cytoplasmic ratio that may approach 1: 1 instead of the normal 1: 4 or 1 :6. Giant cells that are considerably larger than their neighbors may be formed and possess either one enormous nucleus or several nuclei. Anaplastic nuclei are variable and bizarre in size and shape. The chromatin is coarse and clumped, and nucle- oli may be of astounding size. More impoant, mitoses often are numerous and distinctly atypical; anarchic multi- ple spindles may produce tripolar or quadripolar mitotic figures (Fig. 5-5). Also, anaplastic cells usually fail to develop recognizable patterns of orientation to one another (i.e., they lose normal polarity). They may grow Figure 5-3 Well-differentiated squamous cell carcinoma of the skin. The tumor cells are strikingly similar to normal squamous epithelial cells, with intercellular bridges and nests of keratin (arrow). (Couesy of Dr. Trace Worrell, Depament of Pathology, University of Texas Southwestern Medical School, Dallas, Texas.) Figure 5-4 Anaplastic tumor of the skeletal muscle (rhabdomyosar- coma). Note the marked cellular and nuclear pleomorphism, hyperchro- matic nuclei, and tumor giant cells. (Couesy of Dr. Trace Worrell, Depa in sheets, with total loss of communal structures, such as glands or stratified squamous architecture. The more differentiated the tumor cell, the more com- pletely it retains the functional capabilities of its normal counterpas. Benign neoplasms and even well-differenti- ated cancers of endocrine glands frequently elaborate the hormones characteristic of their origin. Well-differentiated squamous cell carcinomas produce keratin (Fig. 5-3), just as well-differentiated hepatocellular carcinomas secrete bile. In other instances, unanticipated functions emerge. Some cancers may elaborate fetal proteins not produced by comparable cells in the adult. Cancers of nonendocrine origin may produce so-called ectopic hormones. For example, ceain lung carcinomas may produce adrenocor- ticotropic hormone (ACTH), parathyroid hormone-like hormone, insulin, glucagon, and others. More is said about these phenomena later. Despite exceptions, the more rapidly growing and the more anaplastic a tumor, the less likely it is to have specialized functional activity. Of relevance in the discussion of differentiation and ana- plasia is dysplasia, referring to disorderly but non-neoplastic proliferation. Dysplasia is encountered principally in epi- thelial lesions. It is a loss in the uniformity of individual cells and in their architectural orientation. Dysplastic cells exhibit considerable pleomorphism and often possess hyperchro- matic nuclei that are abnormally large for the size of the cell. Mitotic figures are more abundant than usual and frequently appear in abnormal locations within the epithe- lium. In dysplastic stratified squamous epithelium, mitoses are not confined to the basal layers, where they normally occur, but may be seen at all levels and even in surface cells. There is considerable architectural anarchy. For example, the usual progressive maturation of tall cells in the basal layer to flattened squames on the surface may be lost and replaced by a disordered scrambling of dark basal- appearing cells (Fig. 5-6). When dysplastic changes are marked and involve the entire thickness of the epithelium, the lesion is referred to as carcinoma in situ, a preinvasive stage of cancer (Chapter 18). Although dysplastic changes often are found adjacent to foci of malignant transforma- tion, and long-term studies of cigarette smokers show that epithelial dysplasia almost invariably antedates the appear- ance of cancer, the term dysplasia is not synonymous with cancer; mild to moderate dysplasias that do not involve the entire thickness of the epithelium sometimes regress completely, par- ticularly if inciting causes are removed.


Question: Most common bone to be fractured in a baby, during birth

During birth, the most common bone to be fractured in the baby is clavicle.


Question: Common carotid aery bifurcation is at

At the level of the upper border of the thyroid cailage, the aery ends by dividing into the external and internal carotid aeries. The right common carotid aery is a branch of the brachiocephalic aery. The left common carotid aery is branch of the arch of the aoa. Ref: BDC volume 3;sixth edition: pg 99


Question: Structures pass through optic foramen

Optic foramen transmits Optic nerve with all layer of meninges Ophthalmic aery Fig: structures passing through various foramina of skull


Question: Not a branch of celiac trunk

(C) Superior mesenteric artery # SUPERIOR MESENTERIC ARTERY (SMA) arises from the anterior surface of the abdominal aorta, just inferior to the origin of the celiac trunk, and supplies the intestine from the lower part of the duodenum through two-thirds of the transverse colon, as well as the pancreas.> The coeliac trunk is the first anterior branch and arises just below the aortic hiatus at the level of T12/L1 vertebral bodies.> It divides into the left gastric, common hepatic and splenic arteries. The coeliac trunk may also give off one or both of the inferior phrenic arteries.


Question: Lymphatic drainage of upper outer quadrant of breast is

MAMMARY GLAND:- Modified sweat gland in superficial fascia of pectoral region. Rudimentary in males. Located in superficial fascia. Extend: veically- 2nd to 6th rib Horizontally- lateral border of sternum to mid axillary line. LYMPHATIC DRAINAGE:- Lymph nodes:- 1. Axillary-anterior, posterior, central and lateral. 2. Internal mammary. 3. Supraclavicular. 4. Posterior intercostal 5. Cephalic. Lymphatics draining the breast:- 1. Superficial- drain skin of the breast except that of nipple and areola. 2. Deep-drain parenchyma of the breast , and skin of nipple and areola. 3. A plexus of lymph ceasefires deep to areola is called subareolar plexus of sappy.The subareolar plexus and most of the lymph from the breast drains into anterior group of axillary lymph nodes. Lymphatic drainage:- 1. Lateral quadrant of breast-drains into anterior axillary/ pectoral group of lymph nodes. 2. Medial quadrant- drains into Internal mammary 3. Lower and medial quadrant- communicates with subdiaphragmatic and subperitoneal lymph plexus. 4. Deep surface of breast-apical group . 5. A few lymph vessels from the breast follow the posterior intercostal aeries and drain into posterior intercostal nodes. About 75% -axillary 20%-internal mammary 5%-posterior intercostal lymph nodes. Among the axillary lymph nodes, most of lymph goes into anterior axillary and remaining into posterior and apical. The lymph from anterior and posterior groups first goes into central and lateral groups and then through them into supraclavicular nodes.Apical group of lymph nodes are terminal. Some lymph vessels from the inferomedial quadrant of breast communicates with the subperitoneal lymph plexus and carry cancer cells to it. From here cancer cells migrate transcoelomically and deposit over ovary- krukenberg&;s tumor. {Reference:vishram singh page no.48}


Question: Compression of a nerve within the carpal tunnel products inability to

FLEXOR RETINACULUM Transverse carpal ligament. Strong fibrous band which bridges anterior concavity of carpus and conves it into osseofibrous tunnel callef carpal tunnel for the passage of flexor tendons of the digits. Rectangular.Formed due to thickening of deep fascia in front of carpal bones. Attachments: medial-pisiform , hook of hamate.Lateral-tubercle of scaphoid and crest of trapezium. Structures passing superficial to flexor retinaculum:-(medial to lateral)1. Ulnar nerve 2. Ulnar aery 3. Posterior cutaneous branch of ulnar nerve.4. Tendon of palmaris longus.5. Palmar cutaneous branch of median nerve.6. Superficial palmar branch of radial aery. Structures passing deep to flexor retinaculum:-1. Tendon of FDS2. Tendon of FDP 3. Tendon of FPL.4. median nerve. Ulnar bursa-tendons of FDS&FDP.Radial bursa- tendon of flexor pollicis Flexor carpi radialis pass through separate canal. CARPAL TUNNEL SYNDROME:-Injury to median nerve in carpal tunnel.Causes:-Tenosynovitis of flexor tendons.MyxedemaRetention of fluid in pregnancy Fracture dislocation of lunate bone.Osteoahritis of wrist. Symptoms:-1. Feeling of burning pain or " pins & needles " along lateral 3 and half digits especially at night.2. Weakness of thenar muscles.3. No sensory loss over thenar eminence.4. Ape thumb deformity if left untreated.5. Positive phalens abd tinel's sign.Phalen' sign-flexion of both wrists against each other for one minute reproduces the symptoms.Tinel's sign- percussion over flexor retinaculum reproduces symptoms. {Reference:vishram singh, page no.196,} mnemonic: Spm fully Boring Flexor digitorum Superficalis tendon, flexor digitorum profundus tendon, median nerve, Flexor poLLicis longus, Bursae- radial & ulnar


Question: Brunner's gland are found in mucosa of


Question: Ligamentum teres of the liver is remnant of

Ligamentum teres is the obliterated fibrous remnant of the left umbilical vein of the fetus. It originates at the umbilicus. It passes superiorly in the free margin of the falciform ligament. From the inferior margin of the liver, it may join the left branch of the poal vein or it may be in continuity with the ligamentum venosum.


Question: Infectious mononucleosis affects


Question: Superior parathyroid derived from


Question: Pericardial space is present between

Pericardial space (pericardial cavity) lies between parietal serous pericardium and visceral serous pericardium.


Question: "Red nucleus" is present at

The red nucleus is diagnostic of midbrain division at the level of the superior colliculus; it lies between the occulomotor nucleus (CN III) and the substantia nigra. fig:- crossection at the level of Superior colliculus Midbrain

Midbrain, at level of superior colliculus

Midbrain, at level of inferior colliculus


Question: The commonest cailage to ossify is

The epiphyseal plate (or epiphysial plate, physis, or growth plate) is a hyaline cailage plate in the metaphysis at each end of a long bone. It is the pa of a long bone where new bone growth takes place; that is, the whole bone is alive, with maintenance remodeling throughout its existing bone tissue, but the growth plate is the place where the long bone grows longer (adds length). The plate is not only found in children and adolescents; in adults, who have stopped growing, the plate is replaced by an epiphyseal line. This replacement is known as epiphyseal closure or growth plate fusion. Complete fusion happens between ages 12-16 for girls and 14-19 for boys. Ref - Medscape.com


Question: Suprapleural membrane is a remnant of

Suprapleural membrane/ Sibson's fascia is a remnant of Scalenus minimus.


Question: A patient presents with a penetrating chest wound associated with intrathoracic haemorrhage. A thoracotomy is done by taking an incision in the 41h/51h intercostals space staing 1 cm away from the lateral margin of the sternum. This is done to avoid injury to the

C i.e. Internal thoracic aeryIntercostal (external, internal & innermost) muscles (not transverses thoracic) are pierced in pleural taping in mild axillary line.Latissimus dorsi, serratus anterior, rhomboidus major & intercostal muscles are cut in posterolateral thoracotomy whereas pectoralis is cut in anterior & anterolateral approach.Thoracotomy in upper 6 intercostal spaces is done by taking an incision 1 cm lateral to sternum to avoid injury to internal thoracic (mammary) aeryQ.


Question: Posterior boundary of Carotid Triangle is formed by

Boundaries of carotid triangle IN FRONT & ABOVE- Post Belly of Digastric and Stylohyoid Muscle. IN FRONT & BELOW- Superior Belly of Omohyoid. BEHIND- Anterior Border of SternoCleidomastoid.


Question: Initial 2cm of Duodenum does not get arterial supply by

Initial 2cm of Duodenum ( Duodenal Cap) is not supplied by Superior pancreaticoduodinal artery.


Question: Winging of scapula is due to injury to

Winging of scapula is due to the injury to long thoracic nerve(C5, C6, and C7). Long thoracic nerve supplies the serratus anterior muscle and injury to this nerve causes the prominence of interior angle and medial border of scapula. The patient is unable to perform pushing action. B D Chaurasia 7th edition Page no: 12


Question: The indifferent embryo begins phenotypic sexual differentiation during

The embryo during weeks 1-6 remains in an undifferentiated stage. The embryo begins phenotypic sexual differentiation during week 7.