Question: Parotid duct opens

The duct runs forwards for a sho distance between the buccinator and the oral mucosa. Finally, the duct turns medially and opens into the vestibule of the mouth opposite to the crown of upper second molar tooth. REF.BDC SIXTH EDITION VOL NO:3 PAGE NO:110


Question: Muscle of neck with dual nerve supply

Digastric muscle Digastric has two bellies United by an intermediate tendon. NERVE SUPPLY; anterior belly by nerve to mylohyoid, facial nerve. ACTIONS; 1. Depresses mandible is opened widely or against resistance it is secondary to lateral pterygoid. 2. Elevates hyoid bone. Ref BDC volume 3;6th edition


Question: Embryological development of the human veebra is form

The paraxial mesoderm becomes segmented to form 40-45 pairs of somites that lie on either side of the developing neural tube and notochord. The somites appear between the 20th and 30th days of development. Hence, the 4th week of development is known as somite period of development. The veebral column is formed from the sclerotomes of the somites. The cells of each sclerotome get conveed into loose mesenchyme. This mesenchyme migrates medially and surrounds the notochord. REF: Inderbir Singh's Human Embryology, eleventh edition, pg. no., 138, 139.


Question: Aery in anatomical snuffbox is

Radial nerve along with superficial branch of radial nerve and cephalic vein are the contents of anatomical snuff box.Brachial aery passes from medial side of arm to its anterior aspect.Ulnar aery passes over the flexor retinaculum in the forearm.B D Chaurasia 7th edition Page no: 136


Question: Laparoscopic cholecystectomy was done, on histopathology, stage was T2. Next line of treatment

Treatment of carcinoma Gallbladder Gallbladder cancer: Incidental pathological finding after laparoscopic cholecystectomy T1a with negative cystic duct margin : No fuher therapy T1a with postive cystic duct margin : Reresection of cystic duct or CBD to negative margin T1b, T2, T3 tumor with no evidence of metastasis : Reresection, extended cholecystectomy (possible CBD or extended hepatic resection) T4: Extended cholecystectomy with extended right hepatectomy N2 or M1 disease : Clinical trial (Chemoradiation or chemotherapy) in good performance status. Laparoscopic trocar site scars are excised for staging purpose to identify M1 disease than for any potential therapeutic benefit Ref: Sabiston 20th edition Pgno : 1512-1514


Question: Muscle attached to the marked area

Masseter arises from zygomatic arch and inses onto lateral aspect of ramus and angle of the mandible.Its innervated by the masseteric nerve from the anterior division of the mandibular nerve.Action is to elevate and protract the angle of the mandible


Question: IV fluid replacement (volume & rate) in a trauma patient is determined by

Urine output "Urine output is a quantitative and relatively reliable indicator of organ perfusion. Adequate urine output is 0.5 ml/kg/ h in an adult, lml/kg/h in a child and 2ml/kg/h in an infant less than 1yr. of age." Pulse- Although tachycardia may be the earliest sign of hypovolemia, individuals in good physical condition, and paicularly trained atheletes with a low resting pulse rate, may manifest only a relative tachycardia, pts on blocking medication may not be able to increase their hea rate. In children, bradycardia or relative bradycardia can occur with severe blood loss. Conversely, hypoxia, pain, apprehension and stimulant drugs produce a tachycardia" Blood pressure Hypotension is not a reliable early sign of hypovolemia. in healthy pts. Blood volume must decrease by 30 to 40 percent before hypotension occurs. Younger pts with good sympathetic tone can maintain systemic blood pressure with severe intravascular deficit untill they are on the verge of cardiac arrest. CVP(Central venous pressure) CVP measurement helps in distinguishing b/w cardiogenic shock and hypovolemic shock. 'A central venous catheter can give information about the relationship b/w intravascular volume and right ventricular function but should not be used to assess either factor independently. Ref: Sabiston 20th edition Pgno : 555 Bailey and love 27th edition Pgno :17


Question: Great vein of Galen is formed by

(A) Two internal cerebral veins # GALEN'S VEINS: The internal cerebral veins; the great vein of Galen is formed by their union.> Anterior cerebral vein also known as Galen's vein.> Great cerebral vein or Great vein of Galen is formed by union of two internal cerebral veins. It terminates in the straight sinus.

Superficial middle cerebral vein & deep middle cerebral vein

Internal cerebral veins & straight sinus


Question: Gluteus medius muscle is supplied by


Question: Internal carotid artery at the  bifurcation from the common carotid is


Question: Shedding of red tears seen in

OP poisoning Pupils will be usually constricted and will be pin point. In the eye, the ciliary muscles are constricted. So the suspensory ligaments are relaxed and the lens will bulge to the anterior chamber. So there will be blurring of vision. There may be lacrimation and in severe cases, chromo-lachryorrhoea (shedding of red tears) This is due to accumulation of porphyrin in the lacrimal glands due to inhibition of porphyrin metabolism, one of the minor actions of some organophosphates especially marathon. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 448


Question: Profound MR the IQ is below


Question: Example of traction epiphysis is

Traction epiphysis is nonaicular and does not take pa in transmission of weight. It always provides attachment to one or more tendons which exe a traction on epiphysis. Traction epiphyses ossify later than pressure epiphyses Eg:Trochanters of femur and tubercles of humerus Description Ref BD CHAURASIA S Handbook of General Anatomy Fouh edition Pg no 41


Question: Green nail syndrome is caused by

It is a paronychia ( inflammation of the tisseues adjacent to the nail with green pus formation) . It results from prolonged submersion of the hands in water.


Question: Nerve supply to the muscles of flexor compament of arm

MUSCULOCUTANEOUS NERVE:- Nerve of front of arm. Arises from lateral cord of brachial plexus in the axilla. Runs downwards and laterally, pierces the corcobrachialis, which it supplies, then passes between biceps and brachialis. Descends over the lateral aspect of forearm as lateral cutaneous nerve of forearm. Branches:- 1. Muscular:- biceps brachii, coracobrachialis and brachialis. 2. Cutaneous- lateral cutaneous nerve of forearm. 3. Aicular branch-elbow joint. {Reference: vishram singh, pg no. 108}


Question: Anterior lymphatics from nose drain into

Lymphatics from the anterior half of the lateral wall pass to the submandibular nodes, and from the posterior half, to the retropharyngeal and upper deep cervical nodes Anterior half of Nasal septum to the submandibular nodes. Posterior half of nasal septum to the retropharyngeal and deep cervical nodes . Ref - BDC vol3 6th e pg 242-246


Question: Least common presentation of HCC

On rare occasions, HCC can present as a rupture with the sudden onset of abdominal pain followed by hypovolemic shock secondary to intraperitoneal bleeding Other rare presentations include hepatic vein occlusion (Budd-Chiari syndrome), obstructive jaundice, hemobilia or fever of unknown origin(PUO) Ref: Sabiston 20th edition Pgno : 1459


Question: Scarpa's fascia is attached to

The fascia of Scarpa is the deep membranous layer, of the superficial fascia of the abdomen. It is a layer of the anterior abdominal wall. It is found deep to the Camper Fascia and superficial to the external oblique muscle. Ref - BDC 6e vol2 pg199


Question: T.U.R. (transurethral resection) syndrome is due to

TUR syndrome and water intoxication syndrome are same. They are caused due to dilutional hyponatremia. Ref : Bailey & Love 25/e p1352


Question: Traction epiphysis is are

Traction epiphysis are usually present at the end if bones and develop due to traction by the attached muscle (and are therefore extracapsular), eg Greater (and lesser) tubercle in humerus and greater ( and lesser) trochanter in femur Ref: Gray's39e/p185-210


Question: Most common cause of pseudopancreatic cyst in children is

Pancreatic pseudocyst follows acute attack of pancreatitis and trauma is the most common cause of acute pancreatitis in children. Most common causes of acute pancreatitis in children include: Blunt abdominal injuries, Mumps and other viral illnesses Congenital anomolies Ref : Nelson 16/e, p 1300


Question: Defenition of Rape is defined under section

Sec 375 IPC defines rape Sec 376 IPC is explaining the punishment of rape. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 298


Question: Dermatome at umbilicus is

Dermatome level of umbilicus is T 10. Dermatome of Epigastric level is T7 Dermatome of Supra pubic level is L1.


Question: Blood supply of thoracic part of esophagus

Blood supply of thoracic part of oesophagus is aorta.


Question: Most common site of Morgagni Hernia is

More common in right side and lies between the pericardium and right pleura. B D CHAURASIA&;S HUMAN ANATOMY LOWER LIMB ABDOMEN AND PELVIS VOLUME-2,SIXTH EDITION Page no-334


Question: Thickening of the respiratory membrane is seen in

Thickening of the airway wall is a feature of airways remodeling and is seen in asthma A condition in which a person's airways become inflamed, narrow and swell and produce extra mucus, which makes it difficult to breathe.


Question: Cutaneous innervations of dorsum of foot are marked in the given diagram. The area D supplied by

Common peroneal nerve wind around the neck of fibula and divide into superficial and deep peroneal nerve Superficial peroneal nerve (musculo cutaneous nerve of lower limb) - supplies peroneus longus and brevis Deep peroneal nerve - supplies extensor compament of leg CHOICE EXPLANATION & ELIMINATION REASON 1 B - area supplied by deep peroneal nerve 2 D - area supplied by superficial peroneal nerve 3 C - area supplied by sural nerve 4 Not correct


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

The middle meatus presents the ethmoidal bulla,the hiatus semilunaris,the infundibulum and the opening of frontal,maxillary and the middle ethmoidal air sinuses.Sphenoidal air sinus opens into the sphenoethmoidal recess,which is a triangular fossa just above the superior concha. REF.BDC VOL.3,5th edition.


Question: MELD score doesn't include

MELD score (CBI) : Creatinine, Bilirubin, INR PELD score(NABIA) : Nutritional status, Age, Bilirubin, INR, Albumin Ref: Sabiston 20th edition Pgno : 658


Question: CD 95 has a major role in


Question: The role played by major histocompatibility complex 1 and 2

Ref Robbins 8/e p191 Class I MHC molecules are encoded by three closely linked loci, designated HLA-A, HLA-B, and HLA-C (Fig. 4-3). Each of these molecules is a heterodimer, con- sisting of a polymorphic 44-kDa a chain noncovalently associated with an invariant 12-kDa b2-microglobulin polypeptide (encoded by a separate gene on chromo- some 15). The extracellular poion of the a chain contains a cleft where the polymorphic residues are located and where foreign peptides bind to MHC mol- ecules for presentation to T cells, and a conserved region that binds CD8, ensuring that only CD8+ T cells can respond to peptides displayed by class I molecules. In general, class I MHC molecules bind and display pep- tides derived from proteins synthesized in the cyto- plasm of the cell (e.g., viral antigens). Because class I MHC molecules are present on all nucleated cells, all virus-infected cells can be detected and eliminated by CD8+ CTLs. Class II MHC molecules are encoded by genes in the HLA-D region, which contains at least three subregions: DP, DQ, and DR. Class II MHC molecules are heterodi- mers of noncovalently linked polymorphic a and b sub- units (Fig. 4-3). The extracellular poion of the class II MHC heterodimer contains a cleft for the binding of antigenic peptides and a region that binds CD4. Class II MHC expression is restricted to a few types of cells, mainly APCs (notably, dendritic cells ), macro- phages, and B cells. In general, class II MHC molecules bind to peptides derived from proteins synthesized outside the cell (e.g., those derived from extracellular bacteria) and ingested into the cell. This propey allows CD4+ T cells to recognize the presence of extracellular pathogens and to orchestrate a protective response. * Several other proteins are encoded in the MHC locus, some of which have been called "class III molecules." These include complement components (C2, C3, and Bf) and the cytokines tumor necrosis factor (TNF) and lymphotoxin. These molecules do not form a pa of the peptide display system and are not discussed fuher.

Transduce the signal to T cells following antigen recognition

Present antigens for recognition by T cells antigen receptor


Question: Following is an example of


Question: Position of nucleus ambiguous is

Nucleus ambiguous lies at the level of olives in medulla, posterolateral to olives.It lies deep within the reticular formation and gives origin to the motor fibres of 9,10 and 11 cranial nerves. Along the posterolateral sulcus emerges the rootlets of 9,10and11 cranial nerves.(Ref: Vishram Singh textbook of clinical neuroanatomy second edition pg 73, fig 8.2)


Question: Indication for PAIR treatment in hydatid cyst

PAIR Puncture, aspiration, injection and reaspiration IIt is the preferred method of treatment for anatomically and surgically appropriate lesions Contraindication - complicated cysts ( communicating with biliary tract) surgery remains the treatment of choice for those not possible or refractory to PAIR


Question: Structure passing through foramen Rotundum is

The foramen rotundum: it leads posteriorly to the pterygopalatine fossa containing pterygopalatine ganglia. Maxillary nerve passes throgh the foramen rotundum. Ref BDC volume:3,6th edition


Question: Proptosis is seen in

B option is also correct Neuroblastoma metastasizes in the orbit causing Proptosis Refer khurana 6/e


Question: Apthous ulcers are also known as

Refer Robbins page no 728 9/e Chronic recurrent oral aphthous ulcers are the most common type of inflammatory efflorescence of the oral mucosa, with a prevalence of 2% to 10% in Caucasian populations. To treat them properly, physicians should know their clinical appearance and course, conditioning factors, underlying causes, and differential diagnosis. Results Hard, acidic, and salty foods and toothpastes containing sodium lauryl sulfate should be avoided, along with alcohol and carbonated drinks. In Germany, the only drugs that have been approved to treat oral aphthous ulcers are coicosteroids, topical antiseptic/anti-inflammatory agents such as triclosan and diclofenac, and local anesthetics such as lidocaine. Antiseptic agents and local anesthetics should be tried first; if these are ineffective, topical coicosteroids should be used. In severe cases, local measures can be combined with systemic drugs, e.g., colchicine, pentoxifylline, or prednisolone. The efficacy of systemic treatment is debated. Other immunosuppressive agents should be given systemically only for refractory or paicularly severe oral aphthous ulcers due to Adamantiades-Behcet disease


Question: Injury to dangerous area of face infection goes to

(Cavernous sinus) (195-BDC-3) (544.581-small 9th)Facial infections and cavernous sinus ThrombosisThe area of facial skin bounded by the nose, the eye, and two upper lip is a potentially dangerous zone to have an infection, for example, a boil in this region can cause thrombosis of two facial vein. With spread of organisms through two inferior ophthalmic vein to the cavernous sinus, the resulting cavernous sinus thrombosis may be fatal unless adequately treated with antibioticsDangerous area of face includes the upper LipQ, and the Lower part of NoseQ.It is called the 'dangerous area' as infections from this region can spread in a retrograde direction from the face to the cavernous sinus causing dangerous complications like 'thrombosis of the cavernous sinusFacial vein can communicate to the cavernous sinus through two major routes or deep connections i.e.-Important Structures Associated with the cavernous sinuses# The internal carotid artery and the 6th cranial nerve which travel through it# In the lateral wall, the 3rd and 4th cranial nerve and the ophthalmic and maxillary division of the 5th cranial nerve# The pituitary gland which lies medially in the sella turcica# The veins of the face, which are connected with the cavernous sinus via the facial nerve and inferior ophthalmic vein, are an important route for the spread of infection from the face# The superior and inferior petrosal sinuses which run along the upper and lower border of the petrous part of the temporal one Cavernous sinus lesions presentation |||Nervous symptomsVenous symptoms| ||| Pain in the distribution of ophthalmic (V1) and Maxillary (V2) nerveParalysis of extra ocular muscles due to lesion affecting III IV & VI cranial nerveMarked oedema of the eyelids, cornea and roof of nose with exophthalmos due to congestion of orbital veins CAVERNOUS SINUS|Incoming channels Draining channels* Superior ophthalmic vein *** Inferior ophthalmic vein *** Central vein of Retina *** (may drain via superior ophthalmic vein)* Superficial middle cerebral vein **** Inferior cerebral vein ** Sphenoparietal sinus ** Middle meningeal vein *( frontal and Anterior Trunk) * Superior petrosal sinus (drain into Transverse sinus)* Inferior petrosal sinus (drain into internal jugular vein) **** Emissary veins *** (drain into pterygoid plexus of veins)* Superior ophthalmic vein (drain into facial vein)* Inter cavernous vein ("sinuses communicate between the left & right cavernous sinuses


Question: In acute pulmonary embolism the most frequent ECG finding is

The ECG is often normal but is useful in excluding other impoant differential diagnoses, such as acute myocardial infarction and pericarditis. The most common findings in PE include sinus tachycardia and anterior T-wave inversion but these are non-specific; larger emboli may cause right hea strain revealed by an S1Q3T3 pattern, ST-segment and T-wave changes, or the appearance of right bundle branch block. Aerial blood gases typically show a reduced PaO2 and a normal or low PaCO2, and an increased alveolar-aerial oxygen gradient, but may be normal in a significant minority. A metabolic acidosis may be seen in acute massive PE with cardiovascular collapse. An elevated D-dimer is of limited value, as it may be raised in a variety of other conditions, including myocardial infarction, pneumonia and sepsis. However, low levels, paicularly in the context of a low clinical risk, have a high negative predictive value and fuher investigation is usually unnecessary . The result of the D-dimer assay should be disregarded in high-risk patients, as fuher investigation is mandatory even when normal. The serum troponin I may be elevated, reflecting right hea strain. Ref Davidson edition23rd pg 620


Question: aplastic anemia is the side effect of

Carbamazepine - SIDE EFFECTS OF THE DRUG - APLASTIC ANEMIA - AGRANULOCYTOSIS - Hyponatremia - Steven Johnson's syndrome - Liver enzyme elevation - It has teratogenic potential Ref. Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no.935


Question: Transient bells palsy during mandibular nerve block after injection of local anesthesia occurs due to needle piercing into


Question: Notochord develops in

(A) 3rd week > Notochord develops in 3rd week.


Question: Number of Hepatic segments in Liver

The Couinaud classification of liver anatomy divides the liver into eight functionally independent segments.Each segment has its own vascular inflow, outflow and biliary drainage.In the centre of each segment, there is a branch of the poal vein, hepatic aery and bile duct.Reference: Chaurasia Volume II; 7th edition; Page no: 336


Question: Regulation of blood flow is maintained by

(Refer: Ganong's Review of Medical Physiology 24thedition, pg no: 570-572, 577)


Question: Example of type 2 hypersensitivity is

Ref Robbins 9/e p206 Antibody-Mediated Diseases (Type II Hypersensitivity) Antibody-mediated (type II) hypersensitivity disorders are caused by antibodies directed against target antigens on the surface of cells or other tissue components. The antigens may be normal molecules intrinsic to cell membranes or in the extracellular matrix, or they may be adsorbed exoge- nous antigens (e.g., a drug metabolite). Antibody-mediated abnormalities are the underlying cause of many human diseases; examples of these are listed in Table 4-3. In all of these disorders, the tissue damage or functional abnormali- ties result from a limited number of mechanisms. Mechanisms of Antibody-Mediated Diseases Antibodies cause disease by targeting cells for phagocyto- sis, by activating the complement system, and by interfer- ing with normal cellular functions (Fig. 4-10). The antibodies that are responsible typically are high-affinity antibodies capable of activating complement and binding to the Fc receptors of phagocytes. * Opsonization and phagocytosis. When circulating cells, such as erythrocytes or platelets, are coated (opsonized) with autoantibodies, with or without complement pro- teins, the cells become targets for phagocytosis by neutrophils and macrophages (Fig. 4-10, A). These phagocytes express receptors for the Fc tails of IgG anti- bodies and for breakdown products of the C3 comple- ment protein, and use these receptors to bind and ingest opsonized paicles. Opsonized cells are usually elimi- nated in the spleen, and this is why splenectomy is of Table 4-3 Examples of Antibody-Mediated Diseases (Type II Hypersensitivity) clinical benefit in autoimmune thrombocytopenia and some forms of autoimmune hemolytic anemia. * Inflammation. Antibodies bound to cellular or tissue anti- gens activate the complement system by the "classical" pathway (Fig. 4-10, B). Products of complement activa- tion serve several functions (see Fig. 2-18, Chapter 2), one of which is to recruit neutrophils and monocytes, triggering inflammation in tissues. Leukocytes may also be activated by engagement of Fc receptors, which rec- ognize the bound antibodies. This mechanism of injury is exemplified by Goodpasture syndrome and pemphi- gus vulgaris. * Antibody-mediated cellular dysfunction. In some cases, antibodies directed against cell surface receptors impair or dysregulate cellular function without causing cell injury or inflammation (Fig. 4-10, C). In myasthenia gravis, antibodies against acetylcholine receptors in the motor end plates of skeletal muscles inhibit neuromuscular transmission, with resultant muscle weakness. Antibodies can also stimulate cellular Figure 4-10 Mechanisms of antibody-mediated injury. A, Opsonization of cells by antibodies and complement components, and ingestion of opso- nized cells by phagocytes. B, Inflammation induced by antibody binding to Fc receptors of leukocytes and by complement breakdown products. C, Antireceptor antibodies disturb the normal function of receptors. In these examples, antibodies against the thyroid-stimulating hormone (TSH) receptor activate thyroid cells in Graves disease, and acetylcholine (ACh) receptor antibodies impair neuromuscular transmission in myasthenia g responses excessively. In Graves disease, antibodies against the thyroid-stimulating hormone receptor stim- ulate thyroid epithelial cells to secrete thyroid hormones, resulting in hypehyroidism. Antibodies against hor- mones and other essential proteins can neutralize and block the actions of these molecules, causing functional derangements.


Question: Middle cerebellar Penducle transmits..... fibres


Question: ACL prevents

Anterior cruciate ligament prevents Posterior dislocation of femur on tibia Anterior displacement of tibia on femur Ref: Gray's Anatomy The Anatomical Basics of Clinical Practice 41 e pg 1394.


Question: The most likely precursor to bronchiectasis is

BronchiectasisAbnormal and permanent dilatation of bronchi.The bronchial dilatation of bronchiectasis of is associated with destructive and inflammatory changes in the walls of medium-sized airways, often at the level of segmental or subsegmental bronchi.Types of bronchiectasisCylindrical bronchiectasis Varicose bronchiectasis Saccular (cystic) bronchiectasis Aetiology & pathogenesisBronchiectasis is a consequence of inflammation and destruction of the structural components of the bronchial wall. Infection is the usual cause of inflammation.Adenovirus and influenza virusImpaired host defence mechanisms Carcinoid tumours or foreign body aspirationPrimary ciliary dyskinesia, Kaagener&;s syndrome and cystic fibrosis are also associated with bronchiectasis.Exposure to toxic substances like inhalation of toxic gases such as ammonia or aspiration of acidic gastric contentsClinical Manifestations:Radiographic findingsPersistent or a recurrent cough and purulent sputum productionHemoptysis due to bleeding from friable, inflamed airway mucosa.Massive bleeding from hyperophied bronchial aeries.Physical examination include crackles, rhonchi, and wheeze may be heard, all of which reflect the damaged airway containing significant secretions HRCT is an investigation of choice When seen longitudinally, the airways appears as"tram tracks"; when seen in cross-section, they produce&;ring shadows" Bronchiectasis of relatively proximal airways suggests ABPA, whereas the presence of multiple small nodules (nodular bronchiectasis) suggest infection with M. avium complex(Refer: Harrison's Principles of Internal Medicine, 18thedition, pg no: 2143-2144)


Question: The skin over the xiphoid process is innervated by the following thoracic spinal nerve

The skin over the xiphoid is innervated by the thoracic spinal nerve from T6. The anterior chest wall is innervated by the lateral cutaneous branches and anterior cutaneous branches of the intercostal nerves. Intercostal nerves T7 to T11 and the subcostal nerve T12 supply the skin and muscle of the abdominal wall. In addition, T5 and T6 supply the upper pas of the external oblique muscle of the abdominal wall. The highest thoracic dermatome on the anterior chest wall is T2. Ref: Gray's Anatomy 41st edition Pgno: 945


Question: Glomus cells are found in

The glomus cells (type I) are specialized glandular-like cells, mainly located in the carotid bodies and aoic bodies, that control the respiratory activity.The glomus cells have a high metabolic rate and good blood perfusion and synapses directly or indirectly with nerve endings. Thus are sensitive to changes in aerial blood gas (specially to low pO2)(Ref: Guyton & hall, pg- 367)


Question: Reverse splitting Of first hea sound is heard in

Ref Harrison 19 th ed pg 1447 Reversed or paradoxical splitting refers to a pathologic delay in aoic valve closure, such as that which occurs in patients with left bundle branch block, right ventricular pac- ing, severe AS, HOCM, and acute myocardial ischemia. With reversed or paradoxical splitting, the individual components of S2 are audible at end expiration, and their interval narrows with inspiration, the oppo- site of what would be expected under normal physiologic conditions.


Question: The main antagonistic muscle of rectus abdominis muscle is

The rectus abdominus muscle reflexes the trunk/lumbar spine, therefore it is a antagonist muscles should extend the spine. The erector spinae muscles are a group of muscles that perform this functions.These can be divided up it into individual muscles. The erector spinae muscles lies on the each side of the veebral column.and extends along the lumbar, thoraxic and cervical sections of the spine.It straightens the back and provide side to side rotation. Ref - researhgate.net


Question: Gold standard test for investigation for chronic Pancreatitis detection of early pathologies and simultaneous treatment possible (e.g., duct dilation, stent inseion) Ductal stones, seen as filling defects "Chain of lakes" or "string of pearls" appearance (characteristic feature) Irregularity, dilation of the main pancreatic duct

ERCP - Considered the gold standard for the diagnosis of CP, the advent of secretion MRCP and EUS have significantly decreased its role as a diagnostic test ERCP : detection of early pathologies and simultaneous treatment possible (e.g., duct dilation, stent inseion) Ductal stones, seen as filling defects"Chain of lakes" or "string of pearls" appearance (characteristic feature)Irregularity, dilation of the main pancreatic duct Ref: Sabiston 20th edition Pgno :1535


Question: Roof of Anatomical snuff box is related to

The name 'snuff box' originates from the use of this surface for placing and then sniffing powdered tobacco, or "snuff" Anatomical Snuffbox boundaries Lateral wall Abductor pollicis longus (APL) Extensor pollicis brevis (EPB) Medial Wall Extensor pollicis longus (EPL) Roof Cephalic vein Superior branch of radial nerve Floor Radial styloid, scaphoid, Trapezium and 1st Metacarpal Only content: Radial aery. Ref: Gray's Anatomy 41st edition Pgno: 893


Question: Oncocytic carcinoma arises from

Refer Robbins 8/e p964, 9/ep953 Oncocytoma This is an epithelial neoplasm composed of large eosinophilic cells having small, round, benign-appearing nuclei that have large nucleoli. It is thought to arise from the intercalated cells of collecting ducts, and accounts for approximately 5% to 15% of renal neoplasms. Ultra-structurally the eosinophilic cells have numerous mitochondria. In gross appearance, the tumors are tan or mahogany brown, relatively homogeneous, and usually well encapsulated with a central scar in one-third of cases. However, they may achieve a large size (up to 12 cm in diameter). There are some familial cases in which these tumors are multicentric rather than solitary.


Question: Skin and facia of great toe drains into

The superficial inguinal lymph nodes form a chain immediately below the inguinal ligament. They lie deep to Camper&;s fascia which overlies the femoral vessels at medial aspect of the thigh. They are found in the triangle bounded by the inguinal ligament superiorly, the border of the saorius muscle laterally, and the adductor longus muscle medially. (Femoral Triangle of Scarpa) There are approximately 10 superficial lymph nodes. The superficial nodes drain to the deep inguinal lymph nodes.

Veical group of superficial inguinal lymph node

Horizontal group of superficial inguinal lymph node


Question: duration criteria for anorexia nervosa is

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: The axillary nerve supplies

Teres minor is supplied by the posterior division of axillary nerve which is characterized by the presence of a pseudoganglion. Posterior division of axillary nerve also supplies the posterior pa of deltoid muscle. B D Chaurasia 7th edition Page no : 180


Question: The cavernous sinus does not communicate with the


Question: A congenital diaphragmatic hernia may result from failure of the

The formation of the diaphragm occurs through the fusion of tissue from four different sources. The pleuroperitoneal membranes normally fuse with the three other components during week 6 of development. Abnormal development or fusion of one or both of the pleuroperitoneal membranes causes a patent opening between the thorax and abdomen through which abdominal viscera may herniate. fig:- development of diaphragm

Pleuroperitoneal membranes to fuse in a normal fashion

Pleuropericardial membrane to develop completely

Dorsal mesentery of the esophagus to develop


Question: Stroma of cornea is developed from

Stroma of cornea develops from neural crest cells derived (secondary) mesenchyme. The adult cornea has developmentally three layers: Outer epithelium layer (surface ectoderm) Middle stromal layer of collagen-rich extracellular matrix between stromal keratocytes (neural crest) Inner layer of endothelial cells (neural crest). Ref - medscape.com


Question: The normal P wave is inveed in lead

Since this vector points toward the positive pole of lead II and toward the negative pole of lead aVR, the normal P wave will be positive in lead II and negative in lead aVR Ref Harrison 20th edition pg 1456


Question: anorexia nervosa is assosiated with

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: A lesion involving upper motor neuron of facial nerve manifests as

The facial muscles are innervated by the facial nerve. Damage to the facial nerve in the internal acoustic meatus (by a tumor), in the middle ear (by infection or operation), in the facial nerve canal (perineuritis, Bell's palsy), or in the parotid gland (by a tumor) or caused by lacerations of the face will cause distoion of the face, with drooping of the lower eyelid, and the angle of the mouth will sag on the affected side. This is essentially a lower motor neuron lesion. Check voluntary movement of the upper pa of the face on the affected side: in supranuclear lesions such as a coical stroke (upper motor neuron; above the facial nucleus in the pons), the upper third of the face is spared while the lower two thirds are paralyzed. The orbicularis, frontalis, and corrugator muscles are innervated bilaterally, which explains the pattern of facial paralysis in these cases

Upper half of the face is affected, lower half normal

Upper half of the face normal, lower half affected


Question: The simple columnar or cuboidal epithelium lining the extrahepatic biliary ducts is derived from

liver gall bladder and biliary apparatus develop from an endodermal diveiculum that arises from ventral aspect of terminal forgut The epithelium lining the extrahepatic biliary ducts is derived from endoderm. The intrahepatic biliary ducts are also derived from endoderm.


Question: Palsy of right genioglossus causes

Palsy of right genioglossus muscle detes the tongue to the right side, due to unopposed medial pull of the left genioglossus. Genioglossus muscle moves the tongue anterior (protrusion), inferior (depression) and medial (AIM). In bilateral contraction of genioglossus, the vector of medial pull is balanced (and cancelled), and there occurs protrusion and depression of tongue in midline.


Question: a super antigen is a bacterial product that

Ref Harrison 16/e p1920 Superantigens (SAgs) are a class of antigens that result in excessive activation of the immune system. Specifically it causes non-specific activation of T-cellsresulting in polyclonal T cell activation and massive cytokine release. SAgs are produced by some pathogenic viruses and bacteria most likely as a defense mechanism against the immune system.Compared to a normal antigen-induced T-cellresponse where 0.0001-0.001% of the body's T-cells are activated, these SAgs are capable of activating up to 20% of the body's T-cells. Fuhermore, Anti-CD3and Anti-CD28 Antibodies (CD28-SuperMAB) have also shown to be highly potent superantigens (and can activate up to 100% of T cells).

Binds to B7 and CD 8 co stimulatory molecules

Binds to beta chain of TCR and MCH class 2 molecules at APC stimulating T cell activation

Binds to CD4 molecules causing TCells activation

Is presented by macrophages to a larger than normal number of T helper CD4 lymphocytes


Question: The aery to the ductus dererens is a branch of

The vas deferens is supplied by an accompanying aery (aery of vas deferens). This aery normally arises from the superior (sometimes inferior) vesical aery, a branch of the internal iliac aery. Ref - researchgate.net


Question: Isolated gastric varices

Most common cause of gastric varices : Cirrhosis Most common cause of isolated gastric varices : Splenic vein thrombosis Ref: Sabiston 20th edition Pgno : 1232

Most commonly due to splenic vein thrombosis

Single treatment can lead to eradication


Question: Occipital myotome gives

The muscles of the tongue develop from myoblasts that migrate into developing tongue from the occipital myotomes. The hypoglossal nerve-the nerve of the occipital myotomes-accompanies the myoblasts during their migration to the pharyngeal arches and innervates the muscle of the tongue as they develop. The migration of the occipital myotomes to the tongue explains the course of the hypoglossal nerve. The laryngeal muscles develop from 4th and 6th pharyngeal arches The muscles of mastication from the first arch. The muscles of facial expression from the second arch. Reference: Textbook of clinical embryology,1st edition, Vishram Singh, page no.123,112


Question: Parofollicular cells develops from

Parafolliculor cells derived from neural crest and ultino - brachail body.
Neural crest is the best option.


Question: Purkinje cells from the cerebellum end in

The output of purkinje cells is inhibitory to the cerebellar nuclei


Question: Hypoglossal nerve is


Question: The etiological agent of Roseola infantum includes

Roseola infantum*A history of 3 days of high-grade fever in an otherwise nontoxic 10-month-old child with a blanchable maculopapular rash on trunk -Roseola.*Mean duration- 6days - so sixth disease/Exanthem subitum.*Nagayama spots-ulcers at the uvulopalatoglossal junction.*DD - Measles, Rubella, Drug allergy.*M/C complication-convulsions / recurrent seizures/temporal lobe epilepsy.*Rx suppoive*Severe cases-Ganciclovir/ Foscarnet.(Refer: Nelson's Textbook of Paediatrics, 19thedition, pg no:1117)


Question: Middle Third of the IJV lies at the cervical lymph node level


Question: Daughter cells formed from the cleavage of zygote are

Zygote first divide into blastomere, 16 cell stage is known as Morula.


Question: Pogonion is present on

Pogonion is anterior most point on chin.


Question: Most common site of ectopic pancreatic tissue is

Ectopic pancreatic tissue, also known as heterotopic pancreatic tissue, refers to the presence of pancreatic tissue in the submucosal, muscularis or subserosal layers of the luminal gastrointestinal tract outside the normal confines of the and lacking any anatomic or vascular connection with the main pancreas. Recognized locations for ectopic pancreatic tissue include: proximal proximal jejunum <a class="internal" style="box-sizing: border-box; background: transparent; color: ; text-decoration-line: none;" href=" </ul>


Question: Sensory supply for upper part of right cheek is by

Maxillary division of trigeminal Nerve supplies Upper lip; side and ala of nose; most of the lower eyelid; upper part of cheek; and anterior part of temple.


Question: Cardiac polyp is seen in

Chicken fat and red current jelly seen in post moem clot


Question: Protrusion of tongue not possible in damage of

ACTIONS OF EXTRINSIC MUSCLES OF TONGUE: Hyoglossus-Depress the tongue Styloglossus-Retracts the tongue Palatoglossus-Elevates the tongue Genioglossus-Protrudes the tongue NOTES: Genioglossus muscle is a life-saving muscle Ref BDC volume 3,sixth edition pg 266


Question: Not a feature of CBD stone

Clinical features of CBD stone CBD stone may be silent and are often discovered incidentally. In these patients, biliary colic, jaundice, clay coloured stools and darkening of the urine Fever and chills may be present in patients with choledocholithiasis and cholangitis Serum bilirubin, aminotransferases, and ALP are commonly elevated in patients with biliary obstruction but are neither sensitive nor specific for the presence of common duct stones Among these, serum bilirubin has the highest positive predictive value for the presence of choledocholithiasis Laboratory values may be normal in one third of Patients with choledocholithiasis Ref: Sabiston 20th edition Pgno:1494


Question: The primordia of the craniofacial complex develops from


Question: Among the following, content of cavernous sinus is

Structures passing through the medial aspect of the sinus: Internal carotid aery -with the venous and sympathetic plexus around it Abducent nerve- inferolateral to the internal carotid aery. Notes: Structures within the lateral wall of the sinus from above downwards: Oculomotor nerve Trochlear nerve Ophthalmic nerve Maxillary nerve Trigeminal ganglion. Ref BDC volume3,sixth edition of 193


Question: Syndesmosis is a type of

Sutures, syndosmosis and gomphosis are the types of Fibrous joint.


Question: Ulnar collateral nerve is

In the arm, the radial nerve is posterior to the brachial aery. Here it gives muscular branches to long and medial heads of triceps brachii. The branch for medial head lies very close to the ulnar nerve and hence is called the ulnar collateral nerve. ReferenceClinicall Anatomy for students, a problem-solving approach, Neeta v Kulkarni, 2nd edition, page no.179

Branch of radial nerve supplying medial head of triceps

Branch of radial nerve supplying long head of biceps

Branch of radial nerve supplying lateral head of triceps


Question: WRONG about ileum as compared with jejunum is

Jejunum has long and sparse vasa recta as compared to ileum. Jejunum are thick walled and peritoneal windows are transparent as compared to ileum. Peyer patches are present in ileum which are absent in jejunum. Jejunum have 1 or 2 rows of aerial arcades whereas ileum have 4 to 5 aerial arcades Ileum have sho club shaped villi. Ileum have more fat in mesentry.


Question: A patient presented with weakness of the right side of the face. There is associated ipsilateral loss of pain and temperature of face and contralateral body. The lesion is most likely located at

Lesion in pons leads to7th nerve palsyas 7th nerve nucleus is present in Pons leading to I/L facial weakness along impairment ofsensory pa of 5th nerve(Present laterally in Pons) leading to I/L loss of sensations on face. As the pain and temp. sensation of left side (C/L) is also affected s/o oflesion to spino-thalamic tractwhich runs laterally. In case of lateral medullary syndrome or wallenburg syndrome, all the symptoms mentioned above will be present. Along with those, there will be impairment of VIII, IX, X and XI CN.


Question: Lunate sulcus is present in

The occipital lobe sulciA. Transverse occipital B. Lateral occipital C. Lunate D. Superior and inferior polarReference: Chaurasia; 6th edition; 417 page


Question: Order of neurovascular bundle in the femoral triangle from medial to lateral

(B) Vein, Artery, Nerve # FEMORAL TRIANGLE: This is a clinically important triangular subfascial space in the superomedial one-third part of the thigh. It appears as a depression inferior to the inguinal ligament when the thigh is actively flexed at the hip joint. Its main contents are the femoral vessels and the femoral nerve.> Boundaries of the Femoral Triangle: Superiorly by the inguinal ligament. Medially by the medial border of the adductor longus muscle. Laterally by the medial border of the sartorius muscle. Muscular floor of the femoral triangle is not flat but gutter-shaped Formed from medial to lateral by the adductor longus, pectineus, and the iliopsoas. It is the juxtaposition of the iliopsoas and pectineus muscles that forms the deep gutter in the muscular floor. Roof of the femoral triangle is formed by the fascia lata, which includes the cribriform fascia.> Contents of the Femoral Triangle: This triangular space in the anterior aspect of the thigh contains Medial to Lateral: Vein-Artery-Nerve (VAN) the femoral Vein and its tributaries, the femoral Artery (femoral artery in femoral triangle) and its branches, the femoral Nerve and its branches, the lateral cutaneous nerve, the femoral branch of the genitofemoral nerve, lymphatic vessels, and some inguinal lymph nodes.


Question: Major pa of intrinsic muscles of hand are innervated by

Median nerve supplies abductor pollicis brevis, flexor pollicis brevis and opponens pollicis ( muscles of thenar eminence).Ulnar nerve supplies adductor pollicis, palmaris brevis, abductor digiti minimi, flexor digiti minimi, opponens digiti minimi, 4 lumbricals, 4 dorsal and 4 palmar interossei.Radial nerve doesn&;t supply any intrinsic muscle of hand.B D Chaurasia 7th edition Page no : 119


Question: unconscious repletion of words said by the examiner

clang, ====subsequent words will have rhyming seen in MANIA puns,=== double meaning words echolalia=== unconscious repletion of words said by the examiner, seen in catatonia Ref. Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg.No.194


Question: Familial amylodotic polyneuropathy is due to amyloidosis of nerves caused by deposition of

Ref Robbins 9/e p259 Familial (Hereditary) Amyloidosis A variety of familial forms of amyloidosis have been described; most are rare and occur in limited geographic areas. The best-characterized is an autosomal recessive condition called familial Mediterranean fever. This is a febrile disorder characterized by attacks of fever ccompanied by inflammation of serosal surfaces, includ- ing peritoneum, pleura, and synol membrane. This dis- order is encountered largely in persons of Armenian, Sephardic Jewish, and Arabic origins. It is associated with widespread tissue involvement indistinguishable from reactive systemic amyloidosis. The amyloid fibril proteins are made up of AA proteins, suggesting that this form of amyloidosis is related to the recurrent bouts of inflamma- tion that characterize this disease. The gene for familial Mediterranean fever is called pyrin and encodes a protein that is a component of the inflammasome (Chapter 2). Patients have gain-of-function mutations in pyrin that result in constitutive overproduction of the pro- inflammatory cytokine IL-1 and persistent inflammation. In contrast with familial Mediterranean fever, a group of autosomal dominant familial disorders is characterized by deposition of amyloid predominantly in the peripheral and autonomic nerves. These familial amyloidotic poly- neuropathies have been described in kindreds in different pas of the world--for example, in Pougal, Japan, Sweden, and the United States. As mentioned previously, the fibrils in these familial polyneuropathies are made up of mutant forms of transthyretin (ATTRs).


Question: Adolescents age stas at the age of

Adolescence ranges from Early (10-13 yrs) Mid( 14-16yrs) Late(17-19 yrs) Ref: Ghai, 9th edition, Page- 60.


Question: Normal length of CBD is

Bile duct : Anatomy It lies in front of the poal vein and to the right of the hepatic aery Common hepatic duct is 1-4cm in length and has a diameter of approx. 4mm CBD is about 7-11 cm in length and 5-10 mm in diameter A fibroareolar tissue containing scant smooth muscle surround the mucosa (a distinct muscle layer is absent) Most impoant aeries to the Supra duodenal bile duct run parallel to the duct at the 3 & 9'o clock position Approximately 60% of the blood supply to the Supra duodenal bile duct originates inferiorly from the pancreaticoduodenal and retro duodenal aeries Whereas 38% of blood supply originate superiorly from the right hepatic atmeru and cystic duct aery Ref: Sabiston 20th edition Pgno : 1482-1484


Question: Osteogenic sarcoma arises from

The tumor most commonly begins in the Metaphysis The most common site of involvement is Metaphysis of long bone around knee ***lower end of femur ***upper end of tibia Refer Maheshwari 4th/e p. 232


Question: In neurofibromatosis 1 most common tumor is

Optic nerve glioma is an astrocytoma common in patients with neurofibromatosis 1. It is tumor of children most commonly seen in girls Refer khurana 6/e 419


Question: The coronary sinus

Coronary Sinus is the largest vein of hea.it ends by opening to posterior of Right atrium. <img src=" /> BD CHAURASIA'S HUMAN ANATOMY,VOL:1,6TH EDITION,PAGE NO:266

Lies in anterior pa of the coronary sulcus

Has venae cordis minimae as its tributaries

Develops from right anterior cardinal vein


Question: Visual acuity used as cut off for school screening program is

Initial screening done by school teachers


Question: Elastic cartilage seen in


Question: A patient presented with weakness of the right side of the face with loss of pain and temperature , Pain and temperature sensation of the left leg is lost The lesion is most likely located

RULE OF 4 weakness of face =palsy of facial muscles of=7th nerve affected =same side=7th NERVE from PONS Loss of pain, temperature from force = Trigeminal Nerve affected=Lesion in lateral side and ipsilateral Loss of pain , temperature in body = UL, LL=spinothalamic tract affected= Lesion in C/L side and also lateral side REF: BD CHAURASIA


Question: Screening method for medullary carcinoma thyroid is

MCT can be of two types - sporadic and familial (occurring in MEN syn. 2A & 2B and Familial cases without MEN syn.) The familial MTC are more aggressive, multicentric (bilateral) and present at a younger age, therefore high risk cases should be screened for MTC by - detecting RET mutation. The genetic screening tests are supplemented by estimating serum calcitonin levels in the basal state and after stimulation by either calcium or pentagastrin. Prophylactic total thyroidectomy is indicated in RET mutation carriers once the mutation is confirmed. Ref : Bailey & love 25/e p797


Question: Gluteus medius is supplied by

SUPERIOR GLUTEAL NERVE Root value: L4,L5,S1Course: enters the gluteal region through greater sciatic notch above pyriformis muscle. Runs between gluteus medius and gluteus minimus to end in tensor fascia lata. Branches :-it supplies 1. Gluteus medius 2. Gluteus minimus3. Tensor fascia lata {Reference: BDC 6E pg no. 173}


Question: Febrile response in CNS is mediated by

ref Harrison 18/e 143p -145 Fever is produced in response to substance called pyrogens that acts by stimulating prostaglandins synthesis in vascular and periferal cells of hypothalamus.there are exogenous and endogenous pyogens


Question: Nerve associated with pharyngeal cleft is derived from

Nerves of pharyngeal cleft - pretrematic nerve Eg: chorda tympani, tympanic branch of glossopharyngeal nerve. Ganglia are derived from neural crest cells Thus, nerves of pharyngeal clefts are derived from Neural crest cells.


Question: Keratometer is used to assess.

It is an objective method. Keratometer is used for: Estimate corneal astigmatism Measure the curvature of the cornea Calculate the power of intraocular lens (IOL) Image: Keratometer


Question: Calcific hepatic metastasis are seen in

Calcified hepatic metastases Clacified hepatic metastases are most frequently associated with mucin-producing neoplasm such as colon carcinoma or less likely ovarian carcinoma


Question: Surgeon excises a poion of liver to the left of the attachment of the falciform ligament. The segments that have been resected are

Falciform ligament Falciform ligament is the most obvious external landmark on the liver surface Plane passing through the falciform ligament passes through the left lobe It divides the left lobe into a medial segment (Segment IV) and lateral segment (Segment II and III) Ref: Sabiston 20th edition Pgno : 1421


Question:
Contents of anatomical snuff box are
(A)Radial Artery
(B)Tendon of Abductor Poilicis longus
(C)Tendon of extensor poilicis brevis
(D)Scaphoid bone
(E)Superficial cutaneous branch of radial nerve

Anatomical Snuff Box - BDC4th/ Vol. 1130
♦ It is a triangular depression in lateral side of wrist seen best when thumb is extended
♦ Boundaries
● Anterior - Tendon of abductor Pollicis lonus Tendon of extensor Pollicis brevis
● Posterior - Tendon of extensor pollids iongus
● Above
♦ Styloid process of radius
♦ Floor – ScaphoidQ & trapezium bone
♦ Crossed by radial A Anatomical Snuff Box – snell’s 8th/533-35
♦ It is a depression in the skin that lies distal to styloid process of radius.
♦ Boundaries
● Medial
● Tendon of Extensor pollicis longus
● Lateral
● Tendon of abductor pollicis longus
● Tendon of Extensor pollicis brevis
♦ Floor
● Proximally-styloid process of radius
● Distally-base of rst metacarpal bone of thumb
♦ B/w these bones , beneath the oor lies the scaphoid & the trapezium (felt but not identiable)
♦ Radial Artery - Can be palpated
♦ Cephalic vein - Can also someti mes be recognised crossing the box as it ascends the forearm Mnemonics Floor -
FiRST Fi- First Metacarpal bone R- Radial Styloid S-Scaphoid bone T- Trapezium Contents - VAN V- Cephalic vein A - Radial artery N - Radial Nerve (cutaneous Branch)
Clinical signicance of anatomical snuff box:
• The pulsations of radial artery can be felt in the anatomical box.
• The tenderness in the anatomical box indicates fracture of scaphoid bone.
• The cephalic vein at this site is often used for giving intravenous uids.
• The supercial branches of the radial nerve can be rolled over the tendon of extensor pollicis longus.
Anatomical Snuff Box Anatomical Snuffbox is a triangular depression on the lateral aspect of wrist immediately distal to the radial styloid process,
that becomes prominent when thumb is fully extended Boundaries Floor Contents Lateral /Anterior wall
● Abductor Pollicis longus (Radially)
● Extensor Pollicis Brevis (Medially') Medial /Posterior wall
● Extensor Pollicis
● Radial styloid
● Scaphoid (smooth convex articular surface)
● Trapezium
● Base of First Metacarpal
● Cephalic vein
● Radial artery
● Supercial radial nerve


Question: Hypoxic hypoxia is seen in

Type of hypoxia Features Examples Hypoxic hypoxia Occur when enough oxygen is not present in the air / when decreasing atmospheric pressure prevents diffusion of oxygen from lungs to blood stream High altitudes COPD AV shunt etc Anemic hypoxia Haemoglobin available to carry oxygen is reduced Anemia Non-functional Hb - Co poisoning; Met-Hb etc Stagnant hypoxia Decreased/ sluggish blood flow to tissues resulting in inadequate oxygen supply Ischemia/ congestion Histotoxic hypoxia Oxygen delivered to tissues is normal but tissues can't utilize oxygen. Cyanide poisoning


Question: The most unlikely feature Iof HCC is

Clinical features of HCC Most common symptom is abdominal pain >weight Significant weight loss : <5% in 1 month or 10% in 6 months or 20% in 1 year Usually presents at late stage, symptoms at advanced stage are vague Non-specific symptoms( anorexia, weight loss) and hepatomegaly Paraneoplastic syndromes in HCC - Hypercholestrolemia( most common), hypoglycemia, erythrocytosis, hypercalcemia Vascular bruit (25%), GI bleed (10%), tumor rupture (2-5%), jaundice due to biliary obstruction (10%), Paraneoplastic syndromes (<5%) Ref: Sabiston 20th edition Pgno :1458-1463


Question: Renal transplantation is preferred in

Renal transplantation is the preferred treatment for many patients with end stage renal disease (ESRD), because it provides a better quality of life for them than dialysis. The most common causes of ESRD (in decreasing order) are: Diabetes mellitus Hypeension Glomerulonephritis Ref : Cambell's Urology 8/e p346


Question: Common bile duct injuries are most commonly seen in

Bile duct injury and ligation Most benign strictures follow iatrogenic bile duct injury. Most commonly during laparoscopic cholecystectomy Incidence of bile duct injury during open cholecystectomy is 0.1-0.2 % Incidence of bile duct injury during laparoscopic cholecystectomy is 0.3-0.85 % Ref :Sabiston 20th edition Pgno :1502


Question: The most common organism causing osteomyelitis is

The most common organism in osteomyelitis in intravenous drug users is staphylococcus aureus. Pseudomonas aeruoginosa an otherwise unusual cause of osteomyelitis, is the second most frequently observed microorganism Refer Maheshwari 6th/e p 168


Question: Growth plate of a long bone is supplied by

Epiphyseal artery supplies Epiphysis and Growth plate.


Question: Common occular manifestation of chromosomes 13 is

Trisomy 13 is called pataue syndrome. And is characterized by micropthalmous cataract,corneal opacity and retinal dysplasia Refer khurana 6/e


Question: In inflammatory process ,the prostaglandins E1and E2 cause

Ref Robbins 9/e p85 It is a direct vasodilator, relaxing smooth muscles, and it inhibits the release of noradrenaline from sympathetic nerve terminals. It does not inhibit platelet aggregation, where PGI2 does. PGE2 also suppresses T cell receptor signaling and may play a role in resolution of inflammation. Up-regulation of PGE2 has been implicated as a possible cause of nail clubbing. Fuhermore, its postpaal synthesis in newborns is considered as one cause of patent ductus aeriosus


Question: The best investigation for diagnosing Best disease is

Best diseaseAutosomal dominant inheritance due to mutation of bestrophin gene on 11q13 chromosomeLipofuscin accumulation throughout the RPELarge yellow yolk like ( vitelliform ) lesion - EGG YOLK APPEARANCEBest investigation for diagnosis of Best disease is made on the basis of abnormal electrooculogram findings - a severe loss of light response of the standing potential occursArden ratio - less than 1.5 & frequently near 1.1Electro-retinography - reduced C waveBEST disease - relatively normal electroretinographic results with abnormal electro oculographic findings(Refer: AH Khurana, Comprehensive Textbook of Ophthalmology,5thedition, pg no: 520-521)


Question: Koch's triangle has blood supply from

Koch&;s triangle has blood supply from Right coronary


Question: cove sensitization is used for

In cove sensitization also called as imagined punishment, the individual who wants to quit alcohol will be asked to think about adverse consequences of taking alcohol like getting arrested for drunken driving or facing a accident underintoxicated state. He would be told to dream as if if he is drunk and lies intoxicated in the road and has to be brought back to the home by family members where he will be given lot of advice from neighbours and there would be a loss of respect. While these imagined exposure the patient feels bad and makes sure thet he should quit alcohol and his thoughts ahgainst alcohol increases. Ref.kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 845


Question: Rosenthal's syndrome is due to deficiency of

Hemophilia C(Rosenthal syndrome) It is due to deficiency of factor XI Ref: http://en.wikipedia.org/wiki/Hemophilia_C


Question: Ligation of the common hepatic aery will compromise blood flow in

Rt. Gastric aeryarises from common hepatic aery andRt. Gastroepiploic aeryarises fromgastroduodenal aerywhich is a branch of common hepatic aery. Therefore,ligation of common hepatic aerywill lead to impaired blood supply inRt. Gastric aeryandRt. Gastroepiploic aery. Left gastric aery arises from CT. Sho gastric aeries arise from splenic aery.

Right gastroepiploic and sho gastric aeries

Right gastric and right gastroepiploic aery


Question: Anterosuperior sternal pa of hea is made up of

Surfaces Anterior (or sternocostal) - Right ventricle. Posterior (or base) - Left atrium Inferior (or diaphragmatic) - Left and right ventricles. Right pulmonary - Right atrium. Left pulmonary - Left ventricle. Borders Right border - Right atrium Inferior border - Left ventricle and right ventricle Left border - Left ventricle (and some of the left atrium) Superior border - Right and left atrium and the great vessels Apex : Left ventricle


Question: Horizontal semicircular canal is


Question: The maximum period of imprisonment a metropolitan magistrate can give is

Power of magistrates Magistrate period of imprisonment amount of fine Chief Judicial Magistrate/ Chief metropolitan Magistrate upto7 yerars unlimited Judicial 1st class magistrate/ Metropolitan magistrate upto 3 years Rs 10,000/- Judicial 2nd class magistrate upto 1 year Rs 5000/- Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 9


Question: Shoest pa of the colon is

The large intestine begins in the right iliac region of the pelvis, just at or below the waist, where it is joined to the end of the small intestine at the cecum, the ileocaecal valve. It then continues as the colon ascending the abdomen, across the width of the abdominal cavity as the transverse colon, and then descending to the rectum and its endpoint at the anal canal. Overall, in humans, the large intestine is about 1.5 meters (5 ft) long, which is about one-fifth of the whole length of the gastrointestinal tract. Ref - BDC 6e vol2 pg271-273


Question: The most impoant function of epitheliod cells in TB is

ref harsh Mohan 9/e p97 The granuloma contains mostly blood-derived macrophages,epithelioid cells (differentiated macrophages) and multinucleated giant cells (also known as Langhans giant cells), surrounded by T lymphocytes . Caseous granulomas are typical oftuberculosis. ... T cells were then rapidly recruited to the forming granuloma. Epithelioid cells are cells of the mononuclear phagocyte system found in ceain granulomas mainly associated with intense immunological activity. ... It is suggested that "vesicular epithelioid cellscould develop from "secretory" epithelioid cells by a process of degeneration.


Question: Gas used in laproscopy is

Ref:Bailey and love 27th edition Pg no :105


Question: To stop variceal bleeding pressure in sengstaken Blakemore tube should be

Sengstaken - Blakemore tube If the rate of blood loss prohibits endoscopic evaluation, a sengstaken-Blakemore tube may be inseed to provide temporary hemostasis Once inseed, the gastric balloon is inflated with 300ml of air and retracted to the gastric fundus, where the varices at the esophagogastric junction are tamponade by the subsequent inflation of the esophageal balloon to a pressure of 40mmHg The remaining two channels allow gastric and esophageal aspiration A radiograph is used to confirm the position of the tube The balloons should be temporarily defalated after 12 hrs to prevent pressure necrosis of the esophagus Ref: Bailey and love 27th edition Pgno : 1164


Question: Sho gastric aery is a branch of

Sho gastric aery is a branch of the splenic aery. Splenic aery gives it branches to branches to pancreas, sho gastric aery, left gastroepiploic and posterior gastric. right gastroepiploic is not its branch. ref - BDC 6e vol2 pg277


Question: Mobile bone of skull

The mandible or lower jaw is the largest and the strongest bone of the face. It develops from the first pharyngeal arch. It has a horseshoe-shaped body which lodges the teeth, and pair of rami which project upwards from posterior ends of the body. The rami provide attachment to the muscles of mastication. Ref BDC volume 3,sixth edition pg 31


Question: Enophthalmus is due to palsy of

Ref: BD Chaurasia's HUMAN ANATOMY, Volume 3, 4th edition. Enophthalmos (i.e. retraction of the eyeball); is possibly caused by paralysis of the smooth (orbitalis) muscle in the floor of the orbit.


Question: Diagnosis of myasthenia gravis is done by using

(Ref: KDT 6/e p104) Myasthenia gravis can be differentiated from cholinergic crisis with the help ot a sho acting anticholinesterase agent, edrophonium. It improves the symptoms in mvasthenia gravis whereas worsens the condition in cases of cholinergic crisis. Neostigmine is used for the treatmet of myasthenia.


Question: Blood supply of femoral head is

BLOOD SUPPLY OF FEMORAL HEAD:- The head of femur is paly supplied by a branch of obturator aery along the ligamentum teres.Main aerial supply is from retinacular aeries, branch of medial circumflex femoral aery.These aeries get injured in intracapsular fracture neck of femur, leading to avascular necrosis of the head. In such cases hip joint need to be replaced. {Reference: BDC 6E pg no.19}


Question: Amotivation syndrome caused by

Psychiatric presentation---------------------Mimics panic attacks Patient on intoxication has increased activation of sympathetic nervous system Gate way drug This drug is called gate way drug as when a person uses this drug, he has a chance of increased exposure to other drugs Amotivation syndrome Patient with amotivation syndrome will lack of drive, abulia, no motivation for any activities hemp insanity insanity caused by cannabis is called hemp insanity if a person with family history of psychosis takes cannabis there is a chance a kindling of psychotic symptoms Ref.kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no.645


Question: Neural tube formation occurs on

18 to 23 days post fertilization and is the second stage of craniofacial development

28 to 38 days post fertilization and is the third stage of craniofacial development

42 to 55 days post fertilization and is the fourth stage of craniofacial development

17th day post fertilization and is the first stage of craniofacial development


Question: General Paresis of insane is associated with

It is a late complication of neurosyphilis


Question: Corneal stroma is derived from

The corneal stroma is a mesenchymal tissue, derived from the periocular neural crest, is the thickest layer of the cornea, and is 'sandwiched' between the epithelium and the inner endothelium. The stroma is composed of organized collagen, mainly type I and type V collagen fibers, which maintain transparency. Keratocytes (fibroblasts) are located between the lamella collagen fibers and secrete an extracellular matrix, which includes collagen and proteoglycans, and also produce crystalline proteins to maintain corneal transparency. Ref - Pubmed.com


Question: Dorsum of first webspace is supplied by nerve

Nerve supply to lower limb Thigh: Anterior compament - femoral nerve Medial compament - obturator nerve Posterior compament - tibial nerve (Sciatic nerve) Leg: Anterior - Deep Peroneal Nerve (DPN) Lateral - Superficial peroneal nerve (SPN) Posterior- Tibial nerve Foot: Dorsum of foot (except first web space)- superficial peroneal nerve Dorsum of first web space - Deep peroneal nerve (DPN) Plantar surface - Medial and lateral plantar nerve (terminal division of tibial nerve) Middle malleolus - Saphenous nerve (branch of femoral nerve) Lateral margin - Sural nerve


Question: Level of hyoid bone is at

Vertebral level of various structures in the neck:
Hyoid bone - C3
Upper border and notch of thyroid cartilage - C3/C4
Thyroid cartilage - C4-05
Cricoid cartilage - C6
Suprasternal notch - T2/T3


Question: The superficial external pudendal aery is a branch of

The femoral aery in the femoral triangle gives off 3 superficial branches :superficial epigastric aery,superficial external pudendal andsuperficial circumflex iliac aery.Reference: Textbook of anatomy, Abdomen and Lower limb, Vishram Singh, 2nd edition, page no.341


Question: Middle piece of sperm tail made up of

Pa of axial filament which lies in middle piece is surrounded a spiral sheath made up of mitochondria Human embryology Tenth edition Pg no19


Question: Posterior dislocation of the femur on the tibia is prevented by

CRUCIATE LIGAMENTS: Very thick and strong fibrous bands.Direct bonds of union between tibia and fibula.Maintain anteroposterior stability of knee joint. Anterior cruciate ligament:- Begins from anterior pa of intercondylar area of tibia, runs upward, backward and laterally and is attached to the posterior pa of medial surface of lateral condyle of femur. Taut during extension of knee. The anterior cruciate ligament is more commonly damaged than the posterior.It may be injured in violent hyperextension of knee or anterior dislocation of tibia. Posterior cruciate ligament:- Begins from posterior pa of intercondylar area of tibia, runs upwards, forwards and medially and is attached to lateral surface of medial condyle of femur. Taut during flexion of knee. The posterior cruciate ligament is injured in posterior dislocation of tibia. It prevents posterior dislocation of femur on tibia. Both these are supplied by middle genicular nerves and vessels. {Reference: BDC 9 E}


Question: Tensile strength of wound aftr laparoscopic cholecystectomy in a 30yr old woman depends upon

ref Robbins, 8/e p105 -106 Collagen is a ubiquitous protein with remarkable mechanical propeies. It is highly elastic, shows large during tropocollagen. The molecular component of a collagen fibril, consisting of three polypeptide chains coiled around each other.

Extensive cross linking of tropocollagen


Question: The optic nerve terminates in the


Question: Extent of esophagus is

The esophagus has cervical, thoracic, and abdominal pas, extending from the lower end of the pharynx (C6 veebrae) to the cardiac opening of the stomach (T11 or 12 veebral level). It is about 25 to 30 cm long


Question: russels sign is assosiated with

Bulimia nervosa * Gender==== more common in females * Age=======adolescence * Comorbidity=== depression and social phobia * Duration====3 months * Criteria= * Binge eating at least once a week for 3 months * Uses laxatives, diuretics, self-induced vomiting * Association= * Impulsive behaviors * increased interest in sex * They may be of normal weight * Less secretive * Mood disorders * Complication * Electrolyte abnormalities * Hypokalemia * Hypochloremia alkalosis * Russel's sign==== as these patients uses their fingers to be stick out in the throat and vomit, there is a lesion in meta carpo phalangeal joints. * Drugs * Carbamazepine * MAOI * SSRI Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no 509


Question: Cranial pa of accessory nerve supplies

Sternocleidomastoid and trapezius develop from branchial arch mesoderm and are supplied by spinal pa of the accessory nerve. Levator scapulae are supplied by a branch from dorsal scapular nerve and branches from C3, C4. BD Chaurasia 7th edition Page no: 65


Question: SAG M stands for

SAG-M solution - Packed red cells are stored to increase shelf life to 5 weeks at 2-6degC SAG-M : is Saline-Adenine-Glucose-Mannitol Ref: Bailey and love 27th edition Pgno :21

Sodium chloride , Adenine , Glucose anhydrate , Mannitol

Sodium citrate , Adenine , Glucose anhydrate , Mannitol

Sodium citrate , Adenosine , Glucose anhydrate , Mannitol

Sodium chloride , Adenine , Gelatin , Mannitol


Question: Inversion / Eversion movements occurs at

(Subtalar joints) (154- BDC-2 4th edition)* Inversion and Eversion of foot occurs at - Subtalar (Talocalcaneum) & Talocalcaneonavicular joints* Principal muscles involved in Inversion are - Tibialis anterior, Tibialis posterior* Principal muscles involved in Eversion are Peroneus longus, Peroneus brevis* Pronation and Supination of the foot - takes place chiefly at the Transverse tarsal joints** and partly at smaller intertarsal, tarsometatarsal and inter metatarsal joints


Question: Occupational lung disease commonly seen in Textile industry workers is

Workers occupationally exposed to cotton dust (but also to flax, hemp, or jute dust) in the production of yarns for textiles and rope making are at risk for an asthma-like syndrome known as byssinosis. Ref Harrison 19th edition pg 1688


Question: Hyoid lies at the level of

Hyoid is a U-shaped bone situated in the anterior midline of the neck between the chin and the thyroid cailage.At rest,it lies at the level of the third cervical veebra behind and the base of the mandible in front. REF,BDC VOL.3,FIFTH EDITION


Question: Large and most impoant branch of the posterior tibial aery is

Peroneal aery is the largest branch of the posterior tibial aery. It supplies the posterior and lateral compaments of the legOther branches of the posterior tibial aery are:circumflex fibular aerymedial plantar aerylateral plantar aeryRef: Vishram Singh; Volume II; 2nd edition; Page no: 416


Question: Internal organs in the fetus develop at

D i.e. 6 weeks The embryonic period or period of organogenesis occurs from 3rd- weeksQ (Langman's) /4th- 801 weeksQ (Persuad) Although the critical development events occur during first three weeks, such as cleavage of the zygote, blastogenesis & early development of the nervous & cardiovascular systems. All major external & internal structures are established during 4- 8 weeks.


Question:
Loss of Direct and consensual light reflex Is due to
lesion of


Question: Cavity of mesencephalon

The cavity of mesencephalon forms the cerebral aqueduct.The cavity of Rhombencephalon forms the fouh ventricle.The cavity of prosencephalon forms lateral and third ventricle.(Ref: Vishram Singh textbook of clinical neuroanatomy second edition pg 4)


Question: The most common cause of preventable hospital death is

PE is the most common preventable cause of death among hospitalized patients. Clinical features The diagnosis of pulmonary embolism (PE) may be aided by asking three questions: * Is the clinical presentation consistent with PE? * Does the patient have risk factors for PE? * Are there any alternative diagnoses that can explain the patient's presentation? Clinical presentation varies, depending on number, size and distribution of emboli and on underlying cardiorespiratory reserve (Box 17.83). A recognised risk factor is present in 80-90% (see Box 23.65, p. 975). The presence of one or more risk factors increases the risk fuher still. Ref Davidson edition23rd pg 619


Question: The main danger with low tension alternating current is

The main danger with alternative current injuries is from alternating current interactions with normal cardiac pacing It can cause cardiac arrest. The electricity itself doesn't usually cause significant underlying myocardial damage. So resuscitation if successful should be lasting. Ref: Bailey and love 27th edition Pg no : 631


Question: Ram Devi presented with generalized edema sweating and flushing tachycardia and fever after bee sting .this is

Ref Robbins 9/e p202 Immediate (Type I) Hypersensitivity Immediate hypersensitivity is a tissue reaction that occurs rapidly (typically within minutes) after the interaction of antigen with IgE antibody that is bound to the surface of mast cells in a sensitized host. The reaction is initiated by entry of an antigen, which is called an allergen because it triggers allergy. Many allergens are environmental substances that are harmless for most persons on exposure. Some people apparently inherit genes that make them susceptible to allergies. This susceptibility is manifested by the propen- sity of such persons to mount strong TH2 responses and, subsequently, to produce IgE antibody against the aller- gens. The IgE is central to the activation of the mast cells and release of mediators that are responsible for the clinical and pathologic manifestations of the reaction. Immediate hypersensitivity may occur as a local reaction that is merely annoying (e.g., seasonal rhinitis, or hay fever), severely debilitating (asthma), or even fatal (anaphylaxis). Sequence of Events in Immediate Hypersensitivity Reactions Most hypersensitivity reactions follow the same sequence of cellular responses (Fig. 4-7): * Activation of TH2 cells and production of IgE antibody. Aller- gens may be introduced by inhalation, ingestion, or injection. Variables that probably contribute to the strong TH2 responses to allergens include the route of entry, dose, and chronicity of antigen exposure, and the genetic makeup of the host. It is not clear if allergenic substances also have unique structural propeies that endow them with the ability to elicit TH2 responses. Immediate hypersensitivity is the prototypical TH2-mediated reaction. The TH2 cells that are induced secrete several cytokines, including IL-4, IL-5, and IL-13, which are responsible for essentially all the reactions of immediate hypersensitivity. IL-4 stimulates B cells specific for the allergen to undergo heavy-chain class switching to IgE and to secrete this immunoglobulin isotype. IL-5 acti- vates eosinophils that are recruited to the reaction, and IL-13 acts on epithelial cells and stimulates mucus secre- tion. TH2 cells often are recruited to the site of allergic reactions in response to chemokines that are produced locally; among these chemokines is eotaxin, which also recruits eosinophils to the same site. * Sensitization of mast cells by IgE antibody. Mast cells are derived from precursors in the bone marrow, are widely distributed in tissues, and often reside near blood vessels and nerves and in subepithelial locations. Mast cells described in Chapter 2. Eosinophils are recruited by eotaxin express a high-affinity receptor for the Fc poion of the e heavy chain of IgE, called FceRI. Even though the serum concentration of IgE is very low (in the range of 1 to 100 ug/mL), the affinity of the mast cell FceRI recep- tor is so high that the receptors are always occupied by IgE. These antibody-bearing mast cells are "sensitized" to react if the antigen binds to the antibody molecules. Basophils are the circulating counterpas of mast cells. They also express FceRI, but their role in most immedi- ate hypersensitivity reactions is not established (since these reactions occur in tissues and not in the circula- tion). The third cell type that expresses FceRI is eosino- phils, which often are present in these reactions and also have a role in IgE-mediated host defense against hel- minth infections, described later. * Activation of mast cells and release of mediators. When a person who was sensitized by exposure to an allergen is reexposed to the allergen, it binds to multiple specific IgE molecules on mast cells, usually at or near the site of allergen entry. When these IgE molecules are cross- linked, a series of biochemical signals is triggered in the mast cells. The signals culminate in the secretion of various mediators from the mast cells. Three groups of mediators are the most impoant in different immediate hypersensitivity reactions (Fig. 4-8): Vasoactive amines released from granule stores. The gran- ules of mast cells contain histamine, which is released within seconds or minutes of activation. Histamine causes vasodilation, increased vascular permeability, smooth muscle contraction, and increased secretion of mucus. Other rapidly released mediators include adenosine (which causes bronchoconstriction and inhibits platelet aggregation) and chemotactic factors for neutrophils and eosinophils. Other mast cell granule contents that may be secreted include several neutral proteases (e.g., tryptase), which may damage tissues and also generate kinins and cleave comple- ment components to produce additional chemotactic and inflammatory factors (e.g., C3a) (Chapter 2). The granules also contain acidic proteoglycans (heparin, chondroitin sulfate), the main function of which seems to be as a storage matrix for the amines. Newly synthesized lipid mediators. Mast cells synthesize and secrete prostaglandins and leukotrienes, by the same pathways as do other leukocytes (Chapter 2). These lipid mediators have several actions that are impoant in immediate hypersensitivity reactions. Prostaglandin D2 (PGD2) is the most abundant media- tor generated by the cyclooxygenase pathway in mast cells. It causes intense bronchospasm as well as increased mucus secretion. The leukotrienes LTC4 and LTD4 are the most potent vasoactive and spasmo- genic agents known; on a molar basis, they are several thousand times more active than histamine in increas- ing vascular permeability and in causing bronchial smooth muscle contraction. LTB4 is highly chemotac- tic for neutrophils, eosinophils, and monocytes. Cytokines. Activation of mast cells results in the syn- thesis and secretion of several cytokines that are impoant for the late-phase reaction. These include TNF and chemokines, which recruit and activate leu- kocytes (Chapter 2); IL-4 and IL-5, which amplify th TH2-initiated immune reaction; and IL-13, which stimulates epithelial cell mucus secretion. In summary, a variety of compounds that act on blood vessels, smooth muscle, and leukocytes mediate type I hypersensitivity reactions (Table 4-2). Some of these com- pounds are released rapidly from sensitized mast cells and are responsible for the intense immediate reactions associ- ated with conditions such as systemic anaphylaxis. Others, such as cytokines, are responsible for the inflammation seen in late-phase reactions. Often, the IgE-triggered reaction has two well-defined phases (Fig. 4-9): (1) the immediate response, characterized by vasodilation, vascular leakage, and smooth muscle spasm, usually evident within 5 to 30 minutes after expo- sure to an allergen and subsiding by 60 minutes; and (2) a second, late-phase reaction that usually sets in 2 to 8 hours later and may last for several days and is characterized by inflammation as well as tissue destruction, such as mucosal epithelial cell damage. The dominant inflammatory cells in the late-phase reaction are neutrophils, eosinophils, and lymphocytes, especially TH2 cells. Neutrophils are recruited by various chemokines; their roles in inflammation were described in Chapter 2. Eosinophils are recruited by eotaxinTH2-initiated immune reaction; and IL-13, which stimulates epithelial cell mucus secretion. In summary, a variety of compounds that act on blood vessels, smooth muscle, and leukocytes mediate type I hypersensitivity reactions (Table 4-2). Some of these com- pounds are released rapidly from sensitized mast cells and are responsible for the intense immediate reactions associ- ated with conditions such as systemic anaphylaxis. Others, such as cytokines, are responsible for the inflammation seen in late-phase reactions. Often, the IgE-triggered reaction has two well-defined phases (Fig. 4-9): (1) the immediate response, characterized by vasodilation, vascular leakage, and smooth muscle spasm, usually evident within 5 to 30 minutes after expo- sure to an allergen and subsiding by 60 minutes; and (2) a second, late-phase reaction that usually sets in 2 to 8 hours later and may last for several days and is characterized by inflammation as well as tissue destruction, such as mucosal epithelial cell damage. The dominant inflammatory cells in the late-phase reaction are neutrophils, eosinophils, and lymphocytes, especially TH2 cells. Neutrophils are recruited by various chemokines; their roles in inflammation were described in Chapter 2. Eosinophils are recruited by eotaxin


Question: A direct acting cholinomimetics that is lipid soluble and has been used in the treatment of glaucoma is

Ref-KDT 6/e p98 Pilocarpine is a directly acting and physostigmine-acetylcholine is an indirectly acting cholinomimetic useful for glaucoma.


Question: Circumflex scapular aery is a branch of

Subscapular aery is the largest branch of the axillary aery, arising from its third pa. It runs along the lower border of the subscapularis to terminate near the inferior angle of the scapula. It supplies the latissimus dorsi and the serratus anterior. The Subscapular aery gives off a large branch, the circumflex scapular aery, which is larger than the continuation of the main aery. Ref : B D Chaurasia's Human Anatomy, seventh edition , volume 1, pg. no., 53.


Question: Sensory nerve supply of the palatine tonsils is by

Glossopharyngeal and lesser palatine nerves supply palatine tonsilPalatine tonsilThe Palatine tonsils are two prominent masses situated one on either side between the glossopalatine and pharyngopalatine arches.Each tonsil consists fundamentally of an aggregation of lymphoid tissue underlying the mucous membrane between the palatine arches.In the child the tonsils are relatively (and frequently absolutely) larger than in the adultThe follicles of the tonsil are lined by a continuation of the mucous membrane of the pharynx, covered with stratified squamous epitheliumAeries supplying the tonsil are the:Dorsalis linguae from the lingualThe ascending palatine and tonsillar from the external maxillaryThe ascending pharyngeal from the external carotidThe descending palatine branch of the internal maxillaryA twig from the small meningeal.The veins end in the tonsillar plexus, on the lateral side of the tonsilThe nerves are derived from the sphenopalatine ganglion, and from the glossopharyngeal.


Question: The Reynold's pentad of fever, jaundice, right upper quadrant pain, septic shock and mental status change is typical of

Clinical features of cholangitis Characterized by charcot's triad: Abdominal pain + jaundice + fever Cholangitis may be either self-limited or toxic with severe illness, including jaundice, fever, abdominal pain, mental status changes, and hypotension (Reynold's pentad) Fever and chills are the MC presentation Ref: Sabiston 20th edition Pgno : 1507


Question: If there is a superficial cut in the region of middle pa of posterior triangle of neck, patient will experience problem

Roof of posterior triangle is formed by the investing layer of deep cervical fascia.Accessory nerve lies just deep to the investing layer at the middle of the posterior border of sternocleidomastoid muscle and across the posterior triangle and reaches the anterior border of trapezius, which it supplies.Shrugging of shoulder is an action of trapezius.


Question: Kupffer cells are found in

Ref Robbins 8/e p834; 7/e p79;9/e p102 Kupffer cells, also known as stellate macrophages and Kupffer-Browicz cells, are specialized macrophages located in the liver, lining the walls of the sinusoids. They form pa of the mononuclear phagocyte system.


Question: The cistern chyli are situated in

CISTERNA CHYLI - This is an elongated lymphatic sac, about 5 to 7 cm long. It is situated in front of the first and second lumbar veebrae,immediately to the right of the abdominal aoa. It is overlapped by the right crus of the diaphragm. Its upper end is continuous with the thoracic duct. It is joined by the right and left lumbar and intestinal lymph trunks. The lumbar trunks arise from the lateral aoic nodes, and bring lymph from the lower limbs, the pelvic wall and viscera, the kidneys, the suprarenal glands, the testes or ovaries, and the deeper pas of the abdominal wall. The intestinal trunks bring lymph from the stomach, the intestine, the pancreas, the spleen, and the anteroinferior pa of the liver. The cisterna chyli may be replaced by anastomotic channels between the two lumbar trunks, or by dilatations of the lumbar trunks which join to form the thoracic duct. The intestinal trunks may thus join the cisterna chyli, the lumbar trunks, or the thoracic duct. Ref : B D Chaurasia's Human Anatomy , seventh edition , volume 2 , pg.no. 371


Question: Inhibitor of Apoptosis is

Ref Robbins 9/e p55; Robbins 7/e p29 Conversely, if cells are exposed to growth factors and other survival signals, they synthesize anti-apoptotic members of the Bcl-2 family, the two main ones of which are Bcl-2 itself and Bcl-xL. These proteins antagonize Bax and Bak, and thus limit the escape of the mitochondrial pro-apoptotic proteins. Cells deprived of growth factors not only activate the pro-apoptotic Bax and Bak but also show reduced levels of Bcl-2 and Bcl-xL, thus fuher tilting the balance toward death. The mitochondrial pathway seems to be the pathway that is responsible for apoptosis in most situa- tions, as we discuss later.


Question: Urogenital diaphragm is not formed by

Urogenital diaphragm consists of :?i) Two muscles :- Sphincter urethrae and deep transverse perinei (also called transverse perinei profundus).ii) Two fascia :- Inferior fasica of urogenital diaphragm (perineal membrane) and superior fascia of urogenital diaphragm.


Question: Metacarpophalangeal joint is

Ellipsoid(functionally) / condylar joints(structurally): 1. Wrist (radio-carpal joints) 2. Knuckle (metacarpophalangeal joint) 3. Atlanto - occipital joint Ellipsoid > condylar joints


Question: Fluconazole different from ketoconazole in that

REF-KDT6/e p762) Ketoconazole is rarely used now a days because of several limitations. Impoant among them are: Poor oral bioavailability Limited CNS penetration Powerful inhibition of microsomal enzymes Anti-androgenic adverse effects like gynaecomastia Fluconazole is preferred agent because it has Very good oral absorption Maximum CNS penetration (therefore effective in cryptococcal meningitis). No inhibitorv action on microsomal enzymes No anti-androgenic propey.

It is more potent inhibitor of drug metabolism

It is not effective in Cryptococcal meningitis

It is unlikely to produce anti androgenic side effects


Question: Morula is a stage of cell


Question: Posterior gastric aery is a branch of

The fundic branches of the stomach can be defined as a group of vessels that can arise either directly or indirectly from the following source aeries: the left inferior phrenic aery, the accessory left hepatic aery, the left gastric aery, the left middle suprarenal aery, the main trunk of the splenic aery Ref - BDC 6e vol2 pg277


Question: Taste sensation from anterior 2/3rd of tongue are carried by

TASTE SENSATION FROM ANTERIOR TWO-THIRDS OF TONGUE IS CARRIED BY CHORDA TYMPANI. CHORDA TYMPANI IS THE NERVE OF TASTE EXCEPT VALLAA PAPILLAE. REFER BDC 6 TH EDITION VOLUME 3 PAGE NO: 268 REFER FIG 17.8


Question: Largest cranial nerve

SOME KEY FACTS ABOUT CRANIAL NERVES

Trigeminal is the largest cranial nerve.
Vagus nerve is with vague or extensive distribution.
Olfactory is the smallest cranial nerve.

iv) Trochlear nerve shows largest intracranial course.
       v) Buccal nerve is the only sensory branch of anterior division of mandibular nerve
       vi) Smallest branch of trigeminal nerve is ophthalmic.
       vii) Smallest of three terminal branches of opthalmic nerve is lacrimal nerve and frontal nerve is largest terminal branch of opthalmic nerve.


Question: Central aery of Retina is branch of

Within the dural sheath, the ophthalmic aery gives off the central aery of the retina. after piercing the dura mater it gives off a large lacrimal branch that runs along the lateral wall of the orbit. the main aery runs towards the medial wall of the orbit giving off a number of branches. Notes: the central aery of retina is the only aerial supply to most of the nervous layer the retina of the eye.if this aery is blocked there is sudden blindness. Ref BDC volume 3;Sixth edition pg 209.


Question: Aliskiren is a

Aliskiren binds to the S3bp binding pocket of renin, essential for its activity . Binding to this pocket prevents the conversion of angiotensinogen to angiotensin I.


Question: Earliest lesion seen in asbestosis is

It is most common manifestation of asbestos exposure composed of plaques of dense collagen containing calcium. They are usually asymptomatic and develop on anterior and posteriolateral pas of parietal pleura and over the diaphragm Refer robbins 9/e


Question: Lymphatic drainage of cervix is to


Question: In regeneration

ref, Robbins 8/e p92-94 .7/e p 88,9/e p101 When the injury is minimal, the tissue may effectively replace the damaged or lost cells . In severely damaged tissues or long-term chronic situations, the ability of the tissue toregenerate the same cell types and tissuestructure may be exceeded, so that a different and imperfect repair occurs.

Cellular proliferation is largely regulated by biochemical factors


Question: Epitheliod granuloma is caused by

ref Robbins 7/e p 83 CD 4 hepler cells are involved in granuloma formation as it secreted lFN - gamma, IL 2 ,IL 12 Histiocytes (specifically macrophages) are the cells that define a granuloma. They often, but not invariably, fuse to form multinucleated giant cells (Langhans giant cell). The macrophages in granulomas are often referred to as "epithelioid".


Question: In an outbreak of cholera in a village of 2,000 population, 20 cases have occurred and 5 died. Case fatality rate is

(Refer: K. Park's Textbook of Preventive and Social medicine, 24thedition, pg no: 63)


Question: Circulus iridis major is seen at

Anterior ciliary aeries join with 2 long posterior ciliary aeries at root of iris


Question: Lining epithelium of vagina is

INDERBIR SINGH&;S TEXTBOOK OF HUMAN HISTOLOGY-PAGE NO:359Mucous membraneThe mucous membrane shows numerous longitudinal folds and is firmly fixed to the underlying muscle layer.it us lined by stratified squamous epithelium(non keratinized)

Keratinized stratified squamous epithelium

Non keratinized stratified squamous epithelium


Question: The nerve supply of Middle ear is from

(B) Tympanic branch of glossopharyngeal nerve# Sensory nerve supply of middle ear cavity is provided by Glossopharyngeal nerve.> Tympanic Plexus It lies on the promontory and is formed by tympanic branch of glossopharyngeal and sympathetic fibres from the plexus round the internal carotid artery.> Tympanic plexus supplies innervation to the medial surface of the tympanic membrane, tympanic cavity, mastoid air cells and the bony eustachian tube.> It also carries secretomotor fibres for the parotid gland. Section of tympanic branch of glossopharyngeal nerve can be carried out in the middle ear in Frey syndrome.> The tympanic cavity contains the tympanic plexus and the facial nerve. Branches from the plexus and the facial nerve supply structures within the tympanic cavity but also leave the cavity to supply structures on the face. The nerves that constitute the tympanic plexus ramify on the surface of the promontory on the medial wall of the tympanic cavity They are derived from the tympanic branch of the glossopharyngeal nerve and the caroticotympanic nerves. The former arises from the inferior ganglion of the glossopharyngeal nerve, and reaches the tympanic cavity via the tympanic canaliculus for the tympanic nerve. The superior and inferior caroticotympanic nerves are postganglionic sympathetic fibres which are derived from the carotid sympathetic plexus and traverse the wall of the carotid canal to join the plexus.

Pharyngeal branch of glossopharyngeal nerve


Question: Bifurcation of Trachea is at the level of

Bifurcation of Trachea is at the level of Body of T6


Question: The secretomotor fibre to the parotid gland passes through

B. i.e. (Otic ganglion) (737- BDC-3 4th)* Parasympathetic secretomotor fibres from the inferior salivary nucleus of the 9th nerve supply the parotid gland. The nerve fibres pass to the otic ganglion via the tympanic branch of the 9th nerve and lesser petrosal nerve* Parotid duct (stenson duct) opens into the opposite the crown of the upper second molar tooth *** Structure within the parotid gland - from lateral to medial are facial nerve, retromandibular vein, external carotid artery, lymph node*** Taste fibres are the peripheral processes of the cells in the geniculate ganglion (712-Snell 8th)* Ciliary Ganglion - is a parasympathetic ganglion situated in the posterior part of the orbit and supply the sphincter pupillae and the ciliary muscle


Question: Antibody found in patients with myasthenia gravis is directed against

Ref Robbins 9/e p195 Myasthenia gravis Acetylcholine receptor Antibody inhibits acetylcholine binding, downmodulates receptors Muscle weakness, paralysis

Acetylcholine vesicles in nerve terminals


Question: Motor nerve supply of muscles of upper lip is by

Temporal—frontalis, auricular muscles, orbicularis oculi
Zygomatic—Orbicularis oculi
Buccal—muscles of the cheek and upper lip
Marginal mandibular—muscles of lower lip.
Cervical—platysma

Marginal mandibular branch of facial nerve


Question: Fear of pain is

Acrophobia - fear of height Hydrophobia- fear of water Nyctophobia - fear of night Algophobia - fear of pain Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 361


Question: Basal lamina of blood vessel in CNS is secreted by


Question: A 40 year old male presents with a painless cystic liver enlargement of four years duration without fever or jaundice. The most likely diagnosis is

Clinical features of hydatid disease Equally common in males and females, age 45 years Most(75%) are singular, located in right liver Mostly asymptomatic until complications occur Most common presenting symptoms - abdominal pain, dyspepsia and vomiting Most common sign- Hepatomegaly Ref:Sabiston 20th edition Pgno :1452


Question: Melanocytes are present in

Melanoblasts, derived from neural crest, migrate to the epidermis and reside in the stratum basaleReference: Krishna Garg Histology; 5th edition; Page no: 113


Question: Testes completely descend in the scrotum by the aha of

Testis lies at superficial ring at 8th month and enters the scrotum at the beginning of 9th month. It reaches the final position in the scrotum just before bih.


Question: Surgical lobes of liver are divided on the basis of

Functional anatomy of the liver is based on couinaud's division of liver into eoght(subsequently nine) functional segments, based upon the distribution of poal venous branches and location of hepatic veins in the parenchyma Couinaud 1957