Question: Structure NOT passing through Aortic opening of diaphragm

(D) VagusVena Cava (8 letters) - Passes through the diaphragm at T8.Oesophagus (10 letters) - Passes through the diaphragm at T10.Aortic Hiatus (12 letters) - Passes through the diaphragm at T12.OPENINGS THROUGH THE DIAPHRAGM & THEIR CONTENTSDescriptionVertebral levelContentsCava! opening lies in central tendon of DiaphragmT8 (to the right side of the median plane)Caval opening passes through the central tendon of the diaphragm. Contains Inferior vena cava, & some branches of the Right Phrenic nerve.Esophageal hiatuslies in Masseter part of diaphragmT10 (to the of the median plane)Esophageal hiatus is situated in the posterior part of the diaphragm, located slightly left of the central tendon through the muscular sling of the right crus of the diaphragm.Oesophagus & anterior & posterior Vagal trunks.Lymphatics from the lower third of the esophagusAortic hiatus OsseoaponeuroticT12 (in the median plane)Aortic hiatus is in the posterior part of the diaphragm, between the left & right crus.Aorta, Azygos vein & Thoracic duct.Two lesser apertures of right crusGreater & Lesser Right splanchnic nervesTwo lesser apertures of left crusGreater & Lesser Left Splanchnic nerves & Hemiazygos veinBehind the diaphragm, under the medial lumbocostal archSympathetic trunkAreolar tissue between the sternal & costal parts (Foramina of Morgagni)Superior epigastric branch of the internal thoracic artery & some lymphatics from the abdominal wall & convex surface of the liverAreolar tissue between the fibers springing from the medial & lateral lumbocostal archesThis interval is less constant; when this interval exists, the upper & back part of the kidney is separated from the pleura by areolar tissue only.OTHER STRUCTURES PASSING THROUGH DIAPHRAGMSplanchnic nerves - which pierce the cruraInferior hemiazygos - Vein which pierce the left crus.Psoas major Muscle.Sympathetic trunk (pass deep to the medial arcuate ligament).Quadratus lumborum.Subcostal Nerve, Vessels (pass deep to the lateral arcuate ligamentClinical Importance:Lumbocostal triangle or Bochdalek's foramen, Diaphragmatic hernia, Diaphragmatic paralysis, Congenital eventration of diaphragm, Hiccup.Aortic opening (Aortic hiatus) is one the three major apertures through the diaphragm & lies at the level of T12.A number of structures pass through the aortic hiatus: aorta, azygos vein, thoracic duct, greater splanchnic nerve.


Question: This finding is seen in


Question: Each lateral ventricle opens into the 3rd ventricle through

Cavities within brain and spinal cord:
a) The cerebrum contains a median cavity, the third ventricle and two lateral ventricles, one in each hemisphere.
b) Each lateral ventricle opens into the 3rd ventricle through interventricular foramen or foramen of  monro.
c) The third ventricle opens into the 4th ventricle  (i.e., cavity of hind brain) through the cerebral aqueduct.
d) The 4th ventricle communicates with subarachnoid space through two lateral foramen or foramen of luschka and a medial foramen or foramen of magendi.


Question: Medical treatment of acute pancreatitis includes

Treatment Cornerstone of the treatment : Aggressive fluid resuscitation using isotonic crystalloid solution with supplementary oxygen Narcotics are usually preferred, especially Buprenophine >Morphine as analgesics In acute pancreatitis medical treatment Analgesics (Buprenophine, meperidine) IV fluids and colloids No oral alimentation Treatment of hypocalcaemia, if symptomatic Antibiotics Ref: Sabiston 20th edition Pgno :1524-1528


Question: Awareness during anaesthesia can be assessed by


Question: Mi's expression of the following homeobox genes alters the position of the forelimbs during development

The carnival limit of expression of HOX B8 is at the carnival border of the forelimbs, and the mid - expression of this gene alters the position of these limbs Position of the limbs along the craniocaudal axis in the flank regions of the embryo is regulated by the HOX genes expressed along this axis. Ref: Gray's 39e/p-1289


Question: The total number of ligamentuni denticulatum lies on side of spinal cord are

(D) 40-42 # Ligamentum denticulatum is a flat, fibrous sheet which lies on each side of the spinal cord between the ventral and dorsal spinal roots. Its medial border is continuous with the subpial connective tissue of the cord and its lateral border forms a series of triangular processes, the apices of which are fixed at intervals to the dura mater. There are usually 21 processes on each side. The first crosses behind the vertebral artery where it is attached to the dura mater, and is separated by the artery from the first cervical ventral root. Its site of attachment to the dura mater is above the rim of the foramen magnum, just behind the hypoglossal nerve: Spinal accessory nerve ascends on its posterior aspect. Last of the dentate ligaments lies between the exiting twelfth thoracic and first lumbar spinal nerves and is a narrow, oblique band which descends laterally from the conus medullaris. Changes in the form and position of the dentate ligaments during spinal movements have been demonstrated by cine- radiography.


Question: Most impoant pathophysiological cause of GERD is

"Transient LES relaxations account for at least 90% of reflux in normal subjects or GERD patients without a hiatus hernia"- Harrison Transient lower oesophagal sphincter relaxations account for essentially all reflux events in individuals with a normal LES pressure at the time of reflux. Pathogenesis of gastroesophageal reflux disease (GERD) The primary event in the pathogenesis of gastroesophageal reflux disease (GERD) is a movement of gastric juice from the stomach into the oesophagus. The three dominant pathophysiologic mechanisms causing gastroesophageal junction incompetence are: Transient lower esophageal sphincter relaxations (tLESRs) A hypotensive lower oesophagal sphincter (LES) Anatomic disruption of the gastroesophageal junction, often associated with a hiatal hernia The latest concept is that the dominant mechanism varies as a function of disease severity with tLESRs predominating with mild disease and mechanisms associated with a hiatus hernia and/or a weak sphincter predominating with more severe disease Transient LES relaxations are different from swallow-induced LES relaxation: tLESRs occur without an associated pharyngeal contraction, are unaccompanied by oesophagal peristalsis, and persist for longer periods (>10 sec) than do swallow-induced LES relaxations. tLESRs are the physiological mechanism of belching. Ref : Harrison 18/e p2433


Question: Child criteria doesnt include

Variables in Child-Turcotte-Pugh scoring system Serum albumin Bilirubin Prothrombin time Ascites Encephalopathy Ref: Sabiston 20th edition Pgno : 1436


Question: Earlier site of bone involvement in Hematogenous osteomyelitis

Metaphysis of long bone is the earliest and most common site involved Refer Maheshwari 6th/e p 168


Question: Posterior columns sensations in lower limbs are lost in

Refer KDT 6/e p589 Deficiency of vitamin B12 leads to Megaloblastic anemia which is indistinguishable from folic acid deficiency Deficiency also have manifestations related to loss of myelin like Subacute combined degeneration of spinal cord


Question: Polyribosyl ribitol phosphate PRP antigen is present in the capsule of H. influenzae

Capsular polysaccharide of serotype b has PRP antigen that is also used in vaccine preparation because of it's immunogenic propey.


Question: Only nerve that originates from the dorsal surface of the brain stem is


Question: Yoke muscle pair

Yoke muscles are the primary muscles in each eye that accomplish a given version (eg, for right gaze, the right lateral rectus and left medial rectus muscles). Each extraocular muscle has a yoke muscle in the opposite eye to accomplish versions into each gaze position. By the Herring law, yoke muscles receive equal and simultaneous innervation. The magnitude of innervation is determined by the fixating eye, which means that the angle of detion between eyes (strabismus) may vary depending on which eye is fixating. The primary detion is misalignment, with the normal eye fixating. If the paretic eye fixates, the ensuing secondary detion is typically larger than the primary detion. Ref - medscape.com


Question: Epithelial lining of the vagina is

The lining of orifices is stratified squamous epithelium. In moist areas it is non-keratinised.Examples of non-keratinized stratified squamous epithelium include corneal epithelium, lining mucosa of the oral cavity, esophagus, anal canal, ectocervix, vagina and the internal poion of the lips.Reference: Chaurasia; 6th edition


Question: Dangerous area of face

The facial vein communicates with the cavernous sinus through emissary veins infections from the face can spread in a retrograde direction and cause thrombosis of the cavernous sinus. This is especially likely to occur in the presence of infection in the upper lip and in the lower pa of the nose. This area is therefore called dangerous area of the face. REF.BDC 6th edition volume 3 pg no 73


Question: Lymphatic drainage of ovary

The left ovarian vein drains into the left renal vein, and the right ovarian vein empties directly into the inferior vena cava. Supply is through the ovarian, hypogastric, and aoic plexuses. Lymph drainage of the ovary is primarily to the lateral aoic nodes; however, the iliac nodes are also involved. Ref - BDC 6e vol2 pg384


Question: Most common metabolic disturbance of cirrhosis is

Electrolyte abnormalities in Cirrhosis Hyponatremia Hypokalaemia Metabolic alkalosis (precipitate PNH) Ref: Sabiston 20th edition Pgno :565


Question: Following appearance is noted in


Question: Cranial nerves III, IV, V, VI lesions are associated with

(D) Cavernous sinus# Each Cavernous Sinus (one for each hemisphere of the brain) contains the following:> Vertically, from superior to inferior (within the lateral wall of the sinus).> Oculomotor nerve (CN III)> Trochlear nerve (CN IV)> Ophthalmic nerve, the V1 branch of the trigeminal nerve (CN V).> Maxillary nerve, the V2 branch of CN V> Unlike the nerves listed above, the abducens nerve (CN VI) does not run within the lateral wall of the cavernous sinus; rather it runs through the middle of the sinus alongside the internal carotid artery.> Horizontally, from medial to lateral> Internal carotid artery and sympathetic plexus.


Question: Nutrient artery to Femur is a branch of

Femur gets its nutrient artery from 2nd perforating Branch arising from profunda femoris artery.

1st perforating Branch of profunda femoris artery

2nd perforating Branch of profunda femoris artery


Question: Internal spermatic fascia is derived from

The transverse fascia is a thin aponeurotic membrane which lies between the inner surface of the transverse abdominal muscle and the parietal peritoneum.It forms pa of the general layer of fascia lining the abdominal parietes, and is directly continuous with the iliac fassia, internal spermatic and pelvic fascia.In the inguinal region, the transverse fascia is thick and dense in structure and is joined by fibers from the aponeurosis of the transverse abdominal. ref - BDC 6e vol2 pg 223,226


Question: Fracture of the neck of fifth metacarpal occurs in

Fracture of the neck of fifth metacarpal occurs usually due to striking the closed hand against a firm surface(Boxer's fracture) occurs in boxers. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 179


Question: Flexion of knee joint is caused by

KNEE JOINT:- Largest and most complex joint of the body.Fusion of 3 joints(lateral femorotibial, medial femorotibial, and femoropatellar) in one.Type: condylar synol joint. Movements:-Flexion,extension,medial and lateral rotation.Flexion and extension takes place in upper compament of the joint, above the menisci. They differ from ordinary hinge movements-The transverse axis around which these movements takes place is not fixed. During extension, the axis moves forward and upwards, and in the reverse direction during flexion.These are accompanied by rotation. Medial rotation of the femur occurs during the last 30 degrees of extension, and lateral rotation of the femur occurs during initial stages of flexion. When feet is on the ground, while standing erect, medial rotation of femur occurs during the last 30 degrees of extension as in " attention " by the vastus medialis.During the position of "stand at ease", there is lateral rotation of femur, during initial stages of flexion by the popliteus. Muscles involved:-1. Flexion- Biceps femoris Semitendinosus Semimembranosus 2. Extension-Quadriceps femoris. {Reference: BDC 6E pg no. 145}


Question: The tongue is formed from

The tongue has contributions from all pharyngeal arches which changes with time.
The tongue initially begins as swelling rostral to foramen cecum, the median
tongue bud.
Arch 1 - oral part of tongue (anterior 3/2)
Arch 2 - initial contribution to surface is lost
Arch 3 - pharyngeal part of tongue (posterior 1/3)
Arch 4 - epiglottis and adjacent regions


Question: Lack of fusion of maxillary and medial nasal process results in

Human embryology Tenth edition Inderbir Singh Page no 160 When one or both maxillary process don't fuse with medial nasal process give rise to defect in upper lip


Question: Following tarsal bone is devoid of muscular attachment

TALUS:- Second largest tarsal bone.Head, neck, and body. Tibia above and calcaneum below, Attachments:-Devoid of muscular attachment. Numerous ligaments attached to it because it takes pa in three joints- ankle, talocalcaneal, and talonavicular.Neck:- Capsular ligament of ankle joint.Dorsal talonavicular Interosseus talocalcanean and cervical ligament.Anterior talofibular ligament. Medial surface of body:- deep fibres of deltoid. Medial tubercle - superficial fibres of deltoid ligament. Groove on posterior surface lodges flexor hallucis tendon. Posterior talofibular ligament attached to posterior process.Plantar border: posterior talocalcanean ligament. {Reference: BDC 6E pg no. 30}


Question: The most commonest cause of acute cor pulmonale is

Ref Harrison 19 th ed pg 1454 ,1505 The most commonest cause of acute cor pulmonale is pulmonary thromboembolism. The most common cause of chronic cor pulmonale is COPD.


Question: Most common splenic cyst is


Question: The following growth indicator may appear relatively normal in patients with chronic severe malnutrition

Height-for-age (or length-for-age for children <2 yr) is a measure of linear growth, and a deficit represents the cumulative impact of adverse events, usually in the first 1,000 days from conception, that result in stunting, or chronic malnutrition. A low height-for-age typically reflects socioeconomic disadvantage. A low weight-for-height, or wasting, usually indicates acute malnutrition. Conversely, a high weight-for-height indicates overweight. Weight-for-age is the most commonly used index of nutritional status, although a low value has limited clinical significance as it does not differentiate between wasting and stunting. Weight-for-age has the advantage of being somewhat easier to measure than indices that require height measurements. In humanitarian emergencies and some field settings, mid-upper arm circumference is used for screening wasted children


Question: Infection of index finger spread to

Infection of thumb and index finger spreads to thenar space. Infection from middle, ring and little finger spreads to midpalmar space.


Question: Most potent stimulator of naive T cell is

Ref Robbins 9/e p191 Naive T cells leave the thymus and home to secondary lymphoid organs. Dendritic cells are the most potent activators of naive T cells. DCs carry antigen from the periphery to the draining lymph nodes. ... CD28 signaling provides "Signal 2" to T cells and is necessary for T cell activation.


Question: cove sensitization is a type of

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: Poor prognostic factor in patient with acute pancreatitis u

Ranson's prognostic criteria for Non-gallstone pancreatitis At admission Age >55 years WBC >16000 cells/mm3 Blood glucose >200mg/dl Serum LDH>350IU/L AST >250 U/L During initial 48hours Hematocrit fall >10 percentage points. BUN elevation >5mg/dl Serum calcium fall to <8mg/dl Aerial pO2v<60 mmHg Base deficit >4mEq/L Estimated fluid sequestration >6 litres Ranson's prognostic criteria for gallstone pancreatitis At admission Age >70 years WBC >18000 cells/mm Glucose >220mg/dl Serum LDH >400IU/L AST >250U/L During initial 48 hours Hematocrit fall >10 percentage points BUN elevation >2mg/dl Serum calcium fall to <8mg/dl Base deficit >5nEq/L Aerial pO2<60 mmHg Estimated fluid sequestration >4 litres Patients with one or two criteria have a predicted moality of less than 1%, with three criteria (10%) of four criteria (15%) with more than seven criteria 50% Ref: Sabiston 20th edition Pgno : 1527-1528


Question: Pisiform bone aiculates with

Pisiform aiculates only with Triquetral. Triquetral aiculates with Pisiform, lunate, hamate and aicular disc of Inferior radioulnar joint. B D Chaurasia 7th edition Page no: 27


Question: In Non hemolytic jaundice, urobilinogen is seen in


Question: In some kidney transplants Hyperacute graft rejection is seen . It is due to


Question: Cleft of upper lip is formed due to failure

Failure of fusion of maxillary process to mandibular process


Question: Most common site of medulloblastoma is

Medulloblastoma is a cancerous tumor--also called cerebellar primitive neuroectodermal tumor (PNET)--that stas in the region of the brain at the base of the skull, called the posterior fossa. These tumors tend to spread to other pas of the brain and to the spinal cord. Refer Robbins page no 1312


Question: Poland Syndrome is

Poland Syndrome is Congenital absence of Pectoralis major

Acquired Weakness and disuse atrophy of Pectoralis minor

Acquired Weakness and disuse atrophy of Pectoralis major


Question: Not a direct branch of aoa

ARCH OF AOA BRANCHES Arch of aoa is the continuation of the ascending aoa.It is situated in the superior mediastinum behind the lower half of the manubrium sterni. BRANCHES 1.Brachiocephalic aery which divides into the right common carotid and right subclan aeries. 2.Left common carotid aery 3.Left suclan aery REF.BDC VOL.1,FIFTH EDITION


Question: Coeliac plexus is located

The celiac plexus or coeliac plexus, also known as the solar plexus because of its radiating nerve fibers, is a complex network of nerves (a nerve plexus) located in the abdomen, near where the celiac trunk, superior mesenteric aery, and renal aeries branch from the abdominal aoa. ref - sciencedirect.com

Anteromedial to lumbar sympathetic chain

Posterolateral to lumbar sympathetic chain


Question: The common peroneal nerve can be rolled against the following pa of the fibula

COMMON PERONEAL NERVE:- Smaller terminal branch of sciatic nerve.Root value: dorsal division of ventral rami of L4,L5,S1,S2.Beginning: begins in back of thigh as a smaller subdivision of the sciatic nerve. Course:lies in upper lateral pa of popliteal fossa. It turns around the lateral surface of the fibula. Then it lies in the substance of peroneus longus muscle.Terminates by dividing into two terminal branches- superficial and deep peroneal. Commonest nerve to be paralysed.Causes of injury:1. Fracture neck of fibula.2. Lathi injury on lateral side of knee joint.3. Due to plaster on leg.- nerve get compressed between hard plaster and neck of fibula.To prevent this cotton must be placed on the upper lateral side of the leg. {Reference: BDC 6E}


Question: In management of thyroglossal cyst

Thyroglossal cyst is managed by Sistrunk operation in which the cyst is completely excised along with the thyroglossal tract. Since the thyroglossal tract is intimately related to the hyoid bone, the central poion of the hyoid bone is also removed. Ref : S. Das Op. Surgery 4/e p201


Question: Skin cancers develop due to sun light exposure induced by

Ref Robbins 7/e p323,9/e p324 Radiation, whatever its source (UV rays of sunlight, x-rays, nuclear fission, radionuclides) is an established carcinogen. Unprotected miners of radioactive elements have a 10-fold increased incidence of lung cancers. Follow-up study of survivors of the atomic bombs dropped on Hiroshima and Nagasaki disclosed a markedly increased incidence of leukemia--principally myelogenous leukemias--after an average latent period of about 7 years, as well as increased moality rates for thyroid, breast, colon, and lung carcino- mas. The nuclear power accident at Chernobyl in the former Soviet Union continues to exact its toll in the form of high cancer incidence in the surrounding areas. More recently, it is feared that radiation release from a nuclear power plant in Japan damaged by a massive eahquake and tsunami will result in significantly increased cancer incidence in the surrounding geographic areas. Therapeutic irradiation of the head and neck can give rise to papillary thyroid cancers years later. The oncogenic propeies of ionizing radiation are related to its mutagenic effects; it causes chromosome breakage, translocations, and, less frequently, point mutations. Biologically, double- stranded DNA breaks seem to be the most impoant form of DNA damage caused by radiation. The oncogenic effect of UV rays merits special mention because it highlights the impoance of DNA repair in car- cinogenesis. Natural UV radiation derived from the sun can cause skin cancers (melanomas, squamous cell carcino- mas, and basal cell carcinomas). At greatest risk are fair- skinned people who live in locales such as Australia and New Zealand that receive a great deal of sunlight. Non- melanoma skin cancers are associated with total cumula- tive exposure to UV radiation, whereas melanomas are associated with intense intermittent exposure--as occurs with sunbathing. UV light has several biologic effects on cells. Of paicular relevance to carcinogenesis is the ability to damage DNA by forming pyrimidine dimers This type of DNA damage is repaired by the nucleotide excision repair pathway. With extensive exposure to UV light, the repair systems may be overwhelmed, and skin cancer results. As mentioned earlier, patients with the inherited disease xeroderma pigmentosum have a defect in the nucleotide excision repair pathway. As expected, there is a greatly increased predisposition to skin cancers in this disorder.


Question: Morula reaches uterus at

Morula is 16 cell structure and reaches uterus by 4th day of feilisation. Soon divisions occurs and blastocyst is formed which is 64 celled structure by day 6.


Question: Tubocurarine action is easily reversed by


Question: depression with reverse vegetative symptoms is treated with MAOIMAOI

MAOI * IMPOANCE First class of antidepressant drugs that were introduced * MECHANISM There are three monoamines namely dopamine, adrenaline and serotonin. These mon amines are degraded by monoamine oxidase. MAOI inhibit this enzyme and acts increasing monoamines * DRUGS Phenelezine Tranylcipromine * USE ATYPICAL DEPRESSION, depression with reverse vegetative symptoms * SIDE EFFECTS Hypeensive crisis Cheese reaction When a patient on MAOI takes tyramine rich food like tyramine there will be increased release of monoamines. These excess monoamines cannot be degraded by MAO as it is blocked by MAOI. Thus, this may result in hypeensive crisis. Paresthesia's due to pyridoxine deficiency LIKE IPRONIAZID WEIGHT gain SEXUAL dysfunction Ref. kaplon and sadock, synopsis of psychiatry, 11 th dition, 925


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

Segmental anatomy of the liver Understanding the internal anatomy of the liver has greatly facilitated safe liver surgery. Couinaud, a French surgeon,described the liver as being divided into eight segments . Each of these segments can be considered as a functional unit, with a branch of the hepatic aery, poal vein and bile duct, and drained by a branch of the hepatic vein. It is the concept of these segments as distinct functional units that guides 'anatomical' liver resection. The overall anatomy of the liver is divided into a functional right and left 'unit'along the line between the gallbladder fossa and the middle hepatic vein (Cantlie's line). Liver segments (V-VIII) to the right of this line are supplied by the right hepatic aery and the right branch of the poal vein, and drain bile the right hepatic duct. To the left of this line (segments I-IV), functionally, is the left liver, which is supplied by the left branch of the hepatic aery and the left poal vein branch, and drains bile the left hepatic duct. Resections can be performed of indi- vidual segments or of the whole of the left or right hemiliver Ref: Bailey and love 27th edition Pg no :1153


Question: Most appropriate marker of GIST

Refer Robbins page no 789-790 Cd117 is the most impoant diagnostic marker is detectable in 95 percnt of the patients


Question: Anteversion of uterus is maintained by

(D) Round ligaments[?]POSITIONS OF UTERUS:Anteversion of uterus: Long axis of uterus is bent forward on long axis of vagina, In most women.Also, long axis of body of uterus is bent forward at level of internal as with long axis of cervix (anteflexion of uterus). Thus, in erect position and with bladder empty, uterus lies in an almost horizontal plane.Fundus and body of uterus are bent backward on vagina so that they lie in rectouterine pouch (pouch of Douglas). Uterus is therefore retroverted. If body of the uterus is, in addition, bent backward on cervix, it is also retroflexed.Angle of Anteflexion is 125degStructures assist in keeping the uterus in position:Sustainer structures: Urogenital diaphragm, Levator ani muscle, Perineal bodySuspensory Structures:Pubocervical ligament, Cardinal ligament (parametrium)Uterosacral ligamentRound ligament of UterusStructures assist in keeping the uterus in Antever- s ion-anteflexion:Cardinal ligament (parametrium):Supports Anteversion, the uterine angle between cervix & body.-Between Vagina & CervixRound Ligament of Uterus:Maintains Anteflexion of the uterus (a position where the fundus of the uterus leans ventrally).-During Pregnancy it gives support to the anteversion as well.Angle of Anteversion 90deg: Maintained by Round & uterosacral ligaments.It has even more significant role during pregnancy. When the uterus grows during pregnancy, the round ligaments can stretch causing pain.#. Position:!. Non pregnant uterus is within the pelvis.!. It is anteverted & anteflexed in position.!. Long axis of cervix is bent on long axis of vagina this is called Anteversion.!. Body of uterus is bent forwards over cervix at the isthmus and is known as Anteflexion.#. Pubocervical ligament:!. Attached Anteriorly to posterior aspect of body of pubis!. Passes to neck of bladder.!. Anterior fornix of vagina.!. Pubocervical ligaments help to maintain normal angle of 45deg between the vagina & horizontal.!. Decrease may cause a cystocoele.


Question: A person driving a vehicle is punishable if his alcohol level exceeds

In India, as per provisions of section 185 of Motor Vehicles act 1985 whoever while driving or attempting to drive, a motor vehicle, his blood alcohol exceeding 30 mg per 100 ml of blood detected in test by breath analyser shall be punishable with imprisonment of a term which may extend to 6 months or with fine which may extend 2000 rupees or with both. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 191


Question: Aerial supply to the head and neck of femur is

The medial circumflex femoral aery (internal circumflex aery, medial femoral circumflex aery) is an aery in the upper thigh that helps supply blood to the neck of the femur. Damage to the aery following a femoral neck fracture may lead to avascular necrosis (ischemic) of the femoral neck/head . Ref - BDC 6th edi vol 2 ; pg 13-15


Question: Sundar Lal 28 year old farmer is found convulsing in the farm. Hea rate is 100/min and blood pressure is 180/110mm Hg. Diarrhoea sweating and urination and Apparent. Pupils are pin point. Drug poisoning is suspected. Most probable cause is

Ref-KDT 6/e p104,105 Only symptoms are of antichlorinesterase poisoning accepted raised blood pressure and hea rate. At hugh dose,ACh can stimulates NN and NM receptor. This symptoms may occur due to the nicotinic action of ACh


Question: Lockwood ligament is found in

A i.e. Orbit - Hammock like check (suppo) ligament k/a suspensory ligament of Lockwood is found in orbit and it retains position of eye & prevent sagging.- Medial orbital wall is formed by body of sphenoid, frontal process of maxilla, lacrimal bone & orbital plate of ethmoidQ. (Mn Buffalo = BFLO).- Inferior orbital fissure lies between lesser wing floor and lateral wall (i.e. b/w maxilla & greater wing of sphenoid). Orbital floor is formed by palatine (orbital process), zygomatic bone & maxillail). Lateral orbital wall is formed by zygomatic (frontal process) & sphenoid (greater wing)Q.


Question: Parafolliculars gland of thyroid developed from

D. i.e. (Neural crest) (320 - I.B.S 8,h)* Derivatives of Endoderm = Glands(a) Endocrine: Thyroid, Parathyroid, Thymus , Islets of langerhans(b) Exocrine: Liver, Pancreas, Glands in wall of GIT, greater part of prostate (except inner glandular zone) and its female homologous* The superior parathyroid glands arise from caudal pharyngeal complex, the complex probably also gives origin to the parafollicular cells of the thyroid. Which may represent the ultimo branchial body of lower animals.*** "C- cells" parafollicuiars, constitute and endocrine system which are derived from neural crest and are found in thyroid, parathyroid and in thymus (544- Rana-shinde 7th)NEURAL -CREST - DERIVATIVES (273-74- IBS 8th)1. The neurons of the spinal posterior nerve root ganglia2. The neurons of the sensory ganglia of the 5, 7, 8, 9 and 10th cranial nerves.3. The Schwann cells that form the neurolemmal sheaths of all peripheral nerves4. The neurons of the sympathetic ganglia5. The specific cells of the adrenal medulla6. Chromaffin tissue7. The pigment cells (melanoblasts**) of the skin8. The pia mater and arachnoidmater are also, probably, derived from the neural crest9. The mesenchyme of the dental papillae (odontoblast**) Some diseases and syndromes are associated with disturbances of the Neural crestHirschsprung's disease (aganglionic megacolon**). Aorticopulmonary septal defects of heart. Cleft lip, cleft palate, frontonasal dysplasia, neurofibromatosis, tumours of adrenal medulla, albinism


Question: Eosinophil are activated by

ref Robbins 8/e p200; IL 5 is required for the development and maturation of eosinophil Through binding to the interleukin-5 receptor, interleukin 5 stimulates B cell growth and increases immunoglobulin secretion - primarily IgA. It is also a key mediator in eosinophil activation.


Question: Short gastric arteries reach the stomach via

(B) (Gastrosplenic ligament) (172-snell 7th)* Short gastric arteries- arises from the splenic artery ** at the hilum of the spleen and passes forward in the gastrosplenic omentum (ligament) to supply fundus1. Gastrosplenic ligamentContains short gastric vessels *2. Lino renal ligamentContains splenic vessels and tail of pancreas**3. Phrenico colic ligamentSupports anterior end of spleen and prevent its down ward displacement **** Massive colonic bleeding in a patients with Diverticulosis is from superior Mesentric arterySUPERIOR MESENTERIC SYNDROME (WILKIE'S syndrome!* Caused by compression of the third portion of the duodenum by the superior mesenteric artery, as it passes over this portion of the duodenum* Most commonly seen in young sthenic individuals with woman (w>m)* Predisposing factors- weight loss, supine immobilization scoliosis, placement of body cast (cast syndrome )* Symptoms- Nausea. Vomiting abdominal distension, weight loss , and post prandial epigastric pain* Diagosis-Barium upper GI series, Hypotonic duodenography* Operative treatment of choice for vascular compression of duodenum is - duodeno- jejunostomy


Question: In strasberg classification of bile duct injury, type C is

Strasberg classification of Laparoscopic Biliary injuries Type A- Bile leaks from minor ducts still in continuity with the CBD Includes leakage from cystic duct stump and from a subvesical duct of Luschka. MC cause of biliary leaks seen after cholecystectomy. Type B- Occlusion of a pa of the biliary tree, almost always an aberrant right sectoral duct Type C- Transection without ligation of an aberrant right sectoral duct. Type D- A lateral injury to an extrahepatic duct. Type E- Includes biliary strictures, divided into E1 to E5 as classified by Bismuth Ref: Sabiston 20th edition Pgno :1502

Bile leak from a minor duct still in continuity with CBD

Injury from bile duct not in communication with CBD

Sectoral duct injury with consequent leak

Circumferential injury to major bile ducts


Question: Nucleus intercalatus is seen in

Nucleus intercalates is present in the medulla at the level of olives between the dorsal nucleus of the vagus nerve (lateral to the intercalated nucleus) and the nucleus of the hypoglossal nerve. Probably involved in the control of the vestibuloocular reflex and may contribute to the veical neural integrator. (Ref: vishram Singh textbook of clinical neuroanatomy second edition pg 77)


Question: Vitamin used for post translational modification of glutamic acid to gamma carboxy glutamate is

Ref Robbins 9/e p442 ,119. The vitamin K-dependent carboxylase carries out the posttranslational modification of specific glutamate residues in proteins togamma-carboxy glutamic acid (Gla) in the presence of reduced vitamin K, molecular oxygen, and carbon dioxide.


Question: Commonest cause of Cushings syndrome is

In most cases, the cause is bilateral adrenal hyperplasia due to hypersecretion of pituitary ACTH or ectopic production of ACTH by a nonpituitary source.


Question: The tumor suppressor gene p 53 induces cell cycle arrest at

Ref Robbins 8/e p290-291 ,9/e p294 The cell cycle has its own internal controls called checkpoint, there are two main checkpoints ,one at the G2/S transition and another at G2/M In the G1/S checkpoint ,cell cycle arrest is mostly mediated through p53, which induces the cell cycle inhibitor p21 Arrest of the cell cycle by the G2/M checkpoint involves both p53 dependant mechanism As can be deduced from above mentioned information that the p53 is associated with both the types of checkpoint , however G2 /M checkpoint can take place even without p53.hence option" C" is the preferred anwers


Question: Pudendal canal is a pa of

The pudendal canal is an anatomical structure in the pelvis through which the internal pudendal aery, internal pudendal veins, and the pudendal nerve pass. The pudendal canal is a space between obturator fascia and the lunate fascia. Others believe that it is formed by splitting of the obturator fascia ref - BDC 6e vol2 pg362


Question: Flexor digitorum profundus muscle nerve supply is

-FDP nerve supply -medial half by ulnar nerve and lateral half by the anterior interosseous nerve- a branch of the median nerve. -reference: Textbook of anatomy ,Upper limb and thorax,Vishram Singh, 2nd edition, page no. 110


Question: Chronic granulomatous disease is

ref Harrison 18/e p 387 It is a congenital and not acquired leucocyte function defect CGD Overview. Chronic Granulomatous Disease (CGD) is an inherited primary immunodeficiency disease (PIDD) which increases the body's susceptibility to infections caused by ceain bacteria and fungi. Granulomas are masses of immune cells that form at sites of infection or inflammation.

Associated with formation of multiple granulomas


Question: Preformed antibiodies cause

Ref Robbins 9/e p233-234 Hyperacute Rejection Hyperacute rejection occurs within minutes to a few hours after transplantation in a presensitized host and typically is recognized by the surgeon just after the vascular anastomosis is completed. In contrast with a nonrejecting kidney graft, which regains a normal pink color and tissue turgor and promptly excretes urine, a hyperacutely rejecting kidney rapidly becomes cyanotic, mottled, and flaccid and may excrete only a few drops of bloody fluid. The histologic picture is characterized by widespread acute aeritis and aeriolitis, vessel thrombosis, and ischemic necrosis, all resulting from the binding of preformed antibodies to graft endothelium. Viually all aerioles and aeries exhibit char- acteristic acute fibrinoid necrosis of their walls, with narrow- ing or complete occlusion of the lumens by precipitated fibrin and cellular debris


Question: Memory T cells can be identified by using the following

Ref Harrison 17/e p2021 CD45 (lymphocyte common antigen) is a receptor-linked protein tyrosine phosphatase that is expressed on all leucocytes, and which plays a crucial role in the function of these cells. ... These CD45-associated molecules may play an impoant role in regulatingCD45 tyrosine phosphatase activity and function. Present on memory T cells


Question: Most effective method of treatment of digitalis toxicity is

Refer kDT 7/e p 516 Digoxin toxicity can emerge during long-term therapy as well as after an overdose. It can occur even when the serum digoxin concentration is within the therapeutic range. Toxicity causes anorexia, nausea, vomiting and neurological symptoms. It can also trigger fatal arrhythmias. There is a range of indications for using digoxin-specific antibody fragments. The amount ingested and serum digoxin concentration help to determine the dose required, but are not essential. Digoxin-specific antibody fragments are safe and effective in severe toxicity. Monitoring should continue after treatment because of the small risk of rebound toxicity


Question: Following pattern in DNA electrophoresis is seen in


Question: The histological feature of shock includes

All the four options is the answer Ref Robbins 7/e p142,9/e p134 Shock is characterized by failure of multiple organ systems.due to systemic hypoperfusioncaused by reduced cardiac output Or ineffective circulatory blood volume The cellular and tissue effects of shock are essentially those of hypoxic injury (Chapter 1) and are caused by a combina- tion of hypoperfusion and microvascular thrombosis. Although any organ can be affected, brain, hea, kidneys, adrenals, and gastrointestinal tract are most commonly involved. Fibrin thrombi can form in any tissue but typically are most readily visualized in kidney glomeruli. Adrenal cor- tical cell lipid depletion is akin to that seen in all forms of stress and reflects increased utilization of stored lipids for steroid synthesis. While the lungs are resistant to hypoxic injury in hypovolemic shock occurring after hemorrhage, sepsis or trauma can precipitate diffuse alveolar damage (Chapter 12), leading to so-called shock lung. Except for neuronal and cardiomyocyte loss, affected tissues can recover completely if the patient survives.


Question: Subcapsular sinuses are seen in

Subcapsular sinuses are seen in lymph node INDERBIR SINGH'S TEXTBOOK OF HUMAN HISTOLOGY SEVENTH EDITION PAGE NO133


Question: Most impoant bactericidal agent is

H2O2 -MPO - halide system is the most efficient bacterial system of neutrophils It is most efficient in Phagocytosis ref Robb ins 9/e p79


Question: Deep vein thrombosis is more common after

The factors which result in increased risk of venous thrombosis include advancing age and greater complexity of surgical treatment. Ohopedic operations on the lower limbs (hip and knee replacements) are especially likely to result in venous thrombosis." - Bailey & Love Ref : Bailey & Love 24/e p969


Question: The most common cause of pulmonary embolism is

About half of the patient with pelvic vein thrombosis or proximal leg deep vein thrombosis have pulmonary thromboembolism. Isolated calf vein thrombosis pose a lower risk of pulmonary embolism. The majority of pulmonary emboli arise from the propagation of lower limb deep vein thrombosis (p. 186). Rare causes include septic emboli (from endocarditis affecting the tricuspid or pulmonary valves), tumour (especially choriocarcinoma), fat following fracture of long bones such as the femur, air, and amniotic fluid, which may enter the mother's circulation following delivery. Ref Davidson edition23rd pg 620


Question: Caudate lobe of liver is

The caudate lobe of the liver is bounded below, by the poa hepatis; on the right, by the fossa for the inferior vena cava; and, on the left, by the fossa for the ductus venosus and the physiological division of the liver called the ligamentum venosum. It looks backward, being nearly veical in position; it is longer from above downward than from side to side and is somewhat concave in the transverse direction. ref - BDC 6e vol2 pg304-307


Question: Iron deficiency anemia is

Cell membrane matyration lags behind the nucleur maturation leading to microcytic appearance


Question: NK cells express

Ref Robbins 8/e p188 ;9/e p192 NK cells (belonging to the group of innate lymphoid cells) are defined as large granular lymphocytes (LGL) and constitute the third kind of cells differentiated from the common lymphoid progenitor-generating B and T lymphocytes. NK cells are known to differentiate and mature in the bone marrow, lymph nodes, spleen, tonsils, and thymus, where they then enter into the circulation. NK cells differ from natural killer T cells (NKTs) phenotypically, by origin and by respective effector functions; often, NKT cell activity promotes NK cell activity by secreting interferon gamma. In contrast to NKT cells, NK cells do not express T-cell antigen receptors(TCR) or pan T marker CD3 or surface


Question: Most common anatomocal lesion of tongue cancer is

Most of 60-70percent of cancer arise from lateral surface of middle third of tongue


Question: An arrow mark or bird foot mark on the centre of head suggest it is

If the head is triangular and covered with small scales, it may be poisonous(viper). If there is an arrow mark or bird foot mark on the centre of the head, it is poisonous (saw scaled viper) Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 511


Question: Increasing severity of mental retardation in male members over generations is a result of

Ref Robbins 8/e p169-171; 9/e p169 Triplet Repeat Mutations: Fragile X Syndrome Fragile X syndrome is the prototype of diseases in which the causative mutation occurs in a long repeating sequence of three nucleotides. Other examples of diseases associated with trinucleotide repeat mutations are Huntington disease and myotonic dystrophy. About 40 diseases are now known to be caused by this type of mutation, and all dis- orders discovered so far are associated with neurodegen- erative changes. In each of these conditions, amplification of specific sets of three nucleotides within the gene disrupts its func- tion. Ceain unique features of trinucleotide repeat muta- tions, described later, are responsible for the atypical pattern of inheritance of the associated diseases. Fragile X syndrome results from a mutation in the FMR1 gene, which maps to Xq27.3. The syndrome gets its name from the karyotypic appearance of the X chromosome inthe original method of diagnosis: Culturing patient cells in a folate-deficient medium typically revealed a discontinuity of staining or constriction in the long arm of the X chromosome. This method has now been supplanted by DNA-based analysis of triplet repeat size as discussed later. With a frequency of 1 in 1550 for affected males and 1 in 8000 for affected females, fragile X syndrome is the second most common genetic cause of mental retardation, after Down syndrome. Clini- cally affected males have moderate to severe mental retar- dation. The characteristic physical phenotype includes a long face with a large mandible, large eveed ears, and large testicles (macroorchidism). Although characteristic of fragile X syndrome, these abnormalities are not always present or may be quite subtle. The only distinctive physi- cal abnormality that can be detected in at least 90% of postpubeal males with fragile X syndrome is macroorchidism. As with all X-linked diseases, fragile X syndrome pre- dominantly affects males. Analysis of several pedigrees, however, reveals some patterns of transmission not typi- cally associated with other X-linked recessive disorders (Fig. 6-17). These include the following: * Carrier males: Approximately 20% of males who, by ped- igree analysis and by molecular tests, are known to carry a fragile X mutation are clinically and cytogeneti- cally normal. Because carrier males transmit the trait through all their daughters (phenotypically normal) to affected grandchildren, they are called normal transmit- ting males.


Question: Drug of choice for mycoplasma pneumonia is

Treatment options for acute M.pneumoniae infection include macrolides (e.g., oral azithromycin, 500 mg on day 1, then 250 mg/d on days 2-5), tetracyclines (e.g., oral doxycycline, 100 mg twice daily for 10-14 days), and respira-tory fluoroquinolones Ref Davidson edition23rd pg 585


Question: The subarachnoid space ends at

Arachnoid & dural sheath end at the lower end of the S-2 veebra. Subarachnoid space terminates at the caudal (lower border) S-2 veebra. This is also the ending of the sub-dural space. Ref - BDC 6thedition vol 2


Question: for diagnosisng bulimia nervosa binge eating should be present for a dutration of

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: Chief cells of stomach are most abundant in

Cheif cells are present in fundic areas . ref - semantischolar.org


Question: Best prognosis after whipple's is seen in

Best prognosis : Duodenal adenocarcinoma >Ampullary carcinoma >Distal Bile duct adenocarcinoma >Head of pancreas >Body and tail of pancreas (DAD Head Body and Tail) Ref: Shackelford 7th edition Pgno : 1201


Question: Central obesity is seen in;

Among given options Central obesity is seen in Cushing's disease. CUSHING'S DISEASE: Form of Cushing's syndrome in which pituitary gland releases too much of ACTH Features of Cushing's syndrome: Moon facies Centripetal Obesity Proximal myopathy Violet/ purple Striae, Thin skin, Purpura Buffalo hump Weight gain / Lemon on sticks description | Peripheral resistance - HTN Insulin resistance - sugar FBS > 126 mg%; 2hr > 200 mg% Coisol | - Activates ENaC - causes salt & water retention; Hypokalemic alkalosis Coisol | - Activates Sex steroid receptors Female - Hirsutism, weight gain, oligomenorrhea, infeility Hyperpigmentation: (+-)


Question: Selective beta 2 agonist is

Pirbuterol is a beta 2 agonist like salbutamol used for COPD and asthma. Ref: KDT 6th ed pg 129-132


Question: Best investigation for air in peritoneal cavity is

free gas under the diaphragm is best shown on an erect chest x-ray or x ray abdomen. If the patient is too ill for an erect film, a lateral decubitus film is done.


Question: Mucinous ascites is seen in

Mucinous ascites is seen in pseudomyxoma peritonei colloid ca of stomach or colon with peritoneal implants


Question: Feature of shock lung is

In ARDS, the presence of alveolar and interstitial fluid and the loss of surfactant can lead to a marked reduction of lung compliance. Without an increase in end-expiratory pressure, significant alveolar collapse can occur at end-expiration,with consequent impairment of oxygenation. Ref Davidson edition23rd pg 199


Question: Most commonly lesioned nerve in intracranial aneurysms is

Intracranial aneurysm may involve oculomotor, abducent and optic nerve in descending order Trochlear nerve is involvement is higher in head trauma. Ref: Gray's 39e/p-227


Question: The obstruction of two or more major hepatic veins is seen in

Budd-Chiari syndrome It is caused by obstruction of hepatic venous outflow producing intense congestion of the liver Etiology Polycythemia rubra Vera is the most common etiology In the West, thrombosis of the major hepatic veins is more common In BCS all three major hepatic veins usually are occluded Small hepatic veins that join the retro hepatic IVC, paicularly veins draining the caudate lobe are spared Membranous obstruction of IVC is the most common cause of BCS in Japan, China, India and South Africa Infections causing BCS : Filariaisis, amebic liver abscess, aspergillosis, schistosomiasis, syphilitic gumma and hydatid disease Most common cancer associated with BCS : HCC, RCC, adrenal carcinoma and leimyosarcoma of IVC Clinical features Characterized by triad of Ascites+Hepatomegaly+ abdominal pain (Asha) Abdominal pain, abdominal distension, weakness, anorexia and jaundice Signs are massive ascites, hepatomegaly (with hyperophied Caudate lobe), wasting, abdominal venous distension, splenomegaly, jaundice and edema of thighs, legs and feet Jaundice and abdominal venous distension is more common in hepatic vein occlusion Edema of thighs, legs and feet is seen only in IVC occlusion Striking and progressive weakness occur as a manifestation in acute form but not in cirrhotic forms of BCS Ref: Schwaz's principle of surgery 10th edition Pg no : 1283-1284


Question: Trachea is lined by

Ciliated columnar epithelium is seen in trachea and bronchus Inderbir Singh&;s textbook of human Histology Seventh edition Pg no 45


Question: Rider's bone ossify in the

In horse riders, the rounded tendon of adductor longus frequently gets calcified as a result of its friction together with the horseback. This calcified tendon is named rider's bone.Reference: Chaurasia Volume II; 7th edition; Page no: 41


Question: The membranous pa of the atrioventricular pa of interventricular septum is between

Inderbir Singh&;s Human embryology; Tenth edition; Pg 244The membranous pa of the interventricular septum is divisible into an anterior pa which separates the right and left ventricle and a posterior pa which separates the left ventricle from the right atrium ( also called interventricular septum).


Question: ECT is contraindicated in

Raised intracranial pressure is the only absolute contraindication for ECT


Question: The function of common neutrophils ,monocytes, macrophages is

Ref Robbins 9/e p97 phagocytosis is a major mechanism used to remove pathogens and cell debris. The ingested material is then digested in the phagosome. Bacteria, dead tissue cells, and small mineral paicles are all examples of objects that may be phagocytized. Some protozoa use phagocytosis as means to obtain nutrients The common function of neutrophil ,monocytes and macrophages is phagocytosis it's the most common function


Question: The weakness of Vastus Medialis causes

The fibers of Vastus medialis are attached medial to cafue half of patella. They prevent lateral displacement of patella.


Question: Common carotid aery divides at the level of

At the level of the upper border of the thyroid cailage, the aery ends by dividing into the external and internal carotid aeries. The right common carotid aery is a branch of the brachiocephalic aery. the left common carotid aery is branch of the arch of the aoa. Ref.BDC volume 3 sixth edition pg no: 99


Question: Abdominal pa of esophagus is supplied by

AERIAL BLOOD SUPPLY TO ESOPHAGUS: Cervical pa of esophagus Esophageal branches of inferior thyroid aery. Thoracic pa of esophagus PICA (posterior Inter costal aery) (Branch of descending Thoracic aoa) + Bronchial aeries. Abdominal pa of esophagus Left gastric aery (Branch of Celiac trunk) + Inferior phrenic aery (Branch Of abdominal aoa)

Right gastric aery and inferior phrenic aery

Left gastric aery and inferior phrenic aery


Question: The Y chromosome carries a gene on its sho arm that codes for

The SRY (sex region Y chromosome) gene present on the sho arm of the Y chromosome codes for TDF (Testes Determining Factor). Presence or absence of this chromosome decides whether the fetus will be male or female. Sex determination is not possible till week 6 i.e. why the embryo is called indeterminate embryo till week 6. External sex differentiation completes after week 11. USG sex determination can be done at this time.

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


Question: Dose limiting toxicity of amphotericin B is

Ref-KDT 6/e p759 Amphotericin B can Cause: Dose limiting nephrotoxicity (A) Infusion related reactions (not dose related) Hypokalemia Hypomagnesenia


Question: NOT a content of carpal tunnel

Carpal tunnel Contents - 1. 4 tendons of Flexor Digitorum Profundus (FDP) 2. 4 tendons of Flexor Digitorum Superficialis (FDS) 3. 4 tendons of Flexor Pollicis Longus (FPL) 4. Median nerve Structure passing anterior to carpal tunnel: 1. Ulnar nerve 2. Ulnar aery 3. Palmaris longus tendon. Structure embedded into flexor retinaculum Flexor carpi radialis tendon.


Question: Structure superficial to mylohyoid in anterior digastric triangle is/are

Structures passing superficial to mylohyoid: Submandibular gland (superficial pa) Mylohyoid nerve and vessels Submental branch of facial vein & aery Submandibular lymph nodes.


Question: The following is not a feature of Alzheimer's disease


Question: Posterior cord of brachial plexus is formed by

Cords of brachial plexus are formed by : (i) The lateral cord - It is formed by the union of the ventral divisions of the upper and middle trunks. (ii) The medial cord - It is formed by the ventral division of the lower trunk. (iii) The posterior cord -It is formed by union of the dorsal divisions of all the three trunks. Ref : B D Chaurasia's Human Anatomy , seventh edition , volume 1 , pg. no., 57.

Ventral division of upper, middle and lower trunk

Dorsal division of upper, middle and lower trunk


Question: The drug of choice for chemoprophylaxis for H.influenzae is


Question: Follicular carcinoma of thyroid is

Follicular cancer of the thyroid 20% of thyroid malignancies More common in iodine-deficient areas Clinical featuresTreatmentPredisposed by long-standing multinodular goiterHematogenous metastasis is more common than lymph nodal metastasis. Pulsatile secondaries may be seen in skull, ribs, pelvis. Malignancy is defined by the presence of capsular and vascular invasion. Hence FNAC cannot differentiate between follicular adenoma and carcinoma Follicular tumors>4 cm size are more likely to be malignant. Follow up can be done using I123 scan or by thyroglobulin estimation. Thyroglobulin levels in patients who have undergone total thyroidectomy should be below 2 ng/ml. Total thyroidectomyProphylactic nodal dissection is not needed because nodal involvement is infrequentIf nodal involvement is seen functional block dissection must be done. If FNAC shows follicular adenoma; lobectomy is enough because 80% of cases are benign. If the biopsy repo becomes positive for malignancy based on angio or capsular invasion. Total thyroidectomy must be done I131 therapyExternal beam RadiotherapyChemotherapy: Adriamycin and taxanes (Refer: Schwaz's Principles of Surgery, 9th edition, pg no: 1363-1365)


Question: Best site for taking biopsy for viral esophagitis is

Refer Robbins page no 768 Herpes virus typically cause punched out ulcers the nuclear inclusions of herpes virus arr found in a narrow rim of degenerating epithelial cells at the margin of ulcer For biopsy should be taken from edge of ulcer in HSV and base of ulcer in CMV


Question: Not an inverter of foot is

Inverters of foot are

Tibialis anterior
Tibialis posterior
Flexor digitorum longus


Question: Nerve involved in Guyon&;s canal syndrome is

Guyon&;s canal is formed by the pisiform and hamate and the ligament that connects them. The ulnar nerve and ulnar aery run through the tunnelGuyon&;s canal syndrome is also known as handlebar palsy (seen in cyclists)


Question: Somatic efferent does not include

Somatic efferent nerves, also called as general somatic efferent (GSE) nerves, supply skeletal muscle of somatic origin ( muscles of eye and tongue).
Somatic efferent nerves include,

Oculomotor nerve - 3rd nerve
Trochlear nerve - 4th nerve
Abducent nerve - 6th nerve
Hypoglossal nerve - 12th nerve


Question: Middle meningeal aery is a branch of

First pa of maxillary aery 1.deep auricular 2.anterior tympanic 3.middle meningeal 4. Accessory meningeal 5.inferior alveolar Second pa of maxillary aery 1.masseteric 2.deep temporal 3.pterygoid 4.buccal Third pa of maxillary aery 1.posterior superior alveolar 2.infraorbital 3.greater palatine 4.pharyngeal 5. Aery of pterygoid canal 6.spenopalatine Ref BDC volume 3;sixth edition pg 119


Question: Interosseous recurrent aery is a branch of

Posterior interosseous aery originates from common interosseous branch of ulnar aery. It gives a branch - recurrent interosseous aery to the vascular network around the elbow joint. Ref : Gray's Anatomy The Anatomical Basics of Clinical Practice 41 e pg 778.


Question: The best prognosis is gastric carcinoma is in type

Reference p772-773 The Stomach cancer, also known as gastric cancer, is a cancer that develops from the lining of the stomach. Early symptoms may include heaburn, upper abdominal pain, nausea and loss of appetite. Later signs and symptoms may include weight loss, yellowing of the skin and whites of the eyes, vomiting, difficulty swallowing and blood in the stool among others Prognosis Five-year survival rate < 10% (globally),28% (US), 65% (S. Korea


Question: The left recurrent laryngeal nerve recurs around the

Early in embryological development, both the right and left recurrent laryngeal nerves hook (recur) around aoic arch 6. The left aoic arch 6 persists as the ductus aeriosus(distal pa) while proximal pa of it forms pulmonary aery. 6TH phyrangeal arch derivatives:- Nerve-reccurent laryngeal nerve Aery- pulmonary aery (and ductus aeriosus) Muscles - all muscles of larynx except cricothyroid.


Question: Hyperglycemia Associated with

The clinical manifestations resulting from the production of metabolic active substance by neoplastic tissue,have been labelled paraneoplastic syndrome.adolescent patients with osteosarcoma Demonstrate abnormal growth hormone ,insulin,growth hormone response to oral glucose loading in78% of the study population No statistical association exists between any of the two or three factors There fore no primary abnormality can be identified high somatomedin levels were noted 72%of group study accompanied by Simultaneous elevation of Growth hormone Study adrenal ,gonadal, gonadotropic hormone were essentially normal thrreby ruling these out as endocrine abnormalities Hyperglycemia is also aAssociated with condrosarcoma and fibrosarcoma


Question: A man was brought to the emergency after meeting with an accident and injured his perineum He gets our urge to micturate but its yuable to pass urine Ole blood was Sti at the tip of urethra and swelling of penis and scrotum


Question: Hyper viscosity is seen in

Ref William hematology 6/e p1268 The term cryoglobulinemia refers to the presence in the serum of proteins that precipitate at temperatures below 37 degrees C and redissolve on rewarming. ... The elective treatment for hyperviscosity syndrome, whether associated with monoclonal, mixed, or polyclonalcryoglobulinemia, is plasma exchange.


Question: Hyoid bone is closely associated with

Hyoid bone is closely associated with the thyroglossal tract from which thyroglossal cyst & fistula originate, thus during surgical excision of the thyroglossal cyst or fistula, the central pa of the hyoid bone is excised (otherwise recurrence may occur). Ref : Bailey Love 25/e p730


Question: Causes for reduced bioavailability include

Ref-KDT 7/e p18 the causes of low availability are reduced absorption highfirst pass metabolism


Question: A 88year old male patient presented with endstage renal disease with coronary Aery block and metastasis in the lungs. Now presents with acute cholecystitis, patients relatives need treatment to do some thing

Tube cholecystectomy If patients are unfit for surgery, per cutaneous, ultrasound guided or CT guided cholecystectomy is the treatment of choice Ref: Sabiston 20th edition Pgno :1496

Antibiotics then elective cholecystectomy


Question: Tonsil is formed from

Second Pouch(a) The epithelium of the ventral pa of this pouch contributes to the formation of the tonsil.(b) The dorsal pa takes pa in the formation of the tubotympanic recess.Reference: Inderbir Singh Embryology; 10th edition; Page no: 135


Question: Length of adult trachea

Trachea is 10-15 cm length. <img src=" /> BD CHAURASIA'S HUMAN ANATOMY VOLUE1 .6 TH EDITION. PAGE NO 281


Question: The posterior 1/3 of the tongue is supplied by....nerve


Question: Appropriate treatment for the mild congenital ptosis;

Treatment of Congenital ptosis In severe ptosis, surgery should be performed at the earliest to prevent stimulus deprivation amblyopia. In mild and moderate ptosis, surgery should be delayed until the age of 34 years, when accurate measurements are possible. - Congenital ptosis can be treated by any of the following operations: Tarso-conjunctivo - Mullerectomy (Fasanella-Servat operation). It is performed in cases having mild ptosis (1.5-2 mm) and good levator function. In it, upper lid is eveed and the upper tarsal border along with its attached Muller's muscle and conjunctiva are resected. Levator resection. It is a very commonly performed operation for moderate and severe grades of ptosis It is contraindicated in patients having severe ptosis with poor levator function. Techniques: Levator muscle may be resected by either conjunctival or skin approach. Conjunctival approach (Blaskovics' operation) Skin approach (Eversbusch's operation) 3. Frontalis sling operation (Brow suspension). This is performed in patients having severe ptosis with no levator function.


Question: Opening of jaw is done by

Lateral pterygoid is sho, conical, and has upper and lower heads. The lateral pterygoid: - depress mandible to open mouth, with suprahyoid muscles. - protrudes mandible - right lateral pterygoid turns the chin to left side.


Question: The cailage of A is

The epiglottis is a leaf-shaped elastic cailage situated behind the root of the tongue.


Question: Lacrimal punctum of upper and lower eyelid is

Each lacrimal canaliculus begins at the lacrimal punctum and is 10 mm long.it has a veical pa which is 2mm long and a horizontal pa which is 8 mm long. There is a dilated ampulla at the bend,both canaliculi open close to the each other in the lateral wall of the lacrimal sac behind the medial palpebral ligament. ref.BDC volume 3;sixth edition pg 76


Question: The interossei are supplied by

Deep palmar arch is formed mainly by terminal pa of the radial aery and is completed medially at the base of fifth metacarpal bone by the deep palmar branch of the ulnar aery. Superficial palmar branch of radial aery joins with the ulnar aery laterally to form a superficial palmar arch which supplies the digits. Deep palmar branch of ulnar aery joins with the radial aery to form deep palmar arch and supplies interossei muscles. BD Chaurasia 7th edition Page no: 126,127


Question: Predominant blood supply to the supraduodenal bile duct is derived from

Blood supply of supraduodenal bile duct Axial Blood supply: (98%) The most impoant of these vessels run along the lateral borders of the bile duct and are called the &;3 o clock &; and &;9 o clock&; aeries. 60% of the blood supply occurs from the duodenal (caudal) end of the duct primarily from branches of the retroduodenal aery (posterior superior pancreaticoduodenal aery). 38% of the blood supply occurs from the hepatic (cephalic) end of the right hepatic aery. Non-axial blood supply: only 2% of blood supply to the supraduodenal bile duct from the branches of the hepatic aery proper. Ref: Gray&;s Anatomy 41st edition Pgno: 1176

Vessels that run upward along the bile duct from the duodenal end of the duct such as the retroduodenal and the gastroduodenal aeries retro

Vessels that run downward along the bile duct from the hepatic and of the duct as the right hepatic aery

Vessels that arise from the hepatic aery proper as it runs up along the common bile duct and supplies it with twigs in a non-axial distribution


Question: The structure not passing through the aoic opening of the diaphragm is

The vagal trunk does not pass through the aoic opening of the diaphragm. It passes through the esophageal opening at the level of T10 veebrae. Major openings through the diaphragm Level of opening T8 T10 T12 Located in In the central tendon In the muscular pa In the crus of the diaphragm Structures passing through Inferior venacava Right Phrenic nerve Oesophagus Vagus nerve-right and left Aoa Thoracic duct Azygous vein Hemiazygous vein Ref: Gray's Anatomy 41st edition Pgno: 899


Question: Iliofemoral ligament arise from

ILIOFEMORAL LIGAMENT:- Inveed Y shaped ligament of Bigelow.Lies anteriorly One of the strongest ligament.Triangular in shape. Attachments:-Apex: lower half of anterior inferior iliac spine. Base: interochanteric line. Action: prevent trunk from falling backwards in standing posture. Fibres:-Upper oblique and Lower veical fibres form thick and strong bands.Middle fibres: thin and weak. {Reference: BDC 6E pg no.137}


Question: Trendelenburg test is positive on right side. Nerve injured is

Superior gluteal nerve, if injured, paralyses the 3 muscles: gluteus medius, gluteus minimus and tensor fascia latae and hence lead to Trendelenberg test positive, which is evident on the contralateral side. Pelvis sags on the unsuppoed lower limb. In Trendelenberg test the action of gluteus medius (superior pelvic tilt of contralateral hip) is absent and we actually observe that there is a downward drop of the unsuppoed hip -due to unopposed action of gravity. This leads to Lurching gait in the patient.


Question: Brunner's gland is a histological finding of

Brunner's gland is a histological finding of duodenum which is present in submucosa which secretes mucus which is alkaline in nature and neutralises the acid in duodenum so that enzymes could work at their optimum pH.It also heals the ulcer by increasing mitotic activity. Peyer patches or Lymphoid follicles seen in Lamina propria.


Question: Branch of pharmacology that deals with medicinal drugs that are obtained from plants and other natural resources are known as


Question: Defective fumarylacetoacetate hydrolase enzyme is associated with

Defective fumarylacetoacetate hydrolase enzyme is associated with type I tyrosinemia (tyrosinosis). it is the most common type of tyrosinemia. Therapy employs a diet low in tyrosine and phenylalanine and nitisinone (NTBC). Reference: Harpers illustrated biochemistry 30th edition


Question: Dorsiflexion of ankle joint is by

Muscles producing movements of ankle - A. Dorsiflexion : Tibialis anterior is the principal muscle,(Extensor digitorum anterior longus, Extensor hallucis longus,Peroneus teius are the accessory muscles) B. Plantar flexion : Gastrocnemius and Soleus are the principal muscles ( plantaris, Tibialis posterior, Flexor hallucis longus, Flexor digitorum longus are the accessory muscles) Ref : B D Chaurasia's Human Anatomy , seventh edition , volume 2 , pg. no. 161 ( table 12.3 )


Question: The upper half of the esophagus in lined by

INDERBIR SINGH'S TEXTBOOK OF HUMAN HISTOLOGY-PAGE NO:263 The mucosa The mucous membrane of the oesophagus shows several longitudinal folds that disappears when the tube is distended The mucosa is lined by stratified squamous epithelium which is normally not keratinized

Stratififed squamous non keratinsed epithelium

Stratififed squamous keratinised epithelium


Question: The nerve piercing sphenomandibular ligament is

Nerve to mylohyoid pierces sphenomandibular ligament.


Question: Bones ossified at bih

Secondary centers around knee joint ( distal femur and proximal tibia) appear during last weeks of intrauterine life (or immediately after bih) Primary center of all tarsal bones (except talus, calcaneus and cuboid) appear after bih Ref: Gray's39e/p185-210


Question: Components of acellular peussis vaccine

aP Avoids neuro side effects of whole cell peussis but less immunogenic


Question: Hatter's shake or glass blower's shake seen in

Mercurial Tremors The hands are first affected. there will be tremors of the hands called Danbury tremors. It may progress to lips, tongue, arms, and legs. The tremors are moderately coarse and intentional to sta with and are interspersed by jerky movements. The advanced condition is called hatter's shake or glass blower's shake. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 428


Question: Coronary vein is


Question: Root value of medial cutaneous nerve of thigh

The medial cutaneous nerve of the thigh (L2, L3) - It is a branch of the anterior division of the femoral nerve. It divides into anterior and posterior divisions. The nerve supplies the skin on the medial side of the lower two thirds of the thigh, and of the upper one-third of the leg. Ref : B D Chaurasia's Human Anatomy , seventh edition , volume 2, pg. no., 45.


Question: Most radiosensitive tumor is

Ref Robbins 8/e p989 In general, radiation therapy is mainly used for patients with seminoma, which is very sensitive to radiation. Sometimes it's used after orchiectomy (the operation to remove the testicle) and is directed at the lymph nodes at the back of the abdomen (the retroperitoneal lymph nodes). This is to kill any tiny bits of cancer in those lymph nodes that can't be seen. It can also be used to treat small amounts of seminoma that have spread to the nodes (based on changes seen on CT and PET scans).


Question: Characterisic microscopic features of Osteogenic sarcoma is

Osteoid formation by Mesenchymal cells with large Pleomorphism Ref :Robbins 8th/1226

Osteoid formation by Mesenchymal cells with pleomorphism


Question: Collecting tubules of human kidney originate from


Question: Zafirlukast used in asthmatic patients acts by

Drugs for Bronchial AsthmaMechanism of actionDrugsBronchodilators b2 sympathomimetics Salbutamol, Terbutaline, Bambuterol, Salmeterol, Formoterol, Ephedrine Methylxanthine Theophylline, Aminophylline, Choline theophyllineAnticholinergics Ipratropium bromide, Tiotropium bromide Leukotriene antagonist Montelukast, Zafirlukast Mast cell stabilizers Sodium cromoglycate, Ketotifen Coicosteroids Systemic Hydrocoisone, Prednisolone Inhalational Beclomethasone, Budesonide, Fluticasone, Flunisolide, Ciclesonide Anti IgE antibody Omalizumab (Refer: Rang and Dale's Clinical Pharmacology, 7th edition, pg no: 345)


Question: Dose of radiation per study in mammography is


Question: The roots and trunks enter the posterior triangle of the neck by passing

The roots and trunks enter the posterior triangle of the neck by passing between the anterior scalene and middle scalene and lie posterior & superior to subclavian Artery.

Between the anterior scalene and middle scalene muscles

Between the middle scalene and posterior scalene muscles

Posterior and inferior subclavian Artery


Question: A 35 year old athlete has height 184 cm , arm span 194 cm, pulse rate 64/min , BP 148/64 mm Hg . Chest auscultation reveals long Diastolic murmur over right 2nd intercostal space on routine examination. The probable diagnosis is

Ref Harrison 19 th ed pg 1536 Arm span greater than height is suggestive of MarfansM syndrome. Aoic regurgitation is a feature associated with Marfan's as well as consistent with a diastolic murmur is second right intercostal space.


Question: VIII cranial nerve affects

The vestibulocochlear nerve consists of two divisions: cochlear and vestibular.Cochlear nerve innervate the organ of Coi and is associated with hearingVestibular nerve innervates the vestibular receptors in the semicircular ducts(kinetic balance) and in the utricle and saccule(for static balance) in the ear.(Ref: Vishram Singh textbook of clinical neuroanatomy second edition pg- 103)


Question: Dorello canal transmitts

Dorello's Canal is the bow-shaped bony enclosure surrounding the abducens nerve and the inferior petrosal sinus as the two structures merge with the cavernous sinus. This canal is named after the famous Italian anatomist Primo Dorello, who proved the existence of this canal after a series of meticulous dissections . Ref - pubmed.com

Superior alveolar branch of maxillary nerve


Question: Action of Lumbricals is

Action of Lumbricals is Flexion at Metacarpo - phalangeal joint and extension at Interphalangeal joint.

Flexion at Metacarpo - Phalangeal joint and flexion at Interphalangeal joint

Extension at Metacarpo - Phalangeal joint and extension at Interphalangeal joint

Flexion at Metacarpo - Phalangeal joint and extension at Interphalangeal joint

Extension at Metacarpo - Phalangeal joint and flexion at  Interphalangeal joint


Question: I time required to reach the steady state after a dosage regimen depends on

after a dosage regimen, concentraton of the drug to reach the stead state (when the eliminaton balances the input) is called steady state plasma concentration cpss cpss is reached in about 4-5 half lives. the amplitule fluctuations in Cpss depends on the dose interal relative t1/2 Ref-KDT 6/e p32


Question: Structure derived from first pharyngeal arch

Ref:- Keith L. Moore -The Developing Human 9th Edition; Pg num:- 165


Question: Ground glass appearance is seen in

Refer Robbins page no 1231 8th edition The lesions of fibrous dysplasia are well circumscribed, intra- medullary, and vary greatly in size. Larger lesions expand and disto the bone. The lesional tissue is tan-white and gritty and is composed of curvilinear trabeculae of woven bone sur- rounded by a moderately cellular fibroblastic proliferation. The curvilinear shapes of the trabeculae mimic Chinese characters, and the bone lacks prominent osteoblastic rimming (Fig. 26-38). Nodules of hyaline cailage with the appearance of disorga- nized growth plate are also present in approximately 20% of cases. Cystic degeneration, hemorrhage, and foamy macro- phages are other common findings.


Question: Haemolytic disease of newborn is an example of

Ref Robbins 7/e p211,9/e p206 Autoimmune hemolytic Anemia Red cell membrane proteins (Rh blood group antigens, I antigen) Opsonization and phagocytosis of erythrocytes Hemolysis, anemia Autoimmune thrombocytopenic purpura thrombocytopenic Platelet membrane proteins (GpIIb/IIIa integrin) Opsonization and phagocytosis of platelets..leads to bleeding..type 2 hypersensitivity reaction


Question: Fibromuscular stroma is present in

Fibromuscular stroma occupies the anterior surface of the prostate gland anterior to the urethra and is composed of dense irregular connective tissue with a large number of smooth muscle fibersReference: Chaurasia; 6th edition


Question: Most sensitive and specific test for diagnosis of iron deficiency is

Ref Harrison 19 th ed pg 627,628 Under steady-state conditions, the serum ferritin level correlates with total body iron stores; thus, the serum ferritin level is the most convenient laboratory test to estimate iron stores. The normal value for ferritin varies according to the age and gender of the individual


Question: More than 90% of this drug is excreted in the urine intact form. Because its urinary solubilities low, patient should be well hydrated to prevent nephrotoxicity.the drug is

Ref-KDT 6 /769 Both indinavir and acyclovir can cause nephrotoxicity and renal stone formation.but indinavir is metabolized mainly in the liver and acyclovir is excreted unchanged in the urine


Question: M.C. site for secondary metastasis in a case of Hypernephroma

The Renal cell Ca is prone to grow into the renal vein. Pieces of growth are swept into the circulation and end up in the lung where they grow to form cannon-ball secondary deposits. Metastasis to bone also occurs. Highly vascular metastasis may pulsate." Also Remember MC site of metastasis from lung Ca - Adrenals next is Liver, Brain MC site for distant metastasis from Bladder Ca - Veebrae MC site for distant metastasis from Colorectal Ca - Liver MC site for distant metastasis from Melanoma (cutaneous) - Skin/subcutanous tissue, Lung MC site for distant metastasis from Melanoma (Ocular) - Liver MC site for distant metastasis from Prostate - Bonesstas MC site for distant metastasis from Soft tissue sarcoma - Lung MC site for distant metastasis from Testis Ca - Lung MC site for distant metastasis from Thyroid Ca - Bone, Lung Metastasis to lung is most commonly from - Breast Ca Ref : Bailey & Love, 25/e p1309


Question: Deep cardiac plexus is present at

Deep cardiac plexus is situated in front of the bifurcation of trachea B D CHOURASIAS HUMAN ANATOMY UPPER LIMB THORAX VOLUME ,1 SIXTH EDITION, PAGE NO, 267


Question: Muscle not in relation with structure marked A

The marked structure is Greater trochanter. Gluteus maximus gets inserted to lliotibial tract.
All other 3 muscles get inserted to Greater trochanter.


Question: Bleeding time assesses

ref Robbins 8/e p666 bleeding time evaluation is used to measure the primary phase of hemostasis, which involves platelet adherence to injured capillaries and then platelet activation and aggregation. The bleeding time can be abnormal when the platelet count is low or the platelets are dysfunctional.


Question: Aery supplying major pa of superolateral surface of brain is

The middle cerebral aery is the largest terminal branch of the internal carotid aery and it runs laterally in the lateral cerebral sulcus of the brain.It supplies the entire lateral surface of the cerebral hemisphere except the narrow strip along the superomedial border extending from the frontal pole to the parieto-occipital sulcus(which is supplied by the anterior cerebral aery) and the occipital pole and inferior temporal gyrus (both of which are supplied by the posterior cerebral aery).


Question: Number of vascular segments present in kidney are

Five vascular segments of kidney were seen based on the branching pattern of the renal aery by angiography and corrosion cast techniques. The renalaery was divided into anterior and posterior branches.The origins of segmental aeries were variable. image Ref - eahslab.om


Question: Normal platelet count is found in

Ref Robbins 9/e p526_527 ;8/e p666;7/e p986-987 All other options have decreased platelet count except henoch schonlein purpura .though it has the name purpura ,but the platelet count in this condition is normal.The skin manifestations in HSP are due to small vessel vasculitis


Question: Angina pectoris and syncope are most likely to be associated with

Ref Harrison 19 th ed pg 1530 patients with pure or predominant AS have gradually increas- ing obstruction over years but do not become symptomatic until the sixth to eighth decades. Adult patients with BAV disease, however, develop significant valve dysfunction and symptoms one to two decades sooner. Exeional dyspnea, angina pectoris, and syncope are the three cardinal symptoms.


Question: Caudal end of neuropore closes by


Question: Wire loop lesions are often characteristics for the following class of lupus nephritis

Ref Robbins illustrated 8/e p218, 9/e p224 Diffuse lupus nephritis (class IV) is the most serious form of renal lesions in SLE and is also the most commonly encountered in renal biopsies, occurring in 35% to 60% of patients. It is distinguished from focal lupus nephritis (class III) by involvement of half or more of glomeruli. Most of the glomeruli show endothelial and mesangial prolifera- tion, leading to diffuse hypercellularity of these structures (Fig. 4-18, B) and producing in some cases epithelial crescents that fill Bowman's space. When extensive, sub- endothelial immune complexes create a circumferential thickening of the capillary wall, resembling rigid "wire loops" on routine light microscopy (Fig. 4-18, C). Electron microscopy reveals prominent electron-dense subendo- thelial immune complexes (between endothelium and basement membrane) (Fig. 4-18, D), but immune com- plexes are also usually present in other pas of the capil- lary wall and in the mesangium. Immune complexes can be visualized by staining with fluorescent antibodies directed against immunoglobulins or complement, result- ing in a granular fluorescent staining pattern (Fig. 4-18, E). In due course, glomerular injury may give rise to scarring (glomerulosclerosis). Most affected patients have hematu- ria with moderate to severe proteinuria, hypeension, and renal insufficiency.

Mesangial proliferative glomerulonephritis(wHO class2)

Focal proliferative glomerulonephritis (WHO class3)

Diffused proliferative glomerulonephritis (WHO class4)

Membranous glomerulonephritis (WHO class5)


Question: The right adrenal vein drains into

These blood vessels supply a network of small aeries within the capsule of the adrenal glands. Venous blood is drained from the glands by the suprarenal veins, usually, one for each gland: The right suprarenal vein drains into the inferior vena cava. ref - semantischolar.org


Question: Blood supply of coronoid process of mandible is primarily from


Question: Longest muscle in the body

REF BD CHAURASIAS HUMAN ANATOMY SIXTH EDITION VOLUME 2 PAGE 53 Saorius is long narrow and ribbon like it run downwards and medially across the front of thigh .it is the longest muscle in the body. It orgin :anterior superior iliac spine Ipper half of notch below spine Inseion: medial surface of shaft of tibia upper pa


Question: Most common cause of amoebic lung abcess

Amoebic lung abscess is a result of direct spread of infection from liver to lung. The infection spreads directly through the diaphragm. The most common area of the lung involved is right lower lobe. The amoebic liver abscess ruptures and then it can involve any of the following structures. Right lung (Most commonly) Right pleural cavity Left Lung Pericardium Peritoneal cavity


Question: AV node is situated in

Koch's triangle is an anatomical area located within right atrium, defined by Ostium of coronary sinus, posteriorly The anterior-septal leaflet commissure Tendon of Todaro ( a tendinous structure connecting the valve of the inferior venacava ostium to the central fibrous body posteriorly) Used as anatomical landmark for location of AV node during electrophysiology procedures such as pacing or ablation. Ref - researchgate.net


Question: On follow up study, elevated CA 125 in a case of epithelial ovarian tumour should be fuher evaluated with

CT Scan Evaluation of patients with suspected ovarian cancer should include measurement of serum levels of the tumour marker CA-125. CA-125 determinants are glycoproteins with molecular masses from 220 to 1000 kDa, and a radioimmunoassay is used to determine circulating CA-125 antigen levels. Between 80 and 85% of patients with epithelial ovarian cancer have levels of CA-125 _ 35 U/mL. Other malignant tumours can also elevate CA-125 levels, including cancers of the endometrium, cervix, fallopian tubes, pancreas, breast, lung, and colon. Ceain nonmalignant conditions that can produce moderate elevations of CA-125 levels include pregnancy, endometriosis, pelvic inflammatory disease, and uterine fibroids. About 1% of normal females have serum CA-125 levels _35 U/mL.

Clinical examination and serial CA 125 monitoring


Question: Cardiac dominance is determined by coronary aery

Cardiac dominance is determined by posterior inter ventricular aery which supplies postero inferior pa of interventricular septum. Mostly this a branch of RCA so right cardiac dominance(65% of population) If posterior inter ventricular aery arise from left coronary aery, then it is left cardiac dominance in 10% of population(bad prognosis) Multiple PIVA one from right side one from left side that is co -dominance in 25% of population.

Supplying circulation to the inferior poion of the interventricular septum

Supplying circulation to the inteatrial septum

Supplying circulation to the anterior poion of the interventricular septum


Question: Most common viral antigen used for diagnosis of HIv

Ref Robbins 7/e p246; 9/e p245 p24 antigen assay: It is available only as a blood test. It detects the HIV antigen called p24 plus antibodies to HIV-1 and HIV-2. ... The level of p24 antigenand the amount of virus (viral load) increase significantly soon after initial infection. Testing for p24 allows for detection of early infections, before HIV antibody is produced


Question: Mucous membrane of cervix is lined by

Ans: B Simple columnar epithelium(Ref: Langman's Embryology 11'h/e p. 269)Lining of uterine cavity - Ciliated columnar epithelium.Lining of cervical canal - Simple (nonciliated) columnar epithelium


Question: The ideal treatment of stenosis of sphincter of oddi is

Sphincter of oddi dysfunction Pain similar to biliary colic with normal LFT and episodes of acute pancreatitis have been attributed to a poorly defined syndrome known as sphincter of oddi dysfunction The pathogenesis is unclear. Postulated theories include gallstone migration inducing fibrosis of the sphincter, trauma, pancreatitis and congenital anomalies Modified Milwaukee classification is used for Biliary sphincter oddi dysfunction. Treatment Treatment of choice : Transduodenal Sphinctereplasty with transampullary septectomy Ref: Sabiston 20th edition Pgno :1497


Question: Feilized orum reaches the uterus

Ans. is 'a' i.e., 3-4 days Feilized ovum (zygote) reaches the uterus in morula stage, 4 days after feilization.Feilization and implantation Feilization refers to fusion of male and female gametes (i.e. spermatozoon and ovum). It takes place in the middle segment (ampulla) of fallopian tube. Before feilization, the ovum and sperms reach the ampulla for feilization. Fusion of spermatocyte and ovum leads to formation of zygote. First week of development begins immediately after feilization and includes :?Cleavage of zygote : Zygote (feilized ovum) stas dividing immediately and large zygote is subdivided into smaller daughter cells called blastomeres. Blastomeres are still surrounded by zona pellucida. Cleavage occurs in fallopian tube (uterine tube).Formation of morula : At about 16 cells stage the blastomeres tightly align by the process of compaction to form a compact ball of cells called morula (mulberry). This process of compaction leads to segregation of cells into two groups (i) inner cells (inner cell mass), and (ii) outer cells (outer cell mass). Morula enters uterine cavity 4 days after feilization.Formation of blastocyst : As the morula enters the uterine cavity, uterine fluid diffuses through zona pellucida and fills small intercellular gaps between blastomeres, and morula is conveed to blastocyst. Blastocyst consists of :?Zona pellucida : Outer covering.Embryoblast : A group of centerally located cells of inner cell mass and later give rise to tissues of embryo proper.Trophoblast : A thin outer layer of cells formed from outer cells mass and later give rise extraembryonic tissues.Blastocele : Cavity of blastocyst :The region of blastocyst containing embryoblast is known as embryonic pole and the opposite pole, the abembryonic pole. The trophoblasts overlying the embryoblast at embryonic pole is called polar trophoblast and that occupying the rest of wall called mural trophoblast. Between 5-6 days after feilization, blastocyst hatches from zona pellucida, and this naked blastocyst is ready for implantation.Implantation : About 6-7 days after feilization the blastocyst attaches to the endometrium, a process called as implantation or embedding. Normal site of implantation is posterior wall of the body of uterus close to fundus (at junction offundus with body).


Question: Unnatural sexual offences deals under

Sec 377 IPC deals with unnatural sexual offences Whoever voluntarily has carnal knowledge against the order of nature with any man, woman, or animal shall be punished with imprisonment for life or either description for a term which may extend to ten years and shall also be liable for fine. Ref: FORENSIC MEDICINE AND TOXICOLOGY DR PC IGNATIUS THIRD EDITION PAGE 308


Question: Root value of long thoracic nerve

Ans. b. C-5, 6, 7Long thoracic nerve is branch of trunk forming brachial plexus with root value of C-5, 6, 7.Dorsal scapular nerveSuprascapular nerveNerve to subclaviusLateral pectoral nerveMusculocutaneous nerveAxillary nerveMeduan nerveUlnar nerveMedial cutaneous nerve of the forearmMedial cutaneous nerve of the armRadial nerveLower subscapular nerveThoraco dorsal nerveMedial pectoral nerveUpper subscapular nerveLong thoracic nerveBranches of the plexus for the upper limbBranches of the RootsNerve to serratus anterior (Long thoracic nerve C5.6,7)Q Nerve to rhomboideus (Dorsal Scapular nerve COdeg


Question: Muscle not included in Anterior compartment of thigh

Gracilis is a muscle of Medial compartment


Question: Dialysis patients are prone to develop

Can lead to anemia, osteopenia, demetia.


Question: Cranial nerve related to apex of the petrous temporal bone

In the intraneural course,the fibres of VI nerve runs veically and downwardsthrough the trapezoid body,medial lemniscus and basilar pa of the pons to reach the lower border of the pons. The nerve is attached to the lower border of the pons,opposite the upper end of the pyramid of the medulla. The nerve then runs upwards,forwards and laterally through the cristerna pontis and usually dorsal to the anterior inferior cerebellar aery to reach the cavernous sinus. The ebducent nerve enters the cavernous sinus by piercing its posterior wall at a point lateral to the dorsum sellae and superior to the apex of the petrous temporal bone. As the nerve crosses the superior border of the petrous temporal bone,it passes beneath the petrosphenoidal ligament,and bends sharply forwards. In the cavernous sinus,at first it lies lateral to the internal carotid aery and then inferolateral to it. The abducent nerve enters the orbit through the middle pa of the superior orbital fissure. Here it lies inferolateral to the occulomotor and nasociliary nerves. In the orbit,the nerve ends by supplying only the lateral rectus muscle. It enters the ocular surface of the muscle. Ref BDC volume 3.6th edition pg 365


Question: Nerve damaged in fracture neck fibula

Common peroneal / fibular nerve injury: 1. The common fibular nerve is susceptible to injury as it passes around the lateral aspect of the neck of the fibula. 2. It can be result of direct trauma. Secondary to knee injury or as a consequence of proximal fibular fracture, sometimes can be iatrogenic (Ex. Ahroscopy) 3. Symptoms of CPN injury. Foot drop Loss of sensation over the lateral aspect of leg & dorsum of foot Wasting of fibular & anterior Tibial muscle.


Question: Stapedius muscle is upplied by …..Nerve


Question: Vidian nerve passes through

In the anterior pa of the foramen lacerum,the greater petrosal nerve unites with the deep petrosal nerve to form the nerve of the pterygoid canal(the vidian nerve)which leaves the foramen by entering the pterygoid canal in the anterior wall of the foramen lacerum. REF.BDC VOL.3,FIFTH EDITION


Question: Valvulae conniventes are seen in

The valvulae conniventes, also known as Kerckring folds or plicae circulares, are the mucosal folds of the small intestine, staing from the second pa of the duodenum, they are large and thick at the jejunum and considerably decrease in size distally in the ileum to disappear entirely in the distal ileal bowel loops. p Ref - radiopedia.org


Question: Right coronary sinus directly drains into

The coronary sinus is the largest vein of the hea.It is situated in the left posterior coronary sulcus.It is about 3cm long.It ends by opening into the posterior wall of the right atrium.It receives the following tributaries such as the great cardiac vein,the middle cardiac vein,the small cardiac vein,the posterior vein of the left ventricle,the oblique vein of the left atrium of Marshall and the right marginal vein. REF.B D Chaurasia's human anatomy vol.1,fifth edition


Question: Danger area of neck is situated between

The space between Alar fascia & Preveebral fascia proper is called danger area as the infection or pus in this place can spread to posterior mediastinum.


Question: Wegeners Granulomatosis

All options are Crct Refer Robbins page no 511 Wegeners Granulomatosis is treated with steroids and cycloohosphamide. They dramatically ameliorate glomerular injury in pauci immune glomerulonephritis


Question: Gene for eye morphogenesis

Ans. is 'a' i.e., Pax-6The Pax-6 gene locus is a transcription factor for various genes and growth factors involved in eye formation.Pax-6 is a master control gene for eye morphogenesis and encodes for Paired box protein Pax-6 (also called aniridia type II protein or oculorhombin).


Question: After meiotic division, the primary oocyte remains arrested in

At the time of bih all primary oocyte are in the prophase of meiotic division The primary oocyte remain in prophase and complete their first meiotic divison until they mature and ready to ovulate Human embryology Tenth edition Inderbier Singh Page 24


Question: The lingual surface of epiglottis is lined by


Question: The gastroduodenal aery is derived from

The gastroduodenal aery is the branch of the common hepatic aery. It passes inferiorly behind the 1st pa of the duodenum and bifurcates into right gastroepiploic aery and superior pancreaticoduodenal aery. Gastroduodenal aery provides blood to the distal pa of the stomach, the duodenum proximal poion and to pancreatic head indirectly through the posterior and anterior and superior pancreaticoduodenal aery. Ref -BDC vol2 6e pg 277


Question: Thyroarytenoid muscle causes

Thyroarytenoid muscle is relaxor of vocal cord. Vocalis muscle which is medial fibre of thyroarytenoid, causes tension in anterior ⅓ and relaxation in posterior ⅔ of vocal cord.


Question: The paracentral lobule is located in

The paracentral lobule is a gyrus on the medial surface of the cerebral hemisphere. It is present in the motor area of frontal lobe where representation is upside down. The areas for the legs and perineum lie in the paracentral lobule.Ref: BD Chaurasia; volume 3; 6th edition; Brain; page no: 378

Superolateral surface of cerebral hemisphere

Tentorial surface of cerebral hemisphere


Question: The narrowest pa of the larynx is

The rima has an anterior intermembranous pa (three-fifth) and a posterior intercailaginous pa, The rima is the narrowest pa of the larynx. It is longer (23 mm) in males than in females (17 mm ). ref : B D Chaurasia's Human Anatomy , sixth edition, volume 3 , pg. no. 256 ref : 16.15a , B D Chaurasia's Human Anatomy , sixth edition, volume 3 , pg. no. 255


Question: The epitheliod cell and multinucleated giant cells of granulomatous inflammation are derived from

Ref Robbins 9/e p97 Delayed type of hypersensitivity results from accumulation of mononucleated cells around small veins and venules producing a perivascular cuffing .mono cytes transform into macrophages which undergo morphological changes to produce epitheliod cell


Question: Tear drop bladder is seen in

In case of extra peritoneal rupture of bladder a cystogram shows extravasation of contrast material into the pelvis around the base of bladder. The characteristic TEAR DROP' deformity represents bladder compression by a large pelvic haematoma. Ref : Schwaz 7/e p1803


Question: The most impoant source of histamine

ref Robbins 8/e p57,9/e p83 Histamine is synthesized in all tissues, but is paicularly abundant in skin, lung and gastrointestinal tract. Mast cells, which are present in many tissues, are a prominentsource of histamine, but histamine is also secreted by a number of other immune cells.


Question: The artery marked X is most commonly a branch of

X marked structure is Right Gastric artery which is most commonly a branch of Hepatic artery proper


Question: Gerlach tonsil in Waldayer's ring is


Question: Nerve roots involved at the Erb's point are

Erb's ParalysisThe site of injury: One region of the upper trunk of the brachial plexus is called Erb's point. Six nerves meet here. Injury to the upper trunk causes Erb's paralysis. Nerve roots involved; Mainly C5 and paly C6.Muscles paralyzed: Mainly biceps brachii, deltoid, brachialis, and brachioradialis. Paly supraspinatus, infraspinatus, and supinator. Deformity and position of the limbArm: Hangs by the side; it is adducted and medially rotated.Forearm: Extended and pronated.The deformity is known as policeman's tip hand' or waiter's tip hand or'poer's tip hand'. Disability: The following movements are lost: Abduction and lateral rotation of the arm at the shoulder joint.Flexion and supination of the forearm.Biceps and supinator jerks are lost.Sensations are lost over a small area over the lower pa of the deltoid. Ref: Chaurasia; Volume 1; 6th edition; Page no: 56


Question: 45 year old alcoholic male came for deaddiction treatment. He has alcohol induced hepatitis with other blood parameters within normal limits. The drug that should not be chosen for relapse prevention is

NALTREXONE is an OPIOID ANTAGONIST given at a dosage of 50-150mg, should not be used in LIVER DYSFUNCTION ACAMPROSATE is an GABA AGONIST given at a dosage of 666MG TDS, should not be used in KIDNEY DYSFUNCTION Ref.Kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no.626


Question: Testicular lymphatics drain into

Lymphatic drainage of the testes follows the testicular aeries back to the paraaoic lymph nodes, while lymph from the scrotum drains to the inguinal lymph nodes. Ref: BD Chaurasia; 6th edition


Question: Mantoux test reading of less than 5mm indicates

Ref Robbins 9/e p371 Mantoux test is simply able to predict the presence or absent of cell mediated immunity against the tubercular antigens .it cannot differentiate between infection and disease Negative mantoux test just indicates that the individual has not been exposed to tuberculin bacilli