Question: mood stablizer used in the management of drug induced neutropenia

- Lithium has a narrow therapeutic index - GIT == diarrhea, vomiting - NEUROLOGICAL=== tremor, co ordination - Therapeutic level is 0.8-1.2meq/l - HEMODIALYSIS is the TOC for lithium toxicity - OTHER USES - Anti- suicidal propey, used to prevent suicide. - Correct drug induced neutropenia. ref, kaplon and sadock, synopsis of psychiatry, 11 thh edition, pg no. 935


Question: Epithelium of cervix mucosa is lined by

Other epithelia: Simple squamous epithelium lines free surface of serous pericardium, pleura & peritoneum (here it is called mesothelium) lines inside hea a endocardium a blood vessels & lymphatics a endothelium etc. Stratified squamous epithelium: 1. keratinized ??' lines skin of whole body & forms epidermis. 2. non keratinized ??'seen in lining of mouth, tongue, pharynx, esophagus, vagina, cornea etc. Simple columnar epithelium ??' (Non cilia / microvilli) present over mucous membrane of stomach & large intestine. Ciliated columnar epithelium ??' Respiratory tract, uterus, uterine tubes, efferent ductules of testes, pas of middle ear & auditory tube, ependyma lining the central canal of spinal cord & ventricles of brain. Pseudostratified columnar epithelium ??' some pas of auditory tube, ductus deferens, male urethra (membranous & penile pas), trachea & large bronchi


Question: Double aoa develops from

Inderbir Singh&;s Human embryology Tenth edition Pg 257Double aoa occurs due to the persistence of distal poion of the right dorsal aoa


Question: Protractor of scapula

Protraction of the scapula (as in pushing and punching movements). It is brought about by the serratus anterior and by the pectoralis minor. It is associated with forward movements of the lateral end and backward movement of the medial end of the clavicle . Ref - BDC 6th e p142


Question: Downward displacement of enlarged spleen is prevented by

Phrenicocolic ligament and left colic flexure prevent downward displacement of enlarged spleen.


Question: The optimal position of the ankle to avoid ankylosis is

The optimal position of the ankle to avoid ankylosis is one of slight plantar flexion.Ref: Chaurasia; Volume 2; 6th edition; Page no: 150


Question: Meckel&;s cave is related to

The trigeminal ganglion lies on the trigeminal impression,on the anterior surface of the petrous temporal bone near its apex.It occupies a special space of duramater,called the trigeminal or Meckel's cave. REF.BDC VOL.3,Fifth edition.


Question: The structure present anterior to transverse pericardial sinus is

Transverse sinus is a horizontal gap between the aerial and venous ends of the hea tube, it is bound Anteriorly: ascending aoa, pulmonary trunk Posteriorly: SVC Inferiorly: L. atrium On each side it opens into the general pericardial cavity. Oblique sinus is a narrow gap behind the hea. It is bound anteriorly : L. atrium posteriorly: R. parietal pericardium, oesophagus.


Question: The mucosa of the posterior third of the tongue is supplied by


Question: Onion skin fibrosis of the common bile duct is

Refer Robbins page no Pg 860 MORPHOLOGY Morphologic changes differ between the large ducts (intrahe- patic and extrahepatic) and the smaller intrahepatic ducts. Large duct inflammation is similar to that seen in ulcerative colitis: acute, neutrophilic infiltration of the epithelium superim- posed on a chronic inflammatory background. Inflamed areas develop strictures because edema and inflammation narrows the lumen or because of subsequent scarring. The smaller ducts, however, often have little inflammation and show a strik- ing circumferential "onion skin" fibrosis around an increas- ingly atrophic duct lumen (Fig. 18-39), eventually leading to obliteration by a "tombstone" scar. Because the likelihood of sampling smaller duct lesions on a random needle biopsy is miniscule, diagnosis depends on radiologic imaging of the extrahepatic and larger intrahepatic ducts. As the disease pro- gresses the liver becomes markedly cholestatic, culminating in biliary cirrhosis much like that seen with chronic obstruction and primary biliary cirrhosis. Biliary intraepithelial neoplasia may develop and cholangiocarcinoma appears usually with a fatal outcomes.


Question: Left posterior sector of liver consists of

Lobar anatomy of the liver Liver is divided into two lobes by the main poal fissure (Scissura), known as Cantlie's line Cantlie's line describes a 75deg angle with a horizontal plane It extends from the gallbladder fossa to the left side of the IVC Right and left halves of the liver is delineated by a plane through the MHV and IVC Right poal fissure divides the right lobe into an anteromedial and posterolateral sector. RHV courses along this fissure Right poal fissure describes an angle of 40deg with the transverse plane. Left poal fissure divides the left lobe into an anterior and posterior sector, LHV courses along this fissure In the right lobe Anteromedial sector : Segment V anteriorly and segment VIII posteriorly Posterolateral sector : Segment VI anteriorly and segment VII posteriorly In the left lobe Anterior sector is divided by the umbilical fissure into segment IV and segment III Posterior sector is comprised of only one segment, segment II Umbilical fissure is not a Scissura, does not contain a hepatic vein, but contains the left poal triad. Left Scissura runs posterior to the ligament I'm teres and contains the LHV; the left liver is split into an anterior (segments III and IV) and posterior (segment II- the only sector composed of a single segment) sector by the left Scissura. Ref: Sabiston 20th edition Pgno : 437-439


Question: Special visceral efferent doesn't include(2018)

Special visceral efferent( purely motor) for the supply of muscles of facial expression, muscles of mastication and muscles of palate and pharynx, larynx(Nucleus ambiguous). Dorsal nucleus of vagus (parasympathetic): it is a mixed nucleus, being both motor (visceromotor and secretomotor) and sensory. General visceral efferent fibres arise in the dorsal nucleus of the vagus. Ref:- BD chaurasia volume 3, pg num:-288,289

B) Dorsal nucleus of the Xth cranial nerve


Question: In pyogenic liver abscess commonest route of spread is

Routes of spread 1st most common - Biliary tract 2nd most common - poal vein

Ascending infection through biliary tract


Question: Claw hand is caused by lesion of

A greate than B Claw hand of 3rd bad 4th finger will be seen in isolated ulnar palsy as 1st ND 2nd fingers lumbricals are spared -----ulnar claw hand Claw hand of all fingers is seen in combined ulnar and median nerve palsy as all lumbricals and Interoosei are paralyzed -----true claw hand Refer ebnezar 4th/e p 336


Question: Prostate gland is derived from

In the hindgut at the region of cloaca develops a urogenital sinus which forms urinary bladder, urethra and lower pa of vagina in females. It also forms inner glandular poion of prostate gland. It is endodermal in origin.

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


Question: In the testis, haploid number of chromosomes are present in

Inderbir Singh's Human embryology; Tenth edition; Pg 20 Primary spermatocyte undergoes meiotic division to form secondary spermatocytes Each secondary spermatocyte divides to form two spermatids by a mitotic division which also contains a haploid number of chromosomes


Question: Structure that does not cross the midline is

Left gonadal vein, left suprarenal vein & right renal vein do not cross midline. Hemiazygos vein cross midline at The veebral level to join azygous vein. Left Renal vein is longer than right renal vein and cross midline anterior to aoa to drain into IVC. However, left gonadal & suprarenal veins drain into left renal vein (almost veically) without crossing midline. Ref: Gray's 39e/p1026


Question: Goblet cells are present in

The lumen of the trachea is lined with mucous membrane that consists of a lining epithelium and an underlying layer of connective tissue. The lining epithelium is pseudostratified ciliated columnar. It contains numerous goblet cells and basal cells that lie next to the basement membrane.Ref: Inderbir Singh&;s Textbook of Human Histology; Pg No: 230


Question: The number of symphyseal cartilages appearing during the development of mandible


Question: Pseudounipolar neurons are seen in

Pseudounipolar neurons are actually unipolar to begin with but become bipolar functionally and are found in dorsal nerve root ganglia and sensory root ganglia of the cranial nerves. REF.B D Chaurasia's human anatomy,Vol 3,fifth edition,Pg.308


Question: percentage of moality in anorexia nervosa is

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


Question: Lesion of medial temporal lobe is associated with


Question: any behaviour is assosiated with reward will be increased in frequency. this is based on

Behavioral therapy is learning given by BF Skinner , according to him all behaviors are learned phenomenon and thus can be unlearned Positive reinforcement a type of reinforcement when a behavior is rewarded there is more chance that the behavior is repeated Negative reinforcement is that when a behavior is done and an aversive response is removed, the behavior is repeated. When I go and meet my girlfriend, she checks my messages and picks up fight (aversive response) suddenly I delete all messages one day and that day there was no fight (no aversive response) then that behavior is repeated (delete all messages before meeting my girlfriend) Extinction is the type of reinforcement where a behavior is done and a rewarding response is removed the chance is that behavior will not be repeated A child likes to play with children( reward) but when the child fights with other children( undesirable behavior) the child will be removed from playing( removing a reward) , then the child stops fighting with other children( reduction of undesirable behaviour) Ref. kaplon and sadock synopsis, 11 th edition, pg no. 845


Question: Kupffer cells present in the adult liver are derived from

Kupffer cells are actually macrophages and are derived from mesoderm. Hepatocytes and the epithelial lining of the intrahepatic biliary tree are derived from endoderm diveiculum of forgut.


Question: Commonest site of branchial cyst is

Branchial cysts are characteristically found anterior and deep to the upper third of the sternocleidomastoid muscle. Branchial fistulas(those derived from 2nd branchial cleft) open externally in the lower third of necic, near the anterior border of sternocleidomastoid. Its internal orifice is located in the tonsillar fossa. Branchial cysts & fistulas are remnants of the branchial apparatus present in fetal life. branchial cysts, fistulas or sinuses are lined by squamous epithelium. Ref : Bailey & Love 25/e p727


Question: Posterior cerebral aery supplies A/E

Posterior cerebral aery supplies occipital, temporal, thalamus, lentiform nucleus, pineal, medial geniculate body, choroid plexus of inferior horn of lateral ventricle, 3rd ventricle, midbrain Ref: Gray's 40e/p-252


Question: Ligament of Berry in thyroid fixes

(Cricoid Cartilage) (166-BDC-3)4th editionCapsules of Thyroid1. The true capsule is the peripheral condensation of the connective tissue of the gland2. The false capsule is derived from the pretracheal layer of the deep cervical fascia. It is thin along the posterior border of the lobes, but thick on the inner surface of the gland where it forms a suspensory ligament (of Berry). Which connects the lobe to the cricoid cartilage


Question: If two buds of pancreas do not fuse, the anomaly is

Pancreatic divisum is a congenital anomaly in the anatomy of the ducts of the pancreas in which a single pancreatic duct is not formed, but rather remains as two distinct dorsal and ventral ducts. imageref- researchgate.net


Question: The red velvety appearance of stomach mucosa is seen in the poisoning of

(Refer: Rajesh Bardale - Principle of Forensic Medicine & Toxicology, 1 st edition, pg no: 430)


Question: Paralysis of opponens muscle leads to loss of thumb....


Question: Deja vu like experiences is seen epilepsies with their focus in

Even though these phenomenon are seen in anxiety disorders and schizophrenia they are most characteristic of temporal lobe epilepsies


Question: Head of scapula is

Lateral angle or glenoid angle is broad and bears the glenoid cavity or fossa, which is directed forwards, laterally and slightly upwards. Glenoid cavity margin gives attachment to the shoulder joint and to the glenoid labrum. BD Chaurasia 7th edition Page no: 9


Question: HLA B27 is positive in

Ref Robbins 8/e p193; Harrison 17/e p2051 ;9/e p215 The HLA complex, which is located on the sho arm of human chromosome 6, contains sequences encoding about 100 genes, most involved in the regulation of the immune response. HLA genes are classically grouped into three major classes.


Question: Nervus furcalis is another name for


Question: The nerve roots blocked in pudendal nerve block is

Pudendal nerve arises from S 2,3,4 roots


Question: Lining epithelium of the uterine cavity is

The endometrium, or mucosal lining of the uterus, is composed of a simple columnar epithelium and a lamina propria. The epithelium is composed of nonciliated secretory columnar cells and ciliated cells, whereas the lamina propria houses simple branched tubular glands that extend as far as the myometrium.Ref: Textbook of histology; 4th edition; Chapter 20; Female Reproductive System


Question: Dermatomal supply of the perianal skin is

The Inferior rectal nerves (inferior anal nerves, inferior hemorrhoidal nerve) usually branch from the pudental nerve but occasionally arises directly from the sacral plexus; they cross the ischiorectal fossa along with the inferior hemorrhoidal vessels, toward the anal canal and the lower end of the rectum, and is distributed to the spincher ani externa and to the integument (skin) around the anus. image ref - Netter atlas


Question: Referred pain from knee to hip is due to

Referred pain from knee to hip and vice-versa is due to Obturator nerve


Question: The pacemaker potential is due to


Question: Hunter&;s canal seen in

ADDUCTOR/ HUNTER'S/ SUBSAORIAL CANAL - The adductor canal is an intermuscular space situated on the medial side of the middle one-third of the thigh <img src=" /> Ref : B D Chaurasia's Human Anatomy , Seventh edition , volume 2, pg. no. 60 ( fig. no. 3.33 & 3.34 )


Question: Largest bursa of the body is

The iliopsaos bursa is the largest bursa of the human body and is bilaterally present in 98% of adults.


Question: In cholangitis, the organism mostly responsible is

Ascending bacterial infection of the biliary ductal system with obstruction Most common cause is choledocholithiasis Most common organisms present in the bile in patients with cholangitis : E.coli (MC). Klebsiella pneumoniae, streptococcus faecalis & Bacteroides fragilis Ref: Sabiston 20th edition Pgno :1507


Question: Nerve root of pudendal nerve is

The pudendal nerve is derived from the sacral roots of S2-S4 and later divides into three branches, the dorsal clitoral/penile, the perineal, and the rectal. It carries motor, sensory and autonomic fibers. Ref - BDC 6e vol2 pg363


Question: Pott's puffy tumor is

POTT'S PUFFY TUMOUR It is formation of diffuse external swelling in the scalp due to subperiosteal pus formation (abscess) and scalp oedema. x It originates commonly in frontal region and may extend into other regions. x There is acute osteomyelitis of frontal bone. Causes x Chronic frontal sinusitis which eventually suppurates and extends into subperiosteal region. x Trauma--subperiosteal haematoma. x Chronic suppurative otitis media. Features x Pain and boggy swelling in frontal region which is warm, tender. x Toxicity and drowsiness. x Pitting scalp oedema is typical. x Investigations:  Total leucocyte count--increased. ESR--raised.  X-ray skull. CT scan. x Differential diagnosis: Secondaries in the skull or brain. Complications Osteomyelitis of frontal bone. Spread of infection into intracranial cavity leads to intracranial abscess (Extradural or subdural abscess) (dumb-bell abscess). So may present with features of raised intracranial tension like headache, coning and convulsions. Pott's Puffy tumor can be associated with coical vein throm- bosis, epidural brain abscess/subdural empyema. The cause of vein thrombosis is explained by diplopic veins in frontal bone, which communicates with the dural venous plexus; septic thrombi can potentially evolve from foci within the frontal sinus and propagate through this venous system. Treatment x Antibiotics and drainage under general anaesthesia before it spreads into cranial cavity. x Once it extends into cranial cavity, it is treated accordingly by formal neurosurgical decompression (often using Dandy's brain cannula). x Osteomyelitis of skull bones requires radical removal with recon- struction of skull defect. Ref: SRB manual of surgery 5th edition Pgno: 48


Question: 3rd extensor compament of wrist contains tendon of

-The extensor retinaculum is a thickened band of deep fascia on the back of wrist. the anterior or deep aspect of this retinaculum is divided into 6osseofibrous compaments by 5 septa arising from back of radius and ulna. These tunnels provide passage to the extensor tendons.they are numbered 1 to 6 lateral to medially. the third compament provides passage to EPL tendon.Reference: clinical anatomy for students a problem-solving approach, Neeta v Kulkarni, page no.84


Question: Nasolacrimal duct opens into the

Nasolacrimal duct is membranous passage 18 mm long.it begins at the lower end of lacrimal sac, runs downwards, backward and laterally, and opens into the inferior meatus of the nose.A fold of mucous membrane called the valve of Hasner forms an imperfect valve at the lower end of the duct. Ref.BDC volume 3;sixth edition pg.76


Question: Most common cause of mitral stenosis is

Refer robbins 9/e 554 Rheumatic hea disease (RHD) is damage to one or more hea valves that remains after an episode of acute rheumatic fever (ARF) is resolved. It is caused by an episode or recurrent episodes of ARF, where the hea has become inflamed. The hea valves can remain stretched and/or scarred, and normal blood flow through damaged valves is interrupted. Blood may flow backward through stretched valves that do not close properly, or may be blocked due to scarred valves not opening properly. When the hea is damaged in this way, the hea valves are unable to function adequately, and hea surgery may be required. Untreated, RHD causes hea failure and those affected are at risk of arrhythmias, stroke, endocarditis and complications of pregnancy. These conditions cause progressive disability, reduce quality of life and can cause premature death in young adults. Hea surgery can manage some of these problems and prolong life but does not cure RHD.


Question: Choose the most effective drug for mild intestinal amoebiasis and asymptomatic cyst passers

Ref-KDT 6/e p801 Diloxanide is a medication used to treat amoeba infections. In places where infections are not common, it is a second line treatment after paromomycin when a person has no symptoms. For people who are symptomatic, it is used after treatment with metronidazole or tinidazole. It is taken by mouth.


Question: Propranolol a non selective Beta blocker can be prescribed to decrease anxiety associated with

Ref-KDT 6/e p143 Propranolol is used for controlling the performance anxiety, major manifestation of which are due to increase the sympathetic activity (tachycardia, palpilpalpit etc)


Question: Special stain useful in the following condition


Question: neologism is a charecterstic of

Type of thought disorder clinical condition clang assosiation mania flight of ideas mania prolixity hypomania loosening of assosiation schizophrenia neologism schizophrenia circumstantiality organicity Ref. Kaplon and Sadock, synopsis of psychiatry, 11 th edition, Pg.No.194


Question: A patient woke up from sleep with difficulty in extending fingers. He can make a grip and hold apen. Wrist extension was possible. No sensory disturbance was found. Injury could be at

Posterior interosseous nerve emerges from supinator on the back of the forearm .and lies between the superficial and deep muscles.At the lower border of the extensor pollicis brevis, it passes deep to the extensor pollicis longus .it then runs on the posterior surface of the interosseous membrane up to the wrist where it enlarges into pseudoganglion and ends by supplying the wrist and intercarpal joints. Reference : page no: 136 - BD chaurasia,upper limb & thorax


Question: According to MTP Act, aboion can be done till

The Medical Termination of Pregnancy (MTP) Act of IndiaIt clearly states the conditions under which a pregnancy can be ended or aboed the persons who are qualified to conduct the aboion and the place of implementation.Women whose physical and/or mental health were endangered by the pregnancy.Women facing the bih of a potentially handicapped or malformed child.Rape.Pregnancies in unmarried girls under the age of eighteen with the consent of a guardianPregnancies in "lunatics" with the consent of a guardianPregnancies that result are a result of failure in sterilization.The length of the pregnancy must not exceed 20 weeks in order to qualify for an aboionMTP Act of 1971 legalizes aboion on the following grounds;TherapeuticEugenic.HumanitarianSocial.MTP RULESOnly registered medical practitioner can perform MTP;Should only be done in Government hospitals or hospitals recognized by GovernmentConsent of woman is required.If minor or mentally ill, written consent from guardian is required.If period of pregnancy is less than 12 weeks, opinion of single doctor is enough.If period of pregnancy is between 12-20 weeks, opinion of 2 doctors required.Refer: Rajesh Bardale - Principle of Forensic Medicine & Toxicology, 1st edition, pg no: 351,352


Question: graded exposure to phobic stimulus along with relaxation is given by

SYSTEMATIC DESENSITIZATION JOSEPH WOLPE Joseph Wolpe gave the concept of systematic desensitization This is a treatment used in phobia In phobia there is a conditioned fear response to aversive neutral stimulus and avoidance of that response leads to phobia Whenever there is a fear response there is stimulation of sympathetic system In that case stimulation of parasympathetic system by relaxation there is reduction in anxiety First step is to make a step ladder which are arranged based on the severity Then is go step by step and along with doing applied relaxation Slowly the the sympathetic system is reduced The patient will be able to approach stimulus without anxiety Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 845


Question: The hyaloid canal is found in the

The hyaloid canal (Cloquet's canal) is found in the vitreous body. In early development, a hyaloid aery passes through the vitreous body to perfuse the developing lens; in the late fetal period, this aery is obliterated to form the hyaloid canal.


Question: Muscles of facial expression develops from


Question: Spinal pa of accessory nerve supplies

Sternocleidomastoid and trapezius are supplied by spinal accessory nerve. Both of them develop from brachial arch mesoderm.It is tested by turning the neck against resistance.B D Chaurasia 7th edition Page no: 65 ( refer head and neck volume )


Question: These ventral spinal rootlets are more prone to injury during decompressive operations because they are shorter and exit in a more horizontal direction

Due to rostral shift of the spinal cord during development, the spinal nerve roots become progressively oblique from above downwards.
In upper cervical region, the spinal nerve roots are short and run almost horizontally but the roots of the lumbar and sacral nerves are long and run almost vertically.


Question: First web space of toes is supplied by

Deep peroneal nerve is the nerve of anterior compament of the leg and the dorsum of foot. This is one of the two terminal branches of common peroneal nerve ( ventral primary rami of L4, L5, S1 and S2 segment) The nerve ends on the dorsum of the foot, close to the ankle joint, by dividing into lateral and medial terminal branches. Lateral terminal branch turns laterally and ends in pseudo ganglion deep to the extended digitorum brevis. Medial terminal branch ends by supplying skin adjoining the first interdigital cleft and the proximal joints of the big toe. Femoral nerve is the nerve of anterior compament of thigh. Root value - dorsal division of ant primary rami of L2 L3 L4 ). Superficial peroneal nerve is smaller terminal branch of common paroneal nerve.Its branches supply the skin over lower 1/3 of lateral side of the leg, skin over the entire dorsum of foot except lateral border supplied by dural nerve and medial border up to base of great toe supplied by saphenous nerve and cleft between 1st and 2nd toes supplied by deep peroneal nerve <img src=" /> Ref: BD Chaurasia(6th edition pg-95,96)


Question: A 14 year old boy present with headache fever and cough for 2 days. Sputum is scant and non purulent and gram stain reveals many white cells but no organisms. The treatment should be initiated with

Ref-KDT 6/e p729 Diagnosis is atypical pneumonia in the DOC is Erythromycin.


Question: Ligament suppoing the talus is

SPRING LIGAMENT:- Also known as plantar calcaneonavicular ligament.Attachments-Anteriorly:plantar surface of navicular bone.Posteriorly: anterior margin of sustentaculum tali. Head of talus directly rests on upper surface of the ligament. The plantar surface of the ligament is suppoed by tendon of tibialis posterior medially,and by tendons of flexor hallucis longus and flexor digitorum longus laterally.Most impoant ligament for maintaining the medial longitudinal arch of foot. <img src=" /> {Reference: BDC 6E}


Question: Embryonic period of development is

Development before bih is called prenatal development, and that after bih is called postnatal development. There are three stages in prenatal development. They are: 1. Preimplantation/pre-embryonic period 2. Embryonic period 3. Fetal period. Embryonic Period- It extends from 3rd week of intrauterine life to 8th week of intrauterine life. The following morphogenetic events take place during this period : 1. Trilaminar germ disc differentiation: Formation of three layered germ disc with the appearance of mesoderm in between ectoderm and endoderm. 2. Early organogenesis: Formation of primordia of various organs like lungs, hea, liver, etc. 3. Formation of extraembryonic suppoive organs and membranes: Placenta, umbilical cord, amnion, allantois. Ref:Inderbir Singh's Human Embryology, eleventh edition , pg. no.,2.


Question: Barrett oesophagus can result from

Refer Robbins page no p 957 Barrett esophagus is a complication of chronic GERD that is characterized by intestinal metaplasia within the esophageal squamous mucosa. The incidence of Barrett esophagus is rising, and it is estimated to occur in as many as 10% of individuals with symptomatic GERD. Barrett esophagus is most common in white males and typically presents between 40 and 60 years of age. The greatest concern in Barrett esophagus is that it confers an increased risk of esoph- ageal adenocarcinoma. Genomic sequencing of biopsies involved by Barrett esophagus has revealed the presence of mutations that are shared with esophageal adenocarci- noma, in keeping with the idea that Barrett esophagus is a precursor lesion to cancer. Potentially oncogenic mutations are more numerous when biopsies demonstrate dysplasia, which is detected in 0.2% to 2% of persons with Barrett esophagus each year. The presence of dysplasia, a prein- vasive change, is associated with prolonged symptoms, longer segment length, increased patient age, and Caucasian race. Although the vast majority of esophageal adenocar- cinomas are associated with Barrett esophagus, it is impor- tant to remember that most individuals with Barrett esophagus do not develop esophageal tumors.


Question: A patient on total parenteral nutrition for 20 days presents with weakness, veigo and convulsions. Diagnosis is

Clinical features for complications of Parenteral Nutrition Hypomagnesemia Weakness, muscle cramps and tremors Marked neuromuscular and CNS hyperirritability with jerking and nystagmus Hyperkalemia Interferes with neuromuscular function to produce muscle weakness which may progress to flaccid paralysis and hypoventilation if respiratory muscles are involved Hypercalcemia Fatigue, depression,mental confusion, lethargy Anorexia, nausea, vomiting, constipation and polyuria Ref: Harrison's 19th edition Pgno :88-97


Question: The screening for HCC in chronic liver disease

Screening is based on regular ultra sound scanning in high risk population and measurement of AFP levels Ref:Sabiston 20th edition Pgno : 1458-1463


Question: Not a B cell marker


Question: Adductor tubercle gives attachement to

ADDUCTOR TUBERCLE:- Posterosuperior to medial epicondyl there is a projection called adductor tubercle. It gives attachment to the inseion of hamstring or ischial head of adductor Magnus. Adductor brevis inseed into the line extending from lesser trochanter to upper pa of linea aspera. Adductor longus inseed into the medial lip of linea aspera between vastus medialis and adductor brevis and magnus. Vastus intermedialis- arise from femur shaft ( upper three fouh of anterior and lateral surface) {Reference: BDC 6E pg no.17}


Question: neuroleptic malignant syndrome is treated with

neuroleptic malignant syndrome is a type of movement disorder assosiated with CLINICAL CRITERIA * 106:F * Abrupt onset * Any of the two * Diaphoresis * Tachycardia Labile bp ETIOLOGY Introduction of Dopamine antagonists or Abrupt Discontinuation Of an antipsychotic this can be treated with Dantrolene sodium and syndopa Ref.kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no. 925


Question: Puschers retinopathy is seen unn

Refer Robbins Puschers retinopathy is manifestrd by a sudden death and severe loss of vision In a patient with acute pancreatitis. It is caused by occlusion of the posterior retinal aery with aggregated granulocytes. There to cotton wool spots and haemorrhage confined to an area. Limited NY the optic disc and macula


Question: Mycotic abcesses are due to

As the name suggests , mycotic abcesses are caused by fungal infections . However mucous aneurysm is caused due to bacterial infection of aerial wall . The infection weakens the wall and causes aneurysm .


Question: drug used in the management of treatment resistant schizophrenia is

CLOZAPINE * Impoance * First SGA * TREATMENT FOR TREATMENT RESISTANT SCHIZOPHRENIA * TOC for TD * Anti suicidal * Psychosis in parkinsonian patients Ref.kaplon and sadock, synopsis of psychiatry, 11 th dition, 935


Question: Facial colliculus is seen in

The motor fibres of the facial nerve undergo a loop course around the dorsomedial aspect of abducent nerve nucleus, producing the facial colliculus in the pons. In the early embryogenesis, the motor nucleus of facial nerve is located dorsolateral to cranial end of abducent nucleus. Gradually, it migrates in close proximity to the Spinal nucleus of trigeminal nerve which is called "NEUROBIOTAXIS". (Ref: Vishram Singh textbook of clinical neuroanatomy, second edition pg 80)


Question: Gluteofemoral bursa is in between gluteus maximus and

Bursae between gluteal maximus and vastus lateralis is called Gluteofemoral bursa. Between gluteus maximus and trochanter is trochanteric bursa. There is also a bursa over ischial tuberosity. {Reference: BDC 6E pgno. 70}


Question: Mechanism of action of paralidoxime is

Pralidoxime and diacetylmonoxime are cholinesterase regenerator compound used for organophosphate poisoning. Ref-KDT 6/e p105


Question: Superior and inferior vesicular aery is a branch of

The superior and inferior vesical aery is a branch(direct or indirect) of the anterior division of the internal iliac aery. It frequently arises in common with the middle rectal aery, and is distributed to the fundus of the bladder. In males, it also supplies the prostate and the seminal vesicles. ref - researchgate.net


Question: Tissue thromboplastin activates

Ref Robbins 9/e, p 118 Coagulation Cascade The coagulation cascade constitutes the third arm of the hemostatic system. The pathways are schematically pre- sented in Figure 3-8; only general principles are discussed here. The coagulation cascade is a successive series of ampli- fying enzymatic reactions. At each step in the process, a proenzyme is proteolyzed to become an active enzyme, which in turn proteolyzes the next proenzyme in the series, eventually leading to the activation of thrombin and the formation of fibrin. Thrombin has a key role, as it acts at numerous points in the cascade (highlighted in Fig. 3-8). Thrombin proteolyzes fibrinogen into fibrin monomers that polymerize into an insoluble gel; this gel encases platelets and other circulating cells in the definitive secondary hemostatic plug. Fibrin polymers are stabilized by the cross-linking activity of factor XIIIa, which also is activated by thrombin. Each reaction in the pathway depends on the assembly of a complex composed of an enzyme (an activated coagula- tion factor), a substrate (a proenzyme form of the next coag- ulation factor in the series), and a cofactor (a reaction accelerator). These components typically are assembled on a phospholipid surface (provided by endothelial cells or platelets) and are held together by interactions that depend on calcium ions (explaining why blood clotting is preventedby calcium chelators). Figure 3-8 The coagulation cascade. Factor IX can be activated by either factor XIa or factor VIIa: In laboratory tests, activation is predominantly dependent on factor XIa, whereas in vivo, factor VIIa appears to be the predominant activator of factor IX. Factors in red boxes represent inactive molecules; activated factors, indicated with a lowercase a, are in green boxes. Note that thrombin (factor IIa) (in light blue boxes) contributes to coagula- tion through multiple positive feedback loops. The red X's denote points at which tissue factor pathway inhibitor (TFPI) inhibits activation of factor X and factor IX by factor VIIa. HMWK, high-molecular-weight kininogen; PL, phospholipid.


Question: Winging of scapula is due to paralysis of

WINGING OF SCAPULA: Paralysis of serratus anterior causes 'winging of scapula' It is supplied by the long thoracic nerve. FEATURES: Medial border of the scapula becomes unduly prominent The inferior angle becomes prominent. The arm cannot be abducted beyond 90degree. REF: BD Chaurasia 7th edition page no: 12.


Question: Lining epithelium of ventricles of brain

The cavity of ventricles is lined by ciliated columnar epithelium- the ependymal cells.Ependyma is one of the four types of neuroglia in the central nervous system.They are of three types: ependymocytes, choroid epithelial cells, tanycytes.TANYCYTES are the ependymal cells lining the floor of fouh ventricle having long basal process.It is involved in the production of cerebrospinal fluid(choroidal epithelial cells) and is shown to serve as a reservoir for neuroregeneration.(Ref: Vishram Singh textbook of clinical neuroanatomy second edition pg 15)


Question: Malignant hydatidosis is caused by


Question: POSTERIOR COMMUNICATING aery is a branch of

Posterior communicating aery is a branch of cerebral pa of internal carotid aery. It arises close to its termination. It runs backwards and anastomoses with proximal pa of posterior cerebral aery.Reference: Textbook of anatomy, Head neck, and brain, Vishram Singh, 2nd edition, page no.406


Question: Left trisegmentectomy involves removal of

Trisegmentectomy Right trisegmentectomy or extended right hepatectomy : Complete resection of segment IV with the right liver (Removal of segment IV, V, VI, VII, VIII Left trisegmentectomy or extended left hepatectomy : Complete resection of segment V and VIII with left liver (removal of segment II, III, IV, V, VIII) Ref: Blumga 5th edition Pg no : 1512-1513


Question: Spleen projects into the following space of peritoneal cavity

The diaphragmatic surface of the spleen (or phrenic surface) is convex, smooth, and is directed upward, backward, and to the left, except at its upper end, where it is directed slightly to the middle. It is in relation with the under surface of the diaphragm, which separates it from the ninth, tenth, and eleventh ribs of the left side, and the intervening lower border of the left lung and pleura. The visceral surface of the spleen is divided by a ridge into two regions: an anterior or gastric and a posterior or renal. The gastric surface (facies gastrica) is directed forward, upward, and toward the middle, is broad and concave, and is in contact with the posterior wall of the stomach. Ref - BDC vol2 6e pg295-298


Question: Hypoglossal nucleus lies on

Hypoglossal nucleus is an elongated column of grey matter extending throughout the length of medulla oblongata in the paramedian plane. Note: *Midbrain - nuclei of 3,4 cranial nerves *Pons - nuclei of 5,6,7,8 cranial nerves * Medulla- nuclei of 9,10,11,12 cranial nerves (Ref: Vishram Singh textbook of clinical neuroanatomy second edition pg -91, 92)


Question: Ritgen maneuver is done in

Ritgen manuever is done for delivery of head in normal labor to allow controlled delivery of head. When the head distends the vulva and perineum enough to open the vaginal introitus to a diameter of 5cn of more , a towel is drapled ,gloved hand may be used to exe forward pressure on the chin of fetus through the perineum just in front of coccyx. Concurrently the other hand exes pressure superiorly against occiput. This ours nect extension so that the head is delivered with its smallest diameter passing through the introitus and over perineum

For delivery of head in breech presentation


Question: Nissl's (substance) bodies are seen in

(A) Cell body # Nissl body (or Nissl granule or Tigroid body) is a large granular body found in nerve cells. It was named after Franz Nissl, German neurologist (1860-1919).> Nissl bodies can be demonstrated by selective staining, which was developed by Nissl and was an aniline stain used to label extranuclear RNA granules.> These granules are rough endoplasmic reticulum (with ribosomes) and are the site of protein synthesis.> Nissl bodies show changes under various physiological conditions and in pathological conditions they may dissolve and disappear (karyolysis).


Question: Round ligament of uterus is derived from

The round ligament develops from the gubernaculum which attaches the gonad to the labioscrotal swelling in the embryo. The round ligament enters the pelvis the deep inguinal ring, passes through the inguinal canal and continues on to the labia majora where its fibers spread and mix with the tissue of the mons pubis.


Question: The term infantile polyaeritis nodosa was formerly used for

Refer Robbins page no 510 Clinically infantile polyaeritis nodosa often ilia pa of the spectrum of Kawasaki disease


Question: Ligamentum teres is the remnant of

(A) Umbilical vein SOME FREQUENTLY ASKED REMNANTS* Ductus arteriosusLigamentum arteriosum* Ductus venosusLigamentum venosum* Left umbilical veinLigamentum teres of liver* Right umbilical veinDisappears* Vitello-intestinal ductMeckel's diverticulum* Wolffian ductGartner duct> After obliteration, the umbilical vein forms the ligamentum teres and the ductus venosus becomes ligamentum venosum.


Question: Insertion of extensor carpi ulnaris

Ans. is 'c' i.e., Base of 5th MetacarpalExtensor carpi ulnariso Origin : Lateral epicondyle of humerus and posterior border ulnao Insertion : Base of 5th metacarpalo Nerve supply : Posterior interosseus nerveo Action : Extension (dorsiflexion) and adduction of hand.


Question: Corneal epithelium consist of

(B) (Stratified, squamous non keratinized) (390-92-I-B. Singh 7th)Key points of cornea (colour less and avascular but has a very rich nerve supply)1. Stratified squamous, non keratinized corneal epithelium -outermost layer2. Anterior limiting membrane (Bowman's membranes)3. Substantia propri- made up of collagen fibres4. Posterior limiting membrane (Descemet's membrane)5. Posterior cuboidal epithelium* Afferent of corneal reflex-trigeminal nerve. (Ophthalmic branch)* Efferent of corneal reflex-facial nerveDEVELOPMENTMesodermExtra- ocular muscle, comeal stroma. Sclera , iris, vascular endothelium of eye, and orbit, choroid parts of vitreousNeural ectodermSmooth muscle of the iris (Dilator sphineter), optic vesicle and cup, iris epithelium, ciliary epithelium, parts of vitreous, Retina, Retinal pigment epitheliumSurface ectodermConjunctival epithelium, comeal epithelium, Lacrimal glands. Tarsal glands. Lens


Question: Deep brain stimulation has been approved for treatment of

DBS is approved only for treatment resistant parkinsonism by FDA, Has been tried for treatment resistant depression, OCD, other movement disorders


Question: Most common site for intra abdominal abscess following laparotomy is

RIGHT SUBHEPATIC SPACE This lies transversely beneath the right lobe of the liver in Rutherford Morison's pouch. It is bounded on the right by the right lobe of the liver and the diaphragm. To the left is situated the foramen of Winslow and below this lies the duodenum. In front are the liver and the gall bladder, and behind are the upper pa of the right kidney and the diaphragm. The space is bounded above by the liver and below by the transverse colon and hepatic flexure. It is the deepest space of the four and the most common site of a subphrenic abscess, which usually arises from appendicitis, cholecystitis, a perforated duodenal ulcer or following upper abdominal surgery It is the most dependent poion of the abdominal cavity in the recumbent position Ref: Bailey and love 27th edition Pgno : 1056


Question: Mastoid fontanelle closes by

Closure of Fontanelles:1. Anterior fontanelle by 18 months2. Posterior fontanelle by 2-3 months3. Sphenoidal fontanelle by 2-3 months and 4. Mastoid fontanelle by 12 months Reference: Chourasia; 6th edition; 12th page


Question: IVC obstruction presents with

IVC obstruction presents with Thoraco epigastric dilation Blockade of IVC causes a communication between SVC & IVC by azygos vein due to which blood from IVC enters the SVC. A communication also sets up b/w superior and inferior epigastric vein in the rectus sheath which drains into Brachiocephalic vein Internal thoracic vein. Superficial Epigastric vein forms collaterals with Lateral Thoracic vein thoracoepigastric vein in case of either IVC or SVC obstruction Normally blood flow in the veins of anterior abdominal wall is in upward direction above the plane of the umbilicus and in downward direction below the plane of umblicus. But in case of IVC obstruction it is completely in upward direction ( both above and below the plane)

Thorax- wall and Bronchopulmonary segment


Question: Lipid in the tissues is detected by

Oil Red O Ref, Bancroft histology 6/e p53


Question: Necrotizing lymphadenitis is seen in

Ref Harrison 17/e p1011 The other name for kikuchis fujimoto disease is histocytic nercrotizing lymphadenitis. Benign and self-centered disorder in young individuals characterised by cervical lymphadenopathy With tenderness .usually accompanied with mild fever and night sweats,may b viral on ethilogy


Question: Muller&;s muscle is found in

Mullers muscle or involuntary pa of levator palpebrae superioris is supplied by sympathetic fibres from the superior cervical ganglion. Paralysis of mullers muscle leads to paial ptosis. This is a pa of horners syndrome. Ref BDC volume 3,Sixth edition pg 74


Question: SA Node is located at

SA node is situated at the atriocaval junction in the upper pa of the sulcus terminalis B D CHAURASIA'S HUMAN ANATOMY UPPER LIMB THORAX-VOLUME 1 SIXTH EDITION Page no-262


Question: Location of Testis in the 7th month of Gestation

Descent of Testis:The testes develop in relation to the developing mesonephros, at the level of segments T10 to T12. Subsequently, they descend to reach the scrotum. Each testis begins to descend during the second month of intrauterine life. It reaches the iliac fossa by the 3rd month, rests at the deep inguinal ring from the 4th to the 6th month, traverses the inguinal canal during the 7th month, reaches the superficial inguinal ring by the 8th month and the bottom of the scrotum by the 9th month.Reference: Chaurasia Volume II; 7th edition; Page no: 249


Question: Collecting tubules of kidney develop from

Collecting ducts of the permanent kidney develop from the ureteric bud, an outgrowth of the mesonephric duct close to its entrance to the cloaca. The bud penetrates the metanephric tissue, which is molded over its distal end as a cap. Subsequently, the bud dilates, forming the primitive renal pelvis, and splits into cranial and caudal poions, the future major calyces.Ref: Guyton; 13th edition; Chapter 65; Secretory Functions of the Alimentary Tract


Question: Most common primary leading to secondaries in pancreas

Metastatic Tumors to pancreas MC site of primary : RCC > Malignant melanoma On autopsy, most common primary : CA Lung Ref: Sabiston 20th edition Pgno : 1544


Question: Majority of lung cysts occur in

The bronchogenic cyst is a congenital lung lesion which arises from the anomalous development of foregut or tracheobronchial tree. Characteristics of Bronchogenic Cysts - Most of the Bronchogenic cysts arise in the mediastinum but ~15% occur in pulmonary parenchyma. In the mediastinum, they are usually located just posterior to the carnia or main stem bronchi. Mediastinal bronchogenic cysts do not communicate with the bronchi but those situated within the lung may communicate with the airways and consequently are prone to abscess formation. When located in the lung, they are more common in right lung and lower lobes These are lined by cuboidal or ciliated columnar epithelium and are usually filled with mucoid material. Complication: - Infection of the cyst leads to abscess Compression can produce either hyper infection of the lung or atelectasis due to obstruction Tension pneumothorax - d/t Rupture of the cyst that communicates with bronchus.


Question: Synesthesia is seen with


Question: Maximum growth spu in boys occurs at

Height velocity curves for male, show maximum growth velocity at 14-15 yrs Height velocity curves for female,show maximum growth velocity at 11-13 yrs Ref: Nelson's 20th edition, page 84-89


Question: The procedure of choice for elective removal of CBD stones for most patients is

Elective definitive treatment Cholecystectomy with choledochotomy and CBD exploration T-tube is left in place for cholangiography and removal of any retained stone T-tube cholangiogram is done on 7th - 10th day Post-operatively Remove the T-tube if cholangiogram is normal If residual stone is discovered on the postoperative cholangiogram, T-tube should be left in place for 4-6 weeks for the tract to mature The stones are removed percutaneously through the matured tract by Burhenne's technique Ref: Sabiston 20th edition Pgno : 1511


Question: Better prognostic factor for operation of biliary duct obstruction in newborn are

Major factors in successful outcome after pooentreostomy Age in days at diagnosis and initial surgery (30-60 days) Length of time jaundice was present before surgery Successful and persistent bile flow postoperatively Size and nature of the microscopic ducts (>150um) Degree and extent of fibrotic changes in the liver Need for phototherapy as a neonate Technical aspects of the postenterostomy and anastomosis Presence of bile on hepatic lobular zone 1 Ref: Blumga 5th edition Pgno :600


Question: Massive transfusion can cause a) Hyperkalemia b) DIC c) Thrombocytopenia d) Hypothermia

Complications of Massive transfusion Massive transfusion cam lead to coagulapathy and metabolic complications Most common cause of death after massive transfusion : Dilutional Coagulopathy or DIC Transfusion of 15-20 units of blood components causes Dilutional thrombocytopenia After massive transfusion initially transient hyperglycemia due to glucose in preservatives leading to insulin release and causing hypoglycemia (MC) Galvimetric method of estimation of blood loss : Blood loss during operation is measured by weighing the swabs after use & subtracting the dry weight plus volume of blood collected in suction or drainage Metabolic complications of Massive transfusion General Fluid overload Hypothermia Impaired oxygen delivery capacity of Hb (decreased 2,3-DPG). Electrolyte Hyperkalemia Hypocalcemia Hypomagnesemia Metabolic alkalosis Metabolic acidosis (rare) Ref: Harrison's 19th edition Pgno :138


Question: Pt. with chronic pancreatitis gives chain of lakes appearance in ERCP examination. MM is

Areas of ductal dilatation alternating with areas of ductal stenosis are common finding in alcoholic patients who have severe chronic pancreatitis. This type of duct obstruction cannot be relieved by a sphincteroplasty because of multiple areas of stenosis along the duct. Although total pancreatectomy would be a beneficial approach, moality and morbidity rate with this procedure are extremely high. Thus the procedure of choice in this pt. is side to side pancreaticojejunostonzy in which the duct is opened longitudinally through the chain of lakes. A Roux-en-Y limb of jejunum should then be brought up for anastomosis with the opened pancreas in side-to-side fashion. Ref : Schwaz Pretest, 7/e, Q. No. 577

Resetting the tail of pancreas and performing a pancreatojejunostomy


Question: The ideal temperature to cool the burnt surface is

In temperate climates cooling should be at about 15degC and hypothermia must be avoided They provide analgesia and delay the micro vascular damage in burns It should occur for a minimum of 20 minutes and is effective upto 1 hour after burn injury. Paicularly impoant in scalds Ref: Bailey and love 27th edition Pg no : 620


Question: Azygous vein drains into

course and termination of azygos vein - The azygos vein enters the thorax by passing through the aoic opening of the diaphragm, The azygos vein then ascends up to fouh thoracic veebra where it arches forwards over the root of the right lung and ends by joining the posterior aspect of the superior vena cava just before it pierces the pericardium Ref : B D Chaurasia's Human Anatomy, seventh edition, volume 1 , pg. no. 233


Question: Remnant of notochord is

HUMAN EMBRYOLOGY-INDERBIR SINGH TENTH EDITION-PAGE NO:60As the embryo enlarges, the notochord elongates considerably and lies in the Midline, in the position to be later occupied by the veebral column. However, the notochord doesn&;t give rise to the veebral column. Most if it disappears, but pas of it persist in the region of each interveebral disc as the nucleus purposes.


Question: Gitter cells are

Microglia are a type of neuroglia (glial cell) located throughout the brain and spinal cord. Microglia account for 10-15% of all cells found within the brain. As the resident macrophage cells, they act as the first and main form of active immune defense in the central nervous system (CNS). Microglia (and other neuroglia including astrocytes) are distributed in large non-overlapping regions throughout the CNS. Microglia are key cells in overall brain maintenance--they are constantly scavenging the CNS for plaques, damaged or unnecessary neurons and synapses, and infectious agents. Since these processes must be efficient to prevent potentially fatal damage, microglia are extremely sensitive to even small pathological changes in the CNS. This sensitivity is achieved in pa by the presence of unique K+ channels that respond to even small changes in extracellular potassium. Ref - Wikipedia.org


Question: Bosophillic stippling is seen in

Refer robbins 8/e p406 Lead poisoning is a type of metal poisoningcaused by lead in the body. The brain is the most sensitive. Symptoms may include abdominal pain, constipation, headaches, irritability, memory problems, inability to have children, and tingling in the hands and feet. It causes almost 10% of intellectual disability of otherwise unknown cause and can result in behavioral problems. Some of the effects are permanent. In severe cases anemia, seizures, coma, or death may occur Associated conditionsEdit Thalassemia (b-thalassemia Minor (i.e Trait) & Major, and a-thalassemia, only when 3 gene loci defective: (--/-a)) Severe megaloblastic anemia Hemolytic anemia Sickle-cell anemia Pyrimidine 5' nucleotidase deficiency Alcoholism Myelodysplastic syndromes Sideroblastic anemia Congenital dyserythropoietic anemia Primary myelofibrosis Leukemia Erythroleukemia Hemorrhage, e.g. from gastrointestinal tract CPD-choline phosphotransferase deficiency Unstable hemoglobins Altered hemoglobin biosynthesis Heavy metal poisoning Lead poisoning Zinc Arsenic Silver Mercury


Question: Middle meningeal aery arises from

Middle meningeal aeryIt is typically the third branch of the first pa (retromandibular pa) of the maxillary aery, one of the two terminal branches of the external carotid aery.After branching off the maxillary aery in the infratemporal fossa, it runs through the foramen spinosum to supply the dura mater and the calvaria.The middle meningeal aery is the largest of the three (paired) aeries which supply the meninges, the others being the anterior meningeal aery and the posterior meningeal aery.


Question: Most commonly seen Choledochal cyst

Most common Choledochal cyst Type I>Type IV >Type III Type I is the most common It is the dilation of extrahepatic biliary tree Type Ia: cystic dilation Type Ib: Focal segmental dilation Type Ic : Fusiform dilation Treatment : Roux-en-Y hepatic jejunostomy Ref: Sabiston 20th edition 1510-1511


Question: Structures present in Radical neck node resection

Radical neck dissection (RND) was attributed to Crile in 1906 and was considered the gold standard for the removal of nodal metastases (Fig. 33-4). Through a subsequent close reading of Crile's surgical notes, it was found that he had begun to modify his surgical technique to remove only selected regions of the neck, depending on the site of the primary tumor; this has become common surgical practice for HNSCC at the present time. All modifications of neck dissection are described in relation to the standard RND, which removes nodal levels I through V and the sternocleidomastoid muscle, internal jugular vein, cranial nerve XI, cervical plexus, and submandibular gland. Preservation of the sternocleidomastoid muscle, internal jugular vein, or cranial nerve XI in any combination is referred to as a modified RND, and the structures preserved are specified for nomenclature. A modified neck dissection may also be referred to as a Bocca neck dissection, named after the surgeon who demonstrated that not only is modi- fied RND equally as effective in controlling neck disease as RND when structures are preserved that are not directly involved in tumor, but also the functional outcomes of patients after modified RND are superior to functional outcomes after RND.18 Although resection of the sternocleidomastoid muscle or one internal jugular vein is relatively nonmorbid, loss of cranial nerve XI leaves a denervated trapezius muscle, which can cause a painful chronic frozen shoulder. RND or modified RND can be performed for removal of detectable nodal disease. Preservation of any of levels I through V during neck dissection is referred to as selective neck dissection and is based on knowledge of the patterns of spread to neck regions. Selective neck dissection is performed on a clinically negative (N0) neck, with preservation of nodal groups carrying less than a 20% chance of being involved with metastatic disease. Regional control has been shown to be as effective after selective neck dissection as after modified RND in patients with a clinically negative neck. Studies evaluating treatment of an N0 neck inves- tigated the use of sentinel lymph node biopsy, which attempts to predict the disease status of the neck based on the first echelon of nodes that drain the tumor.19 Although sentinel lymph node biopsy has been used extensively with melanoma, its use in HNSCC has come about more gradually. Early results using iso- sulfan blue dye alone suggested that this technique cannot con- sistently identify the sentinel node in HNSCC. More recent results using a gamma probe were more encouraging, although the isolated node should be serial step-sectioned at a thickness of 150 nm and be examined through permanent processing. Recom- mendations at the present time are that the technique should be restricted to early-stage (T1 or T2) oral and oropharyngeal cancers, with clinically N0 necks; the gamma probe continues to be an investigational tool pending validation by large randomized clini- cal trials. Ref: sabiston 20th edition Pgno: 794


Question: Structures passing through the centre of the cavernous sinus


Question: Stomach is supplied by

The left gastric aery is a branch of celiac trunk. The left gastroepiploic aery supplies left half of greater curvature of the stomach is a branch of splenic aery. The sho gastric aeries that supply the fundus are also branches of the splenic aery. The right gastroepiploic aery that supplies the right half of greater curvature of the stomach is a branch of gastroduodenal aery.Reference: clinical anatomy for students a problem-solving approach, Neeta v Kulkarni, page no 615, 616.


Question: Boundary of Morrison's pouch is formed by

Boundaries of Morrison's pouch (Hepatorenal pouch) Anteriorly Inferior surface of right lobe of the liver Gall bladder Posteriorly Right Supra renal gland Upper pa of right kidney 2nd pa of duodenum Hepatic flexure of colon Transverse mesocolon Pa of head of pancreas Superiorly Inferior late of corornary ligament Inferiorly Opens into general peritoneal cavity Ref: Gray's 40th edition Pg no : 1101


Question: The virulence factor of P.aeruginosa , endotoxin A acts by

It prevents protein synthesis by inhibiting elongation factor 2


Question: Biceps brachi is supplied by

Root value of musculocutaneous nerve is C5, C6.It arises from the lateral cord of brachial plexus.B D Chaurasia 7th edition Page no : 57


Question: buimia nervosa is treated with

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


Question: Early indication of sexual maturation in females is

The onset of pubey is triggered by various genetic and environmental factors. The activation of the hypothalamic-pituitary-gonadal axis leads to the production of gonadotropins ( LH & FSH) and sex steroids (estrogen & testosterone). Pubey in girls stas with Breast development (thelarche)- 8-13yrs Appearance of public hair(pubarche) At last menstruation ( menarche)- average at 12.6 yrs( range 10-16 yrs) Pubey in boys stas with Increase in testicular size(9-14yrs) Pubarche Lengthening of penis Spermarche( production of sperms at 14-16 yrs) Ref: Ghai, 9th edition, Chapter 5, Page 60.


Question: The HLA class3 region genes are impoant element in

Ref Robbins 9/e p215 Anantha Narayana 6/e p108 Class III molecules include several secreted proteins with immune functions: components of the complement system (such as C2, C4, and B factor), cytokines (such as TNF-a, LTA, and LTB), and heat shock proteins.

Governing susceptibility to autoimmune disease


Question: Investigation to diagnosis of laryngopharyngeal reflux

pH monitoring at the level of pharynx is not helpful because the acid refluxed is neutralised by the pharyngeal secretions Hence a dual (bifurcated) catheter measuring both pH and impedance is used across upper oesophageal sphincter thereby permitting detection of pharyngeal reflux Ref: Shackelford 8th edition Pgno: 222


Question: Structures passing through middle pa of superior orbital fissure

superior orbital Lateral pa: Lacrimal and frontal nerves, trochlear nerve, superior ophthalmic vein, meningeal branch of lacrimal aery, anastomotic branch of middle meningeal aery which anastomoses with recurrent branch of lacrimal aery middle pa Upper and lower divisions of oculomotor nerve, nasociliary nerve, abducent nerve Medial pa Inferior ophthalmic vein; sympathetic nerve from plexus around internal carotid aery Ref BDC volume 3;Sixth edition pg 56


Question: Parakeratinization is seen in

B. i.e. Non - keratinized stratified squamous epithelium

Keratinized stratified squamous epithelium

Non keratinized stratified squamous epithelium


Question: Obturator aery is a branch of

Obturator aery is the branch of internal iliac aery that passes anterio - inferiorly on the lateral wall of the pelvis,to the upper pa of obturator foramen and escaping the pelvic cavity through the obturator canal, it divides both into anterior and posterior branch. ref - BDC 6e vol2 pg63 imageref - teachmeanatomy.com


Question: Tongue muscles are derived from

Inderbir Singh&;s Human embryology Tenth edition Pg 176 The musculature of tongue is derived from occipital myotomes


Question: The hardest and calcified pa of tooth is known as

Enamel is the densely calcified white material covering the crown of the tooth. It is the hardest substance in the body and made up of crystalline prisms.The prisms lie at right angles to the tooth surface.Pulp is the inner core containing soft tissue, blood vessels, nerve, and lymphatics.Pulp is covered by a layer of tall columnar cells called odontoblasts. The space-occupying pulp is called pulp cavity.Dentine is a calcified material surrounding the pulp cavity. It forms the basis of the tooth and contains spiral tubulesradiating from the pulp cavity. Each tubule is occupied by a protoplasmic process from the odontoblast. In dentine, calcium and organic matter are in the same propoion as bone.Cementum is the bony covering over the neck and root of tooth. It commonly overlaps the lower pa of enamel.Reference: Textbook of anatomy, Head Neck, and Brain, Vishram Singh, 2nd edition, page no.184


Question: Fertilization of sperm & ova takes place at


Question: Most common site of biopsy in amyloidosis

Ref Robbins 9/e p261 Kidney. Amyloidosis of the kidney is the most common and most serious feature of the disease. Grossly, the kidney may appear unchanged, or it may be abnormally large, pale, gray, and firm; in long-standing cases, the kidney may be reduced in size. Microscopically, the amyloid deposits are found principally in the glomeruli, but they also are present in the interstitial peritubular tissue as well as in the walls of the blood vessels. The glomerulus first develops focal deposits within the mesangial matrix and diffuse or nodular thickenings of the basement membranes of the capillary loops. With progression, the deposition encroaches on the capillary lumina and eventually leads to total obliteration of the vas- cular tuft (Fig. 4-34, A). The interstitial peritubular deposits frequently are associated with the appearance of amorphous pink casts within the tubular lumens, presumably of a pro- teinaceous nature. Amyloid deposits may develop in the walls of blood vessels of all sizes, often causing marked vascular narrowing. renal biopsy is useful in the presence of urinary abnormalities. Rectal and gingival biopsy specimens contain amyloid in as many as 75% of cases with generalized amyloidosis. Examination of abdominal fat aspirates stained with Congo red is a simple, low-risk method. In suspected cases of AL amyloi- dosis, serum and urinary protein electrophoresis and immunoelectrophoresis should be performed.


Question: The synthesis of one peptide bond involves hydrolysis of

During the translation process, the formation of one peptide bond (adding one amino acid) consumes 4 high energy phosphates (2 from ATP & 2 from GTP). Eukaryotes will add 6 amino acids and prokaryotes will add 18 amino acids per second. (Refer: Harper's Illustrated Biochemistry, 26th edition, pg no: 370)


Question: The vein formed by union of posterior division of retromandibular vein and posterior auricular vein is

External jugular vein is formed by posterior auricular vein and posterior division of retromandibular vein.


Question: According to Bismuth classification, type IV Cholangiocarcinoma involves

Bismuth - corlette classification of Hilar Cholangiocarcinoma Type I- Tumor confined to hepatic duct, not involving the main biliary confluence Type II- Tumor involving the main biliary confluence but not extending to the right or left ducts Type IIIa- Tumor extending upto the right secondary biliary confluence Type IIIb- Tumor extending upto the left secondary biliary confluence Type IV - Tumor extending bilaterally to the secondary biliary confluence Ref : Sabiston 20th edition Pgno :1514-1518

Bifurcation and bilateral secondary intrahepatic ducts

Bifurcation and unilateral secondary intrahepatic ducts


Question: The kinetic energy of the body is least in one of the following phases of walking cycle;

Ans. is 'b' i.e. MidstanceRef.: Gray's 38th/e p 898 & 899According to Gray's- "In walking each foot is on the ground (stance phase) for about 60% of the stride and off (swing phase) for about 40%. Thus single support phases (one foot on the ground) alternate with double support phases (two foot)."Gray's further states- "The speed and so the kinetic energy of the body passes through a maximum in each double-support phase and a minimum in each single support phase."Here are various phases of waling cycle:Double Support phases of the walking - Heel Strike cycle includes - - Foot flatToe flatSingle limb support phases of the - Mid stance walking cycle includes - - Heel offMid swingSo the answer is obvious now because the only single limb support phase in the question is mid stance.


Question: The forward displacement of the tibia and the femur is prevented by

Structurally knee is a weak joint because the aicular surfaces are not congruent. The tibial condyles are too small and shallow to hold the large convex femoral condyles in place. The stability of the joint is maintained by a number of factors:-1.cruciate ligaments-anteroposterior stability. 2.Collateral ligaments-side to side stability.3.Iliotibial tractCRUCIATE LIGAMENTS: Very thick and strong fibrous bands. Direct bonds of union between tibia and fibula. Maintain anteroposterior stability of knee joint. Anterior cruciate ligament:- Begins from anterior pa of intercondylar area of tibia, runs upward, backward and laterally and is attached to the posterior pa of medial surface of lateral condyle of femur. Taut during extension of knee. The anterior cruciate ligament is more commonly damaged than the posterior.It may be injured in violent hyperextension of knee or anterior dislocation of tibia. Posterior cruciate ligament:- Begins from posterior pa of intercondylar area of tibia, runs upwards, forwards and medially and is attached to lateral surface of medial condyle of femur. Taut during flexion of knee. The posterior cruciate ligament is injured in posterior dislocation of tibia. Both these are supplied by middle genicular nerves and vessels. {Reference: BDC 6E pg no.143}


Question: Coagulation defect associated with increased coagulation are seen in

Ref Harrison 16/e p1491 ,9/e p123 Protein C and protein S are two vitamin K-dependent proteins that act in a complex to proteolytically inacti- vate cofactors Va and VIIIa. Protein C activation by thrombomodulin was described earlier; protein S is a cofactor for protein C activity Resistance to activated protein C due to the factor V R506Q (Leiden) mutation is the most common clotting abnormality in patients with venous thromboembolism


Question: Thoracic duct does not drain

Thoracic duct does not drain right upper half above the diaphragm <img src=" /> B D CHAURASIA'S HUMAN ANATOMY UPPER LIMB THORAX-VOLUME-1 SIXTH EDITION,Page no-286


Question: Root value of intercostobrachial nerve is

The intercostobrachial nerve is a lateral cutaneous branch of the second intercostal nerve that supplies sensation to the skin of the Axilla . It leaves the second intercostal space at the midaxillary line and subsequently pierces the serratus anterior muscle to enter the subcutaneous tissues of the axilla. The nerve may be injured during axillary surgery such as nodal clearance for breast cancer The anterior divisions of the second, third, fouh, fifth, and sixth thoracic nerves, and the small branch from the first thoracic, are confined to the walls of the thorax, and are named thoracic intercostal nerves respectively . They pass forward in the intercostal spaces below the intercostal vessels. At the back of the chest they lie between the pleura and the posterior intercostal membranes, but soon they run between the internal intercostals and the innermost intercostals then anteriorly they lie between the pleura and the internal intercostals . Ref - radiology assistant.com


Question: Nodular regenerative changes in liver most commonly occur in


Question: Anterior relation of left kidney

Anterior Relations - (1) Left suprarenal gland, (2) spleen, (3) stomach, (4) pancreas, (5) splenic vessels, (6) splenic flexure and descending colon, and (7) jejunum. Out of these the gastric, splenic and jejunal surfaces are covered by peritoneum. The lateral border of the left kidney is related to the spleen and to the descending colon Ref : B D Chaurasia's Human Anatomy , seventh edition, volume 2 , pg. no. 343


Question: Passavant's ridges is formed by


Question: Angle of mandible is supplied by

Auriculotemporal nerve arises by two roots which run backward, encircle the middle meningeal aery, and unite to form a single trunk. The nerve continues backward between the neck of the mandible and the sphenomandibular ligament above the maxillary aery. Behind the neck of the mandible, it turns upwards and ascends on the temple behind the superficial temporal vessels. Ref BDC volume 3; 6th edition pg 125


Question: Superficial branch of ulnal nerve supplies to the following muscle

Superficial branch of ulnar nerve supplies the palmaris brevis muscle and divides into 2 digital branches for the medial 1 1/2 digits . Adductor pollicis, opponens digiti minimi and abductor digiti minimi is supplied by the deep branch of ulnar nerve. Ref - BD Chaurasia 7th edition Page no: 124


Question: Prion disease is caused by

ref Robbins 9/e p1281 Prion diseases are caused by misfolded forms of the prion protein, also known as PrP. ... The human forms of prion disease are most often the names Creutzfeldt-Jakob disease (CJD), fatal familial insomnia (FFI), Gesmann-Straussler-Scheinker syndrome (GSS), kuru and variably protease-sensitive prionopathy (VPSPr


Question: Renal papillary necrosis is almost associated with the following condition

Refer p 936 Most common cause of papillary necrosis is diabetes mellitus Acute papillary necrosis is most often a complication of acute pyelonephritis in diabetes. Chronic papillary necrosis is seen in assoscation with analgesic nephropathy


Question: Arrange covering on peripheral nerve from inner to outer

Covering on peripheral nerve from inner to outer is Endoneurium, perineurium, Epineurium INDERBIR SINGH&;S TEXT BOOK OF HUMAN HISTOLOGY PAGE NO:171


Question: Most common malignant tumor of parotid gland is

The major salivary glands include the parotid glands, subman- dibular glands, and sublingual glands. There are also approxi- mately 750 minor salivary glands scattered throughout the submucosa of the oral cavity, oropharynx, hypopharynx, larynx, parapharyngeal space, and nasopharynx. Salivary gland neoplasms are rare and constitute 3% to 4% of head and neck neoplasms. Most neoplasms arise in the parotid gland (70%), whereas tumors of the submandibular gland (22%) and sublingual and minor salivary glands (8%) are less common Malignant Salivary gland tumors Acinic cell carcinoma Mucoepidermoid carcinoma Adenoid cystic carcinoma Polymorphous low-grade adenocarcinoma Epithelial-myoepithelial carcinoma Basal cell adenocarcinoma Sebaceous carcinoma Papillary cystadenocarcinoma Mucinous adenocarcinoma Oncocytic carcinoma Salivary duct carcinoma Adenocarcinoma Myoepithelial carcinoma Malignant mixed tumor Squamous cell carcinoma Small cell carcinoma Lymphoma Metastatic carcinoma Carcinoma ex pleomorphic adeno Malignant salivary tumors are staged according to size; T1 is smaller than 2 cm, T2 is 2 to 4 cm, T3 is larger than 4 cm (or any tumor with macroscopic extraparenchymal extension), and T4 involves invasion of surrounding tissues. Malignant salivary tumors are listed in Box 33-1. Mucoepidermoid carcinoma is the most common malignant tumor of the parotid gland and can be divided into low-grade and high-grade tumors. High-grade lesions have a propensity for regional and distant metastases and corre- sponding shoer survival rates than low-grade mucoepidermoid carcinomas Ref: Sabiston 20th edition Pgno: 807


Question: Treatment for polycystic liver disease is

Treatment of symptomatic polycystic liver disease is deroofing of the cyst Treatment Laparoscopic unroofing for small number of large cysts A combination of cyst unroofing+liver resection for reducing liver volume Most common complication specific to surgery: Ascites Ref: Sabiston 20th edition Pgno : 1469


Question: Halocrine secretion is seen in .....gland

The manner in which their secretions are poured out of the cells: Merocrine: In most exocrine glands secretions are thrown out of the cells by a process of exocytosis, the cell remaining intact, this manner of secretion is described as merocrine, e.g., goblet cell (sometimes also called eccrine or epicrine), Apocrine: In some glands the apical pas of the cells are shed off to discharge the secretion, this manner of secretion is described as apocrine. An example of apocrine secretion is seen in some atypical sweat glands and in mammary glands. Holocrine: In some glands, the entire cell disintegrates while discharging its secretion. This manner of discharging secretion is described as holocrine, and is seen typically in sebaceous glands. REF : Inderbir Singh's Textbook of Human Histology, seventh edition, pg.no., 58.


Question: Structures not passing through inferior cerebellar peduncle

The fibres entering or leaving the cerebellum are grouped to form three peduncles which connect the cerebellum to the midbrain,the pons and the medulla. CONSTITUENTS OF THE CEREBELLAR PENDUNCLE Penducle Afferent tracts Efferent tracts A) Superior cerebellar peduncle 1) Anterior spinocerebellar 2) Tectocerebellar 1)Cerebellorubral 2) Dentatothalamic 3) Dentatoolivary 4) Fastigioreticular B) Middle cerebellar peduncle Pontocerebellar C) Inferior cerebellar peduncle 1) Posterior spinocerebellar 2) Cuneocerebellar 3) Parolivocerebellar 4) Olivocerebellar 5) Reticulocerebellar 6) Vestibulocerebellar 7) Anterior external arcuate fibres 8) Straie medullares 9) Trigeminocerebelar 1) Cerebellovestibular 2) Cerebelloolivary 3) Cerebelloreticular REF: B D Chaurasia's human anatomy,Vol:3, Pg:392


Question: The receptor cells of the olfactory epithelium are


Question: The angle that tympanic membrane makes with the floor of meatus is

Tympanic membrane is placed obliquely at an angle of 55 degrees with the floor of the meatus. Ref : B D Chaurasia's Human Anatomy , seventh edition , volume 3 , pg. no., 285.


Question: Muscular component of dorsal aoa develops from

Muscular component of dorsal aoa develops from paraxial mesodermRef: Inderbir Singh&;s Human embryology Tenth edition Pg 257


Question: Infection spreading via lymphatics from the lower lip first enter the blood stream at the


Question: Reticulocytes are stained by

Ref Robbins 9/e p635 Reticulocytes are stained in living state in-vitro so staining with dyes like brilliant cresyl blue and new methylene blue is preferred road supra vital staining Brilliant cresyl blue is a supravital stain used for counting reticulocytes. It is classified as an oxazine dye


Question: Fastest acting schizontocidal drug among the fillowfol is

Ref-KDT 6/e p792 Aemisinin derivatives like dihydroaemisinin,aeether and aemether etc fastest acting anti malarial drugs


Question: The most frequently dislocated joint in the body is

The glenohumeral joint is the most mobile joint in the body and is very unstable As the mobility increases, stability is lost in the joint The shoulder dislocation occurs more commonly in adults and rare in the children. Ref : Gray's Anatomy The Anatomical Basics of Clinical Practice 41 e pg 813.


Question: Amphotercin B causes deficiency of

Refer Katzung 11/e p 838 Renal tubular acidosis and renal wasting of K+ and Mg2+ also may be seen during and for several weeks after therapy. Supplemental K+ is required in one-third on patients with prolonged therapy


Question: In poal venous system, valves are present at

D i.e. The whole system is valvelessLike vena Cava, the poal vein and its tributaries are without valvesQ. The normal pressure in poal vein is 3-5 mmHg and the increase in venous pressure is distributed throughout the splanchenic circulation.

The junction of superior mesentric aery with the splenic aery


Question: The choroid plexus of the fouh ventricle is derived from the

Roof plate & its pial covering give rise to the choroid plexus. Alar plate gives rise to sensory neurons Basal plate gives rise to motor neurons Floor plate contains decussating fibers Rhombic lips give rise to the cerebellum.


Question: There are low many pairs of spinal nerves

Spinal nerves: spinal nerve arise in pairs 8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygealEach spinal nerve arises by a series of dorsal and ventral merve roots. these rootlets unite in or near the interveebral foramen to form spinal nerveBD CHAURASIAS HUAMAN ANATOMY Sixth edition Volume 3


Question: In Apoptosis intiation

Ref Robbins 9/e p56 The Death Receptor (Extrinsic) Pathway of Apoptosis Many cells express surface molecules, called death recep- tors, that trigger apoptosis. Most of these are members of the tumor necrosis factor (TNF) receptor family, which contain in their cytoplasmic regions a conserved "death domain," so named because it mediates interaction with other proteins involved in cell death. The prototypic death receptors are the type I TNF receptor and Fas (CD95). Fas ligand (FasL) is a membrane protein expressed mainly on activated T lymphocytes. When these T cells recognize Fas-expressing targets, Fas molecules are cross-linked by FasL and bind adaptor proteins the death domain. These in turn recruit and activate caspase-8. In many cell types caspase-8 may cleave and activate a pro-apoptotic member of the Bcl-2 family called Bid, thus feeding into the mitochondrial pathway. The combined activation of both pathways delivers a lethal blow to the cell. Cellular proteins, notably a caspase antagonist called FLIP, block activation of caspases downstream of death receptors. Interestingly, some viruses produce homologues of FLIP, and it is suggested that this is a mechanism that viruses use to keep infected cells alive. The death receptor pathway is involved in elimination of self-reactive lympho- cytes and in killing of target cells by some cytotoxic T lymphocytes.

The death receptors induce Apoptosis when they get engaged by fas ligand system

Cytochrome C inhibits Apoptosis activating factor

Apoptosis may be intiated by capase activation


Question: CT severity index is a measure for

Computed Tomography severity index(CTSI) for acute pancreatitis CTSI= Balthazar grade score + necrosis score Highest attainable score =10 CTSI score 0-3: Moality 3%,Morbidity 8% 4-6: Moality 6%, Morbidity 35% 7-10: Moality 17%, Morbidity 92% Refer CTSI table Ref: Sabiston 20th edition Pgno :1527


Question: Parasympathetic ganglion in head are


Question: Coronary cabal fistula is

Inokuchi shunt Interpostion of vein graft between the left gastric (coronary) vein and the IVC Also known as coronary-cabal fistula Choice (TIPS or shunt) is based on the predicted time to transplantation Ref:Sabiston 20th edition Pgno : 1440


Question: In a patient with compensated liver cirrhosis presented with history of variceal bleed. The treatment of choice in this patient is

Management of variceal bleeding In addition to pharmacologic therapy endoscopy should be carried out as soon as possible If varices are found they are treated with either endoscopic ligation or sclerotherapy EVL is the treatment of choice for variceal bleeding Endoscopic scleropathy Variceal bleeding suspected based on history ABC's and resuscitation Sta vasopressin or octreotide infusion Variceal bleeding confirmed on EGD Endoscopic band ligation (or scleropathy) If bleeding stopped - Vasopressin/octreotide for 3-5 days. Complete 7 days of antibiotics. Repeat endoscopic banding every 10-14 days until eliminated If bleeding didn't stop - Balloon tampon ade consider TIPS or surgical shunt if TIPS fails or not vavilable Ref: Sabiston 20th edition Pgno : 1444

TIPS(Transjugular intra hepatic poal shunt)


Question: Example of type 4 hypersensitivity is

Ref Robbins 9/e p209 Delayed-type hypersensitivity (DTH), described next, is an illustrative model of T cell-mediated inflammation and tissue injury. The same reactions are the underlying basis for several diseases. Contact dermatitis is an example of tissue injury resulting from T cell-mediated inflammation. It is evoked by contact with pentadecylcatechol (also known as urushiol, the active component of poison ivy and poison oak, which probably becomes antigenic by binding to a host protein). On reexposure of a previously exposed person to the plants, sensitized TH1 CD4+ cells accumulate in the dermis and migrate toward the antigen within the epidermis. Here they release cytokines that damage kera- tinocytes, causing separation of these cells and formation of an intraepidermal vesicle, and inflammation manifested as a vesicular dermatitis. It has long been thought that several systemic diseases, such as type 1 diabetes and mul- tiple sclerosis, are caused by TH1 and TH17 reactions against self antigens, and Crohn disease may be caused by uncon- trolled reactions involving the same T cells but directed against intestinal bacteria. T cell-mediated inflammation also plays a role in the rejection of transplants, described later in the chapter. Delayed-Type Hypersensitivity DTH is a T cell-mediated reaction that develops in response to antigen challenge in a previously sensitized individual. In contrast with immediate hypersensitivity, the DTH reac- tion is delayed for 12 to 48 hours, which is the time it takes for effector T cells to be recruited to the site of antigen chal- lenge and to be activated to secrete cytokines. The classic example of DTH is the tuberculin reaction, elicited by chal- lenge with a protein extract of M. tuberculosis (tuberculin) in a person who has previously been exposed to the tuber- cle bacillus. Between 8 and 12 hours after intracutaneous injection of tuberculin, a local area of erythema and indura- tion appears, reaching a peak (typically 1 to 2 cm in diam- eter) in 24 to 72 hours and thereafter slowly subsiding. On histologic examination, the DTH reaction is characterized by perivascular accumulation ("cuffing") of CD4+ helper T cells and macrophages (Fig. 4-13). Local secretion of cyto- kines by these cells leads to increased microvascular per- meability, giving rise to dermal edema and fibrin deposition; the latter is the main cause of the tissue induration in these responses. DTH reactions are mediated primarily by TH1 cells; the contribution of TH17 cells is unclear. The tubercu- lin response is used to screen populations for people who have had previous exposure to tuberculosis and therefore have circulating memory T cells specific for mycobacterial proteins. Notably, immunosuppression or loss of CD4+ T cells (e.g., resulting from HIV infection) may lead to a nega- tive tuberculin response even in the presence of a severe infection. Prolonged DTH reactions against persistent microbes or other stimuli may result in a special morphologic pattern of reaction called granulomatous inflammation. The initial perivascular CD4+ T cell infiltrate is progressively replaced by macrophages over a period of 2 to 3 weeks. These accumulated macrophages typically exhibit morphologic evidence of activation; that is, they become large, flat, and eosinophilic, and are called epithelioid cells. The epitheli- oid cells occasionally fuse under the influence of cytokines (e.g., IFN-g) to form multinucleate giant cells. A micro- scopic aggregate of epithelioid cells, typically surrounded by a collar of lymphocytes, is called a granuloma (Fig. 4-14, A). The process is essentially a chronic form of TH1-mediated inflammation and macrophage activation (Fig. 4-14, B). Older granulomas develop an enclosing rim of fibroblasts and connective tissue. Recognition of a granuloma is of diagnostic impoance because of the limited number of conditions that can cause it (Chapter 2).


Question: The rate of newly synthesized Osteoid mineralization is best estimated by

Reference Robbins page no 358 6th edition Tetracycline is absorbed into bone and so it is used as a marker of bone growth for biopsies in humans. Tetracycline binds to newly formed bone at the bone interface where it shows as a linear fluroscencse. Tetracycline labelling is used to determine the amount of bone growth within a ceain period of time


Question: Enchondroma commonly arises from

ENCHONDROMA * Rarely an enchondroma may extend through the coex and demonstrate a exophytic growth pattern. This is known as an enchondroma protuberans, and may either be seen sporadically or as pa of Oilier disease. * Almost all enchondromas are located in the medullary cavity of tubular bones. D/ds: * bone infarct , chondrosarcoma, intraosseous * other benign Ivtic bone lesions, * metastases * granulomatous disease : sarcoidosis, tuberculosis * X-ray & CT Typically enchondromas are small 1 - 2cm lytic lesions with non-aggressive features. narrow zone of transition sharply defined scalloped margins : may have mild endosteal scalloping expansion of the overlying coex may be present but there should not be coical breakthrough unless fractured Chondroid calcifications may be present : rings and arcs calcification-STIPPLED/PUNCTATE/POPCORN no periosteal reaction * The majority of enchondromas more frequ the metaphyseal region entirely arise in A cailaginous lesion in an epiphysis is more likely to be a chondrosarcoma . Refer Apleys 9th/e p 197


Question: Inflammatory mediator of generalised systemic inflammation is


Question: Direct coombs test detects

Refer robbins 8/e p653 A Coombs test (also known as antiglobulin test or AGT) is either of two clinical blood tests used in immunohematology and immunology. The two Coombs tests are the direct Coombs test (DCT, also known as direct antiglobulin test or DAT), and the indirect Coombs test (also known as indirect antiglobulin test or IAT). The direct Coombs test detects antibodies that are stuck to the surface of the red blood cells. Since these antibodies sometimes destroy red blood cells, a person can be anemic and this test can help clarify the condition. The indirect Coombs detects antibodies that are floating freely in the blood. These antibiodies could act against ceain red blood cells and the test can be done if you have had a blood transfusion and might be having a reaction to the blood


Question: Intrinsic muscle of the tongue is derived from

The muscles develop from the occipital myotomes which are supplied by the hypoglossal nerve Notes: The intrinsic muscles of tongue are- 1. Superior longitudinal 2.Inferior longitudinal 3.Transverse 4.Veical Ref BDC volume 3,Sixth edition pg 270


Question: Muscle entering middle ear from pyramid apex is

A conical projection, called the pyramid, lies near the junction of the posterior and medial walls of the middle ear. It has an opening at its apex for passage of the tendon of the stapedius muscle.Ref: BD Chaurasia; 6th edition; Volume 3


Question: Amnion is made up of

Amnion is made up of Amniogenic cells+ Somatopleuric cells

primary yolk sac +splanchnopleuric cells


Question: lithium was introduced by

LITHIUM - Lithium was introduced by ==== JOHN F CADE - It is liver friendly drug - It is mainly eliminated by kidney Ref.Kaplon and Sadock, synopsis of psychiatry, 11 th edition, 935


Question: Deep petrosal nerve is formed from

The deep petrosal nerve,sympathetic in nature is a branch of the sympathetic plexus around the internal carotid aery.It contains postganglionic fibres from the superior cervical sympathetic ganglion. Ref,BDC VOL.3,Fouh edition


Question: Intermediate filaments in connective tissue

Vimentin is the intermediate filaments present in connective tissue It is used as tumor marker in tumor of connective tissue Ref:Guyton and Hall textbook of medical physiology 12th edition,page number 8,9,14


Question: Antegrade cholecystectomy

Types of Cholecystectomy Retrograde Hilar structure dissection occurs first followed by the removal of gallbladder in the triangle of callot's Antegrade or Fundus first or Top-down Seperates GB from the liver before the cystic duct and aery are ligated Considered safer because it allows for the progressive demonstration of the anatomy down to the indundibulocystic junction Ref: Mastery of surgery 5th edition Pg no : 1128


Question: Somites are derived from

HUMAN EMBRYOLOGY-INDERBIR SINGH TENTH EDITION-PAGE NO:62 Some details about the paraxial mesoderm -at first, the cells of the paraxial mesoderm are homogeneously arranged .later, the mesoderm gets segmented -the segment is of two categories, somitomeres, and somites


Question: conveing of psychological syptoms to physical presentation was given by

CONTRIBUTIONS OF FREUD o Father of psychoanalysis He founded a type of psychotherapy called psychoanalysis. It is nothing but analyzing the psych(MIND) o Interpretation of dreams According to Freud dreams are royal road to unconscious In dreams several conflicts that are present in the unconscious comes to the consciousness in the form of dreams Thus by analyzing ones dreams we could understand the unconscious conflicts o Psychosexual stages of life o Freud divided development into 5 stages namely psycho sexual development o It is divivded namely oral , anal , phallic, latent, genital phase. o Conversion disorders conversion disorder is conveing a psychological pain to physical symptoms present physical symptoms which has some connection with unconscious conflict is called SYMBOLIZATION present physical symptoms which has some resemblance with illness in family members, which is called MODELLING patient has illness like neurological deficit but they have apparent in concern towards their own illness which is known as LA BELLE INDIFFERENCE main defense mechanism in conversion disorder is REPRESSION o Repression defence mechanism * REPRESSION is called QUEEN of defense mechanisms o COUCH and FREE ASSOSIATION * He introduced a technique called as a couch technique where he makes the patient lie on the couch, he asks the patient to speak from 'cabbages to kings. This method is called FREE ASSOSIATION. By allowing the patient to speak whatever that comes to their mind randomly so that by analyzing their thoughts we could understand the conflict in the unconscious. o Topographical theory of mind Freud gave topographical theory mind It is divided into pre conscious, unconscious, conscious Later he disregarded topographical theory of mind and gave structural theory of mind o Structural theory of mind It is divided into id, ego, super ego Id= instinctual desires like anger, hunger, sexual instinct Ego= function of mind to work based on ego to avoid guilt from super ego Super ego= based on moral principle, obtained from family members and relatives, teachers Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition pg no. 845


Question: Umbilical cord has

This tube of amnion and the structures within it constitutes the umbilical cord.T his cord contains two umbilical aeries and one umbilical vein. REF HUMAN EMBRYOLOGY; Inderbier singh; Tenth edition; Page 67


Question: Sympathetic trunk rests on

The sympathetic trunk lies just lateral to the veebral bodies for the entire length of the veebral column. ... The sympathetic trunk permits preganglionic fibers of the sympathetic nervous system to ascend to spinal levels superior to T1 and descend to spinal levels inferior to L2/3 The superior end of it is continued upward through the carotid canal into the skull, and forms a plexus on the internal carotid aery ; the inferior pa travels in front of the coccyx, where it converges with the other trunk at a structure known as the ganglion impar . Along the length of the sympathetic trunk are sympathetic ganglia known as paraveebral ganglia . Image showing efferrent system of sympathetic trunk Ref - medscape.com


Question: Huhle cells are seen in

Refer Robbins page no 1087thyroid is often diffusely enlarged, although more localized enlargement may be seen in some cases. The capsule is intact, and the gland is well demarcated from adjacent structures. The cut surface is pale, yellow-tan, firm, and somewhat nodular. There is extensive infiltration of the parenchyma by a mono- nuclear inflammatory infiltrate containing small lympho- cytes, plasma cells, and well-developed germinal centers (Fig. 24-11). The thyroid follicles are atrophic and are lined in many areas by epithelial cells distinguished by the presence of abun- dant eosinophilic, granular cytoplasm, termed Huhle cells. This is a metaplastic response of the normally low cuboidal follicular epithelium to ongoing injury. In fine-needle aspiration biopsy samples, the presence of Huhle cells in conjunction with a heterogeneous population of lymphocytes is character- istic of Hashimoto thyroiditis. In "classic" Hashimoto thyroiditis, interstitial connective tissue is increased and may be abundant. Unlike Reidel thyroiditis (see later), the fibrosis does not extend beyond the capsule of the gland.


Question: Lower 1/3 of vagina is formed by

Lower 2/3rd of vagina formed from sinovaginal bulb which comes from endoderm of urogenital sinus. Upper 1/3rd of vagina is derived from fused paramesonephric duct. Mesonephric duct forms the collecting pa or ductular pa of male reproductive system. Mesoderm of Mullerian duct is basically paramesonephric duct.

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


Question: Angular vein communicates with

Angular Vein is the upper most segment of the Facial Vein, formed by the union of the Supratrochlear Vein and Supraorbital Vein. It runs obliquely downward by the side of the nose, is linked with the cavernous sinus by the superior and inferior ophthalmic veins which are devoid of valves. fig:-Angular vein communication with cavernous sinus


Question: Nucleus ambiguous doesn&;t include

The nuclei of facial nerve are located in the pons.Nucleus ambiguous is an elongated column of typical motor neurons extending throughout the medulla.The fibres from nucleus ambiguous supplies muscles derived from 3,4 and 6 branchial arches. Cells in nucleus ambiguous contain motor neurons associated with three cranial nerves (rostral pole -C.N. IX glossopharyngeal; middle pa -C.N. X vagus; caudal pole -C.N. XI spine accessory).(Ref: Vishram Singh textbook of clinical neuroanatomy second edition pg 94)


Question: Last to recover in spinal anesthesia is


Question: Leucine aminopeptidase is elevated in obstruction of

Leucine Aminopeptidase Increased leucine aminopeptidase (Lap) activity is seen in : Carcinoma of the pancreas, choledocholithiasis, acute pancreatitis Viral hepatitis, cirrhosis, carcinoma with liver metastases In common bile duct obstruction, whether due to carcinoma pancreas or choledocholithiasis, the elevated serum Lap levels returned to normal following relief of the obstruction. This is in agreement with the hypothesis that the increased serum LAP activity in these conditions is the result of bile duct obstruction Ref: American journal of Gastroenterology, Dec 1963, vol 41 issue 6 Pgno : 620


Question: The intiating mechanism in endotoxic shock is

Ref Robbins. 9/e p132-133 Endothelial injury is also a cause..see the above questions In gram-negative sepsis, free LPS attaches to a circulating LPS-binding protein, and the complex then binds to the CD14 receptor on monocytes, macrophages, and neutrophils. Engagement of CD14 (even at doses as minute as 10 pg/mL) results in intracellular signaling an associated "Toll-like receptor" protein 4 (TLR-4). This signaling results in the activation of nuclear factor kappaB (NF-kB), which leads to transcription of a number of genes that trigger a proinflammatory response. It was the result of significant activation of mononuclear cells and synthesis of effector cytokines. It also results in profound activation of mononuclear cells and the production of potent effector cytokines such as IL-1, IL-6, and TNF-a. TLR-mediated activation helps to trigger the innate immune system to efficiently eradicate invading microbes, but the cytokines they produce also act on endothelial cells. There, they have a variety of effects, including reduced synthesis of anticoagulation factors such as tissue factor pathway inhibitor and thrombomodulin. The effects of the cytokines may be amplified by TLR-4 engagement on endothelial cells