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Incomplete closure of palpebral apeure is called: March 2004: (A) Lagophthalmos, (B) Chalazion, (C) Entropion, (D) Ectropion

Answer is A. Ans. A i.e. Lagophthalmos

Galactokinesis means :: (A) Sustaining lactation, (B) Secretion of milk, (C) Ejection of milk, (D) Synthesis of milk

Answer is C. Ejection of milk

The tendon of Sartorius, gracilis, and semi-tendinosus muscles forms a Pes Anserinus at the neck of tibia. Similar kind of structure is also seen in?: (A) Parotid, (B) Submandibular, (C) Cheek, (D) TMJ

Answer is A. None

Serological testing of patient shows HBsAg, IgM Anti-HBc and HBeAg positive . The patient has-: (A) Chronic hepatitis B with low infectivity, (B) Acute hepatitis B with high infectivity, (C) Chronic hepatitis with high in fectivity, (D) Acute on chronic hepatitis

Answer is B. HBs Ag is the first marker appear in the blood after infection. Anti HBc is the earliest antibody seen in blood. HBeAg indicates infectivity REF:MICROBIOLOGY ANANTHA NARAYANAN NINTH EDITION PAGE.546&547

All of the following are seen in GH deficiency except?: (A) Hyperglycemia, (B) Stunting, (C) Delayed bone age, (D) High pitched voice

Answer is A. From late in the first year until mid-teens, poor growth and/ or shoness is the hallmark of childhood GH deficiency. It tends to be accompanied by delayed physical maturation so that bone maturation and pubey may be delayed by several years. Severe GH deficiency in early childhood also results in slower muscular development, so that gross motor milestones may be delayed. Some severely GH-deficient children have recognizable, cherubic facial features characterized by maxillary hypoplasia and forehead prominence. These children have a high pitched voice and are stunted. GH deficiency is associated with hypoglycemia. In contrast gigantism or acromegaly is associated with impaired glucose tolerance.

Hydatidiform - mole, characterized histologically by: (A) Hyaline membrane degeneration, (B) Hydropic degeneration of the villous stroma, (C) Non proliferation of cytotrophoblasts, (D) Non proliferation of syncytiotrophoblasts

Answer is B. (Hydropic degeneration of the villous storma): Ref: 193-97, 201-DHYDATIDIFORM MOLE (Vesicular mole) - It is an abnormal condition of placenta where there are partly degenerative and partly proliferative changes in the young chorionic villi.* It is best regarded as a benign neoplasm of the chorion with malignant potential* Vaginal bleeding is the commonest presentation (90%) "white currant in red currant juice"* Expulsion of grape like vesicles (rich in HCG) per vaginum is diagnostic of vesicular mole* Histology shows - hydropic degeneration of the villous stroma with absence of blood vessels and trophoblastic proliferationRISK FACTORS FOR MALIGNANT CHANGE* Patient above the age of 40 irrespective of parity* Patients having previous 3 or more births irrespective of age. Age is more important than the parity* Initial serum hCG > 100,000 mIU/ml* Uterine size >20 weeks* Previous history of molar pregnancy* Large (> 6 cm) thecaleutin cystsImportant features of complete and Partial molesFEATURESCOMPLETE (CLASSIC) MOLEINCOMPLETE* Embryo/fetusAbsentPresent* Hydropic degeneration of villiPronounced and diffusedVariable and focal* Trophoblast hyperplasia * Uterine sizeDiffuseFocal* Theca leutin cystsMore than the date (30 - 60%)Less than the date* KaryotypeCommon (25 - 50%)Uncommon* phCG46 XX (85%) Paternal in originTriploid (90%) diploid (10%)* Classic clinical symptomsHigh (> 50, 000)CommonSlight elevation (< 50,000)Rare* Risk of persistent gestational trophoblastic neoplasia (GTN)20%<5%

The nerve impulse which leads to initiation of smooth muscle contraction: (A) Cause opening of the calcium channel which leads to increase in Ca+2 contraction, (B) Cause both plasma membrane and T - tubules to undergo depolarisation, (C) Inhibits Na+ entry in sarcomere, (D) Is initiated by binding of acetylcholine to receptors in sarcoplasmic reticulum

Answer is A. Ans. (a) Cause opening of the calcium channel which leads to increase in Ca2+ contraction(Ref: Ganong, 25th ed/p.116)The never impulse which leads to initiation of smooth muscle contraction Cause opening of the calcium channel which leads to increase in Ca2+ contraction

In a family, the father has widely spaced eyes, increased facial hair and deafness. One of the three children has deafness with similar facial features. The mother is normal. Which one of the following is most likely pattern of inheritance in this case?: (A) Autosomal dominant, (B) Autosomal recessive, (C) X-linked dominant, (D) X-linked recessive

Answer is A. A i.e. Autosomal dominant (most likely) Waardenburg's Syndrome (WS) is a rare autosomal dominant syndrome characterized by pigmentary disturbances (skin, hair, iris), sensorineural hearing loss, and other developmental anomalies such as dystopia canthorum (widely spaced eyes) and blepharophimosis. The syndrome that closest matches the features provided in the question is Waardeburg syndrome type-I. This is inherited as an autosomal dominant fashion and hence is the answer of exclusion. As the question does not provide us with details as to the sex of the three children, a sex linked inheritance pattern cannot be worked out. Also the combined presentation of an affected father, unaffected mother and one affected child among three children is possible with both an autosomal dominant and an autosomal recessive inheritance pattern. In absence of any more details, the answer to this question cannot be deduced through the exploration of various permutations and combinations. How both autosomal dominant and autosomal recessive inheritance can be responsible for the above combination: Autosomal Dominant Autosomal recessive (A-affected allele and a normal allele) If the disease is transmitted in an Autosomal Dominant then :Father (affected) will be either 'AA' or 'Aa' Mother (unaffected) will be 'aa' If father is AA and mother aa, the offsprings will be 1. aA - 100% affected If father is Aa and mother aa, the offsprings will Aa - 50% affected aa - 50% not affected The scenario in the above question therefore is possible autosomal dominant inheritance if father is Aa and mother is aa (A'-affected allele and 'a' normal allele) If the disease is transmitted in an Autosomal recessive form :Father (affected) will be 'AA' Mother (unaffected) may be 'aa' or 'Aa' If father is AA and mother aa, the offsprings will be 1. aA - 100% not affected, (but carriers) If father is AA and mother Aa, the offsprings will be Aa - 50% not affected, carrier AA - 50% affected The scenario in the above question therefore is possible with autosomal recessive inheritance if father is aa and mother is Aa

All of the following statements about Heparin are true, except:: (A) Causes Alopecia, (B) Non Teratogenic, (C) Releases Lipoprotein Lipase, (D) Causes Hypokalemia

Answer is D. Heparin inhibits the production of aldosterone. It thus lead to severe Hyperkalemia and not hypokalemia as mentioned in the choice above. Ref: Harrison's Textbook of Internal Medicine, 16th edition, Page 1261; K D Tripathi Textbook of Pharmacology, 5th Edition, Pages 561-63

Tigroid white matter on MRI is seen in?: (A) Pantothenate kinase deficiency, (B) Pelizaeus-merzbacher disease, (C) Neuroferritinopathy, (D) Aceruloplasminemia

Answer is B. The tigroid pattern/ leopard skin sign occurs on MRI head is seen in Pelizaeus-merzbacher disease, due to creation of islands of perivascular myelin due patchy myelin deficiency. It is a rare hypomyelination syndrome caused by mutation in proteolipid protein, PLP 1 gene at chromosome Xq22. Child will show slow psychomotor development with nystagmus(pendular eye movements), hypotonia, extrapyramidal symptoms and spasticity. Tigroid pattern is also seen in metachromatic leucodystrophy.

Which of the following is the Nysten's law: (A) Cadaveric rigidity does not appear in hot humid conditions, (B) Cadaveric rigidity appears faster in older and the young than in middle age, (C) Cadaveric rigidity occurs in men earlier than in woman, (D) Cadaveric rigidity affects successively the masticatory muscles, those of the face and the neck, those of the trunk and arms and finally those of lower limbs rruk

Answer is D. In rigor mois, all muscles of body, both voluntary and involuntary are involved. Externally it first appears in the eye lids, then lower jaw, muscles of the face, neck upper limbs and lastly lower limbs. This descending pattern or proximodistal progression is called Nysten's law. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 26

If a drug is active against the pre-erythrocytic stage of the malarial parasite it will be useful as a:: (A) Suppressive prophylactic, (B) Causal prophylactic, (C) Clinical curative, (D) Radical curative

Answer is B. If a drug is active against the pre-erythrocytic stage of the malarial parasite it will be useful as a Causal prophylactic. Stage killed Clinical Use Pre-erythrocytic Causal Prophylaxis Erythrocytic Clinical cure Suppressive Prophylaxis Exo-erythrocytic Radical cure Gametocytic Prevention of transmission

All are true statement about tracheostomy and larynx in children except:: (A) Omega shaped epiglottis, (B) Laryngeal cailages are soft and collapsable, (C) Larynx is high in children, (D) Trachea can be easily palpated

Answer is D. Infant's larynx differs from adult in:It is situated high up (C2 - C4).Q (in adults = C3 - C6)Of equal size in both sixes (in adults it is larger in males)Larynx is funnel shapedThe narrowest pa of the infantile larynx is the junction of subglottic larynx with trachea and this is because cricoid cailage is very smallEpiglottis is omega shaped, soft, large and patulous.Laryngeal cailages are soft and collapse easilySho trachea and sho neck.Vocal cords are angled and lie at level of C4Trachea bifurcates at level of T2Thyroid cailage is flat. The cricothyroid and thyrohyoid spaces are narrow.Tracheostomy in Infants and Children Trachea of infants and children is soft and compressible and its identification may become difficult and the surgeon may easily displace it and go deep or lateral to it injuring recurrent laryngeal nerve or even the carotid.During positioning, do not extend too much as this pulls structures from chest into the neck and thus injury may occur to pleura, innominate vessels and thymus or the tracheostomy opening may be made twoo low near suprasternal notchTracheostomy in Infants and Children The incision is a sho transverse one, midway between lower border of thyroid cailage and the suprasternal notch. The neck must be well extended.A incision is made through two tracheal rings, preferably the third or fouh.

Drug NOT used in pulmonary hypeension is?: (A) Calcium channel blocker, (B) Endothelin receptor antagonist, (C) Alpha blocker, (D) Prostacyclin

Answer is C. alpha blockers Pulmonary hypeension General management Diuretic therapy may be useful as it relieves pulmonary edema. Anticoagulant therapy is advocated for all patients. Specific management Calcium channel blockers Patients who have substantial reductions in pulmonary aerial pressure in response to sho acting vasodilators at the time of cardiac catheterization should he initially treated with calcium channel blockers. Endothelin receptor antagonist Bostenan is a non-selective endothelium receptor antagonist, is an approved t/t ,for patients who are NYHA .functional classes III and IV. Phosphodiesterase-5 inhibitors Slidenafil is used for patients who are NYHA functional classes II and Prostacyclins Iloprost is a prostacyclin analogue used in PAH patients who are NYHA functional classes III and IV. Pulmonary circulation is unique in that it accommodates a blood flow that is almost equal to that of all the other organs of body but still maintains low pressure. The factors responsible for low pressure in pulmonary circulation (even with large volume of blood) are:- - Larger diameter of pulmonary vessels due to thin wall of pulmonary aery and aerioles.

Which of the following is a good prognostic factor in ALL:: (A) High WBC count, (B) Male sex, (C) Age < 2 years, (D) Hyperdiploidy

Answer is D. Answer is D (Hyperdiploidy): Hyperdiploidy is associated with a good prognosis Hyperdiploidy is associated with a good prognosis Patients with hyperdiploidy (>50 chromosomes) or DNA index > 0.16 have a ourable prognosis - Age < 2 years has a poor prognosis Patients who are very young (< 2 years) and older patients (> 10 years) tend to have a worse prognosis- lthough most textbooks use the criteria of Age < 1 year to define a poor prognostic factor, Age < 2 year has been mentioned as a poor prognostic factor in ceain textbooks including Hoffman's Hematology (4th/1158) Since Hyperdiploidy provided amongst the option is an established good prognostic factor, this is selected as the single best answer of choice. High WBC count is associated with a poor prognosis Initial leukocyte count at diagnosis has proved to be an impoant prognostic factor in viually every ALL study. Different studies (textbooks) quote different values for the initial WBC count that is associated with a poor prognosis but uniformly a high WBC count carries a poor prognosis. Different text books Favourable WBC count Unourable WBC count Wintrobe's Hematology < 10,000 > 20,000 Hoffman Hematology < 50,000 > 50,000 Manual of Clinical oncology <30,000 >30,000 Inference Low WBC count High WBC count Male sex is associated with a poor prognosis 'Female patients have a rare ourable prognosis'

A 28 year old labourer, 3 yrs back presented with penile ulcer which was not treated. Later he presented with neurological symptoms for which he got treated. Which is the test to monitor response to treatment?: (A) VDRL, (B) FTA ABS, (C) TPI, (D) RPR

Answer is A. This is a case of neurosyphilis. A positive nontreponemal CSF serologic test result (CSF VDRL) establishes the diagnosis of neurosyphilis (and an increased cell count in response to the spirochete documents the presence of active disease). In VDRL test, the inactivated serum is mixed with cardiolipin antigen on a special slide & rotated for 4 minutes. Cardiolipin remains as uniform crystals in normal serum but it forms visible clumps on combining with regain antibody. The reaction is read under low power microscope. By testing serial dilutions, the antibody titre can be estimated. The results are repoed as reactive, weak by reactive / not reactive. The VDRL test can be used for testing CSF also, but not plasma. A number of modification of VDRL test have been developed, of which the Rapid Plasma Reagin (RPR) is the most popular. In RPR test. VDRL antigen containing carbon paicles which make the result more clear cut & evident to the naked eye The RPR test is done with unheated serum / plasma but is not suitable for testing CSF. Ref: Ananthanarayanan & Paniker's textbook of microbiology Ed 8 Pg - 375; Klausner J.D., Hook III E.W. (2007). Chapter 20. Neurosyphilis. In J.D. Klausner, E.W. Hook III (Eds), CURRENT Diagnosis & Treatment of Sexually Transmitted Diseases.

70 year old man has abdominal pain with mass inabdomen. Angiography reveals aneurysm of aoa. Mostlikely cause is:: (A) Trauma, (B) Atherosclerosis, (C) Syphilis, (D) Congenital

Answer is B. . Atherosclerosis

Which of the following is false regarding neonatal resuscitation?: (A) T - tube delivers free flow oxygen, (B) Self - inflating bag should not be used without reservoir, (C) Self - inflating bag can deliver free flow oxygen, (D) Flow inflating bag delivers free flow oxygen

Answer is B. 1. T - tube delivers free flow oxygen - TRUE 2. Self - inflating bag should not be used without reservoir - FALSE - can be used but FiO2 will be less. 3. Self - inflating bag can deliver free flow oxygen - TRUE 4. Flow inflating bag delivers free flow oxygen - TRUE

The most impoant prognostic factor of Wilms tumor-: (A) Histopathology, (B) Ploidy of cells, (C) Age < 1 y, (D) Mutation of c 1p gene

Answer is A. Robbins basic pathology 10th edition page no 290. Wilms tumor or nephroblastoma is the most common primary tumor of the kidney in children. On microscopic examination, Wilms tumors are characterized by recognizable attempts to recapitulate different stages of nephrogenesis. The pattern of anaplastic cells within the primary tumor has impoant implications for prognosis.

The relationship of mean height of two group of children is best studied by-: (A) Student's test, (B) Linear regression, (C) Chi-square test, (D) Test of propoions

Answer is A. .

Advantage of brachytherapy – a) Non-invasiveb) Less radiation hazard to normal tissuec) Max.radiation to diseased tissued) Can be given in all malignanciese) Doesn't require trained personnel: (A) a, (B) c, (C) ac, (D) bc

Answer is D. As the radiotherapy source is placed directly in contact with tumor, maximum radiation exposure occurs to tumor tissue with relative sparing of adjacent normal tissue. Brachytherapy is invasive and requires trained personnel. Brachytherapy can be used in most (not all) of the malignancies where radiotherapy is the component of treatment.

Acyl carnitine functions in:: (A) Transport of long chain fatty acid, (B) Transport of short chain fatty acid, (C) Transport of NADH, (D) Transport of FADH

Answer is A. Ans: a (Transport of long....) Ref: Vasudevan, 4th ed, p. 129The long chain fatty acyl CoA cannot pass through the inner mitochondrial membrane. There fore a transporter, carnitine is involved in transfer of fatty acids.Beta oxidation:Beta oxidation is absent in brain and erythrocytes (because erythrocytes lack mitochondria and fatty acids do not cross BBB).Carnitine acyl transferase -1 is inhibited by Malonyl CoA.Clinical correlate:Carnitine acyl transferase(CAT) deficiency (myopathic form)Although all tissues contain CAT most common form of genetic deficiency is myopathic form and due to a defect in muscle specific CAT gene.Features:Muscle aches, red urineRhabdomyolysis, myoglobinuriaProvoked by exerciseIncreased by high fat; low carbohydrate dietMuscle biopsy: increased muscle triglyceride in cytoplasmTreatment: Cease muscle activity, give glucose.

Fatal period in sulphuric acid poisoning is :: (A) 2-4 hours, (B) 6-10 hoursd, (C) 12-16 hours, (D) 8-14 hours

Answer is C. C i.e. 12 -16 hours

Most common method of anterior capsulotomy in phacoemulsification: (A) Can-opener capsulotomy, (B) Intercapsular capsulotomy, (C) Capsulorhexis, (D) Envelop capsulotomy

Answer is C. Answer- C. CapsulorhexisThe most commonly used technique for anterior capsulotomy during phacoemulsification is continuous curvilinear capsulorhexis (CCC).

A 26 year old female patients presents to emegency with history of consuming hair dye paraphenylenediamine . What shall be the expected outcome in such patient ?: (A) Blindness, (B) Nerve pathology, (C) Dermatitis, (D) Rhabdomyolysis

Answer is D. Hair dye poisoning(Paraphenylenediamine ): Cost-effective alternative to Organophosphate poisoning Readily available to masses. Clinical manifestations are Angioedema leading to dysphasia and respiratory distress, Rhabdomyolysis, Intravascular hemolysis, Acute renal failure and hepatic necrosis. Myocarditis or fatal arrhythmia may also occur in PPD poisoning. Mainstay of management is early recognition and suppoive measures as there is no specific antidote

Generally, radiotherapy should not be used for treating benign conditions. The only possible exception being:: (A) Chondromyxoid fibroma, (B) Extensive pigmented villonodular synovitis, (C) Benign fibrous histiocytoma, (D) Desmoplastic fibroma so extensive that it cannot be surgically excise

Answer is B. Ans. B. Extensive pigmented villonodular synovitisPVNS is commonly seen around knee. Synovial inflammation occurs due to cholesterol and pigment deposition. Radiotherapy may alleviate this disease. Else one has to go with synovectomy. Malignant transformation is reported but very rare.SYNOVIAL SARCOMA is a soft tissue tumor that does not have synovial origin despite its name. It is a rare but aggressive tumor that arises from tendon sheaths or joint capsules where there are multipotent stem cell rests that differentiate into mesenchymal as well as epithelial structures, hence a BIPHASIC TUMOR. It is characterized by Ctrl (X;18). Excision is the treatment of choice.

Blockade of nerve conduction by a local anaesthetic is characterized by -: (A) Greater potential to block a resting nerve as compared to a stimulated nerve, (B) Need to cross the cell membrane to produce the block, (C) Large myelinated fibers are blocked before small myelinated fibers, (D) Cause consistant change of resting membrane potential

Answer is B. Ans. is 'b' i.e., Need to cross the cell membrane to produce the block Penetration of axonal membrane by L.A. o Local anaesthetics are weak bases and are used in the form of acid salts (usually HCL). o They penetrate the axoplasmic membrane in unionized form (unionize molecules are lipid soluble and diffusible). o Inside axon they becomes ionized and act from inside of Na+ channel. Sodium bicarbonate speeds the onset of action of LAs by increasing the unionized form (weak bases are unionized at alkaline pH). About other option Stimulated fibers are blocked rapidly (not resting fibers) Smaller fibers are more sensitive than larger o LA does not effect resting membrane potential as it does not block the Na+ channel in resting state (see above explanantion). LA inhibits depolarization as it prolonges the inactive state and prolongs the refractory period.

Presence of spiral grooves in the barrel of weapon is referred to as:: (A) Rifling, (B) Incendiary, (C) Cocking, (D) None of the above

Answer is A. Ans. (A). RiflingShotgunRifled gunCHOKING:* The terminal few cms (7-10) is constricted in shot guns.* Reduces the pelletsdispersionQ* Increases the explosive forces of the pellets.* Increases the velocity of the pellets.RIFLING:* Interior of bore has spiral grooves which run parallel to each other, but twisted spirally from breech to muzzle end.* These grooves are called 'rifling'* Imparts Spinning motion to the bulletQ* Greater power of penetration.* Straight trajectory* Increases accuracy & rangeFully choked shotgun - Least dispersion of pelletsUnchoked shotgun - Maximum dispersionQ of pellets. Paradox gun: A smooth bore gun with small terminal part rifled.Bullets that impart great tissue destruction:Soft nosed bullet that flatten on impactDum Dum bulletBullets that fragment (frangible bullet)Bullets that mushroom on impact

Duhamel procedure is done for -: (A) Hirschsprung's disease, (B) HPSS, (C) Meckels diverticulum, (D) Volvulus

Answer is A. Ans. is 'a' i.e., Hirschsprung's disease * Surgery in Hirschsprung's disease aims to remove the aganglionic segment and 'pull-through' ganglionic bowel to the anus (e.g. Swenson, Duhamel, Soave and transanal procedures) and can be done in a single stage or in several stages after first establishing a proximal stoma in normally innervated bowel.

Post coital test showing non motile sperms in the cervical smear and Motile sperms from the posterior fornix suggests :: (A) Faulty coital practice, (B) Immunological defect, (C) Hypospadias, (D) Azoospermia

Answer is A. Ans. is a i.e. Immunological defect Post coital test is a test for evaluation of the potential role of cervical factor in infeility. The couple is advised intercourse close to ovulation time, in the early hours of morning (preferably) The woman presents herself at the clinic within 2 hours after the intercourse. The mucus is aspirated from the cervical canal and posterior fornix (acts as control) and spread over a glass slide. Result : 10-50 motile Sperms with progressive movement/ HPF in cervical mucus seen Cervical factor ruled out Less than 10 sperms / HPF Need for proper semen analysis to see oligospermia Sperms immotile in mucus aspirated from cervical canal and motile in specimen from posterior fornix or Rotatory/ shaky movement seen in sperms aspirated from cervical canal Immunological defect

The current Global strategy for malaria control is called –: (A) Modified plan of operation, (B) Malaria Eradication Programme, (C) Malaria Control Programme, (D) Roll back Malaria

Answer is D. None

Which of the following is a first-generation Cephalosporin used for surgical prophylaxis?: (A) Ceftriaxone, (B) Cefoxitin, (C) Cefazolin, (D) Cefepime

Answer is C. First-Generation Cephalosporins: include - Cefazolin, Cephalexin, Cephradine, Cefadroxil, Cephalothin and Cephapirin Cefazolin is good for skin preparation as it is active against skin infections from S.pyogenes and MRSA. It is administered Intramuscular or Intravenous (i.e Parenteral drug).It is a drug of choice for surgical prophylaxis.Cefazolin does not penetrate the CNS and cannot be used to treat meningitis. Cefazolin is better tolerated than Antistaphylococcal Penicillins, and it has been shown to be effective for serious Staphylococcal infections e.g Bacteremia. Oral First generation drugs may be used for the treatment of urinary tract infections and Staphylococcal or Streptococcal infections, including cellulitis or soft tissue abscess.

"Birbeck granules" are seen in: (A) Melanosomes, (B) Lamellar bodies, (C) Keratohyalin granules, (D) Langerhan cells

Answer is D. "Tennis racket" shaped Birbeck granules are seen in Langerhan cells, which are antigen presenting cells present in epidermis.

For each extra-articular manifestation of RA, select the most likely diagnosis.Associated with increased frequency of infections.: (A) Felty syndrome, (B) rheumatoid vasculitis, (C) episcleritis, (D) Sjogren syndrome

Answer is A. Felty syndrome consists of chronic RA, splenomegaly, and neutropenia. The increased frequency of infections is due to both decreased number and function of neutrophils.

Bakers cyst is a type of:: (A) Pulsion diveiculum of knee joint, (B) Retention cyst, (C) Bursitis, (D) Benign tumor

Answer is A. Baker's cyst:- It is a pulsion diveiculum of knee joint.- It usually found in the posterior aspect of the knee joint.- It is associated with medial meniscal injury.

Most common cranial nerve involved in ophthalmoplegic migraine is:: (A) II nerve, (B) III nerve, (C) V nerve, (D) VI nerve

Answer is B. Ans. III nerve

Position of wrist in cast of colle's fracture is:: (A) Palmar detion & pronation, (B) Palmar detion & supination, (C) Dorsal detion & pronation, (D) Dorsal detion & supination

Answer is A. A . i.e. Palmar detion & pronation

. Gall stones -: (A) Are about twice as common in men as in women, (B) There is an increased incidence of stones in diabetics, (C) About 80-90% of gall stones are radio-opaque, (D) Are usually more than 50 mm in diameter

Answer is B. None

Dental procedures for which antibiotic of choice for the prophylaxis of endocarditis in adults is (Note: Patient is allergic to penicillin and he is not able to take oral medicine):: (A) Clarithromycin 500mg 1 hr. before dental procedures, (B) Cephalexin 2g 1 hour before dental procedures, (C) Cefadroxil 2g 1 hour before dental procedures, (D) Clindamycin 600 mg. 30 min. before dental procedures

Answer is D. None

Neonate triangular cord sign on USG is seen in -: (A) Galactosemia, (B) Biliary atresia, (C) Hepatitis, (D) None

Answer is B. Ans. is 'b' i.e., Biliary atresiao Triangular cord sign is seen in biliary ateria due to fibrosis.

Surgery for elective hemicolectomy for carcinoma colon is described as -: (A) Clean, (B) Clean contaminated, (C) Dirty, (D) Contaminated

Answer is B. Ans. is 'b' i.e., Clean contaminated

Concentration of adrenaline used with lidocaine is?: (A) 0.180555556, (B) 1.430555556, (C) 1:20000, (D) 1:200000

Answer is D. (334) 1 in 200000 REF: Miller 6th ed p. 589 USES AND DOSES OF ADRENALINE: USE DOSE Anaphylaxis SC or IM injection is 0.3-0.5 mg 1:1,000 Croup Racemic adrenaline is a 1:1 mixture of the dextrototary (d) and levorotatory (1) isomers of adrenaline Local anesthetics 1 in 200000

Patient on treatment on carbidopa + levodopa for 10 yrs now has weaning off effect. What should be added to restore action -: (A) Tolcapone, (B) Amantadine, (C) Rasagiline, (D) Benzhexol

Answer is A. Ans. is 'a' i.e., Tolcapone o Both entacapone and tolcapone enhance and prolong the therapeutic effect of levodopa-carbidopa in advanced and fluctuating parkinsons disease. They may be used to smoothen off the 'wearing off', increase 'on' time and decrease loff' time, improve activities of daily living and allow levodopa dose to be reduced,o Treatment of on - off phenomenon in parkinsonism:Add one or two additional doses of levodopa.Continuous delivery of levodopa in duodenum.Avoid proteins in diet.Controlled release oral levodopa.'' peripheral decarboxylase inhibitor.Use of subcutaneous apomorphine.

A 33-year-old man has never been vaccinated for hepatitis B. Serologic tests reveal negative hepatitis B surface antigen (HBsAg) and positive antibody to surface antigen. Which of the following conditions does this serologic pattern best fit with?: (A) previous hepatitis B infection, (B) chronic active hepatitis, (C) acute hepatitis B infection, (D) poor prognosis

Answer is A. The antibody can be demonstrated in 80-90% of patients, usually late in convalescence, and indicates relative or absolute immunity. In contrast, HBsAg occurs very early and disappears in < 6 months. Persistence of HBsAg indicates chronic infection. The pattern in this patient is also seen postvaccination, and perhaps as a consequence of remote infection.

Which of the following is seen in cystic fibrosis?: (A) Low sweat chloride levels, (B) Elevated sweat chloride levels, (C) Low sweat sodium levels, (D) Elevated sweat potassium levels

Answer is B. b. Elevated sweat chloride levels(Ref: Nelson's 20/e p 2100)Because the function of sweat gland duct cells is to absorb rather than secrete chloride, salt is not retrieved from the isotonic primary sweat as it is transported to the skin surface; chloride and sodium levels are consequently elevated. So sweat chloride is usually 60mEq/L in cystic fibrosis.

All of the following are true for retinopathy of prematurity except:: (A) Occurs in premature infants due to late crying, (B) Due to hypoxia there occurs neovascularization followed by fibroproliferation, (C) End result is bilateral blindness, (D) Blindness can be prevented by early diagnosis and ablation of vascular premature retina with cryotherapy or photocoagulation

Answer is A. Ans. Occurs in premature infants due to late crying

The diagnosis of diabetes mellitus is ceain in which of the following situations?: (A) Abnormal oral glucose tolerance in a 24-yrs-old woman who has been dieting, (B) Successive fasting plasma glucose concentrations of 8, 9, and 8.5 mmol/L in an asymptomatic, otherwise healthy businesswoman, (C) A serum glucose level >7.8 mmol/L in a woman in her twenty-fifth week of gestation after a 50-g oral glucose load, (D) Persistent asymptomatic glycosuria in a 30-yrs-old woman

Answer is B. The occurrence of hyperglycemic ketoacidosis or hyperglycemic hyperosmolar coma is diagnostic of diabetes mellitus. Similarly, persistent fasting hyperglycemia , even if it is asymptomatic, has been recommended by the National Diabetes Data Group as a criterion for the diagnosis of diabetes. However, abnormal glucose tolerance-whether after eating or after a standard "glucose tolerance test" -can be caused by many factors (e.g., anxiety, infection or other illness, lack of exercise, or inadequate diet). Similarly, glycosuria may have renal as well as endocrinologic causes. Therefore, these two conditions cannot be considered diagnostic of diabetes. Gestational diabetes is diagnosed in women between the twenty-fouh and twenty-eighth weeks of gestation, first using a 50-g oral glucose load if the I-h glucose level >7.8 mmol/L (140 mg/dL); a 100-g oral glucose test is performed after an overnight fast. Gestational diabetes is initially treated with dietary measures; if the postprandial glucose level remains elevated, insulin therapy is often staed. About 30% of women with gestational diabetes will eventually develop true diabetes mellitus.

Features of alcohol withdrawl are all EXCEPT: March 2013: (A) Epileptic seizure, (B) Restlessness, (C) Hallucination, (D) Hypersomnolence

Answer is D. Ans. D i.e. Hypersomnolence Alcohol and psychiatry Wernicke's encephalopathy involves: Mammilary bodies Korsakoff's syndrome presents as: - Profound and persistent anterograde amnesia and Confabulation Feature of alcoholic paranoia: Hallucination Questionarrie used: CAGE Alcohol withdrawl: - Visual and tactile hallucination (hangover), - Delirium tremens - MC symptom of alcohol withdrawl; Disorientation, Anxiety, Perceptual defect; Chlordiazepoxide is used for management

The number of line angles in a permanent maxillary central incisor is: (A) Two, (B) Four, (C) Six, (D) Eight

Answer is C. None

The opercular poion of the cerebral coex that contains Broca's area is which of the following?: (A) Superior frontal gyrus, (B) Inferior frontal gyrus, (C) Cingulate sulcus, (D) Insula

Answer is B. Motor speech area of Broca (Brodmann's area 44, 45) occupies the opercular and triangular poions of the inferior frontal gyrus of the dominant hemisphere. Broca's area is formed of two minor gyri, called pars opercularis and pars triangularis, that lie in the posterior end of the inferior frontal gyrus. This area subserves expressive language function.

Autopsy is known by all names except ?: (A) Obduction, (B) Necropsy, (C) Biopsy, (D) Postmoem examination

Answer is C. Ans. is 'c' i.e., Biopsy An autopsy (also known as a post-moem examination, obduction, necropsy, or autopsia cadaverum) is a highly specialized surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause and manner of death and to evaluate any disease or injury that may be present.

Which of the following has strongest association with osteosarcoma?: (A) Wilms tumor, (B) Retinoblastoma, (C) Rhabdomyosarcoma, (D) Ewings tumor

Answer is B. Retinoblastoma and osteosarcoma both can occur due to mutation in common gene i.e RB gene. Hence both have strongest association.

Most useful for sex determination is: Kerala 08: (A) Skull, (B) Femur, (C) Pelvis, (D) Tibia

Answer is C. Ans. Pelvis

Features of shock: (A) Decreased GFR, (B) Increased renin, (C) Decreased rennin, (D) Decreased Coisol

Answer is A. In early clinical septic shock, renal function was lower, which was accompanied by renal vasoconstriction, a lower renal oxygen delivery, impaired renal oxygenation, and tubular sodium reabsorption at a high oxygen cost compared with controls decrease or decline in the GFR implies progression of underlying kidney disease or the occurrence of a superimposed insult to the kidneys. This is most commonly due to problems such as dehydration and volume loss. An improvement in the GFR may indicate that the kidneys are recovering some of their function Ref Davidson 23rd edition pg 460

DOC for listeria meningitis:: (A) Ampicillin, (B) Cefotaxime, (C) Cefotriaxone, (D) Ciprofloxacin

Answer is A. Ans. is 'a' i.e., Ampicillin Treatment of listeria infectiono The antibiotic of choice for listeria infection is ampicillin or penicillin G.Antibiotic regimens for listeria infection||||First line regimensPenicillin allergic patientsAlternative drugso Ampicillin or Penicillin is the drug of choiceo Trimethoprim sulphame- thoxazoleo Imipenem and meropenemo Other antibiotic that are less effective# Vancomycin# Erythromycin# Chloramphenicol

All of the following statements about neuromuscular blockage produced by succinylcholine are true, except:: (A) No fade on Train of four stimulation, (B) Fade on tetanic stimulation, (C) No post tetanic facilitation, (D) Train of four ratio > 0.4

Answer is B. Succinylcholine is a depolarizing neuromuscular blocker. With succinylcholine no fading is observed after train of four or tetanic stimulation. All four stimulatory responses after TOF stimulation are suppressed to the same extent. REF : Smith and atkenhead 10th ed

A man is stuck with lathi on the lateral aspect of the head of the fibula. Which of the following can occur as a result of nerve injury: (A) Loss of sensation of lateral foot, (B) Loss of sensation of adjacent sides of 1st & 2nd toe, (C) Inversion inability, (D) Loss of dorsiflexion

Answer is D. The common peroneal nerve is extremely vulnerable to injury as it winds around the neck of the fibula if that happens, clinical features are:Motor loss-a)The foot drop is due to paralysis of muscles of anterior compament of the leg (dorsiflexors of the foot) {dorsiflexion not possible}.b)Loss of extension of toes due to the paralysis of extensor digitorum longus & extensor hallucis longus.c)Loss of eversion of the foot due to paralysis of peroneus longus & brevis.Sensory loss- Sensory loss on the anterior aspect of the leg & whole of the dorsum of foot except the cleft between the great & second toes, which is supplied by the branch from the deep peroneal nerve.

Contraception with increased risk of actinomycosis -: (A) OCPs, (B) Condom, (C) IUCD, (D) Vaginal

Answer is C. Ans. is 'c' i.e., IUCD o Actinomycosis may occur by use of IUCD.Side effects and complications of lUDs1. Bleeding - Most common2. Pain - Second major side effect3. Pelvic infection - PID4. Uterine perforation5. Pregnancy6. Ectopic pregnancy7. Expulsion8. Mortality' - extremely rare

A six year old male baby presents to a hospital with recurrent gross hematuria for 2 years. There is no h/o burning micturition or pyuria. Urine routine examination demonstrated no pus cells and urine culture was sterile. Serum C3 levels were normal. What is the most probable diagnosis-: (A) Wilm's tumour, (B) IgA nephropathy, (C) Post-streptococcal glomerulonephritis, (D) Urinaiy tract infection

Answer is A. Wilms tumor is a rare kidney cancer that is highly treatable. Most kids with Wilms tumor survive and go on to live normal, healthy lives. Also known as nephroblastoma, Wilms tumor can affect both kidneys, but usually develops in just one Wilms' Tumor; Nephroblastoma) Wilms tumor is an embryonal cancer of the kidney composed of blastemal, stromal, and epithelial elements. Genetic abnormalities have been implicated in the pathogenesis, but familial inheritance accounts for only 1 to 2% of cases. Diagnosis is by ultrasonography, abdominal CT, or MRI The AMER1 gene is located on the X chromosome (one of the two sex chromosomes), so when Wilms tumor is caused by mutations in this gene, the condition follows an X-linked dominant pattern Ref Harrison20th edition pg 233

Diagnosis of carcinoid tumors is done by:: (A) 5HIAA, (B) DHEA, (C) DHEA, (D) Metanephrines

Answer is A. Answer is A (5HIAA): The diagnosis of typical carcinoid tumors is done by measurement of 5HIAA levels. Diagnosis of Carcinoid Tumors (Harrison) The diagnosis of carcinoid syndrome relies on measurement of urinary or plasma serotonin or its metabolites in the urine. Typical carcinoid syndrome (high level of serotonin) is characterized by high levels of 5HIAA. The measurement of 5HIAA is most frequently used for typical carcinoid syndrome. Most physicians' only use urinary 5HIAA levels / excretion rates however plasma and platelets serotonin levels if available provide additional information. Platelet serotonin levels (5-HT) are more sensitive than urinary 5HIAA levels but are not generally available. Atypical carcinoid syndromes (low levels of serotonin) may have normal or minimally elevated 5HIAA levels. In such patient's urinary levels of other tryptophan metabolites such as 5HTP should be measured. Elevated levels of urinary 5 HTP is suggestive of an atypical carcinoid syndrome.

A 6 years child has foreign body in trachea .Best initial management is: (A) Heimlich's maneuver, (B) Cardiac massage, (C) Intubation, (D) Oxygen mask with IPPV

Answer is A. Ans. is 'a' i.e.Heimlich's maneuver The best option here is Heimlich's maneuver."Heimlich man oeuvre: stand behind the person and place your arms around his lower chest and give four abdominal thrusts. The residual air in the lungs may dislodge the foreign body providing some airway. "Heimlich's maneuveris actually performed for laryngeal foreign bodies and not for tracheal or bronchial foreign bodies.Heimlich's is performed for completed obstruction and should not be tried in partial obstructions (for fear of causing total obstruction )If Hemlocks m fails then cricothyrotomy or emergency tracheostomy is done.Once the emergency is over, foreign body can be removed by direct laryngoscopy or by laryngofissure (if body is impacted )Tracheal & Bronchial foreign bodiesEmergency removal is not indicated in these ( unless there is airway obstruction or they are of vegetable matter eg seeds likely to swell up)Removed by bronchoscopy with full preparation and under GA.Rigid bronchoscope is used.

Stapes develops from:: (A) 1st arch, (B) 2nd arch, (C) 3rd arch, (D) 4th arch

Answer is B. Malleus and incus are derived from mesoderm of 1" arch. Stapes develops from second arch except its footplate and annular ligament which are derived from the otic capsule.

Buerger waves (alpha waves) of EEG have the rhythm per sec of -: (A) 0-4, (B) 7-Apr, (C) 13-Aug, (D) 13-30

Answer is C. C i.e. 8-13

Type of cataract in chalcosis is: (A) Sunflower cataract, (B) Blue dot Cataract, (C) Snowflake cataract, (D) Polychromatic lustre

Answer is A. Answer- A. Sunflower cataract

Following are more common in multipara women than primipara woman, EXCEPT:: (A) Anemia, (B) Placenta pre, (C) PIH, (D) None of the above

Answer is C. The incidence of preeclampsia in multiparas is variable but is less than that for primiparas. Risk factors associated with pre-eclampsia: Primigravida (young and elderly) Family history (Hypeension, pre-eclampsia, eclampsia) Placental abnormalities Poor placentation Hyperplacentosis Placental ischemia Molar pregnancy Genetic disorder Immunologic phenomenon New paternity Pre-existing vascular or renal disease Thrombophilias Ref: Textbook of Obstetrics by DC Dutta, 6th edition, Page 222.

Which category of ICD is associated with schizophrenia: (A) F0, (B) F1, (C) F2, (D) F3

Answer is C. ICD ICD mentions International classification of mental and behavioural disorders this was given by WHO( World health Organisation) ICD is used all over the world except America latest edition of ICD is ICD11 ICD 11 was released in 2018 DSM DSM mentions Diagnostic and Statistical manual of mental disorders this was given by APA( American Psychiatric Assosiation) DSM is used in America latest edition of DSM is DSM 5 ICD 11 was released in 2018 categorisation ofmental disorders in ICD 10 is mentioned below F00-F09 Organic, including symptomatic, mental disorders F10-F19 Mental and behavioural disorders due to psychoactive substance use F20-F29 Schizophrenia, schizotypal and delusional disorders F30-F39 Mood disorders ICD-10 Classification of Mental and Behavioural Disorders, World Health Organization, Geneva, 1992

Terminal axillary draining lymph nodes -: (A) Anterior, (B) Posterior, (C) Scapular, (D) Apical

Answer is D. Ans. is 'd' i.e., Apical o The apical group of axillary lymph node receives lymph from anterior (pectoral), posterior (subscapular), central and lateral (humeral) group of axillary lymph nodes. Hence apical group of lymph node is the terminal group of axillary lymph node.Axillary lymph nodeRelated vesselsAnterior (pectoral)Along lateral thoracic vesselsPosterior (scapular)Along subscapular vesselsLateralMedial to axillary veinApical (terminal or infraclavicular)Along axillary vessels

True about gastric acid secretion:: (A) Secretion ,l,ses with secretin, (B) H2 blockers prevent release, (C) Total acid output indicates parietal cell mass activity, (D) All

Answer is D. A i.e. Secretion decreases with secretin B i.e., H2 blocker prevents relapse C i.e., Total acid output indicates parietal cell mass activity

All of the swelling moves with deglutition except: March 2012: (A) Thyroglossal cyst, (B) Thyroid swelling, (C) Branchial cyst, (D) Tuberculous lymph nodes

Answer is C. Ans: C i.e. Branchial cyst Swellings which are adherent to the larynx and trachea moves on swallowing, e.g. thyroid swelling, thyroglossal cyst & subhyoid bursitis. Tuberculous & malignant lymph nodes when they become fixed to the larynx or trachea will also move on deglutition

Shakir's tape is an example of:: (A) Community paicipation, (B) Intersectoral coordination, (C) Equitable distribution, (D) Appropriate technology

Answer is D. Norms under Appropriate technology: Technology that is scientifically sound. adaptable to local needs. acceptable to those who apply it and those for whom it is used. can be maintained using the locally available resources. - Shakir's tape used to measure mid-arm circumference of child accept all the above norms.

In pyogenic liver abscess commonest route of spread: (A) Hematogenous through poal vein., (B) Ascending infection through biliary tract, (C) Hepatic aery, (D) Local spread

Answer is B. "Along with cryptogenic infections, infections from the biliary tree are presently the most common identifiable cause of the hepatic abscess. Biliary obstruction results in bile stasis, with the potential for subsequent bacterial colonization, infection and ascension into the liver. This process is k/a ascending suppurative cholangitis. The nature of biliary obstruction is mostly related to stone disease or malignancy. In Asia, intrahepatic stones and cholangitis (recurrent pyogenic cholangitis) is a common cause, whereas, in the Western world, malignant obstruction is becoming a more predominant factor" Ref : Sabiston 18/e p1485

Most common cause for acute infantile gastroenteritis is?: (A) Adenovirus, (B) E coli, (C) Norwalk virus, (D) Rota virus

Answer is D. ANSWER: (D) Rota virusREF: www.ncbi.nlm.nih.gov, J Clin Microbiol v. 26(12); Dec 1988Though none of the text books specifically mention most common causes of acute infantile gastroenteritis, most of the literature search in pubmed , cochrane and medscape and major text books of pediatrics point to: Viruses are more common causes of gastroenteritits in children. Of the viruses most common is rotavirus.Other viruses implicated are calciviruses, Norwalk, adenovirus.Also E.coli is a major cause of diarrhea in children.Other bacteria are: campylobacterium, yersinia enterocolitica, A. hydrophillia .

Hypotension in acute spinal injury is due to:: (A) Loss of sympathetic tone, (B) Loss of parasympathetic tone, (C) Orthostatic hypotension, (D) Vasovagal attack

Answer is A. • High spinal cord injuries can also result in systemic hypotension because of loss of sympathetic tone. • The patient will usually have hypotension and relative bradycardia and will show evidence of good peripheral perfusion on physical examination. • The term neurogenic shock is used but is somewhat of a misnomer because these patients are typically hyperdynamic, with high cardiac output secondary to loss of sympathetic vascular tone. Treatment • Hypotension associated with high spinal injury can be treated by alpha-agonist phenylephrine.

What overlies the lateral wall of the mastoid antrum?: (A) Tegmen tympani, (B) Mastoid process, (C) Tympanic plate, (D) Suprameatal triangle

Answer is D. BOUNDARIES: SUPERIORLY-Tegmen tympani and beyond it the temporal lobe of the cerebrum INFERIORLY-Mastoid process containing the mastoid air cells ANTERIORLY-It communicates with the epitympanic recess through the aditus. The aditus is related medially to the ampullae of the superior and lateral semicircular canals. and posterosuperiorly to the facial canal POSTERIORLY-It is separated by a thin plate of bone from the sigmoid sinus. Beyond the sinus, there is the cerebellum MEDIALLY-Petrous temporal bone LATERALLY-It is bounded by pa of the squamous temporal bone. This pa corresponds to the suprameatal triangle seen on the surface of the bone. Ref:BDC VOLUME 3,sixth edition pg 281

Ferruginous bodies are seen in?: (A) Silicosis, (B) Bysinosis, (C) Asbestosis, (D) Baggassosis

Answer is C. Ans. is 'c' i.e., Asbestosis "Ferruginous bodies are most commonly seen in asbestosis". ------------Chandrasoma Taylor* Ferruginous bodies represent foreign inorganic or organic fibers coated by complexes of iron and glycoproteins.* While ferruginous bodies are most commonly seen in asbestosis they are not diagnostic because it may be seen in other type of pneunoconiosis.* When asbestos fiber is coated by iron and glycoprotein, this ferruginous body is called asbestos body-characteristic of asbestosis.* Ferruginous bodies are best seen in section that have stained for iron with prussion blue.* Microscopically ferruginous bodies give a Sheikh Kebab appearance.

65-year-old man presents with anaemia and posterior column dysfunction, the likely cause is -: (A) B1-deficit, (B) B12-deficit, (C) SSPE, (D) Multiple selerosis

Answer is B. None

Which type of cattle poisoning occurs due to ingestion of LINSEED plant?: (A) Aconite, (B) Atropine, (C) Pilocarpine, (D) Hydrocyanic acid

Answer is D. Hydrocyanic acid is also used as cattle poison. Cattle poisoning has been known to occur from eating linseed plant because of the natural development of a cyanogenic glycoside which may liberate hydrocyanic acid. Ref: Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, 27th Edition, Pages 559-60

A 40 year old female patient complains of excessive bleeding and drowsiness. Patient gives a history of road traffic accident 5 hours ago and had a lacerated wound on lower back region. General physical examination reveals- Blood pressure-80/60mmHg. Juglar venous pressure- low. Pulsus paradoxus- present. Cardiac output- Increased. The patient is in which type of shock?: (A) Neurogenic, (B) Obstructive, (C) Distributive, (D) Hypovolemic

Answer is C. Includes anaphylactic shock, septic shock and spinal cord injury (neurogenic shock). Inadequate organ perfusion is associated with vascular dilatation and hypotension, low systemic vascular resistance, inadequate afterload and a resulting abnormally high cardiac output. In anaphylaxis, vasodilatation is due to excess histamine release. Neurogenic shock is caused by traumatic or pharmacological blockage of the sympathetic nervous system, producing dilatation of resistance arterioles and capacitance veins, leading to relative hypovolemia and hypotension. In neurogenic shock, because of loss of vascular tone, JVP will fall.

Which of the following induction agent produce cardiac stability-: (A) Ketamine, (B) Etomidate, (C) Propofol, (D) Midazolam

Answer is B. Ans. is 'b' i.e., Etomidate Effects of Etomidate on cardiovascular systemEtomidate has minimal effects on the cardiovascular system.It causes mild reduction in peripheral vascular resistance which may cause a slight decline in arterial blood pressure.Myocardial contractility and cardiac output are usually unchanged. Etomidate does not release histamine. Cardiovascular effect of Propofol:The major cardiovascular effect of propofol is a decrease in arterial blood pressure due to a drop in systemic vascular resistance (inhibition of sympathetic vasoconstrictor activity, cardiac contractility and preload).Propofol markedly impairs the normal arterial baroreflex response to hypotension. Sometimes there may be a marked drop in preload.Cardiovascular effect of barbiturates (Thiopental)The cardiovascular effect of barbiturates vary markedly depending on the volume status, bas line autonomic tone and preexisting cardiovascular disease.Normally, intravenously administered barbiturates cause a fall in blood pressure.Cardiac output is maintained due to increase in heart rate and increased myocardial contractility from compensatory baroreceptor reflexes.However, in the absence of adequate baroreceptor response (e.g., hypovolemia, congestive heart failure, b adrenergic blockade) cardiac output and arterial blood pressure may fall dramatically due to uncompensated pooling and unmasked direct myocardial depression.Effect of ketamine on cardiovascular systemKetamine causes central stimulation of sympathetic system which causes increased arterial blood pressure, heart rate and cardiac output. There is also increase in pulmonary artery pressure and myocardial work.Because of these effects, ketamine should be avoided in patients with coronary artery disease, uncontrolled hypertension, congestive heart failure and arterial aneurysms.

Which of the following statement regarding Septic tank is true ?: (A) The minimum capacity of a septic tank should be at least 100 gallons, (B) A capacity of 20-30 gallons or 2 & half to 5 c.ft. per person is recommended for household septic tanks, (C) The length of septic tank is usually equal to its breadth., (D) There should be a minimum air space of 3 cm between level of liquid in the tank & under-surface of the cover

Answer is B. SEPTIC TANK It is water-tight masonry tank into which household sewage is admitted for treatment. It is satisfactory means of disposing excreta & liquid wastes from individual dwellings, small groups of houses & institutions which have adequate water supplies but do not have access to a public sewerage system. Main design features of septic tank are: - Capacity : Depends on number of users. A capacity of 20-30 gallons or 2 and half to 5 c.ft. / person is recommended for household septic tanks. Minimum capacity of a septic tank= at least 500 gallons. - Length is usually twice the breadth. - Depth = 1.5 to 2 m (5-7 ft.). - Recommended liquid depth = 1.2 m (4 ft.). - There should be a minimum air space of 30 cm (12 in.) b/w level of liquid in tank & undersurface of cover. - There are submerged inlet & outlet pipes. - In some septic tanks, bottom is sloping towards inlet end, facilitating retention of solids as sludge. - Septic tank is covered by a concrete slab of suitable thickness & provided with manhole. - These are designed in this country to allow a retention period of 24 hours. Too long retention period will result in undue septicity of effluent. Too sho period gives insufficient treatment. - Sewage is purified by anaerobic digestion in tank f/b aerobic oxidation outside the tank. - De-sludging should be done atleast once/ year.

Following are adverse effects of Clofazimine except: (A) Skin staining, (B) Icthyosis, (C) Diarrhoea, (D) Gastritis

Answer is D. Clofazimine is a brick red, fat-soluble crystalline dye. It has weakly bactericidal action against M. leprae It has an anti-inflammatory effect, which is useful in the management of ENL reactions. High drug concentrations are found in the intestinal mucosa, mesenteric lymph nodes and body fat. The most noticeable side effect is skin discoloration, ranging from red to purple-black The degree of discoloration depending on the dose and amount of leprous infiltration. Urine, sputum and sweat may become pink. Clofazimine also produces a characteristic ichthyosis on the shins and forearms. Gastrointestinal side effects, ranging from mild cramps to diarrhoea and weight loss, may occur as a result of clofazimine crystal deposition in the wall of the small bowel.

Osteoblastic secondaries arises from: March 2003: (A) Renal carcinoma, (B) Thyroid carcinoma, (C) GIT carcinoma, (D) Prostate carcinoma

Answer is D. Ans. D i.e. Prostate carcinoma Metastases to bones are usually osteolytic. Osteoblastic lesions are uncommon.

A 52 year old male presents to his physician with a chief complaint of a substantial increase in the size of his breasts over the past few months. Three months ago he was diagnosed with hypeension, and placed on antihypeensive medication. Which of the following medications was most likely prescribed?: (A) Captopril, (B) Furosemide, (C) Hydrochlorothiazide, (D) Spironolactone

Answer is D. All of the medications listed as answer choices can be effectively used in the treatment of hypeension. Spironolactone is a "potassium-sparing" diuretic that exes its action primarily as a competitive inhibitor of aldosterone receptors in the distal nephron. One of the repoed side effects of spironolactone is gynecomastia. None of the other choices have gynecomastia as a side effect. Captopril is an angiotensin-conveing enzyme (ACE) inhibitor that causes a decrease in plasma angiotensin II concentration, resulting in decreased aldosterone secretion. Furosemide is a "loop diuretic" that acts by inhibiting the reabsorption of sodium and chloride ions in the loop of Henle as well as in the proximal and distal renal tubules. Hydrochlorothiazide is a "thiazide diuretic" that inhibits the reabsorption of sodium and chloride ions in the distal renal tubules. Ref: Snyder P.J. (2011). Chapter 41. Androgens. In B.C. Knollmann (Ed), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.

True about treatment of nocturnal enuresis: (A) lmipramine, (B) CPZ, (C) Alprazolam, (D) Haloperidol

Answer is A. A i.e. Imipramine

50 year old male with positive family history of prostate cancer has come to you for a screening test. The screening test done to pickup prostate cancer is: (A) DRE, (B) PSA, (C) DRE + PSA, (D) Endorectal coil MRI with T1 and T2 W images

Answer is C. Prostate-specific antigen (PSA) and Digital rectal examination (DRE) Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years. Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65). Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

Refsum's syndrome is associated with ?: (A) Retinitis pigmentosa, (B) Xerophthalmia, (C) Chalcosis, (D) Diabetes retinopathy

Answer is A. Ans. is 'a' i.e., Retinitis pigmentosa Associations of retinitis pigmentosa Ocular associations : These include myopia, primary open angle glaucoma, microphthalmos, conical cornea and posterior subcapsular cataract. Systemic associations : These are in the form of following syndromes :- i) Laurence-Moon-Biedl syndrome : It is characterised by retinitis pigmentosa, obesity, hypogenitalism, polydactyly and mental deficiency. ii) Cockayne's syndrome : It comprises retinitis pigmentosa, progressive infantile deafness, dwarfism, mental retardation, nystagmus and ataxia. iii) Refsum's syndrome : It is characterized by retinitis pigmentosa, peripheral neuropathy and cerebellar ataxia. iv) Usher's syndrome : It includes retinitis pigmentosa and labyrinthine deafness. v) Hallgren's syndrome : It comprises retinitis pigmentosa, vestibulo-cerebellar ataxia, congenital deafness and mental deficiency.

All are synonyms for PM staining seen in dependant pas of the body during postmoem, except: PGI 13: (A) Cadaveric lividity, (B) Suggilation, (C) Livor mois, (D) Algor mois

Answer is D. Ans. Algor mois

All viruses can be cultured in: (A) Chemically defined media as that used for bacteria, (B) Living systems only, (C) Agar culture, (D) Non living systems also

Answer is B. Viruses can be cultivated in living systems only.

Bone marrow finding in myelofibrosis-: (A) Dry tap (hypocellular), (B) Megaloblastic cells, (C) Microcytic cells, (D) Thrombocytosis

Answer is A. Dry tap is usually defined as a "failure to obtain bone marrow on attempted marrow aspiration". The diagnosis and management of many haematological diseases depends on examination of the bone marrow, which involves two separate specimens i.e. a cytologic and a histologic preparation.Bone marrow examination refers to the pathologic analysis of samples of bone marrow obtained by bone marrow biopsy (often called a trephine biopsy) and bone marrow aspiration. Bone marrow examination is used in the diagnosis of a number of conditions, including leukemia, multiple myeloma, lymphoma, anemia, and pancytopenia. The bone marrow produces the cellular elements of the blood, including platelets, red blood cells and white blood cells. While much information can be gleaned by testing the blood itself (drawn from a vein by phlebotomy), it is sometimes necessary to examine the source of the blood cells in the bone marrow to obtain more information on hematopoiesis; this is the role of bone marrow aspiration and biopsy.

40 yr old female presented with breast lump of size 4 cm with involvement of skin and mobile palpable axillary LN, FNAC of lesion showed intrductal carcinoma. What is the initial management of for this pt?: (A) Radiotherapy, (B) Neo-adjuvant chemotherapy, (C) Modified radical mastectomy, (D) Simple mastectomy

Answer is B. .Locally Advanced Carcinoma of Breast (LABC) * It means locally advanced tumour with muscle/chest wall involvement, extensive skin involvement or fixed axillary nodes. It will be T3, T4a, T4b, T4c or T4d or N2 or N3. * It is investigated by FNAC of tumor, mammography of opposite breast, chest CT, CT abdomen or whole body bone scan. Biopsy is needed to assess receptor status. * Treatment of LACB is always palliative by simple mastectomy, toilet mastectomy, chemotherapy and therapy using tamoxifen. * Initial neoadjuvant chemotherapy; surgery; radiotherapy; adjuvant chemotherapy are other therapeutic plan. ref:SRB&;s manual of surgery,ed 3,pg no 491

Pott's spine is commonest at which spine:: (A) Thoracolumbar, (B) Sacral, (C) Cervical, (D) Lumbosacral

Answer is A. ANSWER: (A) ThoracolumbarREF: Apley 387-389, S M Tuli 3rd edition page 192Most common site of skeletal tuberculosis is spine followed by hip and knee SPINE (50%) > HIP > KNEECommonest spine involved in spine TB is Thoracolumbar/Dorsolumbar T12-L1 (Lower thoracic to be precise)LOWER THORACIC > LUMBAR > UPPER THORACICParaplegia due to pott s spine most commonly involves upper thoracic vertebrae as in upper thoracic vertebrae there is more acute kyphosis, spinal canal is narrow and spinal cord is relatively large.First symptom of TB spine is "Pain on movement"Commonest symptom of TB spine is "Back pain"

A patient present with lower gastrointestinal bleed. Sigmoidoscopy shows ulcers inthe sigmoid. Biopsy from this area shows flask-shaped ulcers. Which of the following is the most appropriate treatment -: (A) Intravenous ceftriaxone, (B) Intravenous metronidazole, (C) Intravenous steroids and sulphasalazine, (D) Hydrocoisone enemas

Answer is B. This may be caused by haemorrhage from the colon, anal canal or small bowel. It is useful to distinguish those patients who present with profuse, acute bleeding from those who present with chronic or subacute bleeding of lesser severity .Severe acute lower gastrointestinal bleeding .This presents with profuse red or maroon diarrhoea and with shock. Diveicular disease is the most common cause and is often due to erosion of an aery within the mouth of a diveiculum. Bleeding almost always stops spontaneously, but if it does not, the diseased segment of colon should be resected after confirmation of the site by angiography or colonoscopy. Angiodysplasia is a disease of the elderly, in which vascular malformations develop in the proximal colon. Bleeding can be acute and profuse; it usually stops spontaneously but commonly recurs. Diagnosis is often difficult. Colonoscopy may reveal characteristic vascular spots and, in the acute phase, visceral angiography can show bleeding into the intestinal lumen and an abnormal large, draining vein. In some patients, diagnosis is achieved only by laparotomy with on-table colonoscopy. The treatment of choice is endoscopic thermal ablation but resection of the affected bowel may be required if bleeding continues. Bowel ischaemia due to occlusion of the inferior mesenteric aery can present with abdominal colic and rectal bleeding. It should be considered in patients (paicularly the elderly) who have evidence of generalised atherosclerosis. The diagnosis is made at colonoscopy. Resection is required only in the presence of peritonitis. Meckel's diveiculum with ectopic gastric epithelium may ulcerate and erode into a major aery. The diagnosis should be considered in children or adolescents who present with profuse or recurrent lower gastrointestinal bleeding. A Meckel's 99mTc-peechnetate scan is sometimes positive but the diagnosis is commonly made only by laparotomy, at which time the diveiculum is excised Primary prevention of variceal bleeding If non-bleeding varices are identified at endoscopy, b-adrenoceptor antagonist (b-blocker) therapy with propranolol (80-160 mg/day) or nadolol (40-240 mg/day) is effective in reducing poal venous pressure. Administration of these drugs at doses that reduce the hea rate by 25% has been shown to be effective in the primary prevention of variceal bleeding. In patients with cirrhosis, treatment with propranolol reduces variceal bleeding by 47% (number needed to treat for benefit (NNTB) 10), death from bleeding by 45% (NNTB 25) and overall moality by 22% (NNTB 16). The efficacy of b-blockers in primary prevention is similar to that of prophylactic banding, which may also be considered, paicularly in patients who are unable to tolerate or adhere to b-blocker therapy. Carvedilol, a non-cardioselective vasodilating b-blocker, is also effective and may be better tolerated at doses of 6.25-12.5 mg/day). For these, dose should be titrated, as tolerated, to achieve a hea rate of 50-55 beats/min, if possible.metrandazole can be given sigmoidal ulcer Ref Davidson edition23rd pg 869

Lalita, a female pt. presents with pigmentation of the lips and oral mucosa and intestinal polyps. Her sister also gives the same history. Most probable diagnosis is -: (A) Carcinoid tumor, (B) Melanoma, (C) Villous adenoma, (D) Peutz-Jegher syndrome

Answer is D. Ans. is 'd' ie. Peutz-jeghers syndrome Peutz-Jeghers syndorme consists of: hamaomatous polyps throughout the intestine with maximum density in the jejunum* melanosis of the oral mucous membrane and the lips. The melanosis takes the form of melanin spots sometimes presents on the digits and the perianal skin, but the pigmentation of the lips is the sine quanon.

Tripod fracture is the name given for -: (A) Zygomatic fracture, (B) Maxillary fracture, (C) Mandibularfracture, (D) Temporal fracture

Answer is A. Ans. is 'a1 i.e., Zygomatic fracture o Zygoma fracture is also known as tripoid fracture.Clinical features of zygoma fractureo Considerable swelling over zygomatic arch is common and makes clinical diagnosis more difficult.o Flattening of malar prominence.o Step-deformit of infraorbital margin.o Anaesthesia in the distribution of infraorbital nerve.o Trimus, due to depression of zygoma on the underlying coronoid process.o Oblique palpebral fissure, due to the displacement of lateral palpebral ligament.o Restricted ocular movement, due to entrapment of inferior rectus muscle. It may cause diplopia.o Periorbital emphysema, due to escape of air from the maxillary sinus on nose-blowing.o The mucosa of the maxillary sinus may be lacerated and cause epistaxis on that side.o Fracture of the zygoma may or may not be painful to palpation and running a finger along the zygomatic arch may give a feel of a depressedfracture or a small dimple. The cheek may appear flattened; compared symmetry with the opposite side. This may be obvious immediately following trauma or several days later once swelling has subsided.

A 12-year-old boy reported with a class II and div 1 malocclusion with proclined upper incisor and deep bite. Intraoral examination revealed a bilaterally symmetrical face, convex profile, potentially competent Lips with normal incisor display during rest and smile. Cephalometric finding showed that the patient had a horizontal growth direction with CVMI stage III, increased overjet and normal lower incisor inclination What would be the appliance of choice for this patient: (A) Twin block, (B) Activator, (C) Bioator, (D) Supermarionator

Answer is A. None

For diagnosis of carcinoma cervix, PAP smear screening is done to: (A) 100% Informative, (B) Detects to change into sarcoma, (C) Prevents progress of the disease, (D) Every six months cervical smear in all sexually active women.

Answer is C. C. i.e. (Prevents progress of the disease) (721- Basic pathology 8th)* PAP smear is highly effective screening tool in the detection of cervical dysplasia and carcinoma and has reduced the incidence of cervical carcinoma* Flow cytometry is used routinely in the classification of leukemias and lymphomas* Pap smear is 90- 95% accurate in detecting early lesions such as CIN but is less sensitive in detecting cancer when frankly invasive cancer or fungating masses are present. Inflammation, necrosis and hemorrhage may produce false- positive smears (608 - Harrisons 17th)* Annual cervical smear in all sexually active women (above the age of 18 years) having any risk factors

SLE like reaction is caused by: (A) Hydralazine, (B) Rifampicin, (C) Paracetamol, (D) Furosemide

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

Platelet transfusion is not indicated in -: (A) Dilutional Thrombocytopenia, (B) Immunogenic Thrombocytopenia, (C) Aplastic Anemia, (D) DIC

Answer is B. None

The drug of choice in digitalis induced ventricular arrhythmias is:: (A) I.V. Lignocaine, (B) Phenytoin, (C) Quinidine, (D) Procainamide

Answer is A. (IV Lignocaine): Ref: 463-KDT (514-KDT 6th)Treatment of digitalis induced ventricular arrhythmias* Lignocaine IV repeated as required is the drug of choice. It suppresses the excessive automaticity but does not accentuate A V block* Phenytoin is also useful but not preffered now (sudden death occurs)* Quinidine and procainamide are contraindicated.

Deformity in transient synovitis of Hip ?: (A) Abduction, (B) Flexion, (C) External rotation, (D) All of the above

Answer is D. Ans. is 'd' i.e., All of the above Transient synovitis of Hip Transient synovitis of hip is also known as observation hip, toxic synovitis or irritable hip. Its a self-limiting, inflammatory condition of the synovium, that lasts only a sho time (therefore known as transient) It is the most common cause of hip pain and limp in children under 10 yrs of age. Cause is not known but association has been seen with a recent history of an upper respiratory tract infection. Presentation is with hip pain or limp. The limb is in attitude of slight flexion, abduction and external rotation. The child may have low grade fever. The ESR, C-Reactive protein & WBCs count are normal (This differentiates Transient synovitis from Septic ahiritis a serious condition, in which patient has high grade fever and elevated ESR, C-Reactive protein and WBC count). Radiograph or ultrasound may show widening of the joint space However, most of the time x-ray is normal. Usually the treatment of a clinically suspected case of transient synovitis of hip is Bed rest, NSAIDS and observation. USG guided aspiration is indicated for :- Temperature > 99.5deg F ESR > 20 (Raised ESR) Severe hip pain with ROM