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Test Information
Test Name
DNB Semifinal Mock
Total Questions
300
Test Type
Examination
Difficulty Level
Difficult
Total Marks
1500
Duration
180minutes
Test Question Language:- ENGLISH
(1).
Methemoglobinemia caused by
a. Procaine
b. Prilocaine
c. Bupivacaine
d. Lignocaine
Solution. Ans- (b) Prilocaine
Ref:Read the text below
Sol:
Morgan Clinical Anesthesiology, Fourth Edition
- Metabolites of prilocaine (o-toluidine derivatives), which accumulate after large doses of drug (> 10 mg/kg), convert hemoglobin to
methemoglobin.
- Neonates of mothers who have received prilocaine epidural anesthesia during labor and patients with limited cardiopulmonary reserve
are particularly susceptible to the alteration in oxygen transport.
- Benzocaine, a common ingredient in local anesthetic sprays, can also cause methemoglobinemia
- Treatment of significant methemoglobinemia includes intravenous administration of methylene blue (1–2 mg/kg of a 1% solution over 5
min). Methylene blue reduces methemoglobin (Fe3+) to hemoglobin (Fe2+).
Correct Answer. b
(2).
Arrhenius theory is
a. Substance which accepts the H+ from the acid is called the ‗conjugate base
b. Acid is a substance which was capable of dissociating in water solution to produce hydrogen ions
c. Acid as any compound that was a potential electron pair acceptor
d. Acid is a a substance that donates a cation, or accepts an anion or an electron
Solution. Ans- (b) Acid is a substance which was capable of dissociating in water solution to produce hydrogen ions
Ref:Read the text below
Sol:
- The first modern approach to acid-base chemistry was by Arrhenius in 1887. He defined an acid as a substance which was capable of
dissociating in water solution to produce hydrogen ions.
- This definition identified most of the substances which were considered to be acids at that time.
- A base was defined as a substance which dissociated in water solution to produce hydroxide ions. The theory was not totally satisfactory
for several reasons.
- For example, some substances which had acidic properties did not contain hydrogen and some bases did not contain hydroxide ions.
The theory also applied only to aqueous solutions.
Correct Answer. b
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(3).
Nalorphine is used as an antidote for all of the following, except
a. Morphine
b. Pethidine
c. Pentazocine
d. Heroin
Solution. Ans- (c) Pentazocine
Ref:Read the text below
Sol:
- Nalorphine is a strong μ receptor antagonist, so can be used as an antidote for μ agonists like morphine, pethidine and heroin.
- Nalorphine is also an agonist of κ receptors and pentazocine is also mainly a κ agonist, so nalorphine is not an antidote for pentazocine.
Correct Answer. c
(4).
Which of the following agents is long-duration ester for a local anesthesia ?
a. Bupivacaine
b. Cocaine
c. Lidocaine
d. Tetracaine
Solution. Ans- (d) Tetracaine
Ref:Read the text below
Sol:
- Tetracaine is a long – duration ester local anesthetic.
Correct Answer. d
(5).
The volatility of an anesthetic agent is directly proportional to lowering the flow in the portal vein. Portal flow is maximally reduced by
a. Ether
b. Halothane
c. Isoflurane
d. Enflurane
Solution. Ans- (b) Halothane
Ref:Read the text below
Sol:
- Halothane impairs liver blood flow and oxygenation the most, perhaps explaining increased incidence with its use.
- Enflurane was shown to reduce hepatic blood flow less than halothane.
Correct Answer. b
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(6).
A young boy has sickle cell trait. which of the following anaesthesia is contraindicated?
a. IV regional anaesthesia
b. Brachial plexus block by suraclavicular approach
c. Brachial plexus block by infraclavicular approach
d. Brachial plexus block by axillary approach
Solution. Ans-(a) IV regional anaesthesia
Ref: Miller: Anesthesia, 5th ed 1478
Sol:
Intravenous Regional Anesthesia
- Intravenous regional anesthesia, also termed Bier block, has been used in children for upper limb operations distal to an inflated
tourniquet.
- Occasionally, some authors still recommend its application in pediatric patients.Bupivacaine must not be used, whatever the
concentration; chloroprocaine (thrombophlebitis), procaine (methemoglobinemia), and mepivacaine (acidosis and hyperkalemia) should
also be avoided
- . Lidocaine (0.25-0.5%) without epinephrine is the safest agent and is administered on the basis of 1 mL/kg up to a maximum volume of
40 mL and a maximum dose of 3 mg/kg.
- The technique is the same as foadults. After placement of an intravenous plastic cannula, as close as possible to the site of surgery, the
limb is exsanguinated, preferably by compression with an Esmarch bandage.
- A tourniquet is placed proximally and inflated (two to three times the systolic pressure) before the Esmarch bandage is removed and the
anesthetic solution injected.
- Ten minutes later a second tourniquet is placed immediately below the first one (i.e., in an anesthetized area) and inflated to the same
pressure values.
- The upper tourniquet is then removed and the surgeon can proceed.
- In no case should the tourniquet be deflated before the 20th or later than the 90th minute.
- The tourniquets are not well tolerated by children, and the technique has many contraindications such as extensive wounds, ischemic
disorders, unstable fractures, convulsive disorders, septicemia, cardiac dysrhythmias, hypovolemia, and sickle cell disease.
- Furthermore, Bier blocks cannot be considered safe procedures, as they depend on the inflation of a tourniquet.
- There is danger of systemic toxicity, and fatalities have been reported in children.
- In children, the technique should not be used routinely for upper limb operations, and it is definitely contraindicated for lower limb
procedures.
Correct Answer. a
(7).
Which is not a coaxial circuit:
a. Lack
b. Bain
c. Penlon
d. Jackson Rees
Solution. Ans- (d) Jackson Rees
Ref:Read the text below
Sol:
Coaxial system are systems with two tubing - one inner and one outer. Coaxial circuit are:
1. Lack.
2. Bain.
3. Penlon.
4. Humphry ADE.
5. Mera F
Correct Answer. d
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(8).
Caudal anaesthesia is
a. Anesthetic injection in coccygeal canal
b. For perineal and rectal surgery
c. Injection into umbilical vein,
d. Same as epidural
Solution. Ans- (b) For perineal and rectal surgery
Ref:Read the text below
Sol:
- A caudal anesthesia is administered by a catheter inserted through the sacral hiatus.
- Anesthetic is placed in the catheter, and the anesthetic bathes the sacral nerve roots. The catheter is in the epidural space, and this is
where the anesthesia is placed.
- The central canal of the spinal cord is a space in the spinal cord through which CSF circulates. The dural sinuses are venous sinuses
found in the brain--this is where blood drains from the brain.
- The subarachnoid space is found under the arachnoid mater; this is the space where the cerebrospinal fluid circulates around the spinal
cord. Finally, the subdural space is a space between the dura and arachnoid mater--this is a potential space only.
- When a caudal anesthesia is given what happens is the needle is inserted into the sacral hiatus and the injected anesthesia fills up the
epidural space and will diffuse up into the nerves which are passing through this space especially the sacral nerves which being
distributed to the woman‘s perineum, external genitalia, and lower uterus.
Correct Answer. b
(9).
Pulse oximetry
a. Pulse oximeters measure the amount of oxygen dissolved in blood
b. Readings over 75% are normal
c. Patients with Spo2 _90% should not receive supplemental oxygen as this may depress respiratory drive
d. Is not affected by skin pigmentation
Solution. Ans- (d) Is not affected by skin pigmentation
Ref:Read the text below
Sol:
- Pulse oximetry is not affected by skin pigmentation.
Correct Answer. d
(10).
In the event of intubation of the right main bronchus, the following would not occur within the next 10 min
a. Increased requirement for volatile anaesthetic agent
b. Hypoxaemia.
c. Decreased ventilatory pressures.
d. A rise in arterial CO2 tension.
Solution. Ans- (c) Decreased ventilatory pressures
Ref:Read the text below
Sol:
- Ventilatory pressures increase after intubation.as artificial pressure settings are more than natural settings.
Correct Answer. c
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(11).
The trefoil which is used in international radiation warning symbol has three blades and the angle between each blade should be
a. 45
b. 50
c. 60
d. 70
Solution. Answer-C)
60 The international radiation symbol (also known as trefoil) first appeared in 1946, at the University of California, Berkeley Radiation
Laboratory. At the time, it was rendered as magenta, and was set on a blue background. The modern version used in the US is magenta
against a yellow background, and it is drawn with a central circle of radius R, an internal radius of 1.5R and an external radius of 5R for
the blades, which are separated from each other by 60°. The trefoil is black in the international version, which is also acceptable in the
US.
Correct Answer. c
(12).
Bear claw sign on CT
a. HCC
b. Hepatic laceration
c. RCC
d. pancreatic laceration
Solution. Answer- B)
Correct Answer. b
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(13).
Which one of the following imaging modalities is most sensitive for evaluation of extra adrenal pheochromocytoma.
a. Ultrasound
b. CT
c. MRI
d. MIBG Scan
Solution. Ans-: (d) MIBG Scan
Ref:Read the text below
Sol:
·
MIBG Scan “The sensitivity of MIBG scanning with 1st for pheochromocytoma is 100% and specifity 95-98% making it the most
useful efficacious of the localization of pheochromocytoma, including those that arise at nonadrenal sites.
Correct Answer. d
(14).
A 48 yr old woman comes with bilateral progressive weakness of both lower limbs, spasticity & mild impairment of respiratory
movements. MRI shows an intradural mid-dorsal midline enhancing lesion. What is the diagnosis?
a. Intradural lipoma
b. Meningioma
c. Neuroenteric cyst
d. Dermoid cyst
Solution. Ans- (b) Meningioma
Ref: Grainger & Allison's Diagnostic Radiology, 5th ed
Sol:
INTRAVENTRICULAR LESIONS
Tumour
Typical site
Colloid cyst
Foramen of Monro/third ventricle
Meningioma
Trigone of lateral ventricle
Choroid
Fourth ventricle
Ependymoma Lateral ventricle (more common in children) and fourth ventricle
Neurocytoma Lateral ventricles (involving septum pellucidum)
Metastases
Lateral ventricles, ependyma and choroid plexus
Meningiomas
·
Meningiomas originate from arachnoid cell rests, related to arachnoid granulations of the dura mater and may assume a spherical,
well-circumscribed shape or be flat, infiltrating (‘en plaque’) lesions
·
There are several histological types of meningioma including meningothelial, fibrous/fibroblastic, transitional and psammomatous
tumours. Most of them correspond to WHO grade I.
·
Meningiomas with atypical features such as increased mitotic activity, patternless growth and necrosis correspond to grade II
(atypical) or grade III (anaplastic meningioma), depending on the extent of these features
·
Of meningiomas, 90 per cent are supratentorial arising, in decreasing order of frequency, from the parasagittal region, cerebral
convexities, sphenoid ridge and olfactory grove.
·
Infratentorial meningiomas are most frequently located on the posterior surface of the petrous bones and clivus and can mimic
acoustic neuromas.
·
Bone sclerosis is in favour of meningioma and enlargement of the internal auditory meatus is much more common in neuroma.
·
On CT, 60 per cent of meningiomas are spontaneously hyperdense and up to 20 per cent contain calcification.
·
Enhancement on CT is usually intense and uniform Hyperostosis, best seen on bone window settings, indicates the site of the
tumour attachment to the meninges.
·
On MRI, meningiomas appear frequently isointense to cerebral cortex on both T1W and T2W images and may be difficult to detect
without IV contrast medium. Meningiomas can have ‘capping cysts’ of similar MRI signal intensity to CSF.
Correct Answer. b
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(15).
Mammography is used to diagnose all of the following breast diseases except?
a. Early breast carcinoma
b. Mastitis
c. Fibroadenoma
d. Phylloides tumor.
Solution. Ans : (b) Mastitis
Reference: (Ref. Grainger Diagnostic Radiology, 4th ed., 2245)
Sol:
INDICATIONS FOR MAMMOGRAPHY INCLUDE:
• Before breast surgery, as it may avert an unnecessary biopsy demonstrating that the palpable mass has a characteristically benign
appearance.
• Follow up of breast cancer patients.
• Work up a patient with metastases from an unknown primary.
• Mammographic screening is best screening method for carcinoma breast.
Correct Answer. b
(16).
'Soap bubble‘ appearance on USG is seen in
a. Cystic lymphangiectasis
b. Multicystic kidneys
c. Fibrous dysplasia
d. Meconium ileus.
Solution. Ans 6: (b)
Reference: Read the text below Sol: Multicystic dysplastic Kidney on USG shows Lobulated renal contour with multiple internal cysts of
varying sizes and shapes: the renal parenchyma is usually fibrous and echogenic with absent or small hilar vessels. The cysts typically
cluster and are non-communicating. Real time imaging is extremly useful to exclude any communication with the ureter and between
each other.
Correct Answer. b
(17).
Causes of cavitating metastatic lung lesion on the chest radiograph are all except
a. Malignant melanoma
b. Renal cell carcinoma
c. Carcinoma of cervix
d. Osteosarcoma
Solution. Ans 7: (b) Renal cell carcinoma
Reference: (Refer Sutton Radiology 7th ed.)
Sol:
- Cavitation may occur in metastases from any primary site, but is more common in squamous carcinomas and sarcomas.
- Cavitation in subpleural metastasis is recognized cause of spontaneous pneumothorax.
-Calcification is most commonly seen in metastasis from osteosarcoma, and rarely in chondrosarcoma and mucinous adenocarcinoma.
Correct Answer. b
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(18).
What is the cellular characteristic that most contributes to FDG accumulation in cancer cells?
a. High mitotic rate
b. Up regulation of glucose transporters and glycolytic enzymes
c. Increased cell membrane permeability
d. Over expression of high affinity cell surface receptors
Solution. Answer: B) Explanation
Incorrect. Increased mitotic rate may indirectly contribute to increased FDG uptake by increasing tumor volume; but, this is not the
target for FDG molecular imaging. Correct. Hexokinase and glucose transporters (GLUT 1) are up regulated in tumor cells which have
increased reliance on glycolysis for growth. Incorrect. FDG, a glucose analogue, enters cancer cells by facilitated transport, not passive
diffusion; transmembrane glucose transporters are up regulated in malignant cells. Incorrect. FDG, a glucose analogue, enters cancer
cells by facilitated transport of transmembrane glucose transporters, not cell surface receptors.
Correct Answer. b
(19).
Acoustic shadow on ultrasound is due to
a. Reflection
b. Refraction
c. Artifact
d. Absorption of waves
Solution. Ans-: (a) Reflection
Ref:Christensen’s physics of Diagnostic Radiology 4th ed., 334
Sol:
• Percentage of the beam reflectedat the tissue interface depends on the tissue’s acoustic impedance and the angle of incidence of the
beam.
• Two factors determine the acoustic impedance of the tissue, density of the tissue and the velocity of ultrasound.
• But as the velocity of ultrasound in tissues is almost constant (1540 m/s), reflection of the ultrasound beam (change in impedance) is
mainly dependent on density.
• More the dense a tissue is, more will be the acoustic impedance, reflection of the ultrasound beam will be more, producing more
acoustic shadow.
Correct Answer. a
(20).
Ultrasonography is not useful in
a. CBD stones at the end of the CBD
b. Breast cyst
c. Ascites
d. Full bladder
Solution. Ans-: (a) CBD stones at the end of the CBD
Ref:Read the text below
Sol:
• Air (gas) is greatestenemy of ultrasonograph.
• When stone is in distal CBD, overlying bowel gas interferes with ultrasonic waves and makes visualization of CBD, especially in its
distal part almost imposible.
Hence, CT scores over ultrasound when stone is in distal CBD.
Correct Answer. a
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(21).
Which of the following is the most serious complication of displaced fracture of the distal end of the humerus?
a. Nonunion of fracture fragments
b. Nonunion of fracture fragments with deformity
c. Disruption of the growth plate at the distal end of the humerus
d. Forearm compartment syndrome (Volkmann‘s ischemia)
Solution. (d) Forearm compartment syndrome (Volkmann‘s ischemia)
Reference: Read the text below
Sol:
- Ischemia contracture may result in deformity and disability of the hand, which impairs function of the entire upper extremity, not only
of the elbow area.
Correct Answer. d
(22).
All the following are methods for reduction of posterior dislocation of hip except :a. Allis maneuver
b. Bigelow‘s maneuver
c. Gravity method of Stimpson
d. Holdswoth maneuver
Solution. (d) Holdswoth maneuver
Reference: Read the text below
Sol:
- Patients with a posterior dislocation of the hip generally present with a shortened, internally rotated, adducted limb in slight flexion.
- This injury typically occurs from a longitudinally directed force applied through the femur to a flexed hip, often when a patient‘s knee
strikes the dashboard in an automobile head-on collision.
- If the hip is adducted at the time of injury, a pure dislocation occurs, whereas a neutral position or abduction leads to dislocation
associated with a fracture of the femoral head or acetabulum.
Reduction of a dislocated hip is an emergency and the following methods can be used –
- Gravity Method of Stimson
- Allis Maneuver
- Bigelow Maneuver- East Baltimore Lift Correct Answer. d
(23).
Most common variety of spondylolisthesis is:
a. Isthmic
b. Dysplastic
c. Degenerative
d. Traumatic
Solution. (a) Isthmic
Reference: Read the text below
Sol:
Spondylolisthesis :
- Commonly occurs between L5- S1 and between L4 - L5.
- Isthmic variety is the overall commonest type
- Dysplastic is the least common type
- Presenting symptom is usually backache
- Oblique view of spine may sow defect in the pars interticularis (Scottish dog sign)
Correct Answer. a
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(24).
Craniosynostosis occurs due to fusion of
a. Saggital
b. Coronal
c. Lambdoid
d. Any of the above
Solution. (d) Any of the above
Reference: (Ref. OP Ghai 6th ed., 601; Nelson Paediatrics 17th ed., 1992)
Sol:
- Craniosynostosis is defined as premature closure of all cranial sutures.
- Primary craniosynostosis refers to closure of one or more sutures due to abnormalities of skull development.
- Secondary craniosynostosis results from failure of brain growth and expansion.
Correct Answer. d
(25).
The commonest site for rheumatoid nodules is:
a. Olecranon process
b. Tendo - Achilles
c. Proximal interphalangeal joints
d. Distal interphalangeal joints
Solution. (a) Olecranon process
Reference: Read the text below
Sol:
- Commonest site for rheumatoid nodules is over olecranon process.
Correct Answer. a
(26).
"Waddell's triad of injury" in children includes all the following injuries except :
a. Fracture femur
b. Head injury
c. Thoracic injury
d. Abdominal injury
Solution. (d) Abdominal injury
Reference: Read the text below
Sol:
- Waddell's triad of injury is the name for an arbitrary combination of Fracture femur, head injury and thoracic injury.
- It is seen when a child is struck by a car while crossing the street. It is a life threatening injury
Correct Answer. d
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(27).
The synovium in TB knee is thickened and doughy to feel, it is best palpated on the :a. Medial aspect of the knee
b. Posterior aspect
c. Anterior aspect
d. Lateral aspect
Solution. (a) Medial aspect of the knee
Reference: Read the text below
Sol:
- The thickened synovium in TB knee gives a boggy feel and can be rolled between the fingers and the underlying femur.
- It is best felt on the medial side because vastus medial is muscular upto its insertion to the patella and gets wasted early.
- Muscles on the lateral side are aponeurotic and covered by the thick iliotibial band.
Correct Answer. a
(28).
Treatment of fracture head of radius in young patients (if a fragment more than one-third in size is broken off) :a. Above-elbow plaster cast
b. Open reduction internal fixation
c. Close manipulation
d. Excision of the head
Solution. (d) Excision of the head
Reference: Read the text below
Sol:
Treatment of fracture head of radius :
It depends upon the types of fracture as discussed below :1. A crack only :- The fracture is treated by immobilisation in an above-elbow plaster slab for 2 weeks with the elbow at 90° of flexion and
the forearm in mid pronation.
2. A fragment of the head broken off :- If the fragment is less than 1/3 than size of the head it can be treated as above. If it is more than
1/3 in size, or if it is lying loose inside the joint, it needs excision.
3. Comminuted fracture with displacement :-This is treated by excision of the head.
Correct Answer. d
(29).
Excision of fracture fragment is practised in all fractures except :
a. Patella
b. Lateral condyle humerus
c. Olecranon
d. Head of radius
Solution. (b) Lateral condyle humerus
Reference: Read the text below
Sol:
- Fracture of lateral condyle of humerus is a type-IV epiphyseal injury, accurate reduction is important if normal growth of the elbow is to
be expected, is treated by open reduction and internal fixation using two K-wires.
Correct Answer. b
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(30).
Osteochondritis Dissecans in knee – most common site of involvement is :a. Lateral aspect of medial femoral condyle
b. Medial aspect of lateral femoral condyle
c. Inferocentral
d. Retropatellar
Solution. (a) Lateral aspect of medial femoral condyle
Reference: Read the text below
Sol:
- Osteochondritis Dissecams is a defect in the subchondral region with partial or compete separation of the bone fragment;
- Most often seen on the postero-lateral aspect of the medial femoral condyle (about 80% of cases),
Correct Answer. a
(31).
In Pityriasis versicolor infection, the hypopigmented or depigmented macules which are seen are due to :a. Degranulation of melanosomes by local immunological action of Malassezia fungus over melanocytes
b. Competitive inhibition of tyrosinase by dicarboxilic acids produced by Malassezia
c. Noncompetitive inhibition of DOPA hydroxylase
d. Competitive inhibition of DOPA hydroxylase
Solution. Ans- (b) Competitive inhibition of tyrosinase by dicarboxilic acids produced by Malassezia
Ref: Read the text below
Sol:
- In P. versicolor both hypo & hyperpigmented macles are seen.
- These are mainly distributed over trunk that too over back region most commonly.
- The hypopigmented macules are due to Competitive inhibition of tyrosinase by dicarboxilic acids (Azealic acid) produced by Malassezia
while the hyper pigmented lesions are due to increased size of the melanosomes.
Correct Answer. b
(32).
Manak, 18 years old male presents with multiple discrete papules, pustules with erythematous halo over back of shoulders & few
nodulocystic lesions over face with 'ice pick like scarring'. The line of management in this case should be :a. Oral azithromycin & topical fuscidin
b. Oral cyanomycin & topical clarithromycin
c. Retinoids
d. Excision & drainage of the nodulocystic leions under high antibiotic coverage with topical clarithromycin on back
Solution. Ans- (c) Retinoids
Ref: Roxburgh's -149-157; Rooks p 1953-72
Sol:
- The above case is of acne vulgaris ( nodulocystic variety ) in which now a days the drug of choice is Retinoids ( Isotretinoin ) which is
3rd generation Retinoids & is used orally.
- It is having teratogenic effect, so should not be used in pregnant or hopeful females.
Correct Answer. c
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(33).
Which of the following statement is correct :a. Density of eccrine sweat glands is highest in axilla
b. Body odour is due to eccrine sweat gland secretion
c. Langerhans cells are modified lymphocytes
d. Breast is modified apocrine sweat gland
Solution. Ans- (d) Breast is modified apocrine sweat gland.
Ref: Rooks p 37
Sol:
-Density of eccrine sweat glands is highest in palms & soles
- Body odour is due to Apocrine sweat gland secretion
- Langerhans cells are modified Macrophages
Correct Answer. d
(34).
Lines of Blaschko represent
a. Lines of embryonal migration
b. Lines of vessels
c. Lines of nerves
d. Lines of lymphatics
Solution. Ans- (a) Lines of embryonal migration
Ref: Read the text below
Sol :
- Lines of Blaschko represent the lines of migration of embryonal cells. Many mosaic skin disorders like nevi follow these lines.
Correct Answer. a
(35).
Desmosomes connect
a. Keratinocyte and melanocyte
b. Keratinocyte and Langerhans cell
c. Keratinocyte and Merkel cell
d. Langerhans cell with melanocyte
Solution. Ans- (c) Keratinocyte and Merkel cell
Ref: Read the text below
Sol :
- Desmosomes connect two keratinocytes together.
- Desmosomal connections have also been identified between keratinocytes and Merkel cells.
- As a result Merkel cells are now believed to be ectodermal in origin despite the presence of neurosecretory granules arguing for a
neural crest origin.
- Langerhans cells and Melanocytes are intruders into the epidermis and are not connected with surrounding keratinocytes with
desmosomes.
Correct Answer. c
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(36).
Which of the following is not a feature of poikiloderma
a. Atrophy
b. Reticulate pigmentation
c. Telangiectasia
d. Desquamation
Solution. Ans- (d) Desquamation
Ref: Read the text below
Sol :
- Poikiloderma is a triad of atrophy, reticulate pigmentation and telangiectasia.
- Desquamation is scaling.
- Poikiloderma is typically seen in photosensitive disorders.
Correct Answer. d
(37).
Pseudo isomorphic response is seen in
a. Vitiligo
b. Psoriasis
c. Lichen planus
d. Warts
Solution. Ans- (d) Warts
Ref: Read the text below
Sol :
- True isomorphism (Koebner‘s) is seen in vitiligo, psoriasis and lichen planus while pseudo isomorphism is seen in autoinoculation in
warts and molluscum contagiosum.
Correct Answer. d
(38).
Choose the correct sentence
a. Crystalline miliaria is due to obstruction of most superficial part of eccrine sweat duct
b. Fordyce disease is associated with apocrine glands
c. Palms and soles have eccrine glands solely controlled by thermal stimuli
d. Sebaceous glands are mostly free but sometimes may be associated with hair follicles
Solution. Ans-(a) Crystalline miliaria is due to obstruction of most superficial part of eccrine
sweat duct
Ref: Read the text below
Sol :
- Blockage of eccrine glands produces miliaria.
- Most superficial type produces crystalline miliaria while mid level block produces miliaria rubra (prickly heat) and deep blocks produce
miliaria profunda.
- Sebaceous glands are always associated with hair follicles except free/ectopic glands like Fordyce disease or granules.
- Eccrine sweat glands of palms and soles differ from other glands by responding to emotional stimuli too.
Correct Answer. a
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(39).
Fish handler‘s disease is
a. Swimming pool granuloma
b. Fish tank granuloma
c. Erysipeloid
d. Sporotrichosis
Solution. Ans- (c) Erysipeloid
Ref: Read the text below
Sol :
- Fish handler‘s disease is erysipeloid caused by Erysipelothrix spp.
- Fish tank granuloma and swimming pool granuloma are cutaneous atypical mycobacteriosis caused by M. marinum.
- Sporotrichosis is known as rose gardener‘s disease.
Correct Answer. c
(40).
Sweat glands are innervated by :a. Sympathetic fibers with Acetylcholine as neurotransmitter
b. Parasympathetic fibers with Acetylcholine as neurotransmitter
c. Sympathetic fibers with Adrenaline as neurotransmitter
d. Both Sympathetic & Parasympathetic fibers with Acetylcholine as neurotransmitter
Solution. Ans- (a) Sympathetic fibers with Acetylcholine as neurotransmitter
Ref: Read the text below
Sol:
- This is very peculiar about sweat glands that though they are having sympathetic innervation but the neurotransmitter is Acetylcholine.
- Also remember that all postganglionic parasympathetic & few postganglionic. Sympathetic (sweat glands & some blood vessels) are
having Muscarinic receptors while ganglia of both sympathetic & parasympathetic are having nicotinic receptors
Correct Answer. a
(41).
Term psychoanalysis is coined by :a. Erik Ericson
b. John Piaget
c. Sigmund Freud
d. Alfred Adler
Solution. Ans-: (c) Sigmund Freud
Ref: Read the text below
Sol:
Freud is the pioneer of field of psychiatry. He was basically a neurologist but his contribution is central to psychiatric &
psychotherapeutic practise.
He coined terms like – Psychoanalysis
·
Psychodynamics
·
Free association
·
Oedipus complex
·
Electra complex
·
Penis envy
·
Primal scene
·
Ego defense mechanisms
·
Repression
·
Psychological determinism
·
Pleasure principle
·
Reality principle
Correct Answer. c
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(42).
Patient named Raja feels inability to relax, moves here & there, rapidly alters his sitting & standing position. He has been started tablet
Haloperidol 20 mg a day, ten day back. What is the best treatment for him :a. Give propranolol
b. Give Benztropine
c. Increase the dose of Haloperidol
d. Give clonazepam
Solution. Ans-: (a) Give propranolol
Ref: Read the text below
Sol:
Patient is suffering from neuroleptic induced acute akathisia. In this, there are subjective complaints of restlessness after exposure to
neuroleptic medication.
Most efficacious treatment of akathisia are b adrenergic receptor antagonist eg. propranolol.
– Anticholinergics, Benzodiazepene & cyprohepta-dine may benefit some patients.
– Neuroleptic dose must be reduced. One may switch to low potency Neuroleptics.
Correct Answer. a
(43).
The most common mental abnormality on presentation with the Wernicke-Korsakoff syndrome is
a. A global confusional state
b. Delirium with hallucinations
c. Impaired recent memory without confusion
d. Coma
Solution. Ans-: (a) A global confusional state
Ref:Read the text below
Sol :
·
Wernicke-Korsakoff syndrome is a clinical triad consisting of ataxia, oculomotor abnormalities, and mental status impairment,
though all three sign may not be present.
·
In 229 patients with the Wernicke-Korsakoff syndrome, 56 percent had a global confusional state at the time of presentation
compared with 16 percent with delirium tremens, 5 percent with stupor or coma, and 10 percent without mental abnormality.
Correct Answer. a
(44).
Levodopa-induced hallucinations are usually
a. Auditory
b. Visual and threatening
c. Visual and nonthreatening
d. Auditory and visual
Solution. Ans-: (c) Visual and nonthreatening
Ref:Read the text below
Sol :
·
Levodopa hallucinationsare fairly common but occur mainly in older patients with some degree of cognitive dysfunction, although
this is not always the case.
·
The hallucinations may be threatening, but this is extremely uncommon; they are mainly nonthreatening and visual.
·
It is common to hallucinate about children, friendly strangers, or occasionally relatives.
·
The hallucinations may occur in a clear or clouded sensorium and may or may not recognized as hallucinatory in origin by the
patient.
Correct Answer. c
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(45).
Dissociative states and panic attacks are frequently seen in which of the following psychiatric disorders?
a. Depression
b. Mania
c. Conversion reactions
d. Posttraumatic stress disorder
Solution. Ans-: (d) Posttraumatic stress disorder
Ref:Read the text below
Sol :
·
Posttraumatic stress disorder covers a wide range of problems that occur after server psychological trauma. It was called “shell
shock” during World War I but not adequately studied until the Vietnam War.
·
The abnormality extends to all traumatizing events “outside the range of usual human experience, that would be markedly
distressing to almost anyone,” such incest, rape, seeing a murder, and so on.
·
The subject often reexperiences the event and undergoes an process of numbing. Dissociative states, in which patients experience
fugue states, may occur, as well as panic guilt, humiliation, illusions, and delusions.
·
Sometimes the dissociative episodes may be described in ways that suggest complex partial seizures .
Correct Answer. d
(46).
Which of the following is a defense process common I obsessive compulsive disorder and in which unacceptable impulse are transformed
into their opposites?
a. Intellectualization
b. Displacement
c. Reaction formation
d. Sublimation
Solution. Ans-: (c) Reaction formation
Ref:Read the text below
Sol :
·
Displacement refers to a process in which an emotion related to one idea or object is shifts to another that bears some
resemblance to the original.
·
Sublimation is a defense process that allows one to achieve gratification through achievement of more acceptable goals than those
actually desired.
·
Dissociation is a major alteration of a person’s character to avoid emotional distress, often without memory for the alteration, as
with fugue states.
·
Intellectualization is a defense process in which emotions are avoided through a highly rationalized and intellectual interpretation
of events.
Correct Answer. c
(47).
Advantages of benzodiazepines as antianxiety agents include which of the following?
a. Wide gap between effective doses and lethal doses
b. Relatively low activation of hepatic microsomal enzymes
c. Long duration of action
d. All of the above
Solution. Ans-: (d) All of the above
Ref:Read the text below
Sol :
·
Benzodiazepines have become the most frequently prescribed antianxiety medication.
·
Although overused, they do have specific advantages when they are indicated. These advantages include a wide gap between the
effective and lethal doses, low activation of hepatic microsomal enzymes, long duration of action(around 24 h), and relatively low
production of physical tolerance.
·
The low activation of hepatic microsomal enzymes means that the benzodiazepines produce little alteration in the metabolism of
drugs such as coumarin, antipsychotic agents, tricyclic antidepressants will, however, add to the pharmacologic effects of other
medications, such as increasing the sedation caused by anticonvulsants or alcohol.
Correct Answer. d
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(48).
Insomnia is frequently associated with
a. Depression
b. Alcoholism
c. Parkinson‘s disease
d. All of the above
Solution. Ans-: (d) All of the above
Ref:Read the text below
Sol :
·
Insomnia is a clinically definedproblem of initiating or maintaining sleep. It is a common complaint of patients.
·
Although it is often present in patients with depression and mania, only the former complain.
·
It occurs in many neurologic disorders, including periodicmovement of sleep, and is a frequent problem for patients with
Parkinson’s disease.
·
Alcohol and other depressant drugs are a common cause as well.
Correct Answer. d
(49).
Electroconvulsive therapy is most effective in reducinga. Affective symptoms
b. Memory impairment
c. Delusions
d. Obsessions
Solution. Ans-: (a) Affective symptoms
Ref: Read the text below
Sol:
·
Electroconvulsive therapy ismost effective in reducing affective symptoms, i.e. major severe depression especially when it is
associated with suicidal risk, this is the fast and most important indication for ECT.
·
It is also indicated in severe depression associated with stupor, poor food intake, melancholia, psychotic features or unsatisfactory
response to drug therapy.
Correct Answer. a
(50).
Schizophrenia with worst prognosis is :a. Simple schizophrenia
b. Hebephrenic schizophrenia
c. Paranoid schizophrenia
d. Catatonic schizophrenia
Solution. Ans-: (a) Simple schizophrenia
Ref: Read the text below
Sol:
Simple schizophrenia is characterised by gradual insidious loss of drive & ambition. They are not overtly psychotic & do not experience
persistent hallucinations & delusions. They are very difficult to diagnose & have the worst prognosis.
Important points about schizophrenia 1. Most common type – paranoid
2. Most late onset – paranoid
3. Best prognosis – catatonic
4. Early onset & – hebephrenic & simple poor prognosis
Correct Answer. a
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(51).
Falanga is a type of?
a. Physical torture
b. Sexual torture
c. Mental torture
d. Method of homicide
Solution. (a) Physical torture
Ref: Read the text below
Sol:
- "Foot whipping, variously known as bastinado, falanga (phalange), and falaka ( falaqa), is a form of corporl punishment whereby the
soles of the feet are beaten with an object such as arcane or rod, a club , a piece of wood, a stout leather bullwhip, or a flexible bat of
heavy rubber.
- It is also sometimes favored as a form of torture because, although extremely painful, it leaves few physical marks, though evidence can
be detected.
Correct Answer. a
(52).
Which is not a derivative of cannabis?
a. Cocaine
b. Charas
c. Ganza
d. Bhang
Solution. (a) Cocaine
Ref: Read the text below
Sol:
Cannabis sativa is also known as Indian hemp in India, dagga in Africa& hashish in Egypt.
The active principal is not an alkaloidbut a fat souble oleoresin, cannabinol( Delta-9 trtrahydrocannabinol or –THC)
It is stimulant of central nervous system and is used in the following four forms
Forms of Cannabis
Source
Concentration of active principle
Bhang
Dried Lea & fruit shoot
15%
Majun
Sweetmeat made of bhang
15%
Ganga
Flowering tops
25%
Charas (AKAHashish)
Resinous exudates from the leaves and steam of the plants 25-40%
Correct Answer. a
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(53).
Keyhole bullet entry is a feature of :
a. Tandem Bullet
b. Dum Dum Bullet
c. Ricochet Bullet
d. Fragmentation Bullet
Solution. (c) Ricochet Bullet
Ref.: Read the text below
Sol :
- A ricochet is a rebound, bounce or skip off a surface, particularly in the case of a projectile. The possibility of ricochet is one of the
reasons for the common firearms safety rule "Never shoot at a flat, hard surface
- Keyhole may be a noun which refers to the hole which a tumbling bullet makes in a target, or it may be an adjective which describes the
tumbling which the bullet was doing when it struck the target.
- When a conical bullet strikes a surface in any attitude other than truly stabilized flight, that bullet has keyholed. Evidence of keyholing
most often comes in the form of oblong holes in a paper target. Sometimes the holes are just a bit longer in one direction, and at other
times the bullet will strike the target sideways. See the photo for examples of both.
- The causes of keyholing may vary, but in all cases the bullet's flight was not properly stabilized when it struck the target.
Correct Answer. c
(54).
Medico-legal importance of rigor mortis is in estimation of :
a. Time of death
b. Manner of death
c. Cause of death
d. All the above
Solution. (a) Time of death
Ref.: Read the text below
Sol :
- Rigor mortis is one of the recognizable signs of death, caused by chemical changes in the muscles after death, causing the limbs of the
corpse to become stiff and difficult to move or manipulate.
- In humans, it commences after about three to four hours, reaches maximum stiffness after 12 hours, and gradually dissipates until
approximately 48 to 60 hours after death.
- After death, cellular respiration in organisms ceases to occur, depleting the corpse of oxygen used in the making of adenosine
triphosphate (ATP). ATP is no longer provided to operate the SERCA pumps in the membrane of the sarcoplasmic reticulum, which pump
calcium ions into the terminal cisternae.
- This causes calcium ions to diffuse from the area of higher concentration (in the terminal cisternae and extracellular fluid) to an area of
lower concentration (in the sarcomere), binding with troponin and allowing for crossbridging to occur between myosin and actin proteins
Correct Answer. a
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(55).
MTP Act was passed in the year :
a. 1971
b. 1974
c. 1981
d. 1984
Solution. (a) 1971
Ref.: Read the text below
Sol :
As per India‘s abortion laws only qualified doctors under stipulated conditions can perform abortion on a woman in an approved clinic or
hospital. The Indian abortion laws fall under the Medical Termination of Pregnancy (MTP) Act, which was enacted by the Indian
Parliament in the year 1971. The MTP Act came into effect from April 1, 1972 and was once amended in 1975.
The Medical Termination of Pregnancy (MTP) Act of India clearly states the conditions under which a pregnancy can be ended or
aborted, the persons who are qualified to conduct the abortion and the place of implementation.
Some of these qualifications are as follows:
- Women whose physical and/or mental health were endangered by the pregnancy
- Women facing the birth of a potentially handicapped or malformed child
- Rape[
- Pregnancies in unmarried girls under the age of eighteen with the consent of a guardian
- Pregnancies in "lunatics" with the consent of a guardian[
- Pregnancies that result are a result of failure in sterilization
The length of the pregnancy must not exceed twenty weeks in order to qualify for an abortion.
Correct Answer. a
(56).
Atypical drowning is due to :
a. Laryngospasm
b. Vagal inhibition
c. Water inhalation
d. Electrolyte disturbance
Solution. (b) Vagal inhibition
Ref.: Read the text below
Sol :
Dangers of Cold Water Immersion
This doesn‘t necessarily have to be cold water, though the colder the water the worse the danger:1) ‗ATYPICAL‘ DROWNING. This accounts for 10 – 20% of all cases of drowning, and can be almost instantaneous on hitting the water.
This is more likely to happen when the water is entered feet first (like when a rower gets out of a sinking boat), and when the victim is in
a state of surprise or unpreparedness (like when your boat suddenly sinks below you). You go unconscious very quickly (so you can‘t hold
onto the boat), and an unconscious person sinks like a stone. When you go under a disturbed water surface you go out of sight very
quickly, so can‘t be retrieved. The mechanism is reflex laryngospasm leading to asphyxia. There is little or no inhalation of immersion
fluid. The cause is thought to be cold water hitting the back of the throat, causing a reflex closing of the airway.
2) DROWNING. When a person goes under water due to exhaustion and/or hypothermia initially the breathing automatically stops
(diving reflex), until the carbon dioxide builds up enough to produce an involuntary gasp. Water floods the lungs, there is vomiting and
inhalation of gastric contents, heart rhythm disruption and lack of oxygen to the brain. Unconsciousness follows and the person sinks to
the bottom.
3) HYPOTHERMIA. This is more common in those with a high surface area to body weight ratio, such as children, or lightweight rowers.
Even brief local cooling below 12degrees C of limbs (e.g. when a warm, vasodilated, exercised rower is suddenly immersed in water)
causes a motor and sensory paralysis (so you can‘t swim or hold onto the boat). Mental slowing, confusion and amnesia occur relatively
early (so the immersed rower will not then behave rationally, or remember their ARA education). Circulatory, respiratory, renal,
metabolic, gastro-intestinal, and blood system disruptions follow. The death rate from hypothermia is 20 – 80 % according to age, health
status, degree of cooling, and the quality and timing of treatment received.
Correct Answer. b
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(57).
Dichotomy means :
a. Erasure of name
b. Disclosure of secrets of a patients
c. Fee-splitting
d. Adultery
Solution. (c) Fee-splitting
Ref.: Read the text below
Sol :
Dichotomy of fee splitting is receiving or giving commission or other benefits to a professional colleague or manufacturer or trader in
drugs, appliances or a chemist, dentist etc.
Correct Answer. c
(58).
Cyanide is dangerous because it acts by?
a. Decreasing oxygen carrying capacity of bloods thus lactic academia
b. Inhibition of Oxidative phosphorylation thus causing tissue level hypoxia
c. Causing hemolysis & internal bleeding
d. Causing Respiratory paralysis thus causing asphyxia
Solution. (b) Inhibition of Oxidative phosphorylation thus causing tissue level hypoxia
Ref: Read the text below
Sol:
Principles of toxiclogy environmental and industrial application 2nd ed by Phillips Williams, Robert Jame pg 105, Parikh 6th ed page 8.39
- Cyanide inhibits cytochorme oxidase, thus halting electron transport, oxidative phosphorylation, and aerobic glucose metabolism.
- Inhibition of glucose metabolism results in the buildup of lactate 9 lactic academia) and the increase in the concentration of oxygenated
hemoglobin in venous blood returning to the heart.
- Increase oxyhemoglobin in the venous circulation reflects the fact that oxygen is not being utilized in the peripheral tissue.
- The most serious consequence of oxide phosphorylation inhibition are related to neurological and cardiovascular problems, including
adverse neurological squeal respiratory arrest, arrhythmia, and cardiac.
- Cyanide exposure can occur via inhalation of hydrogen cynide gas as through ingestion of sodium of potassium cyanide.
Correct Answer. b
(59).
In a medicolegal investigation of alleged death due to Anaesthesia, all of the following are correct statements except
a. Blood samples of the cadaver must be taken
b. Devices introduced into the patient, such as endotracheal tubes, catheters etc. must be removed before starting autopsy
c. Injuries due to resuscitative measures may mimic strangulation
d. Radiographs of the dead body must be taken before autopsy
Solution. (b) Devices introduced into the patient, such as endotracheal tubes, catheters etc. must be removed before starting autopsy
Ref: Read the text below
Sol:
MEDICOLEGAL INVESTIGATION OF ALLEGED DEATH DUE TO ANAESTHESIA
- Blood samples of the cadaver must be taken
- Injuries due to resuscitative measures may mimic strangulation
- Radiographs of the dead body must be taken before autopsy
- Devices introduced into the patient, such as endotracheal tubes, catheters etc. should not be removed before starting autopsy
Correct Answer. b
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(60).
Shivering stops completely below:
a. 35 degree
b. 32 degree
c. 30 degree
d. 27 degrees
Solution. -NACorrect Answer. b
(61).
Which of the following are the most common fatal complications of measles?
a. Fever and bacterial pneumonia
b. Hepatitis and giant cell pneumonia
c. Meningitis and respiratory complications
d. SSPE and immunodeficiency
Solution. Ans- (C) Meningitis and respiratory complications
Ref: Read the text below.
Sol:
- Complications with measles are relatively common, ranging from relatively mild and less serious diarrhea, to pneumonia and acute
encephalitis (and rarely subacute sclerosing panencephalitis); corneal ulceration leading to corneal scarring.
- Complications are usually more severe amongst adults who catch the virus.
- The most common fatal complications of measles are meningitis and respiratory complications, such as pneumonia.
Correct Answer. c
(62).
Which of the following statements is true regarding measles?
a. An individual can recontract measles because the immunity conferred by an infection will decrease over time.
b. A mother will pass measles immunity to her newborn only if she has had the natural disease
c. Measles temporarily depresses the humeral immune system
d. Less than half of patients contracting measles encephalitis survive without residual neurologic signs.
Solution. Ans- (d) Less than half of patients contracting measles encephalitis survive without residual neurologic signs.
Ref: Read the text below.
Sol:
- Measles encephalitis: Inflammation of the brain (encephalitis) occurs in perhaps 1 in 1,000 cases of measles, starting (up to 3 weeks)
after onset of the rash and presenting with high fever, convulsions, and coma.
- It usually runs a blessedly short course with full recovery within a week. Or it may eventuate in central nervous system impairment or
death.
- Measles encephalitis is a serious complication. Of the patients who survive, most will have some degree of residual neurologic signs.
Correct Answer. d
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(63).
Which of the following statements is true regarding tetanus?
a. All patients with contaminated wounds should be given a Td.
b. HIV patients should avoid tetanus vaccines
c. Most cases of tetanus are preventable
d. Risus sardonicus is a condition where the jaw becomes locked
Solution. Ans- (c) Most cases of tetanus are preventable.
Ref: Read the text below.
Sol:
- Tetanus can be prevented by vaccination with tetanus toxoid.
- The CDC recommends that adults receive a booster vaccine every ten years, and standard care practice in many places is to give the
booster to any patient with a puncture wound who is uncertain of when he or she was last vaccinated, or if he or she has had fewer than
three lifetime doses of the vaccine. The booster may not prevent a potentially fatal case of tetanus from the current wound, however, as it
can take up to two weeks for tetanus antibodies to form.
- In children under the age of seven, the tetanus vaccine is often administered as a combined vaccine, DPT/DTaP vaccine, which also
includes vaccines against diphtheria and pertussis. For adults and children over seven, the Td vaccine (tetanus and diphtheria) or Tdap
(tetanus, diphtheria, and acellular pertussis) is commonly used
Correct Answer. c
(64).
About enterotoxigenic Ecoli true is
a. Does not cause travellers diarrhea
b. Most commonly causes diarhea in deveoping countries
c. Invasion of gut mucosa
d. Fomite borne
Solution. Ans-(b) Most commonly causes diarhea in deveoping countries.
Ref: Jawetz, Melnick, & Adelberg's Medical Microbiology, 24th ed pg 219.
Sol:
Enterotoxigenic E coli (ETEC)
- It is a common cause of "traveler's diarrhea" and a very important cause of diarrhea in infants in developing countries.
- ETEC colonization factors specific for humans promote adherence of ETEC to epithelial cells of the small bowel.
- Some strains of ETEC produce a heat-labile exotoxin (LT) (MW 80,000) that is under the genetic control of a plasmid.
- Its subunit B attaches to the GM1 ganglioside at the brush border of epithelial cells of the small intestine and facilitates the entry of
subunit A (MW 26,000) into the cell, where the latter activates adenylyl cyclase.
- This markedly increases the local concentration of cyclic adenosine monophosphate (cAMP), which results in intense and prolonged
hypersecretion of water and chlorides and inhibits the reabsorption of sodium.
- The gut lumen is distended with fluid, and hypermotility and diarrhea ensue, lasting for several days. LT is antigenic and cross-reacts
with the enterotoxin of Vibrio cholerae. LT stimulates the production of neutralizing antibodies in the serum (and perhaps on the gut
surface) of persons previously infected with enterotoxigenic E coli.
- Persons residing in areas where such organisms are highly prevalent (eg, in some developing countries) are likely to possess antibodies
and are less prone to develop diarrhea on reexposure to the LT-producing E coli. Assays for LT include the following: (1) fluid
accumulation in the intestine of laboratory animals; (2) typical cytologic changes in cultured Chinese hamster ovary cells or other cell
lines; (3) stimulation of steroid production in cultured adrenal tumor cells; and (4) binding and immunologic assays with standardized
antisera to LT.
- Some strains of ETEC produce the heat-stable enterotoxin STa (MW 1500–4000), which is under the genetic control of a heterogeneous
group of plasmids. STa activates guanylyl cyclase in enteric epithelial cells and stimulates fluid secretion.
- Many STa-positive strains also produce LT. The strains with both toxins produce a more severe diarrhea.
- The plasmids carrying the genes for enterotoxins (LT, ST) also may carry genes for the colonization factors that facilitate the
attachment of E coli strains to intestinal epithelium.
- Recognized colonization factors occur with particular frequency in some serotypes. Certain serotypes of ETEC occur worldwide; others
have a limited recognized distribution.
- It is possible that virtually any E coli may acquire a plasmid encoding for enterotoxins. There is no definite association of ETEC with the
EPEC strains causing diarrhea in children.
- Likewise, there is no association between enterotoxigenic strains and those able to invade intestinal epithelial cells.
Correct Answer. b
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(65).
Which of the followings is false about Cl.perfringes
a. Food poisoning strains produce heat resistant spores
b. Show positive naegler reaction
c. Most important toxin is hyaluronidase
d. M.C. cause gas gangrene
Solution. Ans- (c) Most important toxin is hyaluronidase .
Ref: Ananthanarayan and Paniker‘s textbook of microbiology 8th ed pg 252.
Sol:
- Four major toxins produced by clostridia species are alpha, beta, epsilon, iota.
- Tha alpha toxin is produced by all strains of clostridia and most predominantly by type A strain
- This is the most important toxin biologically and is responsible for profound toxaemia in gas gangrene
Resistance:
- Spores are destroyed by boiling with in five minutes but those of food poisoning strains of type A and certain type C strains resists
boiling for 1-3 hours
Nagler‘s reaction
- When cl.perfringes is grown on a medium containing 6% agar, 5% fildes‘ peptic digest of sheep blood and 20 % human serum, with the
antitoxin spread on one half of the plate, colonies on the other half with out the antitoxin will be surrounded by a zone of opacity. There
will be no opacity around the colonies on the other half of the plate with the anti toxin due to the specific neutralisation of alpha toxin.
This specific lecithinase effect is known as nagler‘s reaction
Correct Answer. c
(66).
All can cause candidiasis except
a. DM
b. HTN
c. Ca Breast
d. Pregnancy
Solution. Ans- (b) HTN.
Ref: Harrison’s principle of internal medicine 17th ed pg 1254.
Sol:
Candidiasis have identified the following predisposing factors or conditions:
a) Antibacterial agents,
b) Indwelling intravascular catheters,
c) Hyperalimentation fluids,
d) Indwelling urinary catheters,
e) Parenteral glucocorticoids,
f) Respirators, neutropenia,
g) Abdominal and thoracic surgery,
h) Cytotoxic chemotherapy, and
i) Immunosuppressive agents for organ transplantation.
j) Patients with severe burns, low-birth-weight neonates, and persons using illicit iv drugs are also susceptible. Hiv-infected patients with
low cd4+ t cell counts and patients with
diabetes are susceptible to mucocutaneous infection, which may eventually develop into the disseminated form when other predisposing
factors are encountered.
k) Women who receive antibacterial agents may develop vaginal candidiasis.
Correct Answer. b
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(67).
A deficiency in nicotinamide adenine dinucleotide (NADH) or nicotinamide adenine dinucleotide phosphate (NADPH) oxidase and an
increased susceptibility to organisms of low virulence are characteristic of
a. Chronic granulomatous disease
b. Angioneurotic edema
c. Chronic active hepatitis
d. Graves' disease
Solution. Ans (a) Chronic granulomatous disease..
Ref– Read the text below
Sol:
- Only patients with chronic granulomatous disease exhibit a deficiency in nicotinamide adenine dinucleotide (NADH) or nicotinamide
adenine dinucleotide phosphate (NADPH) oxidase and increased susceptibility to organisms of low virulence.
- Chronic granulomatous disease is an inherited condition.
Correct Answer. a
(68).
CD8 is a surface membrane protein on T cells and has which of the following characteristics?
a. It recognizes class I human leukocyte antigens (HLA).
b. It recognizes class II HLA
c. It characterizes T helper cells
d. It is strongly chemotactic
Solution. Ans (a) It recognizes class I human leukocyte antigens (HLA)..
Ref– Read the text below
Sol:
- CD8 recognizes class I human leukocyte antigens selectively. It is found on suppressor and cytotoxic T cells.
- CD4 characterizes T helper cells.
Correct Answer. a
(69).
An immunocompromised person with history of seizures had an MRI that revealed a temporal lobe lesion. Brain biopsy results showed
multinucleated giant cells with intranuclear inclusions. The most probable cause of the lesion is
a. Hepatitis C virus
b. Herpes simplex virus
c. Listeria monocytogenes
d. Coxsackievirus
Solution. Ans (b) Herpes simplex virus.
Ref– Read the text below
Sol:
- Herpes simplex virus causes primary and recurrent disease.
- The typical skin lesion is a vesicle that contains virus particles in serous fluid. Giant multinucleated cells are typically found at the base
of the herpesvirus lesion.
- Encephalitis, which usually involves the temporal lobe, has a high mortality rate. Severe neurologic sequelae are seen in surviving
patients.
Correct Answer. b
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(70).
Hantavirus is an emerging pathogen that is best described by which of the following statements?
a. Influenza-like symptoms are followed rapidly by acute respiratory failure
b. Hemolysis is common in infected patients
c. It is acquired by inhalation of aerosols of the urine and feces of deer
d. Transmission from human to human is common
Solution. Ans (a) Influenza-like symptoms are followed rapidly by acute respiratory failure.
Ref– Read the text below
Sol:
- A fatal respiratory disease is caused by a Hantavirus endemic in deer mice.
- It is not transmitted from person to person.
- The mortality rate is 60%. Ribavirin has been used but is not effective.
- A vaccine is not available.
Correct Answer. a
(71).
Which of the following viruses does not use a reverse transcriptase during replication?
a. Mouse mammary tumor virus
b. Rous sarcoma virus
c. Polyoma virus
d. Human T lymphotrophic virus
Solution. Ans (c) Polyoma virus
Ref– Read the text below
Sol:
- Therefore, only polyoma virus is not dependent on this enzyme activity for replication.
Correct Answer. c
(72).
The initial host defense mechanism that occurs at the first site of primary virus infection is
a. Inflammation.
b. Immunoglobulin M antibody production
c. Sensitized T-cell production
d. Interferon production.
Solution. Ans (d) Interferon production.
Ref– Read the text below
Sol:
- Because interferon is produced in the first cell infected by the virus, it is the first host defense mechanism that occurs in response to a
primary virus infection.
Correct Answer. d
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(73).
Which of the following protozoans is transmitted primarily by the motile trophozoite form?
a. Balantidium coli
b. Entamoeba histolytica
c. Taenia solium
d. Trichomonas vaginalis
Solution. Ans (d) Trichomonas vaginalis.
Ref– Read the text below
Sol:
- Protozoans transmitted by the fecal-oral route are transmitted in the cyst form, which survives stomach acid.
- Only the sexually transmitted Trichomonas vaginalis is transmitted in the motile form.
- Taenia solium is not a protozoan, but a flatworm.
Correct Answer. d
(74).
A noncompliant human immunodeficiency virus (HIV)-positive patient with a CD4+ cell count of 40/mm3 has a pulmonary infection caused
by an organism that requires 4 weeks to grow on Lowenstein-Jensen medium. What is the nature of the most likely causative agent?
a. Acid-fast organism
b. Dimorphic fungus
c. Filamentous fungus
d. Gram-positive coccus
Solution. Ans (a) Acid-fast organism.
Ref– Read the text below
Sol:
- Mycobacterium avium-intracellulare or Mycobacterium tuberculosis, both acid-fast organisms, are the most likely causes of this
pulmonary infection in a patient with acquired immunodeficiency syndrome.
- Pneumocystis carinii cannot be cultured yet.
Correct Answer. a
(75).
Which of the following protozoans is free living and acquisition does not generally indicate fecal contamination?
a. Acanthamoeba
b. Dientamoeba fragilis
c. Entamoeba histolytica
d. Entamoeba coli
Solution. Ans (a) Acanthamoeba.
Ref– Read the text below
Sol:
- Acanthamoeba is a free-living organism with a sturdy cyst stage that is found in dust. A common way of acquiring.
- Acanthamoeba infections is through homemade saline solutions for soft contact lenses.
Correct Answer. a
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(76).
What is the most likely reason for a chloroquine-treated case of Plasmodium vivax relapsing?
a. P vivax has a significant level of chloroquine resistance.
b. P vivax has a persistent erythrocytic stage.
c. P vivax has a persistent exoerythrocytic stage (hypnozoite).
d. Chloroquine is not one of the drugs of choice.
Solution. Ans (c) P vivax has a persistent exoerythrocytic stage (hypnozoite)..
Ref– Read the text below
Sol:
- Both Plasmodium ovale and Plasmodium vivax may form liver hypnozoites, which are very slow to develop into schizonts with
merozoites and proceed onto the chloroquine-sensitive erythrocytic stages.
- It's not over with P ovale or P vivax unless you also treat with primaquine phosphate, which kills the liver stages.
Correct Answer. c
(77).
Amoebiasis is not transmitted through
a. Vertical Transmission
b. Fecooral
c. cockroach
d. Oral
Solution. Ans- (a) Vertical Transmission .
Ref: Harrison’s principle of internal medicine 17th ed pg 1275.
Sol:
Mode of infection
- Fecal oral route: E. histolytica is acquired by ingestion of viable cysts from fecally contaminated water, food, or hands. Food-borne
exposure is most prevalent and is particularly likely when food handlers are shedding cysts or food is being grown with fecescontaminated soil, fertilizer, or water. Besides the drinking of contaminated water, less common means of transmission include oral and
anal sexual practices and—in rare instances—direct rectal inoculation through colonic irrigation devices. Motile trophozoites are
released from cysts in the small intestine and, in most patients, remain as harmless commensals in the large bowel
- Sexual transmission
- Vectors such as flies, cockroachs and rodents
1. Boy with skin ulcer on leg. Culture reveals beta hemolysis, Bacitracin sensitive. Cultures from school children with sore throat some
days back also revealed beta hemolysis. What is the similarity between both
a) C carbohydrate antigen is different
b) M protein is same
Correct Answer. a
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(78).
Genetic reassortment is found in
a. Hepadna virus
b. Parvo virus
c. Rota virus
d. Astro virus
Solution. Ans- (c) Rota virus .
Ref: Harrison’s principle of internal medicine 17th ed pg 1206.
Sol:
- Rotaviruses are members of the family Reoviridae.
- The viral genome consists of 11 segments of double-strand RNA that are enclosed in a triple-layered, nonenveloped, icosahedral capsid
75 nm in diameter.
- Viral protein 6 (VP6), the major structural protein, is the target of commercial immunoassays and determines the group specificity of
rotaviruses.
- There are seven major groups of rotavirus (A through G); human illness is caused primarily by group A and, to a much lesser extent, by
groups B and C. Two outer-capsid proteins, VP7 (G-protein) and VP4 (P-protein), determine serotype specificity, induce neutralizing
antibodies, and form the basis for binary classification of rotaviruses (G and P types).
- The segmented genome of rotavirus allows genetic reassortment (i.e., exchange of genome segments between viruses) during coinfection—a property that may play a role in viral evolution and has been utilized in the development of reassortant animal-human
rotavirus–based vaccines.
Correct Answer. c
(79).
Which of the following is diagnostic of pertussis ?
a. Lymphocytosis
b. Direct immunofluorescent assay (DFA) of nasopharyngeal secretions
c. Bordetella pertussis cultured from nasopharyngeal specimens
d. Chest x-ray
Solution. Ans-(c) Bordetella pertussis cultured from nasopharyngeal specimens
Ref: Read the text below.
Sol:
- Methods used in laboratory diagnosis include culturing of nasopharyngeal swabs on Bordet-Gengou medium, polymerase chain reaction
(PCR), direct immunofluorescence (DFA), and serological methods.
- The bacteria can be recovered from the patient only during the first three weeks of illness, rendering culturing and DFA useless after
this period, although PCR may have some limited usefulness for an additional three weeks.
- For most adults and adolescents, who often do not seek medical care until several weeks into their illness, serology may be used to
determine whether antibody against pertussis toxin or another component of B. pertussis is present at high levels in the blood of the
patient.
- By this stage they have been contagious for some weeks and may have spread the infection to many people. Because of this, adults, who
are not in great danger from pertussis, are increasingly being encouraged to be vaccinated.
Correct Answer. c
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(80).
Which of the following statements is true regarding pertussis?
a. Immunity from vaccination lasts about 3 years
b. Erythromycin will cure pertussis
c. Most adults are immune to pertussis
d. None.
Solution. Ans- (a) Immunity from vaccination lasts about 3 years.
Ref: Read the text below.
Sol:
- Pertussis vaccines are highly effective, strongly recommended, and save thousands of lives each year. The efficacy rate depends on the
type of vaccine (acellular or whole cell), the manufacturer, how many other immunizations are given at the same time, and the age of the
patient; various estimates range from preventing disease transmission in 50%–95% of people exposed to the disease.
- The duration of protection is between five to ten years. This covers childhood, which is the time of greatest exposure and greatest risk
of death from pertussis.
- For children, the immunizations are commonly given in combination with immunizations against tetanus, diphtheria, polio and
haemophilus influenzae type B, at ages two, four, and six months. A single later booster is given at three to four years of age.
- The pertussis component of the DPT vaccine accounted for most of the minor local and systemic side effects in many vaccinated infants
(such as mild fever or soreness at the injection site).
- Unlike some vaccines, immunization against pertussis does not confer life-long immunity. While adolescents and adults rarely die if they
contract pertussis after the effects of their childhood vaccinations have worn off, they may be very sick and may transmit the disease to
infants and other people at much higher risk of death.
Correct Answer. a
(81).
The lymphocytic and histiocytic variant of Reed-Sternberg cell is seen in :a. Follicular center lymphoma
b. Lymphocyte depleted Hodgkin‘s disease
c. Nodular sclerosis Hodgkin‘s disease
d. Lymphocyte predominant Hodgkin‘s disease
Solution. Ans-: (d) Lymphocyte predominant Hodgkin’s disease
Ref:Read the text below
Sol:
In lymphocytic predominant type of hodgkins lymphoma, typical Reed-sternberg cells are extremely difficult to find.
Lymphocyte predominant Hodgkin’s lymphoma is characterized by the presence of lymphohistocytic variant of Reed sternberg cells.
Correct Answer. d
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(82).
Which one of the following is the most significant risk factor for development of gastric carcinoma?
a. Paneth cell metaplasia
b. Pyloric metaplasia
c. Intestinal metaplasia
d. Ciliated metaplasia
Solution. Ans-: (c) Intestinal metaplasia
Ref:Read the text below
Sol:
“The risk of tumor development is greatly increased in patients in whom mucosal inflammation progress to multifocal atrophy and
intestinal metaplasia”-Robbins
‘Serial endoscopic examinations of the stomach in patients with atrophic gastritis have documented replacement of the usual gastric
mucosa by intestinal type cells. This process of intestinal metaplasia may lead to cellular atypia and eventual neoplasia.’
Risk factors for stomach carcinoma :
1. Long term ingestion of high concentration of nitrates in dried smoke and salted foods.
2. Loss of gastric acidity - atrophic gastritis
- partial gastrectomy (peptic ulcer surgery)
- pernicious anemia
3. Infection with H. pylori
4. Intestinal metaplasia
5. Gatric ulcer & polyps – (No association has been found between deodonal ulcer and gastric cancer)
6. Menetrier’s disease – extreme hypertrophy of gastric rugal folds.
7. Blood group A
8. Cigarette smoking, Dust ingestion, Ingestion of spirits, Genetic factors have also been implicated.
Correct Answer. c
(83).
Edema is caused by
a. Increased hydrostatic pressure
b. Decreasd capillary pressure
c. Decreased venous pressure
d. Increased plasma proteins
Solution. Ans-: (a) Increased hydrostatic pressure
Ref.:Read the text below
Sol :
Edema due to hydrostatic pressure
Edema due to ¯plasma oncotic pressure
Impaired venous return
Arteriolar dilation
Hypoproteinemia
·
·
·
·
·
·
·
·
·
·
CCF
Constrictive pericarditis
Ascites
Venous obstruction
Heat
Neurohumoral dysregulation
Protein losing glomerulopathies
Liver cirrhosis
Malnutrition
Protein losing gastroenteropathy
Correct Answer. a
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(84).
Disorders of defective DNA repair are all of the following except:
a. Fanconi anemia
b. Bloom syndrome
c. Xeroderma pigmentosum
d. Li Fraumeni syndrome
Solution. Ans-: (d) Li Fraumeni syndrome
Ref.:Read the text below
Sol :
Inherited autosomal recessive syndromes of defective DNA repair
• Xeroderma pigmentosum(defective nucleotide excision repair)
• Ataxia – telangiectasia(hypersensitivity to ionizing radiation causing DNA damage)
• Fanconi anemia(hypersensitivity to DNA cross – linking agents)
• Hereditary NonpolyposisColon Cancer syndrome is a disorder with defective DNA mismatch repair.
Correct Answer. d
(85).
TGF - α
a. Seen exclusively in erythrocytes
b. Not excreted in urine
c. Down regulated in cancers
d. Mediates tyrosine phosphorylation
Solution. Ans-: (d) Mediates tyrosine phosphorylation
Ref.:Read the text below
Sol :
TGF - a
TGF - b
·
Has intrinsic tyrosine kinase activity
·
Replication of hepatocytes (important after resection)
·
Malignant transformation of normal cells
·
Over expression in astrocytoma and hepatocellular
carcinoma
·
Involved in chemotaxis, angiogenesis and production of bone
morphogenic protein
·
Growth inhibitor for most epithelial cell types and leukocytes
·
Potent fibrogenic and strong anti-inflammatory
·
Can promote invasion and metastasis during tumor growth
Correct Answer. d
(86).
Renal pathology in SLE is all f the following except :
a. Acute glomerulo nephrosis
b. Focal proliferative
c. Diffuse proliferative
d. Diffuse membranous
Solution. Ans-: (a) Acute glomerulo nephrosis
Ref: Read the text below
Sol :
Glomerular changes are highly variable. The commonest alteration is the presence of mesangial and/or capillary immune deposits. Other
changes include: increase of the matrix and/or mesangial cellularity, endocapillary proliferation, thickening of capillary walls, glomerular
tuft necrosis, extracapillary proliferation (crescents), karyorrhexis, hyaline thrombi (micronodular intracapillary aggregation of immune
complexes), and glomerular sclerosis (segmental or global). Some features are suggestive of lupus nephritis: hyaline thrombi and “wire
loop” lesions (homogenous and “rigid” thickening of peripheral capillary loops due to subendothelial immune deposits), nevertheless, the
only alteration considered by many authors as pathognomonic of lupus nephritis are the hematoxylin bodies: they are rounded, smudgy,
lilac-staining structures, seen as cells with degenerated aspect; probably they represent degenerated nuclei and correspond to LE cells
described in the blood of patients with SLE; it is very unusual to find them at the present, reason why its utility is very limited (sensitivity
near 2%).
Correct Answer. a
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(87).
Regarding autosomal dominant disorders, all are true except :
a. Manifest in homozygous state
b. Manifest in heterozygous state
c. Chance of offspring with one affected heterozygous parent is 50%
d. Only one parent must be affected for an offspring to be at risk
Solution. Ans-: (b) Manifest in heterozygous state
Ref: Read the text below
Sol :
Autosomal Dominant inheritance
• The characteristics of autosomal dominant inheritance in humans can be summarized as follows :
• There is a vertical pattern in the pedigree, with multiple generations affected.
• Heterozygotes for the mutant allele show an abnormal phenotype.
• Males and females are affected with equal frequency and severity.
• Only one parent must be affected for an offspring to be at risk for developing the phenotype.
• When an affected person mates with an unaffected one, each offspring has a 50% chance of inheriting the affected phenotype. This is
true regardless of the sex of the affected parent specifically male – to – male transmission occurs.
• The frequency of sporadic cases is positively associated with the severity of the phenotype. More precisely, the greater the
reproductive fitness of affected persons, the less likely it is that any given case resulted from a new mutation.
• The average age of fathers is advanced in the case of isolated (sporadic or new mutation) cases.
Correct Answer. a
(88).
Serum C3is persistently low in the following except :
a. Post streptococcal glomerulonephritis
b. Membranoproliferative glomerulonephritis
c. Lupus nephritis
d. Glomerulonephritis related to bacterial endocarditis
Solution. Ans-: (c) Lupus nephritis
Ref: Read the text below
Sol :
Group
Deficiency
Syndrome
I
CI inhibitor
Hereditary angio-neurotic edema.
II
Early components of classical pathway CI,
C2, C4
SLE and other collagen vascular diseases.
III
C3 and its regulatory protein C3b inactivator Severe recurrent pyogenic infections
IV
C5 to C8
Bacteremia, mainly with Gram negative diplococci.
V
C9
Toxoplasmosis No particular disease.
Correct Answer. a
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(89).
A 37-year-old multipara construction labourer has a blood picture showing hypochromic anisocytosis. This is most likely indicative of :
a. Iron deficiency
b. Folic deficiency
c. Malnutrition
d. Combined iron and folic acid deficiency
Solution. Ans-: (a) Iron deficiency
Ref: Read the text below
Sol :
Anisocytosis is a medical term meaning that a patient's red blood cells are of unequal size. This is commonly found in anemia and other
blood conditions. False diagnostic flagging may be triggered by an elevated WBC count, agglutinated RBCs, RBC fragments, giant
platelets or platelet clumps. In addition, it is a characteristic feature of bovine blood.
Anisocytosis is identified by RDW and is classified according to the size of RBC measured by MCV. According to this, it can be divided
into
• Anisocytosis with microcytosis - Iron deficiency, sickle cell anemia
• Anisocytosis with macrocytosis - Folate or vitamin B12 defeciency, autoimmune hemolytic anemia, cytotoxic chemotherapy, Chronic
liver disease, Myelodysplastic syndrome
Increased RDW is seen in iron deficiency anemia, Thalassemia Major (Cooley's anemia), Thalassemia Intermedia and myelodysplastic
syndromes
Correct Answer. a
(90).
The most common site of pigmented villonodular synovitis is ?
a. Shoulder joint
b. Knee joint
c. Ankle joint
d. Metacarpophalyngeal joint
Solution. Ans-: (b) Knee joint
Ref:Read the text below
Sol:
Pigmented villonodular synovitis is characterized by the slowly progressive, exuberant, benign proliferation of synovial tissue, usually
involving a single joint.
- The synovium has a brownish color and numerous large, finger-like villi that fuse to form pedunculated nodules.
- There is marked hyperplasia of synovial cells in the stroma of the villi.
- Hemosiderin granules and lipids are found in the cytoplasm of macrophages and in the interstitial tissue.
- Multinucleated giant cells may be present.
- The proliferative synovium grows into the subsynovial tissue and invades adjacent cartilage and bone.
The clinical picture of pigmented villonodular synovitis is characterized by the insidious onset of swelling and pain in one joint, most
commonly the knee. Other joints affected include the hips, ankles, calcaneocuboid joints, elbows, and small joints of the fingers or toes.
The treatment of pigmented villonodular synovitis is complete synovectomy.
Correct Answer. b
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(91).
Transient myeloproliferative disorder of the new born is seen in association with:
a. Turner syndrome.
b. Down syndrome.
c. Neurofibromatosis.
d. Ataxia telangiectasia
Solution. Ans-: (b) Down syndrome
Ref:Read the text below
Sol:
·
A subtype of AML seen in children with Down’s syndrome has been described as a transient myeloproliferative disorder.
·
If they develop acute leukaemia this is often megakaryoblastic in type.
Correct Answer. b
(92).
A39-year-old woman reports headaches, weakness and fatigue, and frequent urination over the past several weeks. Physical examination
reveals diastolic hypertension. Laboratory findings include hypokalemia and reduced rennin levels. Which of the following is the most
likely cause of these various findings?
a. Conn syndrome
b. Diabetes insipidus
c. Diabetes mellitus
d. Pheochromocytoma
Solution. Ans-: (a) Conn syndrome
Ref:Read the text below
Sol:
·
Primary aldosteronism caused by an aldosterone-secretingadrenal neoplasm is known as Conn syndrome. Excess aldosterone
production leads to increased sodium retention and reciprocal potassium depletion in the renal distal tubule; polyuria results from
impairment in urinary concentrating ability.
·
Increased sodium reabsorptionand associated extracellular fluid expansion lead to diastolic hypertension and suppression of the
reninangiotensin pathway.
·
Muscle weakness and fatigue are a consequence of hypokalemia, which may be severe in some cases.
·
Diabetes insipidus) ismarked by the fairly sudden onset of extreme polyuria and (for the central type) is due to decreased activity
of antidiuretic hormone typically associated with an intracranial lesion or trauma.
·
In diabetes mellitus glucose levels exceed renal reabsorption capacity, leading to glycosuria and a consequent osmotic diuresis,
hypovolemia, and pseudohyponatremia.
·
Pheochromocytomas are unilateral, solitary neoplasms most commonly arising from chromaffin cells in the adrenal medulla.
·
Although biologically benign, excessive secretion of catecholamines causes paroxysmal systolic and diastolic hypertension that may
reach life-threatening pressures.
Correct Answer. a
(93).
Sarcoma spreads through
a. Blood
b. Lymph
c. Direct invasion
d. Perineural
Solution. Ans-: (a) Blood
Ref.:Read the text below
Sol :
Metastasis
• Metastasis by direct seeding of body cavities – carcinoma ovary
• Lymphatic spread – Typical of carcinomas, but seen in some carcomas
• Hematogenous spread – Typical of sarcomas, but seen in some carcinomas
• Cancers which do not metastasize – Gliomas, Basal cell carcinoma of skin
Correct Answer. a
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(94).
Acinic cell carcinomas of the salivary gland arise most often in the :
a. Parotid salivary gland
b. Minor salivary glands
c. Submandibular salivary gland
d. Sublingual salivary gland
Solution. Ans-: (a) Parotid salivary gland
Ref:Read the text below
Sol:
Most acinic cell tumors arise in the parotid
Acinic Cell tumor of salivary glands
Correct Answer. a
(95).
A 12-year-old girl presents with fever, polyarthritis, a rash, purposeless involuntary movements, and a diastolic murmur over the mitral
valve area. Which one of the following cardiac histologic features is an expected finding in this child's myocardium ?
a. Coagulation necrosis with an infiltrate of neutrophils
b. Multiple abscesses due to streptococcus group B
c. Fibrinoid necrosis surrounded by lymphocytes, macrophages, and plasma cells
d. Deposition of amyloid around small vessels
Solution. Ans-: (c) Fibrinoid necrosis surrounded by lymphocytes, macrophages, and plasma cells
Ref:Read the text below
Sol:
·
The clinical description is classic for acute rheumatic fever.
·
During the acute stages, changes in the myocardium consist of fibrinoid necrosis, lymphocytes, macrophages, and occasional
plasma cells.
·
These focal lesions are called Aschoff bodies.
Correct Answer. c
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(96).
An example of tumour suppressor gene is :
a. MYC.
b. FOS.
c. RAS.
d. RB gene
Solution. Ans- (d) RB gene
Ref:Read the text below
Sol:
·
‘Tumor suppressor genes’ are genes whose products, down regulate the cell cycle, and thus apply brakes to cellular proliferation.
·
Loss of tumor suppressor genes is associated with several important human tumors.
·
RB gene is a tumor suppressor gene, loss of which (when both normal copies are lost) is associatedwith Retinoblastoma (and
osteosarcomas).
·
MYC, FOS and RAS are all examples ofprotooncogenes and not tumor suppressor genes.
Correct Answer. d
(97).
To which of the following family of chemical mediators of inflammation, the Lipoxins belong ?
a. Kinin system
b. Cytokines
c. Chemokines
d. Arachidonic acid metabolites
Solution. Ans- (d) Arachidonic acid metabolites
Ref:Read the text below
Sol:
·
Lipoxins are the most recent addition to the family of bioactive products generated from arachidonic acid’
·
Lipoxins have a number of pro inflammatory and antinflammatory actions :
·
Inhibit neutrophil chemotaxis and adhesion but stimulate monocyte adhesion
·
(LXA4) stimulates vasodilation and attenuates the action of Leukotriene induced vosoconstriction (May act as endogenous negative
regulators of Leukotriene action)
Arachidonic acid metabolites include :
·
Prostaglandins
·
Leukotrienes
·
Lipoxins
Correct Answer. d
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(98).
To which of the following events is ‗good‘ outcome in neuroblastoma associated :a. Diploidy
b. N-myc amplification
c. Chromosome / p depletion
d. TRK-A expression
Solution. Ans-: (d) TRK-A expression
Ref:Read the text below
Sol:
The following prognostic factors have been elaborated in Robbins text :
Correct Answer. d
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(99).
A 47-year-old man has been chronically ill for the past 18 months. He undergoes a lung biopsy and a section is shown in Fig.Which of the
following is the most likely diagnosis?
a. Aspergillosis
b. Pneumocystosis
c. Sarcoidosis
d. Tuberculosis
Solution. Ans-: (d) Tuberculosis
Ref:Read the text below
Sol:
·
Fig shows a microscopic section of lung in which there are a number of necrotizing granulomas-containing giant cells.
·
Aspergillosis and pneumocystosis are not associated with granuloma formation.
·
Leprosy does (in tuberculoid leprosy) form granulomas and may be found in the upper airways, but does not involve viscera such
as the lung.
·
Sarcoidosis is a granulomatous disease of unknown etiology that can involve the lung and many other organs but the granulomas
are non-necrotizing.
Correct Answer. d
(100).
A 5-week-old girl, who appeared to be healthy at birth, develops diarrhea and vomiting a few days after birth. Your current examination
reveals that she has hepatomegaly, jaundice, and early cataract formation and is not meeting developmental milestones. You suspect that
she has which of the following conditions?
a. Galactosemia
b. Hurler syndrome
c. Pyloric stenosis
d. Tay-Sachs disease
Solution. Ans-: (a) Galactosemia
Ref:Read the text below
Sol:
·
Galactosemia is an autosomal recessive disorderdue (in this more common and more severe form of the disease) to a lack of
galactose-1-phosphate uridyl transferase. This results in the formation and accumulation of galactose metabolites. If the infant’s diet is
not modified to exclude milk products, this will result in damage to the liver (fatty change, cholestasis, cirrhosis, liver failure), eyes
(cataract formation), and brain (mental retardation).
·
Hurler syndromeis a severe form of mucopolysaccharidosis that typically becomes apparent between 6 months and 2 years of age.
·
Prominent features include coarse facies,dwarfism, organomegaly, cataracts, and mental retardation, not diarrhea, vomiting, and
jaundice.
·
Pyloric stenosiscan occur as a congenital condition, more frequently in baby boys (M:F = 4:1). It is marked by projectile vomiting
in the first month of life, but not the other findings in this case.
·
Tay-Sachs disease is a lipid storage disease due to a deficiency of hexosaminidase A. There is an inexorable deterioration of mental
and motor functions within a few months of birth culminating in a vegetative state and death within 3 or 4 years.
Correct Answer. a
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(101).
Highly plasma protein bound opioid among the following is :
a. Pethidine
b. Fentany1
c. Sufentany1
d. Meperidine
Solution. Ans-: (c) Sufentany1
Ref.: Miller - 4th ed.
Sol :
Opioids :
- Drugs with high lipid solubility, high unionised fraction or low protein binding in the plasma, demonstrate large volumes of distribution.
- Most opioids are extensively distributed in the body and their volumes of distribution exceed total body water.
- Small intravenous dose of short acting opioid (like alfentanil, sufentanil or fentany1) produce short duration of action because plasma
(and brain) concentration remain above the threshold for therapeutic action for only a brief period as the drug rapidly redistributes from
the CNS to other tissues.
Correct Answer. c
(102).
Which of the following antibiotic is a glycopeptide?
a. Clindamycin
b. Vancomycin
c. Azithromycin
d. Linezolid
Solution. Ans87: (b) Vancomycin
Ref.:Goodman Gilman’s - 1539
Sol :
• Vancomycin is atricyclic glycopeptide antibiotic produced by streptococcus orientalis.
• Teicoplanin, a glycopeptide antibioticproduced by Actinoplanes teichomyetius.
• Lipoglycopeptide derivatives– telavancin, oritavancin and dalbavancin.
• Rapid intravenous infusionof vancomycin may cause erythematous or urticarial reactions, flushing, tachycardia, and hypotension.
The extreme flushing that can occur is sometimes called “red-neck” or “red-man” syndrome.
• Daptomycin is a lipopeptide which is inactivated by pulmonary surfactants.
Correct Answer. b
(103).
Which should not be given in liver failure?
a. Acetozolamide
b. Furosemide
c. Epelerone
d. Spironolactone
Solution. Ans-88: (a) Acetozolamide
Ref.:Katzung - 256
Sol :
• Carbonic anhydrase inhibitor– induced alkalinization of the urine decreases urinary excretion of NH4+ (by converting it to rapidly
reabsorbed NH3) and may contribute to the development of hyperammonemia and hepatic encephalopathy in patients with
cirrhosis.
• Another carbonic anhydrase inhibitor, sulthiame, is an anticonvulsant under clinical trials in the USA.
Correct Answer. a
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(104).
Anticraving drug used in alcohol dependence?
a. Naltrexone
b. Methadone
c. Vareniciline
d. Rimonabant
Solution. Ans89: (a) Naltrexone
Ref.:Katzung 11th p. 566
Sol :
• The 1 –opioid receptor antagonist and partial agonist naltrexone is FDA-approved for reducing craving in opioid and alcohol
addiction.
• Its effect is modest and may involve a modulation of endogenous opioid systems.
• Clinical trials are currentlybeing conducted with a number of drugs, including the high-affinity GABA B-receptor agonist
BACLOFEN, and initial results have shown a significant reduction of craving.
• This effect may be mediated by the inhibition of the dopamine neurons of the VTA, which is possible at baclofen concentrations
obtained by oral administration because of its very high affinity for the GABA-B receptor.
Correct Answer. a
(105).
Antieptic drug of choice in child treated with ketogenic diet?
a. Carbamazipine
b. Phentoin
c. Valproate
d. Lamotrigine
Solution. Ans-90: (c) Valproate
Ref.:Internet www.epilepsy.com
Sol :
• Ketogenic diet and medication combinations.
• The ketogenic diet is commonly used in conjunction with one or more anticonvulsant medication, and more is being learned about the
risks and benefits of these combinations. To begin with, the ketogenic diet does not seem to change the blood (plasma) levels of
common anticonvulsant medications in any significant way.
• Investigators have measuredplasma levels both before and after diet initiation and found no significant differences.
• It seems that you don’t need to decrease or increase any medications when starting the diet to keep blood levels the same.
• Regarding tolerability, valproic acid, topiramate and zonisamide have garnered the most concern, as the side effects of the
ketogenic diet and these medications overlap.
Correct Answer. c
(106).
Substance which acts by decreasing cAMP?
a. Nor epinephrine via alpha 2 receptor
b. ADH via V2 receptor
c. Nor epinephrine via beta 2 receptor
d. Acetyl choline via M1 receptor
Solution. Ans-80: (a) Nor epinephrine via alpha 2 receptor
Ref.:Katzung 11th ed. Pg. 129
Sol :
• Norepinephrine actsthrough alpha 2 receptor which is a GPCR.
• The G protein involved here is Gi and it acts by inhibition of cAMP.
• Other receptors where cAMP is inhibited are Muscarinic2, Alpha2, Dopaminergic2 .
Correct Answer. a
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(107).
Which of the following is a direct rennin inhibitor?
a. Aliskrein
b. Losartan
c. Perindopril
d. Vernakalant
Solution. Ans81: (a) Aliskrein
Ref.:Goodman Gilman’s - 799
Sol :
• DRIs are a novel class of antihypertensive drugsthat inhibit the RAS at its origin.
• Angiotensinogenis the only specific substrate for rennin, and its conversion to Angl presents a rate – limiting step for the generation
of downstream components of the RAS.
• Aliskiren is a low-molecular– weight non-peptide that is a potent competitive inhibitor of renin. It binds the active site of rennin of
block conversion of angiotensinogen to Angl, thus reducing the consequent production of AngII.
• Aliskiren has a 10,000-fold higher affinity to rennin than to any other aspartic peptidases.
• The t½ is 20-45 hours.
Plasma protein binding is 50% and is independent of concentration
Correct Answer. a
(108).
All of the following are non selective β-blockers with additional actions except
a. Carvedilol
b. Betoxalol
c. Oxprenolol
d. Labetolol
Solution. Ans-82: (b) Betoxalol
Ref: Readthe text below
Sol:
Nonselective agents
• Alprenolol
• Bucindolol
• Carteolol
• Carvedilol(has additional α-blocking activity)
• Labetalol(has additional α-blocking activity)
• Nadolol
• Oxprenolol(has intrinsic sympathomimetic activity)
• Penbutolol(has intrinsic sympathomimetic activity)
• Pindolol(has intrinsic sympathomimetic activity)
• Propranolol
• Sotalol
• Timolol
• Eucommiabark (herb)
Correct Answer. b
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(109).
Anti-Platelet therapy is usually given for patients with stroke, MI and peripheral vascular disease. PPIs are frequently administered along
with these drugs to prevent the risk of increased gastrointestinal erosions and bleeding. The interaction between clopidogrel and PPI has
recently been given much attention due to its clinical significance. The metabolizing enzyme common to these two drugs is –
a. CYP2C10
b. CYPA2
c. CYP2C19
d. CYP2C20
Solution. Ans-: (c) CYP2C19
Ref: Read the text below
Sol:
- Clopidogrel is converted in the body to its active form by an enzyme called CYP2C19.
- The studies confirmed that omeprazole can reduce the levels of the active form of clopidogrel in the blood and reduce its antiplatelet
effects, therefore supporting the conclusion that there is an interaction between clopidogrel and omeprazole and esomeprazole.
- There are no solid grounds to extend the warning to other PPIs.
Correct Answer. c
(110).
Alcohol intake during pregnancy causes all, except ?
a. Brachycephaly
b. Microcephaly
c. Hyperkinetic disorder
d. Congenital malformation
Solution. Ans-: (a) Brachycephaly
Ref: Read the text below
Sol:
Fetal alcohol syndrome:
- The diagnosis of FAS typically is based on the observance of a triad of abnormalities in the newborn, including (1) a cluster of
craniofacial abnormalities, (2) CNS dysfunction, and (3) pre- and/or postnatal stunting of growth.
- Facial features (short palpebral fissures, hypoplastic philtrum, and flattened maxilla), and Major organ-system malformations
- CNS anomalies (microcephaly, behavioral abnormalities, and mental retardation),
- Children exposed prenatally to alcohol most frequently present with attentional deficits and hyperactivity, even in the absence of
intellectual deficits or craniofacial abnormalities'
Correct Answer. a
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(111).
Which teratogen causes deafness?
a. Isotretnoin
b. Chloroquine
c. Alcohol
d. Warfarin
Solution. Ans-: (d) Warfarin
Ref: Read the text below
Sol:
Warfarin
- Contradi Syndrome : nasal hypoplasia and stippled epiphyseal calcifications
- Limb hypoplasia , hearing loss and ophthalmic anomalies
- dorsal midline dysplasia (agenesis of corpus callosum and Dandy–Walker malformations) or ventral midline dysplasia (optic atrophy)
Isotretinoin
- CNS defects - hydrocephalus, optic-nerve blindness, retinal defects, microphthalmia, posterior fossa defects, and cortical and cerebellar
defects
- Craniofacial defects (microtia or anotia, low-set ears, hypertelorism, depressed nasal bridge, microcephaly, micrognathia, and agenesis
or stenosis of external ear canals)
- CVS (transposition of great vessels, tetralogy of Fallot, and ventricular or atrial septal defects);
- Thymic defects (ectopia and hypoplasia or aplasia); and
- Miscellaneous defects (limb reduction, decreased muscle tone, spontaneous abortion, and behavioral abnormalities)
Correct Answer. d
(112).
All of the following drugs are correctly matched with their metabolism except –
a. Calcium channel blockers – CYP3A4
b. Carvedilol – CYP2D6
c. Digoxin – P glycoprotein
d. Simvastatin – Glucuronide conjugation
Solution. Ans-: (d) Simvastatin – Glucuronide conjugation
Ref: Read the text below
Sol:
Calcium channel blockers are metabolized by CYP3A4 expressed in the small bowel.
- Carvedilol – CYP2D6
- Extensively metabolized by oxidation by CYP2D6 and CYP2C9
- Inhibition of P-glycoprotein may play a role in cases of digoxin toxicity.
- Statins are metabolized by CYP3A4
Correct Answer. d
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(113).
Anti-Adrenergic drug which crosses the blood – brain barrier minimally is a. Propranolol
b. Atenolol
c. Oxprenolol
d. Alprenolol
Solution. Ans-1: (b) Atenolol
Ref: Read the text below
Sol:
- Atenolol is a selective β1 receptor antagonist, a drug belonging to the group of beta blockers (sometimes written β-blockers), a class of
drugs used primarily in cardiovascular diseases.
- Atenolol was developed as a replacement for propranolol in the treatment of hypertension. The chemical works by slowing down the
heart and reducing its workload.
- Unlike propranolol, atenolol does not pass through the blood–brain barrier thus avoiding various central nervous system side effects.
Correct Answer. b
(114).
Side effect of Beta 2 agonist are all except
a. Hyperglycemia
b. Pulmonary odema
c. Tachycardia
d. Tremors
Solution. This question was left out and not taken into account during evaluation by IRT method
(115).
Mobius syndrome in fetus can caused by antenatal intake of which of the following?
a. Mifepristone
b. Misoprostol
c. Dinoprostone
d. Methotrexate
Solution. Ans86: (b) Misoprostol
Ref: Readthe text below
Sol:
The use of drugsand a traumatic pregnancymay also be linked to the development of Mobius syndrome. The use of the drugs
misoprostolor thalidomideby women during pregnancy has been linked to the development of Möbius syndrome in some cases.
Misoprostol is used to induce abortions
Möbius syndrome(also spelled Moebius) is an extremely rare congenital neurological disorder which is characterized by facial
paralysisand the inability to move the eyes from side to side. Most people with Möbius syndrome are born with complete facial
paralysisand cannot close their eyes or form facial expressions. Limb and chest wall abnormalities sometimes occur with the syndrome.
Correct Answer. b
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(116).
Phenobarbitone in mother causes all in baby except :
a. Hypoglycemia
b. Aaxia
c. Neonatal drowsiness
d. Vitamin K deficiency
Solution. Ans-9: (a) Hypoglycemia
Ref.: Martindale 36th ed.P.492
Sol :
- The most frequent adverse effect associated with Phenobarbital is sedation.
- Prolonged use can occasionally result in folate deficiency; rarely, megaloblastic anaemia has been reported. There is some evidence
that phenobarbital interferes with vitamin D metabolism.
- At high doses nystagmus and ataxia may occur and the typical barbiturate-induced respiratory depression may become severe.
- Neonatal drug dependence and symptoms resembling vitamin K deficiency have been reported in infants born to mothers who received
phenobarbital during pregnancy.
- Congenital malformations have been reported in children of women who received phenobarbital during pregnancy but the causal role of
the drug is a matter of some debate.
Correct Answer. a
(117).
Entry of new drug into the market :
a. Phase 1
b. Phase 2
c. Phase 3
d. Phase 4
Solution. Ans-: (c) Phase 3
Ref.: KDT 6th ed. P.77
Sol :
- Phase 3 is also known as therapeutic confirmation/comparison.
- Generally these are randomized double blind comparative trials conducted on a larger patient population (500-3000) by several
physicians at many centres.
- The aim is to establish the value of the drug in relation to existing therapy.
- Safety, tolerability and possible drug interactions are assessed on a wider scale, while additional pharmacokinetic data may be
obtained. A ' new drug application‘ (NDA) is submitted to the licencing authority, who if convinced give marketing permission.
- Phase 2 is known as Therapeutic Exploratory and carried out in patients.
- Phase 1 trials are done on healthy volunteers
- IND is the investigational new drug which is filed before starting trial on human beings.
Correct Answer. c
(118).
What is the mechanism of action of Apixaban ?
a. It is a factor X a inhibitor
b. It is thrombin inhibitor
c. it is a anti thrombin inhibitor
d. It is anti platelet inhibitor
Solution. Ans-: (d) It is a factor X a inhibitor
Ref: Read the text below
Sol:
- Apixaban (INN, trade name Eliquis) is an anticoagulant for the prevention of venous thromboembolism and venous thromboembolic
events.
- It is a direct factor Xa inhibitor. Apixaban has been available in Europe since May 2011 and was approved for preventing venous
thromboembolism after elective hip or knee replacement.
The FDA approved apixaban in December 2012 with an indication of reducing the risk of stroke and dangerous blood clots (systemic
embolism) in patients with atrial fibrillation that is not caused by a heart valve problem
Correct Answer. a
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(119).
Clofazimine therapy can cause all except
a. Skin
b. Icthyosis
c. Subacute
d. Peripheral
Solution. This question was left out and not taken into account during evaluation by IRT method
(120).
An antidepressant found to be associated with tardive dyskinesia and neuroleptic malignant syndrome is a. Fluxetine
b. Amineptin
c. Amoxapine
d. Trazodone
Solution. Ans-: (c) Amoxapine
Ref: Read the text below
Sol:
- Amoxapine (Amokisan, Asendin, Asendis, Defanyl, Demolox, Moxadil) is a tetracyclic antidepressant of the dibenzoxazepine family,
though it is often classified as a secondary amine tricyclic antidepressant. It is the N-demethylated metabolite of Loxapine.
- Common side effects of amoxapine include hypotension, drowsiness, dry mouth, constipation, blurred vision, fatigue, and vertigo.
- Additionally, due to the drug's and its metabolite 7-hyroxyamoxapine's potent blockade of dopamine receptors, it can cause neuroleptic
malignant syndrome as well as acute extrapyramidal symptoms and tardive dyskinesia.
- Cardiovascular and anticholinergic side effects are much reduced compared to other tri- and tetracyclic antidepressants
Correct Answer. c
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(121).
All of the following are derivatives of the pharyngeal arches except –
a. Orbicularis oculi
b. Levator palpebrae superioris
c. Palatine tonsil
d. Tensor tympani
Solution. Ans-(b) Levator palpebrae superioris
Ref:Read the text below
Sol :
Gross Anatomy (Board Review)by Hagerstown, MD: Lippincott Williams & Wilkins
·
There are six pharyngeal arches, but in humans the fifth arch only exists transiently during embryologic growth and development.
·
Since no human structures result from the fifth arch, the arches in humans are I, II, III, IV, and VI.
·
More is known about the fate of the first arch than the remaining four.
·
The first three contribute to structures above the larynx, while the last two contribute to the larynx and trachea.
Pharyngeal
arch
Muscular contributions
Skeletal contributions
Nerve
Artery
1st (also
Muscles of mastication, anterior belly of
called
the digastric, mylohyoid, tensor tympani, tensor veli
"mandibular
palatini
arch")
Maxilla, mandible (only as
a model for mandible not
actual formation of
Trigeminal
mandible),
nerve(V2 and V3)
the incus and malleus of
the middle ear,
also Meckel's cartilage
Maxillary
artery,external
carotid artery
2nd (also
called the
"hyoid
arch")
Muscles of facial expression,
buccinator, platysma, stapedius,stylohyoid, posterior
belly of the digastric
Stapes, styloid
process, hyoid (lesser
Facial nerve (VII)
horn and upper part of
body), Reichert's cartilage
Stapedial
artery,hyoid
artery
3rd
Stylopharyngeus
Hyoid (greater horn and
lower part of
body), thymus, inferior
parathyroids
Glossopharyngeal
nerve (IX)
Common
carotid,internal
carotid
Thyroid cartilage,
superior
parathyroids, epiglottic
cartilage
Vagus
nerve (X),superior
laryngeal nerve
Right 4th aortic
arch: subclavian
artery
Left 4th aortic
arch:aortic arch
Cricoid
cartilage, arytenoid
cartilages, corniculate
cartilage
Vagus
nerve (X),
recurrent
laryngeal nerve
Right 6th aortic
arch: pulmonary
artery
Left 6th aortic
arch:pulmonary
arteryand ductus
arteriosus
4th
6th
Cricothyroid muscle, all intrinsic muscles of soft
palate including levator veli palatini
All intrinsic muscles of larynx except the cricothyroid
muscle
Orbicularis oculi is muscle of facial expression which is derivative of 2nd pharyngeal arch.
Structures developing from Pharyngeal pouchesFirst pouch
The endoderm lines the future auditory tube (Pharyngotympanic " Eustachian " tube) , middle ear, mastoid antrum, and inner layer of the
tympanic membrane & origin of Mandibular nerve & Maxillary artery.
Second pouch
Contributes to the middle ear, palatine tonsils, supplied by the facial nerve.
Third pouch
The third pouch possesses Dorsal and Ventral wings. Derivatives of the dorsal wings include the inferior parathyroid glands, while the
ventral wings fuse to form the cytoreticular cells of the thymus. The main nerve supply to the derivatives of this pouch is Cranial Nerve
IX, glossopharyngeal nerve.
Fourth pouch
Superior parathyroid glands and ultimobranchial body which forms the parafollicular C-Cells of the thyroid gland.
Musculature and cartilage of larynx (along with the sixth pharyngeal pouch).
Fifth pouch
Rudimentary structure, becomes part of the fourth pouch contributing to thyroid C-cells
Sixth pouch
Along with the fourth pouch, contributes to the formation of the musculature and cartilage of the larynx
Correct Answer. b
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(122).
Which of the following about the valves of Houston is true?
a. They disappear after mobilization of the rectum
b. The middle valve folds towards the right side
c. The upper valve corresponds to the anterior peritoneal reflection
d. The valves contain all layers of the muscle wall
Solution. Ans- (a) They disappear after mobilization of the rectum
Ref: Sabiston‘s 'Text book of Surgery‘ 18/e
Sol :
The rectum possesses three involutions or curves known as the valves of Houston.
The middle valve folds to the left (option ‗2‘), and the proximal and distal valves fold to the right.
These valves are more properly called folds because they have no specific function as impediments to flow.
They are lost after full surgical mobilization of the rectum, a maneuver that may provide about 5 cm of additional length to the rectum,
greatly facilitating the surgeon's ability to fashion an anastomosis deep in the pelvis.
These folds are about 12 mm. in width and are composed of the circular muscle coat of the rectum (option ‗4‘). They are usually three in
number; sometimes a fourth is found, and occasionally only two are present.  One is situated near the commencement of the rectum, on
the right side.  The second extends inward from the left side of the tube, opposite the middle of the sacrum.  The third, the largest and
most constant, projects backward from the forepart of the rectum, opposite the fundus of the urinary bladder.  When a fourth is present,
it is situated nearly 2.5 cm above the anus on the left and posterior wall of the tube.
Correct Answer. a
(123).
Dilator pupillae is supplied by –
a. Post-ganglionic parasympathetic fibres from Edinger-Westphal nucleus
b. Post-ganglionic sympathetic fibres from the cervical sympathetic chain
c. III nerve
d. Sympathetic fibres from the fronto-orbital branch of V nerve
Solution. Ans- (b) Post-ganglionic sympathetic fibres from the cervical sympathetic chain Ref: Gray‘s anatomy, 39/e, pg 710; Parson‘s
‗Diseases of the Eye‘; 20/e, pg 33
Sol :  Dilator pupilae is supplied with nonmyelinated post ganglionic fibers from the superior sympathetic ganglion. (Gray‘s anatomy)
 Dilator pupillae is supplied by adrenergic fibers of cervical sympathetic nerves.The dilator tract probably commences in hypothalamus
not far from constrictor centre and also has connection with cerebral cortex. (Parson‘s)  Sphincter ppillae is supplied by myelinated post
ganglionic fibers from parasympathetic system.  The sphincter papillae is supplied by cholinergic nerves of parasympathetic system
through the third canal nerve.The fibers start in E W nucleus near the third nerve nucleus in floor of aqueduct of sylvius.
 Sympathetic supply of eye:
 First order neuron : from hypothalamus till ciliospinal centre of budge in intermediolateral columns of c8, t1 and t2
 Second order neuron : from ciliospinal centre of budge till superior cervical ganglion in neck
 Third order neuron: post ganglionic fibres arise from cervical ganglion, ascends along internal carotid artery to enter skull, where post
ganglionoic fibres join Nasocilliary branch of trigeminal nerve. Ultimately, postganglionic sympathetic fibres reach ciliary body and
dilator papillae long ciliary nerve.  Light reflex pathway(pupillary pathway)-  Retina →optic nerve(Afferent) → chiasma →optic tract
→Pretectal Nucleus→EW nucleus(in Mid Brain)→3rd Nucleus(occulomotor Nu. i.e. efferent→lower div.→nerve to inferior oblique →cilliary
ganglion →short ciliary nerve→ Sphincter Pupillae.  Short cilliary nerve are only post ganglionic nerve which is myelinated  No LGB &
No cortex in this pathway.  As cortex is not invoved so not affected by cortical lesion.  Accomodation reflex  Retina →optic
nerve(Afferent) → chiasma →optic tract→ LGB →Optic radiation(occipital cortex)→occipitomesencephalic tract→Pons→3rd nerve
Nu.→Accessory ganglion (axenfield ganglion)
Correct Answer. b
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(124).
All of the following cross the right ureter anteriorly except –
a. Terminal ileum
b. Genitofemoral nerve
c. Right colic artery and ileocolic artery
d. Vas deferens
Solution. Ans- (b) Genitofemoral nerve
Ref: Snell‘s ‗Clinical anatomy‘, 7/e, pg 226,241,284
Sol :
- Ureter is a 25 cm long structure on each side.
- The upper half of its length lies in posterior abdominal wall and the lower half lies in the true pelvis.
- The relations of abdominal part of ureter are different on each side while its similar on both the sides for the pelvic part.
Relations of Abdominal part1. Right ureter- The abdominal part of right ureter is overlapped at its upper end by the descending part of duodenum.
- Lower down it is crossed by terminal ileum & by root of mesentry.
- Genitofemoral nerve crosses behind the ureter.
- Crossing in front of ureter, there are the testicular & ovarian vessels, right colic & ileocolic branches of superior mesenteric artery &
terminal part of superior mesenteric artery itself (in the root of mesentry). The arteries are accompanied by corresponding veins.
- The inferior vena cava lies a short distance medial to right ureter.
2. Left ureter- Abdominal part of left ureter is crossed (near the brim of the pelvis) by sigmoid colon. The ureter passes deep to the apex of the Vshaped attachment of the sigmoid mesocolon.
- As on the right side, the ureter is crossed, posteriorly by the genitofemoral nerve and in front by testicular or ovarian vessels.
- It is also crossed by left colic branches of inferior mesenteric artery.
- The inferior mesenteric vein is placed parallel to left ureter, a little to its medial side.
Relations of the pelvic part of ureter- These are similar on right & left side.
- As the ureter runs backwards & laterally on the lateral wall of pelvis, it lies on the fascia covering the obturator internus.
- Here the ureter crosses several structures that lie between it & lateral pelvic wall.
- In the male, these are, superior vesical artery,obturator nerve,artery & vein,inferior vesical artery.
Correct Answer. b
(125).
In case of perforation of ulcer in the posterior wall of 1st part of duodenum, which of the following structure is likely to be involved?
a. Inferior vena cava
b. Gastroduodenal artery
c. Bile duct
d. Portal vein
Solution. Ans- (b) Gastroduodenal artery
Ref: Bailey & Love‘s ‗Short Practice of Surgery‘, 25/e, Michels, N. A.: Blood Supply and Anatomy of the Upper Abdominal Organs with a
Descriptive Atlas.
Sol :
-A highly lethal form of exigent hemorrhage due to peptic ulcer is that which occurs consequent to perforation of the gastroduodenal
artery, its bifurcation, or either major branch, in the base of a large juxtapyloric ulcer.
- Perforations involving the gastroduodenal artery complex occur as a sequel to transmural ulceration of the posterior duodenal wall.
- Such erosion excavates the pancreas on each side of the more resistant artery, leaving a portion of the circumference of a segment of
the vessel protruding from the relatively non-fibrotic pancreatic base of the usually large ulcer.
Correct Answer. b
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(126).
True about hepatic duct are all except
a. Left hepatic duct formed in umbilical fissure
b. Caudate lobe is drained by left hepatic duct only
c. Right hepatic duct is formed by segment V and VIII
d. Left hepatic duct crosses IV segment
Solution. Ans- (b) Caudate lobe is drained by left hepatic duct only
Ref: Gray's anatomy 40th ed page1177, sabiston 8th ed page1548
Sol :
- The left hepatic duct drains segments II,II and iv, and the right hepatic duct drains segment V,VI, VII , and VII .
- Segment I, the caudate lobe, has its own biliary drainage.
- Variations of this are common and in 78% of individuals the caudate lobe drain into both the left and right hepatic duct
Correct Answer. b
(127).
Sphicter of oddi consists of how many sphincters
a. 2
b. 3
c. 4
d. 5
Solution. Ans-(b) 3
Ref: Ref. B.D.C. vol 2,4th edition,pg-275, 276
Sol :
- The terminal part of the bile duct is surrounded just above its junction with the pancreatic duct by a ring of smooth muscle that forms
the sphincter choledochus ( cholidochus= bile duct ). This sphincter is always present.
- It normally keeps the lower end of the bile duct closed . As a result, bile formed in the liver keeps accumulating in the gallbladder and
also undergoes considerable concentration.
- When food enters the duodenum, specially a fatty meal, the sphincter opens and bile stored in the gall bladder is poured into the
duodenum. The sphincter choledochus is, therefore, essential for filling of the gall bladder.
- Another less developed sphincter, which is usually but not always present around the terminal part of the pancreatic duct is the
sphincter pancreaticus.
- A third sphincter surrounds the hepatopancreatic ampulla and is called the sphincter ampullae. The sphincter ampullae may extend
upwards to enclose the lower parts of the bile and pancreatic ducts. The sphincters named above are often referred to collectively as the
sphincter of Oddi, although this term applies strictly only to the sphincter ampullae.
Correct Answer. b
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(128).
All of the following muscles retract the scapula except
a. Trapezius
b. Rhombopoid major
c. Rhomboid minor
d. Levator scapulae
Solution. Ans- (d) Levator scapulae
Ref: Gray's anatomy page 610,634
Sol :
- Levator scapulae originates from the dorsal tubercles of the transverse processes of cervical vertebrae one to four. The muscle is
inserted on the superior angle and adjacent medial border of the scapula.
- The levator scapulae may lie deep to the sternocleidomastoideus at its origin, deep or adjacent to the splenius capitis at its origin and
mid-portion, and deep to the trapezius in its lower portion.
Actions
- When the spine is fixed, levator scapulae elevates the scapula and rotates its inferior angle medially.
- It often works in combination with other muscles like the rhomboids and pectoralis minor to rotate down like this.
- Elevating or rotating one shoulder at a time would require muscles to stabilize the cervical spine and keep it immobile so it does not
flex or rotate. Elevating both at once with equal amounts of pull on both side of cervical spinal origins would counteract these forces.
Downward rotation would be prevented by co-contraction of other muscles that elevate the spine, the upper fibers of the trapezius, which
is an upward rotator.
Correct Answer. d
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(129).
Sternocleidomastoid is supplied by all of the following arteries except
a. Occipital
b. Posterior auricular
c. Thyrocervical trunk
d. Superior thyroid
Solution. Ans- (c) Thyrocervical trunk
Ref: Gray's Anatomy 39th edn., pg.536
Sol :
- Sternocleido mastoid receives its blood supply from branches of the occipital and posterior auricular arteries (Upper part of muscle),
the Superior thyroid artery (Middle part of muscle) and the suprascapular artery (lower part of muscel).
- Among the given options, Thyrocervical trunk is the better option, though suprascapular artery is a branch of Thyrocervical trunk, the
other given options are directly supplying sternoclido mastoid muscle.
Correct Answer. c
(130).
In a subclavian artery block at the outer border of 1st rib, all of the following arterires help in maintaining the circulation to upper limb
except.
a. Subscapular artery
b. Superior thoracic
c. Thyrocervical trunk
d. Suprascaplular artery
Solution. Ans- (b) Superior thoracic
Ref: Ref. B.D.C. vol 1,4th edition, page
Sol :
Anastomosis around shoulder is between
3rd part of Axillary artery and 1st part of Subclavian artery
Following take part in this anastomosis
a.branches of 3rd part of Axillary artery
i Subscapular
ii Circumflex scapular
Lymph nodes related to the colon from four groups. Namely epicolic, paracolic, intermediate colic and pre-terminal colic lymph nodes.
Pre-aortic nodes at the origin of these vessels. These are commonly refered to as
the highest nodes of the territory which they drawn.
Correct Answer. b
(131).
Which of the folloing is not true about the trochlear nerve
a. Has the longest intracranial course
b. Supplies the ipsilateral superior oblique muscle
c. Only cranial nerve that arises from the dorsal aspect of the brainstem
d. Enters orbit through the superior orbital fissure outside the annulus of zinn
Solution. Ans- (b) Supplies the ipsilateral superior oblique muscle
Ref: BDC4th ,vol 3 pg108,25,26,115; Kanski 3rd /418 kanski 4th / 622
Sol :
- Trochlear nerve is a crossed cranial nerve that supplies the contra lateral superior oblique
- The nucleus of trochlear nerve ( IVth nerve nucleus)
- Supplies the contralateral superior oblique muscle and not the ipsilateral muscle.
- Trochlear nerve emerges from the dorsal aspect of brainstem
- Trochlear nerve has the longest intracranial course
- Trochlear nerve is the longest and slender of all cranial nerves
- 'Trochlear nerve is the only cranial nerve to emerge from the dorsal aspect of the brain'
- Trochleal nerve enters the orbit through the superior orbital Fissure outside the annulus of Zinn
Correct Answer. b
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(132).
Vertical crest in fundus of internal acoustic canal is
a. Falciform crest
b. Bills bar
c. Ponticulus
d. Cog
Solution. Ans- (b) Bills bar
Ref:
Sol :
- The internal auditory meatus (also internal acoustic meatus, internal auditory canal, and internal acoustic canal) is a canal in the
petrous part of the temporal bone of the skull that carries nerves from inside the cranium towards the middle and inner ear
compartments namely cranial nerve VII and cranial nerve VIII
- The opening of the meatus is called the porus acusticus internus, the internal acoustic opening.
- The antero-superior part transmits the facial nerve and nervus intermedius and is separated from the postero-superior section, which
transmits the superior vestibular nerve, by Bill's ba (named by William House who founded the House Ear Institute). The falciform, or
transverse, crest separates the superior part from the inferior part. The cochlear nerve runs antero-inferiorly and the inferior vestibular
nerve runs postero-inferiorly.
- Bill's bar is a vertical crest that divides the superior compartment of the internal acoustic meatus into anterior and posterior
compartments
- The anterior compartment contains the facial nerve and the nervus intermedius
- The posterior compartment contains the superior vestibular nerve (which supplies utricle, superior and lateral semicircular canals)
Correct Answer. b
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(133).
A patient presents with a penetrating chest wound associated with intrathoracic haemorrhage, A thoracotomy is done by taking an
incision in the 4th/5th intercostals space starting 1 cm away from the lateral margin of the sternum. This is done to avoid injury to the
a. Pleura
b. Intercostal artery
c. Internal thoracic artery
d. Intercostal nerve
Solution. Ans-(c) Internal thoracic artery Ref: Guillermo Parra Sanchez, Edward W.K. Peng, Richard Marks, Pradip K. Sarkar. 'Sccop
and Run' strategy for a resuscitative sternotomy following unstable penetrating chest injury. Interactive Cardiovascular and Thoracic
Surgery.
Sol :
Thoracotomy in Penetrating Chest Wound- - The anatomy of the thoracic cage is well-known and encompasses the area beneath the
clavicles and superior to the diaphragm, bound laterally by the rib cage, anteriorly by the sternum and ribs, and posteriorly by the rib
and vertebral bodies. - Entry into the thorax may be made by sternotomy; thoracotomy (incising between selected ribs, most commonly
the fourth and fifth) on either the right or left side; or a clamshell incision, consisting of left and right thoracotomy incisions traversing
the sternum to join the two. - Particular care must be exercised laterally near the sternum, where the internal thoracic (mammary) artery
lies 2-4 cm on either side. - Similarly, remember that immediately inferior to each rib body are the intercostal artery, vein, and nerve,
from which voluminous bleeding can occur. - Patients have required reexploration for injuries to these various vessels and have
exsanguinated as a result of missed injuries to these vessels.
Correct Answer. c
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(134).
All the following pass through the inguinal canal in females except –
a. Inferior epigastric artery
b. Round ligament of uterus
c. Ilioinguinal nerve
d. Lymphatics from the fundal part of the uterus
Solution. Ans- (a) Inferior epigastric artery
Ref: Gray‘s Anatomy, 40/e
Sol :
-The inguinal canal is a natural hiatus in the tissues of the anterior abdominal wall, and is formed from the various layers of the wall in
the region of the groin.- Its size and form vary with age, and although it is present in both sexes it is most well developed in the male.
- The canal is an oblique tunnel, with deep and superficial openings or rings.
- It contains the spermatic cord in males, the round ligament of the uterus in females, and the ilioinguinal nerve in both sexes.
- The inferior epigastric artery is posterior & medial to deep inguinal ring. It is not a content of the inguinal canal.
Correct Answer. a
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(135).
All of the following are correct about spinal cord except –
a. The efferent nerve fibres originate from the anterior horn cells
b. The central canal is situated in the white commisure
c. It has grey matter core with white matter covering
d. The ligamentum denticulatum anchors the lateral borders of the spinal cord to the meninges
Solution. Ans- (b) The central canal is situated in the white commisure
Ref: Spinal Cord Medicine: Principles and Practice. Lin VW, Cardenas DD, Cutter NC, et al
Neuroanatomic organisation of spinal cordSol : - On cross section, the spinal cord is composed of a central portion of butterfly-shaped gray matter and peripherally oriented white
matter. - The gray matter is comprised predominantly of neurons, their processes, and glial cells and has an enriched blood supply. - The
white matter contains ascending and descending fiber tracts and glial cells and appears white in unfixed tissue because of a
predominance of myelin.
- The two halves of the gray matter are connected across the midline by a dorsal and ventral gray commissure, which is located above
and below the central canal respectively. - The gray matter is further subdivided into a posterior (dorsal) horn (column) and an anterior
(ventral) horn (column). - The thoracic and upper two lumbar spinal cord segments also display a wedge-shaped, intermediate lateral
horn (intermediolateral cell column). CENTRAL CANAL- - It is the conduit that runs the entire length of the spinal cord and contains
some of the 140 mL of cerebrospinal fluid (CSF) in the body of the average individual. - The central canal of the spinal cord lies in the
center of the cord between the ventral and the dorsal gray commissures and extends toward the cranium into the medulla oblongata,
where it opens into the fourth ventricle of the brain. - Lumbar puncture, often performed to obtain samples of CSF for diagnostic
purposes, draws fluid from the subarachnoid space around the spinal cord and not from the central canal. - The anterior horn of the
spinal cord is the ventral (front)grey matter section of the spinal cord. The anterior horn contains motor neurons also known as efferent
neurons that affect the axial muscles while the posterior horn receives information regarding touch and sensation. The anterior horn is
where the cell bodies of alpha motor neurons are located. - The Ligamentum Denticulatum is a narrow, fibrous band, situated on each
side of the spinal cord, throughout its entire length, and separating the anterior from the posterior roots of the spinal nerves, having
received its name from the serrated appearance which it presents. - Its inner border is continuous with the pia mater, at the side of the
cord. - Its outer border presents a series of triangular, dentated serrations, the points of which are fixed, at intervals, to the dura mater,
serving to unite together the two layers of the arachnoid membrane. - These serrations are about twenty in number, on each side, the
first being attached to the dura mater, opposite the margin of the foramen magnum, between the vertebral artery and the hypoglossal
nerve; and the last corresponds to nearly the lower end of the cord. - Its use is to support the cord in the fluid by which it is surrounded.
Correct Answer. b
(136).
All of the following effects can occur if vagus is stimulated, except :
a. Reduction in blood pressure
b. Increase in secretions of the intestine
c. Reduction in heart rate
d. Bronchial musculature relaxation
Solution. (d) Bronchial musculature relaxation
Ref: Ganong‘s Physiology, 23rd ed., p.-238
Sol :
- Activation of the vagus nerve typically leads to a reduction in heart rate, blood pressure, or both.
- This occurs commonly in the setting of gastrointestinal illness such as viral gastroenteritis or acute cholecystitis, or in response to other
stimuli, including carotid sinus massage, Valsalva maneuver, or pain from any cause, in particular, having blood drawn. When the
circulatory changes are great enough, vasovagal syncope results. Relative dehydration tends to amplify these responses.
Correct Answer. d
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(137).
True statement regarding alpha wave is :
a. They are often slightly higher in amplitude on the dominant side
b. Alpha activity appears normally with attention
c. In most instances, it is regarded as a normal waveform
d. They tend to be present anteriorly more than posteriorly
Solution. (c) In most instances, it is regarded as a normal waveform
Ref: Ganong‘s Physiology, 23rd ed., p.-234
Sol :
- Alpha waves generally are seen in all age groups but are most common in adults.
- They occur rhythmically on both sides of the head but are often slightly higher in amplitude on the nondominant side, especially in
right-handed individuals.
- A normal alpha variant is noted when a harmonic of alpha frequency occurs in the posterior head regions.
- They tend to be present posteriorly more than anteriorly and are especially prominent with closed eyes and with relaxation.
- Alpha activity disappears normally with attention (eg, mental arithmetic, stress, opening eyes).
- In most instances, it is regarded as a normal waveform.
- An abnormal exception is alpha coma, most often caused by hypoxic-ischemic encephalopathy of destructive processes in the pons (eg,
intracerebral hemorrhage).
- In alpha coma, alpha waves are distributed uniformly both anteriorly and posteriorly in patients who are unresponsive to stimuli.
Correct Answer. c
(138).
Vomiting centre is situated in the :
a. Hypothalamus
b. Midbrain
c. Pons
d. Medulla
Solution. (d) Medulla
Ref: Ganong‘s Physiology, 23rd ed., p.-474
Sol :
- Vomiting is believed to be controlled by two distinct brain centres-the vomiting centre and the chemoreceptor trigger zone-both located
in the medulla oblongata.
- The vomiting centre initiates and controls the act of emesis, which involves a series of contractions of the smooth muscles lining the
digestive tract.
Correct Answer. d
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(139).
Optic nerve is :
a. 1st order neuron
b. 2nd order neuron
c. 3rd order neuron
d. 4th order neuron
Solution. (b) 2nd order neuron
Ref: Read the text below
Sol :
- In the case of the optic nerve and tracts there are three separate neurons linked together, extending from the retina to the occipital
cortex.
The sensory end-organ consists of the rods and cones.
- The first neuron begins in the outer plexiform or granular layer, and ends in the inner plexiform or granular layer. The cell-body
governing the nutrition of this fibre is the bipolar cell, which cells forms the inner nuclear layer.
- This neuron, although extremely short is the true optic nerve in the physiological sense, and corresponds to the long fibre with runs
from the sole of the foot up into the spinal cord.
- The second neuron in the retina begins in the inner nuclear layer and runs from here up to the primary optic ganglia, i.e. chiefly the
external geniculate body.
- This is the anatomical optic nerve.
- The cell governing the nutrition of this fibre is the ganglion cell.
Correct Answer. b
(140).
Less O2 saturation in blood is seen in :
a. R-L shunt
b. LV obstruction
c. RV obstruction
d. L-V shunt
Solution. (a) R-L shunt
Ref: Ganong‘s Physiology, 23rd ed., p.-620
Sol :
- Shunting of blood from the right side to the left side of the circulation (right-to-left shunt) is powerful cause of hypoxemia.
- The shunt may be intracardiac or may be intrapulmonary.
- It has been traditionally thought that this cause could be readily distinguished from the others as the only cause that cannot be
corrected by the administration of 100% oxygen.
Correct Answer. a
(141).
Which one of the following statements correctly describes the ductus arteriosus?
a. It prevents the flow of blood into the lungs of the fetus
b. It delivers oxygenated blood from the placenta to the left ventricle
c. It allows blood to flow from the aorta to the pulmonary artery in the fetus
d. Its resistance to blood flow decreases soon after birth
Solution. (a) It prevents the flow of blood into the lungs of the fetus
Ref: Read the text below
Sol :
- The ductus arteriosus is a low-resistance arterial vessel of the fetus through which blood flows from the pulmonary artery to the aorta,
bypassing the lungs.
- In fetal life, there is no need for blood to flow through the lungs because blood is oxygenated in the placenta.
- Soon after birth, the pulmonary vascular resistance falls, allowing blood to flow from the pulmonary artery to the lungs. The high
oxygen tension in the blood of the baby causes the resistance of the ductus arteriosus to increase.
- When the ductus arteriosus does not close at birth, it is called a patent ductus arteriosus. The opening between the left and right atria
in the fetus is called the foraman ovale.It, too, normally closes at birth.
Correct Answer. a
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(142).
Following major surgery a young fit 70-kg man will normally excrete, in 24 h
a. 500 ml water
b. 30 mmol Na
c. 10 mmol K
d. 20 mmol urea
Solution. (a) 500 ml water.
Ref– Read the text below
Sol:
Normal daily excretion is affected by a number of factors.
(a) The metabolic response to trauma results in the following changes:
- Urine volume is reduced and its Na content is reduced
- Urine K and nitrogen (N2) content are raised
- Plasma Na and albumin are decreased
- Plasma antidiuretic hormone (ADH), aldosterone, cortisol, catecholamines, insulin, glucose, free fatty acids (FFA) and amino acids (AA)
are increased
(b) Intraoperative factors
(c) Fluid administration
(d) Renal impairment
Principle urine constituents
Correct Answer. a
(143).
In a given muscle fiber at rest, the length of the I band is 1.0 mm and the A band is 1.5 mm. Which of the following is the length of the
sarcomere?
a. 4.0 μm
b. 3.5 μm
c. 2.5 μm
d. 2.0 μm
Solution. (c) 2.5 m .
Ref– Read the text below
Sol:
·
During contraction, the sarcomere, the distance between adjacent Z lines, decreases in length, and the length of the A band
is almost constant. However, as the degree of overlap of thick and thin filaments is altered, the thin filaments, which form the I band
and are anchored to the Z line, are pulled toward the center of the sarcomere.
·
As this occurs, the I band decreases in length and the H band is no longer visible. The filaments themselves do not
decrease in length; they slide past one another in the sliding-filament model of muscle contraction.
·
The average length of a sarcomere is 2.5 m. This distance is measured from one Z line to the next Z line. If the resting length of
the A band is 1.5 m and the length of the I band is 1.0 m, then the resting length of the sarcomere is determined by adding the
length of the I band to the length of the A band.
If there is a 20% contraction of the muscle (contraction to 80% of its length), then the sarcomere is reduced in length from
2.5 to 2.0 m. The size of the A band remains unchanged (whether the contraction is 10 or 20%); therefore, the length of the I band is
reduced from 1.0 to 0.5 m and makes up for the 0.5-m reduction in length during muscle contraction.
Correct Answer. c
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(144).
A 72-year-old man with an atrial rate of 80 beats/min develops third-degree (complete) AV block. A pacemaker site located in the AV
node below the region of the block triggers ventricular activity, but at a rate of only 40 beats/min. What would be observed?
a. One P wave for each QRS complex
b. An inverted T wave
c. A shortened PR interval
d. A normal QRS complex
Solution. (d) A normal QRS complex.
Ref– Read the text below
Sol:
- The form of the QRS will be normal because electrical excitation of the ventricles occurs over essentially the normal pathway (i.e., AV
node to bundle branches to Purkinje system to myocardium).
- The T wave will be normal as well. With complete heart block, P waves and QRS complexes are completely independent of each other.
Some PR intervals could be shortened by chance, others will be very long;that is, there is no predictable PR interval.
- There will not be a consistent ratio of P waves to QRS complexes because the two are disassociated, but the average ratio would be
80/40 or 2:1.
Correct Answer. d
(145).
Afferent muscle spindle activity is increased by
a. Active muscle contraction
b. Passive muscle shortening
c. Painful stimul
d. None
Solution. (c) Painful stimuli.
Ref– Read the text below
Sol:
When a muscle is stretched
- Primary sensory fibres (Group Ia afferent neurones) of the muscle spindle respond to both the velocity and the degree of stretch, and
send this information to the spinal cord
- Secondary sensory fibres (Group II afferent neurones) detect and send information about the degree of stretch (but not the velocity
thereof) to the CNS
This information is transmitted
- Monosynaptically to an alpha efferent motor fibre, which activates extrafusal fibres of the muscle to contract, thereby reducing stretch
- Polysynaptically through an interneurone to another alpha motorneurone; this inhibits contraction in the opposing muscles
Correct Answer. c
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(146).
During the physical examination of a newborn child, it was observed that the genitalia were female, but masculinized. The genotype was
determined to be 46,XX. Which of the following is the most likely cause of this condition?
a. Androgen insensitivity
b. Decreased blood ACTH levels
c. Atrophy of the zona reticularis
d. A defect in the cortisol pathway
Solution. (d) A defect in the cortisol pathway.
Ref– Read the text below
Sol:
- The newborn described is genotypically female and suffers from adrenogenital or congenital virilizing hyperplasia in which there is a
deficiency in the pathway that leads to cortisol synthesis.
- The inability to synthesize cortisol in turn leads to production of high levels of ACTH and ACTH-releasing factor from the hypothalamus.
The result is hypertrophy
of the fetal adrenal cortex, which is a critical fetal structure that produces dehydroepiandrosterone.
- The excessive production of androgens by the fetal adrenal leads to masculinization of the female genitalia. Increased secretion of
cortisol cannot occur because of the metabolic defect in this pathway; therefore, negative feedback control is not functional.
- The fetal cortex is part of maternal-feto-placental unit because the dehydroepiandrosterone is used by the placenta to produce estradiol.
The fetal adrenal cortex involutes following birth, causing an overall reduction in the size of the adrenal.
- The adult cortex (zona glomerulosa, zona fasciculata, and zona reticularis) replaces the fetal adrenal cortex. The zona fasciculata and
zona reticularis produce androgens after birth. Vasopressin [AVP; also known as antidiuretic hormone (ADH)] is released by the posterior
pituitary and regulates fluid balance.
- ADH increases the permeability of the collecting duct through an aquaporin-mediated mechanism. Androgen insensitivity is the cause of
testicular feminization and is not a factor in the adrenogenital syndrome.
Correct Answer. d
(147).
Which one of the following values is greater in the pulmonary circulation than in the systemic circulation?
a. The mean arterial pressure
b. The arterial resistance
c. The vascular compliance
d. The blood flow
Solution. (c) The vascular compliance
Ref: Read the text below
Sol :
- The same amount of blood flows through the pulmonary and systemic circulations.
- However, the mean blood pressure in the pulmonary circulation is much lower (15 (80 mmHg − 20 mmHg) compared to the mean blood
pressure in the systemic circulation (90 mmHg).
- The pulmonary blood pressure is lower because the resistance to blood flow in the pulmonary circulation is much lower than the
resistance to blood flow in the systemic circulation. In addition, the pulmonary blood vessels are more compliant than the systemic blood
vessels.
- Therefore, although the stroke volume of the left and right ventricles is the same, the pulse pressure in the pulmonary artery (25/10) is
lower than that in the aorta (120/80).
- The resistance of the systemic circulation is determined by the activity of the sympathetic nerves innervating the arteriolar smooth
muscle. The smooth muscle surrounding the pulmonary vessels receives very little sympathetic innervation.
Correct Answer. c
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(148).
The greatest percentage of blood volume is found in the
a. Heart
b. Aorta
c. Capillaries
d. Venules and veins
Solution. (d) Venules and veins
Ref: Read the text below
Sol :
- The total circulating blood volume is approximately 70 mL/kg, about two-thirds of which is found in the systemic veins and venules.
- A significant volume of blood (15%) is found in the pulmonary circulation.
- The large volume of blood found on the venous side of the circulation is used to adjust circulating blood volume.
- For example during hemorrhage, contraction of the veins and venules of the skin increases the amount of blood available for perfusion
of the heart and brain.
Correct Answer. d
(149).
The diastolic pressure equals
a. 0 mmHg
b. 5 mmHg
c. 70 mmHg
d. 90 mmHg
Solution. (c) 70 mmHg
Ref: Read the text below
Sol :
- Diastolic pressure is the lowest pressure observed in the aorta during each cardiac cycle.
- It occurs at the end of isovolumic contraction, just before ejection of blood from the left ventricle begins.
- In this case, isovolumic contraction ends when the pressure within the ventricle rises to 70 mmHg.
- The term diastolic pressure always refers to arterial blood pressure. In the diagram, the left ventricular end-diastolic pressure equals 5
mmHg.
Correct Answer. c
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(150).
Which is responsible for respiratory drive:
a. O2
b. CO
c. CO2
d. Bicarbonate ions
Solution. (c) CO2
Ref: Ganong‘s Physiology, 23rd ed., p.-516
Sol :
- Although the body requires oxygen for metabolism, low oxygen levels do not stimulate breathing. Rather, respiratory centre is directly
stimulated by higher carbon dioxide levels or excess hydrogen ions in the blood.
- As a result, breathing low-pressure air or a gas mixture with no oxygen at all (such as pure nitrogen) can lead to loss of consciousness
without ever experiencing air hunger.
- The respiratory centers try to maintain an arterial CO2 pressure of 40 mm Hg. With intentional hyperventilation, the CO2 content of
arterial blood may be lowered to 10-20 mm Hg (the oxygen content of the blood is little affected), and the respiratory drive is diminished.
Correct Answer. c
(151).
In an embryo that lacked nucleoli, the synthesis of which type of RNA would be most directly affected?
a. tRNA
b. rRNA
c. mRNA
d. 5S RNA
Solution. (b) rRNA
Ref– Read the text below
Sol:
- In nucleoli, rRNA genes are transcribed to produce the 45S rRNA precursor, which is trimmed, modified, and complexed with proteins
to form ribosomal subunits.Therefore, the synthesis of rRNA would be most directly affected. The embryo probably would not survive.
Correct Answer. b
(152).
Eukaryotic genes that produce mRNA
a. Contain a TATA box downstream from the start site of transcription
b. May contain a CAAT box in the 5' flanking region
c. Are transcribed by RNA polymerase III
d. Contain long stretches of thymine nucleotides that produce the poly(A) tail of mRNA
Solution. (b) May contain a CAAT box in the 5' flanking region
Ref– Read the text below
Sol:
- Eukaryotic genes contain TATA and CAAT boxes in the 5' flanking region, upstream from the start site for transcription. RNA
polymerase II transcribes these genes, producing hnRNA, which is modified and processed to form mRNA.
- A cap is added at the 5' end and poly(A) is added to the 3' end posttranscriptionally; they are not encoded in the DNA. These genes
contain introns, which are removed during processing of hnRNA.
Correct Answer. b
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(153).
How many net molecules of ATP are generated in the conversion of glucose to pyruvate?
a. 0
b. 1
c. 2
d. 3
Solution. (c) 2
Ref– Read the text below
Sol:
- One ATP is used to convert glucose to glucose 6-phosphate and a second to convert fructose 6-phosphate to the bisphosphate.
- Two triosephosphates are produced by cleavage of fructose 1,6-bisphosphate.
- As the two triosephosphates are converted to pyruvate, four ATPs are generated, two by phosphoglycerate kinase and two by pyruvate
kinase.Net, two ATPs are produced.
Correct Answer. c
(154).
Vitamin B12 acts as a co-enzyme to which of the following enzyme?
a. Isocitrate dehydrogenase
b. Homocystein methyltransferase
c. Glycogen synthase
d. G-6- dehydrogenase
Solution. (b) Homocystein methyltransferase
Ref.: Read the text below
Sol :
- This enzyme is needed for conversion of homocystein to the methionine. This is B12 dependent enzyme, which requires methyl THF as a
methyl donor. Deficiency of vitamin B12 leads to accumulation of methyl THF (Folate trap).
- As free form of THF is required for the synthesis of N5 – N10 methylene THF, a form of THF required for the synthesis of dTMP from
dUMP by the enzyme thymidylate synthetase, the deficiency of B12 leads to defective synthesis of the dTMP and thus that of the DNA
and thus megaloblatic anemia.
Correct Answer. b
(155).
Abnormal base in t RNA is :
a. Dihydrouracil
b. Orotic acid
c. Methyl Xanthine
d. Cystine
Solution. (a) Dihydrouracil
Ref.: Read the text below
Sol :
- The transfer RNAs show extensive internal base pairing and acquire clover leaf like structure.
- They contain a significant proportion of unusual bases.
- These include dihydrouracil (DHU), pseudouridine and hypoxantine.
- Many bases are methylated ; this occurs in the nucleus.
- The 5‘ end often has a phosphorylated guanosine.
Correct Answer. a
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(156).
True about competitive inhibition is :
a. Increased Km and Vmax is same
b. Increased Vmax and Km remains constant
c. Increased Km and increased Vmax
d. Decreased Km and increased Vmax
Solution. (a) Increased Km and Vmax is same
Ref.: Read the text below
Sol :
Competive inhibition
- The inhibitor competes with the substrate for binding at the enzymes active site.
- Km therefore increases, since a higher concentration of inhibitor decreases substrate binding and more substrate is needed to reach ½
Vmax.
- Vmax remains unchanged since the dissociation of the enzyme – substrate complex, once formed, is unaffected.
Correct Answer. a
(157).
Poly A tail is translated in to ?
a. Polysine
b. Polyalanine
c. Polyarginie
d. Polycysteine
Solution. (a) Polysine
Ref.: Read the text below
Sol :
- Poly A tail is translated into the polylysine tail.
- As AAA is the codon for lysine amino acid.
Correct Answer. a
(158).
Which of the following enzyme is used in recombinant DNA technology :
a. Restriction endonuclease
b. Pyridoxine dehydrogenase
c. RNA polymerase II
d. DNA ligase
Solution. (a) Restriction endonuclease
Ref.: Read the text below
Sol :
- Werner Arber showed that certain enzymes of bacteria restrict the netry of phages into host bacteria. Hence, the name restriction
endonucleases. Hamilton Smith in 1970 isolated the first restriction enzyme beta Hindi.
- Daniel Nathans in 1971 for the first time applied this restriction enzyme to cut SV 40 DNA. All the three scientists received Nobel prize
in 1978.
- The Restriction endonucleases are named after the species and strains of bacteria and the order of discovery. For example, the enzyme
Eco RI is isolated from Escherichia Coli RY13 strain.
- The Roman numberal ―one‖ indicates the order‘ discovery of an enzyme from that species. Restriction enzymes are isolated from
bacteria. Bacterial DNA is not broken by RE, because restriction sites are protected by site specific methylation.
Correct Answer. a
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(159).
For single carbon transfer, which co-enzyme is responsible?
a. Acetyl Coenzyme A
b. Biotin
c. THFA
d. Pyridoxine
Solution. (c) THFA
Ref.: Read the text below
Sol :
Folic Acid
- Coenzyme from : Tetrahydro-folic acid (THFA).
Function : Transporter for single carbon units (-CH3, - Ch2, COOH) for purine, thymidylate synthesis and methionine synthesis from
homocysteine – requires B12.
Deficiency :
- Most common vitamin deficiency in humans
- Hematopoietic tissue – anemia
- Epithelial cells – nutrient absorpt*ion *impaired.
Correct Answer. c
(160).
What type of bond is formed between phosphate and carbon 1 of 1,3-bisphosphoglycerate?
a. Anhydride
b. Ester
c. Phosphodiester
d. Amide
Solution. (a) Anhydride
Ref– Read the text below
Sol:
- The carboxylic acid (carbon 1) reacts with phosphoric acid, splitting out H20 and forming an anhydride.
- Cleavage of this bond in the next step of glycolysis generates enough energy to produce one ATP from ADP and Pi
Correct Answer. a
(161).
An infant with an enlarged liver has a glucose 6-phosphatase deficiency. This infant
a. Cannot maintain blood glucose levels either by glycogenolysis or by gluconeogenesis
b. Can use liver glycogen to maintain blood glucose levels
c. Can use muscle glycogen to maintain blood glucose levels
d. Can convert both alanine and glycerol to glucose to maintain blood glucose levels
Solution. (a) Cannot maintain blood glucose levels either by glycogenolysis or by gluconeogenesis
Ref– Read the text below
Sol:
- Glucose 6-phosphatase deficiency is a glycogen storage disease (von Gierke's disease) in which neither liver glycogen nor
gluconeogenic precursors (such as alanine and glycerol) can be used to maintain normal blood glucose levels.
- The last step (conversion of glucose 6-phosphate to glucose) is deficient for both glycogenolysis and gluconeogenesis.
- Muscle glycogen cannot be used to maintain blood glucose because muscle does not contain glucose 6-phosphatase.
Correct Answer. a
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(162).
Which of the following enzymes is not directly required in the sequence of reactions by which galactose is converted to UDP-glucose?
a. Galactokinase
b. An epimerase
c. Phosphoglucomutase
d. A uridyl transferase
Solution. (c) Phosphoglucomutase
Ref– Read the text below
Sol:
- Galactose is phosphorylated by galactokinase to galactose l-phosphate, which reacts with UDP-glucose in a reaction catalyzed by uridyl
transferase to form UDP-galactose and glucose l-phosphate.
- An epimerase converts UDP-galactose to UDP-glucose.
- Phosphoglucomutase interconverts glucose 1-phosphate and glucose 6-phosphate.
Correct Answer. c
(163).
Which of the following statements concerning lactose synthesis is true?
a. The reactions occur in most tissues
b. α-Lactalbumin acts as a modifier of galactosyl transferase
c. UDP-glucose reacts with galactose
d. UDP-galactose requires dietary galactose for its synthesis
Solution. (b) α-Lactalbumin acts as a modifier of galactosyl transferase
Ref– Read the text below
Sol:
- UDP-galactose reacts with glucose to form lactose only in the mammary gland.
- α-Lactalbumin acts as a modifier of the enzyme galactosyl transferase, lowering its Km for glucose.
- Glucose may be converted to UDP-glucose and epimerized to form the UDP-galactose used in lactose synthesis; therefore; dietary
galactose is not required.
Correct Answer. b
(164).
The pentose phosphate pathway generates each of the following products except
a. NADPH, which may be used for fatty acid synthesis
b. Ribose 5-phosphate, which may be used for the biosynthesis of ATP
c. Xylulose 5-phosphate by one of the nonoxidative reactions
d. Glucose from ribose 5-phosphate and CO2
Solution. (d) Glucose from ribose 5-phosphate and CO2
Ref– Read the text below
Sol:
- In the first three reactions of the pentose phosphate pathway, glucose is converted to ribulose 5-phosphate and CO2, with the
production of NADPH. These reactions are not reversible.
- Ribose 5-phosphate and xylulose 5-phosphate may be formed from ribulose 5-phosphate.
- A series of reactions catalyzed by transketolase and transaldolase produce the glycolytic intermediates fructose 6-phosphate and
glyceraldehyde 3-phosphate.
Correct Answer. d
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(165).
A common mutagenic event is the deamination of cytosine in DNA to form uracil. If the damaged strand is replicated, a CG base pair in
DNA will be converted to a
a. TA base pair
b. GC base pair
c. GG base pair
d. UG base pair
Solution. (a) TA base pair
Ref– Read the text below
Sol:
- When the DNA is replicated, U in the template strand will pair with A in the daughter strand.
- Subsequent rounds of replication will cause the original CG base pair to become a TA base pair.
Correct Answer. a
(166).
In a patient of total parenteral nutrition daily montitoring is done with:
a. Body weight
b. Plasma protein
c. CBC
d. Plasma osmolality
Solution. Ans-: (a) Body weight
Ref: Harrison 17th/460
Sol:
- In a patient of total parenteral nutrition daily monitoring is done with body weight.
- Strict input-output chart & body weight should be monitored daily.
Correct Answer. a
(167).
Neoadjuvant chemotherapy is used in all except:
a. Esophageal Ca
b. Breast Ca
c. Thyroid Ca
d. Lung non-small cell Ca
Solution. Ans-: (c) Thyroid Ca
Ref: Harrison 17th/467
Sol:
·
Neoadjuvant chemotherapyis used in all except thyroid carcinoma. There is no role of adjuvant chemotherapy in thyroid
carcinoma. Thyroid carcinoma is poorly responsive to chemotherapy.
Chemosensitivity
Highly chemosensitive tumours
·
Hodgkin’s lymphoma
·
Teratoma of testis
·
Wilm’s tumour
·
Embryonal rhabdomyosarcoma
·
Ewing’s sarcoma
·
Choriocarcinoma
·
ALL
Chemoresistant tumours
·
Melanoma
·
Squamous cell carcinoma
·
Large bowel carcinoma
·
Hepatocellular carcinoma
·
Thyroid carcinoma
Correct Answer. c
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(168).
All the following increase risk for cholangiocarcinoma except:
a. Ulcerative colitis
b. Gall stones in CBD
c. Sclerosing cholangitis
d. Chlonorchis
Solution. Ans-: (b) Gall stones in CBD
Ref: Bailey 24th/1081-1083
Sol:
Risk Factors for cholangiocarcinoma
1.
Primary sclerosing cholangitis
2.
Choledochal cyst
3.
Ulcerative colitis
4.
Clonorchis sinensis infection
5.
Chronic typhoid carriers
6.
Hepatolithiasis
7.
Biliary enteric anastomosis
8.
Liver flukes
Correct Answer. b
(169).
The deficiency of all the following factors increases the incidence of thrombus formation except:
a. Lipoprotein A
b. Protein – C
c. Anti-thrombin III
d. Protein-S
Solution. Ans-: (a) Lipoprotein A
Ref: read the text below
Sol:
Causes of thrombophilia can be acquired or congenital.
• Acquired refers to transient or acquired conditions that increase the tendency to clot. This might include antiphospholipid antibodies or
a temporary hypercoagulable state such as pregnancy. Also, advanced carcinomas of the pancreas or lung may produce Trousseau
syndrome, which creates a hypercoagulable state.
• Congenital refers to hereditary conditions that increase the tendency to clot. These include Factor V Leiden (see below); prothrombin
G20210A; protein C, protein S and antithrombin deficiencies.
Correct Answer. a
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(170).
Breast conservative surgery is done in all except:
a. Young patients
b. Ductal carcinoma in situ
c. Lobular carcinoma
d. Infiltrative ductal carcinoma
Solution. Ans-: (c) Lobular carcinoma
Ref: CSDT 11th/330
Sol:
Breast Conservative Surgery (BCT)
·
Involves resection of primary breast cancer with a margin of normal appearing breast tissue, adjuvant radiation with or without
assessment of axillary lymph node status.
·
Surgical proceduresemployed: wide local excision, lumpectomy, quadrantectomy.
·
BCT is currently treatment forwomen with DCIS, Stage I & Stage II invasive breast cancer
Suitable candidates for BCT
1.
The cancer is solitary, with no clinical or mammographic evidence of cancer elsewhere ion the breast.
2.
The tumors can be excised with tumor free surgical margins without producing a cosmetically unacceptable breast.
3.
There are no contraindications to radiations
4.
The patients is wiling and motivated for breast conservation.
Contraindications for BCT
Absolute contraindications:
1.
Pregnancy is an absolute contraindicationto the use of breast irradiation.
2.
Women with two or more primary tumours in separate quadrants of the breast or with diffuse malignant appearing micro
calcifications.
3.
A history of prior therapeutic irradiation to the breast region that would require treatment to an excessively high total-radiation
does to a significant volume.
4.
Persistent positive margins after reasonable surgical attempts
Relative contraindications:
1.
History of collagen vascular disorders (Scleroderma & active lupus erythematosus but not the rheumatoid arthritis)
2.
Presence of multiple gross tumours in the same quadrant & indeterminate calcifications
3.
Large tumour in small breast
4.
Breast size, large pendulous breast presents difficulty in delivering uniform radiation dose
5.
Centrally located tumour, for which removal of nipple-areola complex is required to obtain a tumour free margin.
Correct Answer. c
(171).
The most common malignancy found in Marjolin‘s ulcer is:
a. Basal cell carcinoma
b. Squamous cell carcinoma
c. Malignant fibrous histiocytoma
d. Neutrophic malignant melanoma
Solution. Ans-: (b) Squamous cell carcinoma
Ref: Bailey 24th/208
Sol:
Marjolin’s Ulcer
·
Low grade squamous cell carcinoma , which develops on a chronic benign ulcer or a long standing scar tissue.
Marjolin’s ulcer may develop in:
1.
Post burn scar
2.
Long standing venous ulcer
3.
Chronically discharging osteomyelitis sinus
4.
Post-radiation ulcer
5.
Chronic ulcer due to trauma
Characteristics:
·
Slow growing as scar tissue is relatively avascular
·
Painlessas there are no nerves in the scar tissue
·
No secondary deposits in regional lymph node, as there are no lymphatic vessels in scar tissue
·
If the ulcer invades the normal tissue, then only lymph node may be involved by lymphatic spread
·
Radioresistant due to avascularity
Correct Answer. b
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(172).
Reparative granuloma of Jaw is treated by
a. Antibiotics
b. Wedge resection
c. Resection and bone grafting
d. Curettage
Solution. Ans-: (d) Curettage
Ref: Bailey 24th/208
Sol:
Giant Cell Reparative Granuloma
·
Giant Cell Reparative Granuloma (GCRG) is an apparently reactive intraosseous lesion of the mandible and maxilla following
trauma induced intraosseous hemorrhage and containing prominent giant cells.
·
Commonest site is anterior part of mandible (2/3 rd of cases) between the 2nd premolar and 2nd molar with extension across the
midine.
Treatment
·
Treatment consists of curettage or local excision
·
Recurrence rate of 22% - 50% is reported, although, although lesion eradication typically does not require more than two
excisions.
·
Chemical cautery, electrocautery, cryotherapy have all been used and newer therapies like Calcitonin, Interferon alpha and
intralesional steroids are being used for more aggressive and recurrent lesions.
Correct Answer. d
(173).
Dentigerous cyst arises from:
a. The root of a caries tooth
b. The periosteum of the fractured mandible
c. An unerupted permanent tooth
d. The sequestrum of osteomyelitis of mandible
Solution. Ans-: (c) An unerupted permanent tooth
Ref: Bailey 24th/208
Sol:
Dental Cyst
Dentigerous Cyst
·
Develops at the apices of caries tooth
with necrotic pulp
·
More common in upper jaw
·
·
Ameloblastoma
Arises from unerupted teeth
·
Benign neoplasm arising from
Cyst also contain unerupted teeth ameloblast (odontogenic epithelium)
Correct Answer. c
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(174).
A 21 years old woman has 3cm node in the lower deep cervical chain on the left. The biopsy is interpreted as revealing normal thyroid
tissue in a lymph node. The most likely diagnosis is:
a. Subacute thyroiditis
b. Metastatic carcinoma thyroid
c. Hashimoto‘s disease
d. Lateral aberrant thyroid
Solution. Ans-: (d) Lateral aberrant thyroid
Ref: (Bailey 24th/777
Sol:
Lateral aberrant thyroid
·
Any thyroid tissuefound laterally separate from the thyroid gland, is always considered to be metastasis in a cervical lymph node,
as aberrant thyroid tissue never occurs in lateral position.
Aberrant thyroid tissues are found along the coruse of the thyroglossal tract:
·
Lingual
·
Cervical
·
Thoracic
Papillary carcinoma of thyroid is MC associated with lateral aberrant thyroid
Correct Answer. d
(175).
Minimum amount of GI bleed to cause malena is:
a. 10ml
b. 40ml
c. 60ml
d. 115ml
Solution. Ans-: (c) 60ml
Ref: CSDT 11th/548
Sol:
Melena
·
Malena indicatespassing of black, tarry stools (which are foul-smelling) due to the presence of digested blood.
·
50-100 cc of blood will render the stool melenic.
·
Malenic stools result from oxidation of haemoglobin.
·
Malena is usually caused by bleeding proximal to the ascending colon, and more than 90% of such patients are bleeding from the
upper GIT.
·
Ingestion of bismuth(as bismuth subsalicylate) leads to similar stools but without foul-smell.
·
Iron ingestion leads to greenish stools.
Correct Answer. c
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(176).
Which of the following is a delayed absorbable synthetic suture material?
a. Chronic catgut
b. Vicryl
c. Silk
d. Nylon
Solution. Ans-: (b) Vicryl
Ref: read the text below
Sol:
Vicryl
·
Polyglactin 910 (Vicryl): This synthetic suture is a braided multifilament suture coated with a copolymer of lactide and glycolide
(polyglactin 370). The water-repelling quality of lactide slows loss of tensile strength, and the bulkiness of lactide leads to rapid
absorption of suture mass once tensile strength is lost.
·
The suture is also coated with calcium stearate, which permits easy tissue passage, precise knot placement, and smooth tie-down.
Tensile strength is approximately 65% at 14 days postimplantation. Absorption is minimal for 40 days and complete in 56-70 days.
·
These sutures cause only minimal tissue reaction. Vicryl sutures are used in general soft tissue approximation and vessel ligation.
Another similar suture material is made from polyglycolic acid and coated with Polycaprolate (Dexon II). This material has a similar
tensile strength and absorption profile.
Correct Answer. b
(177).
Sistrunk‘s operation consists of:
a. Excision of hyoid bone and cone of tongue muscle
b. Excision of hyoid bone and the cyst
c. Excision of central part of hyoid bone and cone of tongue muscles upto foramen caecum
d. Excision of cyst only
Solution. Ans-: (b) Excision of hyoid bone and the cyst
Ref: read the text below
Sol:
• Walter Ellis Sistrunkdescribed the classic operation of thyroglossal cyst excision including the central portion of the hyoid bone and a
core of tissue around the thyroglossal tract to open into the oral cavity at the foramen caecum.
Correct Answer. b
(178).
All of the following patients presenting with abdominal pain and shock need immediate laparotomy except:
a. Ruptured ectopic pregnancy
b. Haemorrhagic pancreatitis
c. Rupture abdominal aortic aneurysm
d. Ruptured liver hemangioma
Solution. Ans-: (b) Haemorrhagic pancreatitis
Ref: read the text below
Sol:
- All of the following patients presenting with abdominal pain and shock need immediate laparotomy except Haeomorrhagic pancreatitis.
Correct Answer. b
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(179).
All of the following are indicators of adequacy of pre-operative resuscitation except:
a. C-reactive protein level
b. Consciousness level
c. Urine output
d. Hematocrit level
Solution. Ans-: (a) C-reactive protein level
Ref: Sabistion 18th/1191; Internet
Sol:
Pre-operative Resuscitation
·
IV access is obtained and any fluid or electrolyte abnormalities are corrected.
·
Nearly all patients require antibiotic infusions
·
Foleys catheter bladder draingage to assess urine output (Pre-operative urine output of 0.5m/kg/hour, along a with systolic blood
pressure of at least 100 mm Hg and a pulse rate 100 beats/minute or less, is indicative of adequate intravascular volume.
·
A common electrolyte abnormalityrequiring correction is hypokalemia
·
Pre-operative acidosis may respnd to fluid repletion and IV bicarbonate infusion.
·
Patient should have blood typed and crossmatched.
Correct Answer. a
(180).
Which of the following statements about acalculous cholecystitis is incorrect:
a. Manifestation of disturbed microcirculation in critically ill patient
b. Prolonged parenteral nutrition can be causative
c. It is life threatening condition
d. Cholecystectomy is not indicated
Solution. Ans-: (d) Cholecystectomy is not indicated
Ref: read the text below
Sol:
·
In surgical candidates, open or laparoscopic cholecystectomy is indicated.5 In patients who are not surgical candidates,
percutaneous cholecystostomy may be performed in the radiology suite.
·
Catheters are usually removed after approximately 3 weeks in critically ill patients with acalculous cholecystitis who have
undergone percutaneous cholecystostomy.
·
This allows for the development of a mature track from the skin to the gallbladder.
Correct Answer. d
(181).
In an avulsion injury to the scalp, the plane of separation usually passes through :a. In an avulsion injury to the scalp, the plane of separation usually passes through :b. Subcutaneous connective tissue
c. Epicranial aponeurosis
d. Loose areolar connective tissue
Solution. Ans-: (d) Loose areolar connective tissue
Ref:Ref. K.L Moore 5th ed. - 906
Sol:
·
The first three layers, also known as the 'clinical scalp', are considered a single entity due to fibrous septa that passes from the
aponeurosis to the skin through the subcutaneous connective tissue, thus tethering the skin firmly to the underlying tissues.
·
The fourth layer of the scalp, being made up of loose areolarconnective tissue, is easily separable. It also allows fluid/blood to
collect here.
·
The periosteum, the fifth layer of the scalp, is firmly adherent to the skull vault
Correct Answer. d
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(182).
Which statement about lymphangiomas is true?
a. Most lesions appear during puberty
b. These lesions frequently respond to small doses of radiation therapy
c. The lesions usually grow slowly but may infiltrate local tissues
d. Malignant transformation is frequent.
Solution. Ans-: (c) The lesions usually grow slowly but may infiltrate local tissues
Ref: read the text below
Sol:
• Lymphangiomas are congenital malformations of the lymphatic vessels. Most appear at birth or during early infancy.
• The lesions grow slowly and infiltrate local tissues, but actual malignant degeneration is exceedingly rare.
• The lesions are not responsive to radiation therapy.
Correct Answer. c
(183).
The primary cause of death from sickle cell disease in the first decade of life are which of the following?
a. Sepsis
b. Splenic sequestration crisis
c. Acute chest syndrome
d. Both a and b
Solution. Ans-: (d) Both a and b
Ref: read the text below
Sol:
• Sickle cell disease and thalassemiaare the principal hemoglobinopathies that cause clinically important disease.
• Clinical symptoms are directly dependent upon the amount of HgbS present, and this is variable.
• Patients who are homozygous for HgbS usually have small sequential splenic infarcts as a result of microvascular occlusion and the
spleen usually becomes small, fibrotic, and dysfunctional by the age of 5 years.
• Splenic sequestration crisis is a cause of anemiathat can be acute and life-threatening.
• Sepsis associated with functional asplenia can be lethal as well. These are the two primary causes of death in sickle cell disease during
the first decade of life.
Correct Answer. d
(184).
The most common hernia in females is:
a. Femoral hernia.
b. Direct inguinal hernia.
c. Indirect inguinal hernia.
d. Obturator hernia.
Solution. Ans-: (c) Indirect inguinal hernia
Ref: read the text below
Sol:
• Indirect inguinal herniasare the most common hernia in both females and males.
• Femoral hernias are more common in females than in males.
Correct Answer. c
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(185).
The following statements about the repair of inguinal hernias are true except:
a. The conjoined tendon is sutured to Cooper's ligament in the Bassini hernia repair.
b. The McVay repair is a suitable option for the repair of femoral hernias.
c. The Shouldice repair involves a multilayer, imbricated repair of the floor of the inguinal canal.
d. The Lichtenstein repair is accomplished by prosthetic mesh repair of the inguinal canal floor in a tension-free manner.
Solution. Ans-: (a) The conjoined tendon is sutured to Cooper's ligament in the Bassini hernia repair.
Ref: read the text below
Sol:
• The Bassini repair is accomplished by high ligationof the hernia sac followed by suturing the conjoined tendon and the internal oblique
muscle to the inguinal ligament.
Correct Answer. a
(186).
A 21-year-old woman presents with an asymptomatic breast mass. Which of the following statement is true concerning her diagnosis and
treatment?
a. Mammography will play an important role in diagnosing the lesion
b. Ultrasonography is often useful in the differential diagnosis of this lesion
c. The mass should always be excised
d. The lesion should be considered pre-malignant
Solution. Ans-: (b) Ultrasonography is often useful in the differential diagnosis of this lesion
Ref: read the text below
Sol:
• Fibroadenoma represents the most commontumor in adolescents and young woman, but if also frequently encountered in older women.
• It generally presents as a palpable breast mass and must be differentiated from cancer. Typically, fibroadenoma presents as a painless,
slow-growing mass found incidentally on breast self examination.
• Palpation of a mass usually reveals a well-circumscribed, oval or round, mobile mass with a firm, rubbery texture. Because the
mammographic appearance of a fibroadenoma is rarely characteristic, mammography plays little role in diagnosing this lesion.
• Ultrasonography can differentiate a solid mass from a cyst. Additionally, the ultrasonic appearance of a well-marginated, homogenous
mass may be sufficiently characteristic to permit diagnosis of fibroadenoma. Excisional biopsy is not necessary for every fibroadenoma.
• Women under 30 years of age with characteristic physical examination and sonographic appearance of the fibroadenoma may be given
the option of observation.
• Generally, fibroadenomas are not felt to be pre-malignant lesions, nor to indicate any increased risk for the development of breast
cancer.
Correct Answer. b
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(187).
Which of the following are factors associated with an increased risk for developing breast cancer?
a. Nulliparity
b. Oophorectomy before age 35
c. Use of oral contraceptives
d. Post-menopausal use of conjugated estrogens
Solution. Ans-: (a) Nulliparity
Ref: read the text below
Sol:
• Women who undergo oophorectomy before age 35 and do not take replacement estrogens have a two-thirds reduction in their breast
cancer risk. Replacement estrogen therapy eliminates the beneficial effect of oophorectomy.
• Most investigations of oral contraceptive use do not demonstrate an associated increased risk of breast cancer development.
• Studies of estrogen replacement therapy for post-menopausal women have yielded equivocal results.
• Most contemporary studies fail to demonstrate an association between breast cancer risk and post-menopausal use of conjugated
estrogens.
BREAST CANCER RISK FACTORS
DEMOGRAPHIC FACTORS
Age more than 30 y
Female gender (130:1 female/male ratio)
GREATLY INCREASED RISK
• Known carrier of breast cancer susceptibility gene
• Strong family history—two or more first-degree relatives with
• bilateral or premenopausal breast cancer
• Atypical ductal or lobular hyperplasia or lobular carcinoma in situ
• Ductal carcinoma in situ, risk limited to ipsilateral breast
MODERATELY INCREASED RISK
• Family history—one or more relatives with breast cancer, notbilateral or premenopausal
• Menstrual history—menarche before age 12 y, menopause afterage 55 y
• Parity—nulliparity or first live birth after age 30 y
• Radiation—exposure to low-dose ionizing radiation in childhood oradolescence
• Previous breast cancer—low-grade, node-negative, or receptor-positive; lobular histology
• Other cancers—colon or endometrial cancer
• Diet—high-fat or high-calorie diet
Correct Answer. a
(188).
Pindborg tumor arises from
a. Vasular origin
b. Smooth muscle
c. Epithelium
d. Connective tissue
Solution. Ans-: (c) Epithelium
Ref: read the text below
Sol:
·
The calcifying epithelial odontogenic tumor, also known as a Pindborg tumor or CEOT, is an odontogenic tumor also described
as adenoid adamtoblastoma, unusual ameloblastoma and a cystic odontoma.
·
Like other odontogenic neoplasms, it is thought to arise from the epithelial element of the enamel origin.
Correct Answer. c
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(189).
Which of the following symptoms would ensue due to pressure of an enlarged left atrium ?
a. Difficulty in breathing
b. Difficulty in swallowing
c. Difficulty in phonation
d. Hoarseness of voice
Solution. Ans-: (b) Difficulty in swallowing
Ref:Read the text below
Sol:
·
An enlarged left atrium would tend to compress the oesophagus, which forms an important posterior relation. This would result in
difficulty in swallowing.
·
The compression would be evident in a "barium swallow".
Correct Answer. b
(190).
All of the following are boundaries of the epiploic foramen except :a. Quadrate lobe
b. Lesser omentum
c. First part of duodenum
d. Inferior vena cava
Solution.
Ans-: (a) Quadrate lobe
Ref:K.L Moore 5th ed. - 239
Sol:
·
The caudate and not the quadrate lobe of the liver forms the superior boundary of the epiploic foramen, which is a communication
between the lesser and greater sacs.
·
The lesser omentum with the portal vein, bile duct and hepatic artery in its free fold, form its anterior boundary.
·
The first part of the duodenum forms its inferior boundary while the inferior vena cava is its posterior boundary
Correct Answer. a
(191).
All are true about congenital rubella syndrome, except :
a. Cardiac abnormality
b. Renal anomalies
c. Deafness
d. Cataract
Solution. Ans- (b) Renal anomalies
Ref.: Nelson - 1033
Sol :
Congenital rubella syndrome –
- Most common manifestation is IUGR
Other common findings are –
- Cataract unilateral or bilateral
- Microphthalmia
- Myocarditis and structural cardiac defects (PDA is the most common)
- Blue berry muffin, skin lesion.
- Sensorineural deafness
- Pneumonia, hepatitis
- Bone lucencies.
- Thrombocytopenic purpura and anemia.
- Late squeal include motor and mental retardation.
Correct Answer. b
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(192).
Polio virus infection can result in all except :
a. Anterior horn cell damage
b. Autonomic involvement
c. Respiratory involvement
d. Paralysis in > 70% of cases
Solution. Ans-(d) Paralysis in > 70% of cases
Ref.: O.P. Ghai
Sol :
- Poliovirus selectively damage motor and autonomic nervous system.
- Most commonly affected areas are the anterior horn of the spinal cord, vestibular and cranial nerve nuclei and vital centres in the
medulla and vermis, and nuclei in the roof of cerebellum.
- When respiratory centers are involved the respiration becomes shallow and irregular.
Areas which are usually not affected :
- White matter of spinal cord.
- Cerebellar hemisphere
- Nonmotor part & cerebral cortex.
- Paralytic polio is seen only about 0.1% of polio infections.
Correct Answer. d
(193).
“Microsomia” is defined as :
a. Birth weight below 90th percentile
b. Birth weight below 10th percentile
c. Birth weight below 20th percentile
d. Birth weight below 50th percentile
Solution. Ans- (b) Birth weight below 10th percentile
Ref.: Read the text below
Sol :
- Microsomia was defined as birth weight below the 10th percentile for the gestational age.
- The prefix “micro-“ is derived from the Greek “micros” meaning small. It diminishes whatever it precedes. “Soma” is also from the
Greek and means “body”
- Macrosomia was defined as birth weight at or above the 90th percentile for the gestational age.
Correct Answer. b
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(194).
All are true regarding tricuspid atresia except
a. Split S2
b. Patent foramen ovale
c. Pulmonary oligemia in chest X-ray
d. Left axis deviation in ECG
Solution. Ans (a) Split S2
Ref.: Read the text below
Sol :
- Tricuspid atresia is a form of congenital heart disease whereby there is a complete absence of the tricuspid valve. Therefore, there is an
absence of right atrioventricular connection.
- This leads to a hypoplastic (undersized) or absent right ventricle. This defect is contracted during prenatal development, when the heart
does not finish developing. It causes the heart to be unable to properly oxygenate the rest of the blood in the body. Because of this, the
body does not have enough oxygen to live, and steps must be taken to keep the child alive.
- Because of the lack of an A-V connection, an atrial septal defect (ASD) must be present to maintain blood flow. Also, since there is a lack
of a right ventricle there must be a way to pump blood into the pulmonary arteries, and this is accomplished by a ventricular septal
defect (VSD).
Blood is mixed in the left atrium. Because the only way the pulmonary circulation receives blood is through the VSD, a patent ductus
arteriosus usually also persists to increase pulmonary flow.
Clinical manifestations
- progressive cyanosis
- poor feeding
- tachypnea over the first 2 weeks of life
- holosystolic murmur due to the VSD
-- left axis deviation on electrocardiography and left ventricular hypertrophy
Correct Answer. a
(195).
NADA’s criteria are used for
a. Assessment of child for degree of dehydration
b. Assessment of child for degree of malnutrition
c. Assessment of child for presence of heart disease
d. Assessment of child for degree of mental retardation
Solution. Ans- (c) Assessment of child for presence of heart disease
Ref.: Read the text below
Sol :
NADA’s Criteria
- To assess that child for the absence or presence of heart disease.
- Either one major or 2 minor criteria are necessary for indicating the presence of heart disease.
Major Criteria
- Systolic murmur grade II or more especially with a thrill.
- Diastolic murmur
Minor Criteria :
- Systolic murmur less than grade III in intensity.
- Abnormal S2
Correct Answer. c
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(196).
Therapy of a "blue" or "tet" spell could include all of the following except:
a. Epinephrine
b. Knee-chest position
c. Oxygen
d. Sodium bicarbonate
Solution. Ans- (a) Epinephrine
Ref.: Read the text below
Sol :
- Epinephrine is potentially dangerous because it may exacerbate inotropy and contractile forces, which may obstruct the right
ventricular infundibulum.
- Indeed, propranolol has been used to treat "tet" spells.
Correct Answer. a
(197).
Which of the following scoring systems is useful for triage decisions?
a. PRISM (Pediatric RISK of Mortality)
b. Pediatric Trauma Score
c. APACHE (Acute Physiology and Chronic Health Evaluation)
d. TISS (Therapeutic Intervention Scoring System)
Solution. Ans- (b) Pediatric Trauma Score
Ref.: Read the text below
Sol :
- The pediatric trauma score is made specifically for triage to a higher-level unit, such as a level I trauma center.
- The other scores are most useful in assessing physiologic instability resource utilization in an acute PICU setting.
Correct Answer. b
(198).
“Potter’s syndrome” is associated with :
a. Renal anomalies
b. Severe oligohydramnio’s
c. Flattened nose
d. All the above
Solution. Ans- (d) All the above
Ref.: Read the text below
Sol :
- Potter sequence (also known as Potter's syndrome, Potter's sequence or Oligohydramnios sequence) is the atypical physical appearance
of a fetus or neonate due to oligohydramnios experienced in the womb.
- Oligohydramnios is the decrease in amniotic fluid volume sufficient to cause disruptions in morphogenesis of the fetus.
 Oligohydramnios is the causative agent of Potter sequence, but there are many things that can lead to oligohydramnios. It can be
caused by renal diseases such as bilateral renal agenesis (BRA), atresia of the ureter or urethra causing obstruction of the urinary tract,
polycystic or multicystic kidney diseases, renal hypoplasia, amniotic rupture, uteroplacental insufficiency from maternal hypertension or
toxemia.
Correct Answer. d
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(199).
Trisomy 21 is usually characterized by each of the following except :
a. Mental retardation
b. Cleft palate
c. Simian creases in the hands
d. Results from non-disjunction of chromosomes
Solution. Ans-(b) Cleft palate
Ref.: Read the text below
Sol :
- Cleft palate is commonly found in trisomy 13-14, but is uncommon in trisomy 21, which is characterized by each of the other conditions.
Correct Answer. b
(200).
Which of the following is true about roseola infantum
a. Defervescene follows the rash
b. Caused by HHV 6 and 7
c. Slapped check appearance is seen
d. Otitis media is common complication
Solution. Ans- (b) Caused by HHV 6 and 7
Ref.: Read the text below
Sol :
- Exanthema subitum (meaning sudden rash), also referred to as roseola infantum (or rose rash of infants), sixth disease (as the sixth
rash-causing childhood disease), and (confusingly) baby measles, or three-day fever, is a disease of children, generally under two years
old,although it has been known to occur in eighteen-year-olds, whose manifestations are usually limited to a transient rash ("exanthem")
that occurs following a fever of about three day's duration.
- It is caused by two human herpesviruses, HHV-6 (Human herpesvirus 6) and HHV-7, which are sometimes referred to collectively as
Roseolovirus.
Correct Answer. b
(201).
Cysticercosis present as –
a. Seizure
b. Neuropathy
c. Anosmia
d. Muscular hypertrophy
Solution. Ans-(a) Seizure
Ref.: O.P. Ghai -259
Sol :
- Cysticercosis can be found any where in the body but are most commonly detected in – brain, skeletal muscles, subcutaneous tissue or
eye.
- Neurocysticerosis is the most common parastitic infection of the CNS.
- Seizures are the presenting finding in > 70% of cases. Seizures are generalized in 80% cases but simple or complex partial seizure may
occurs.
- Intraventicular neurocysticercosis is associated with hydrocephalous and acute, subacute or intermittent signs of increased intracranial
pressure.
- Meningeal neurocysticercosis is associated with signs of meningeal irritation.
- A fulminant encephalitis like presentation also occurs most frequently in children who have had a massive initial infection.
Correct Answer. a
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(202).
Keratomalacia is seen in which of the following diseases:
a. Measles
b. Mumps
c. Rubella
d. Chickenpox
Solution. Ans- (a) Measles
Ref.: Read the text below
Sol :
- Keratomalacia due to severe vitamin A deficiency is common in developing countries.
- Non-infectious keratomalacia in young children resulting from vitamin A deficiency is predisposed by multiple factors like malnutrition,
systemic diseases, and lack of immunisation. Acute corneal melting result from the ocular pathological changes in severe vitamin A
deficiency and is invariably accompanied by malnutrition
- Keratomalacia in children is hastened by protein-caloric malnutrition in addition to its association with measles.
- Malnutrition leads to multiple vitamin deficiencies including vitamin A deficient states and hence triggers keratomalacia. In our study,
all the 29 children were malnourished. Pneumonia, diarrhoea and measles were the systemic conditions leading to the occurrence of
keratomalacia in our study. Of 29 children, 27 (93.1%) were not immunised at all. The remaining two children (6.9%) had been partially
immunised.
- Measles vaccination is a major preventive measure in malnourished children and can help to decrease nutritional keratomalacia in
developing countries.
Correct Answer. a
(203).
A child present with diarrhoea and peripheral circulatory failure. The arterial pH is 7.0, PCO2 15 mm Hg, and PO2 76 mm Hg. What will
be the most appropriate therapy.
a. Sodium bicarbonate infusion
b. Bolus of Ringers lacate
c. Bolus of hydroxyethyl starch
d. 5% Dextrose infusion
Solution. Ans (b) Bolus of Ringers lacate
Ref.: Harrison -265
Sol :
- Child has severe diarrhoea and he is in peripheral circulating failure due to excessive water loss. Metabolic acidosis is developed as a
result of decrease circulation(Hypovolemic shock)
- In general, severe acidosis (PH<7.2) warrants the intravenous administration of bicarbonate and if PH is >7.2, no need of bicarbonate
therapy, correct only underlying cause.
Correct Answer. b
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(204).
If you calculate the plasma osmolality of a child with plasma Na+ 125 mEq/L, glucose 108 mg/dL, and BUN (blood urea Nitrogen) 140
mg/dL, the most appropriate answer would be :
a. 300 mOsm/kg
b. 306 mOsm/kg
c. 312 mOsm/Kg
d. 318 mOsm/kg
Solution. Ans- (b) 306 mOsm/kg
Ref.: Read the text below
Sol :
- The plasma osmolality can be calculated based on the following formula.
BUN → 140 mg/dl
Putting these values in furmula :
= 2× 125 + 108/18 + 140/2.8
= 250 + 6 + 50
= 306 m Osm/kg.
Correct Answer. b
(205).
All of the following are true regarding tetralogy of fallot except
a. Ejection systolic murmur in second intercostals space
b. Single second heart sound
c. Predominantly left to right shunt
d. Normal jugular venous pressure
Solution. Ans- (c) Predominantly left to right shunt
Ref.: Read the text below
Sol :
- Tetralogy of Fallot results in low oxygenation of blood due to the mixing of oxygenated and deoxygenated blood in the left ventricle via
the VSD and preferential flow of the mixed blood from both ventricles through the aorta because of the obstruction to flow through the
pulmonary valve. This is known as a right-to-left shunt.
- The primary symptom is low blood oxygen saturation with or without cyanosis from birth or developing in the first year of life. If the
baby is not cyanotic then it is sometimes referred to as a "pink tet."
- Other symptoms include a heart murmur which may range from almost imperceptible to very loud, difficulty in feeding, failure to gain
weight, retarded growth and physical development, dyspnea on exertion, clubbing of the fingers and toes, and polycythemia.
Correct Answer. c
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(206).
Diaphragmatic hernias are on the left in …...% cases
a. 75
b. 80
c. 85
d. 90
Solution. Ans- (c) 85
Ref: Nelson's textbook of Pediatrics 19th Edition; 95.8 Diaphragmatic Hernia
Sol :
- The incidence of CDH is between 1/2,000 and 1/5,000 live births, with females affected twice as often as males.
- Defects are more common on the left (85%) and are occasionally (<5%) bilateral.
- Pulmonary hypoplasia and malrotation of the intestine are part of the lesion, not associated anomalies.
Correct Answer. c
(207).
The most common cause of neonatal sepsis in India is?
a. Klebsiella
b. E.coli
c. Staph.aureus
d. Group B streptococci
Solution. Ans- (a) Klebsiella
Ref: Read the text below
Sol :
Correct Answer. a
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(208).
The definition of encopresis requires the voluntary or involuntary passage of feces into inappropriate places at least once a month for 3
consecutive months once a chronologic or developmental age of......yr has been reached.
a. 3
b. 4
c. 5
d. 6
Solution. Ans- (b) 4
Ref: Read the text below
Sol :
- The definition of encopresis requires the voluntary or involuntary passage of feces into inappropriate places at least once a month for 3
consecutive months once a chronologic or development age of 4 yr has been reached.
- Encopresis is not diagnosed when the behavior is due exclusively to the direct effects of a substance (e.g. laxatives) or a general
medical condition (except through a mechanism involving constipation).
- Subtypes include retentive encopresis (with constipation and overflow incontinence) representing 65-95% of cases, and nonretentive
encopresis (without constipation and overflow incontinence.
Correct Answer. b
(209).
Least common finding in a case of neonatal sepsis:
a. Raised CRP
b. Raised ESR
c. Neutrophilia
d. Raised immature to mature neutrophil ratio
Solution. Ans- (c) Neutrophilia
Ref: Read the text below
Sol :
Correct Answer. c
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(210).
A 21 years old female nullipara found to have severe cervical dysplasia, the preferred treatment is :a. Hysterectomy
b. Cryo surgery
c. Conization
d. Amputation of cervix
Solution. (c) Conization
Ref– Read the text below
Sol:
- To preserve her fertility cervical conization is preferred treatment.
- The early symptoms of cervical carcinoma are
1) Intermenstrual bleeding.
2) Contact bleeding following coitus or vaginal examination.
3) Leucorrhea with often pinkish discharge.
Correct Answer. c
(211).
Pseudomyxoma peritoni is associated with all except :a. Mucinous Cystadenoma of the ovary
b. Mucocele gall bladder
c. Squamous cell carcinoma of uterus
d. Carcinoma of the large bowel
Solution. (c) Squamous cell carcinoma of uterus
Ref– Read the text below
Sol:
- Pseudomyxoma peritoni seen in Brenner tumor of ovary.
- Laprotomy finding is boiled sagopudding, recur after operation.
- Chemotherapy is treatment of choice.
Correct Answer. c
(212).
A primigravida, diabetic woman presents at 38 weeks pregnancy with monilial vaginitis. The treatment is :a. Treat monilial vaginitis and observe
b. Elective caesarean section
c. Induction of labour
d. Trial of labour
Solution. (b) Elective caesarean section
Ref– Read the text below
Sol:
- Elective caesarean section will avoid neonatal thrush infection and death. Vaginal delivery in any form is not safe in presence of
moniliasis.
Correct Answer. b
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(213).
Chlamydia trachomatis infection commonly cause :a. Infertility
b. Malignancy
c. Amenorrhoea
d. Post coital bleeding
Solution. (a) Infertility
Ref– Read the text below
Sol:
- Chlamydia causes tubal block with adhesion as a sequele of chronic PID's Diagnosis is made by tissue culture.
- It is treated with azithromycin 1 gm stat.
Correct Answer. a
(214).
A second gravida is diagnosed to suffer from pulmonary tuberculosis at 8 weeks gestation.What is the management ?
a. MTP
b. Anti-TB therapy
c. Withold medical treatment during pregnancy
d. Elective caesarean delivery at term
Solution. (b) Anti-TB therapy
Ref– Read the text below
Sol:
- Give anti-TB therapy, but avoid streptomycin, as it is ototoxic to the embryo and fetus. All other lines of treatment are wrong.
Correct Answer. b
(215).
Best result of tuboplasty are seen in :a. Isthmic - ampulary anastomosis
b. Isthmic - cornual anastomosis
c. Isthmic - Isthmic anastomosis
d. Removing tubal adhesion
Solution. (c) Isthmic - Isthmic anastomosis
Ref– Read the text below
Sol:
- Isthmic - Isthmic anastomosis restore a good thickness of tube's lumen, hence patency of tube is complete, so chances of conception.
- To improve the result a solution of combined decadron, Normal saline, heparin should be constantly spread over site of fallopian tube, it
prevents postoperative adhesion formation.
Correct Answer. c
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(216).
All of the following statements are true except:a. Depoprovera is given at the interval of 90 days.
b. Copper-T 375 is effective for 3 years.
c. OCP's Causes lactation failure
d. Norplant is long acting contraceptive.
Solution. (b) Copper-T 375 is effective for 3 years.
Ref– Read the text below
Sol:
- Copper - T 375 is effective for 5 years CU-T 250 is effective for 3 years. E-Nova is IUCD effective for 10 years.
Correct Answer. b
(217).
Placental anomalies are major contributors to obstetric haemorrhage. Which placental anomaly is shown in the image below?
a. Circumvallate placenta
b. Succenturiate placenta
c. Velamentous placenta
d. Furcate placenta
Solution. (b) Succenturiate placenta
Ref.: Read the text below
Sol :
Succenturiate placenta :
- A small part of placenta is separated from the rest of the placenta.
Clinical importance is :
- The accessory lobe may be retained in the uterus resulting in post partum hemorrhage and sepsis.
- It is associated with placenta previa and vasa previa.
Circumvallate placenta
- There is inward insertion of membranes from the edge towards the centre of the placenta (from deep implantation of the placenta into
the deciduas). Because of this excessive implantation, the placenta covers more than half of the fetal sac.
- Unusually small chorionic plate with growth of extrachorial placental tissue
- Complications of circumvallate placenta; antepartum hemorrhage, IUGR, pre-term labour.
Correct Answer. b
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(218).
The following changes occur in the vascular system of the newborn after birth
a. The proximal parts of the umbilical arteries become the lateral umbilical ligaments.
b. Anatomical closure of the ductus arteriosus occurs soon after birth
c. Anatomical closure of the foramen ovale occurs with onset of respiration.
d. Ductus venosus become ligamentum venosum.
Solution. (d) Ductus venosus become ligamentum venosum.
Ref.: Read the text below
Sol :
- The proximal parts of the umitical arteries remain open as superior vesical arteries.
- Anatomical closure of the ductus arteriosus occurs at about 1-3 months.
- Anatomic closure of foramen ovale occurs in about 1 year.
Correct Answer. d
(219).
Premature menopause occurs before the age of :
a. 40 years
b. 35 years
c. 45 years
d. 50 years
Solution. (a) 40 years
Ref.: Read the text below
Sol :
- The range for the age of menopause is 48-55 years age,about 1% women will experience menopause < 40 years‖ especially those who
underwent abdominal hysterectomy followed by compromised ovarian vasculature.
Correct Answer. a
(220).
All are true about oxytocin except:
a. Causes regular uterine
b. Octapeptide
c. Promotes development of lobules of beast
d. Has ADH-like action
Solution. (c) Promotes development of lobules of beast
Ref.: Read the text below
Sol :
- Oxytocin is an octapeptide, with ADH-like action in high doses – antidiuresis; pulmonary edema can occur.
- Oxytocin is responsible for milk ejection reflex i.e. contraction o the myoepithelial cells of mammary alveoli, which is initiated by
suckling (Galactokinesis).
- While development of breast lobules is the process of mammogenesis occurring during the course of pregnancy, while prolactin is
responsible for Galactopoiesis which is the process of maintenance and continuous lactation, during suckling.
Correct Answer. c
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(221).
In an uncomplicated twin pregnancy normal delivery should be attempted in the following situation :
a. First baby-vertex and second baby transverse lie
b. Both babies and breech presentation
c. First baby transverse lie and second longitudinal lie
d. First baby transverse lie and second frank breech
Solution. (a) First baby-vertex and second baby transverse lie
Ref.: Read the text below
Sol :
- The first baby vertex, and 2nd baby with malpresentation or abnormal lie, can be undertaken for vaginal delivery (in an unscarred
uterus, i.e. no history of previous cesarean section).
- If the 2nd twin is persistently in tranverse lie (as per the option), following delivery of 1st twin, internal podalic version for the 2nd twin
(the only indication of the manoeuvre in modern obstetrics), can be done.
- All other options are indications for cesarean section.
Correct Answer. a
(222).
HCG is secreted by :
a. Amniotic membrane
b. Yolk sac
c. Decidua
d. Tropholast cells
Solution. (d) Tropholast cells
Ref.: Read the text below
Sol :
HCG
- Glycoprotein synthesized by syncytiotrophoblast of the placenta
- It has 2 subunits; alpha (non specific, similar to LSH, FSH, LH) and beta (specific)
- It can be detected in maternal serum 8 days following ovulation by immunoassay
- Half life of HCG is 24-36 hours
- Most sensitive test to detect hCG is Radioimmunoassay (RIA)
- In early pregnancy, doubling time of hCG in plasma is 2 days
- Very high levels of HCG are seen in : multiple pregnancies, hydatidiform mole, Down‘s syndrome
Correct Answer. d
(223).
What is the most common cause of obstetric death?
a. Hemorrhage
b. Cardiac disease
c. Anemia
d. Gestational hypertension
Solution. (a) Hemorrhage
Ref.: Read the text below
Sol :
- Hemorhage is the single most important cause of maternal death worldwide obstetrical hemorrhage accounts for almost half of all
postpartum deaths in developing countries.
Correct Answer. a
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(224).
Which of the following hormones increase after menopause?
a. Estrogen
b. Progesterone
c. FSH
d. Inhibin
Solution. (c) FSH
Ref.: Read the text below
Sol :
- Cessation of ovarian activity and a fall in inhibin level, cause a rebound increase in secretion of FSH and LH by the anterior pituitary.
- FSH may rise as much as 50 fold and LH by 3-4 fold.
- Estrogen fall by 66% and the main estrogen of menopause is estrone, derived from the peripheral conversion of androstenedione
secreted by the ovary.
Correct Answer. c
(225).
The result of which the following tests is most likely to be inaccurate as a result of bacterial vaginosis.
a. Nitrazine test
b. "Fern" test
c. Transabdominal instillation of methylene blue
d. Pooling of amniotic fluid in speculum exam.
Solution. (a) Nitrazine test
Ref: Read the text below
Sol :
- The amniotic fluid or vaginal discharge is then tested with nitrazine paper which will turn dark blue in the presence of an alkaline pH.
- Hence, bacterial vaginosis, which also results in an alkaline vaginal discharge can yield a false positive result.
- A more definitive test is the presence of ferning n an air-dried slide. The most definitive test is transabdominal instillation of indigocarmine dye. A tampon is then inserted into the vagina and later inspected for discoloration.)
Correct Answer. a
(226).
After the B-hCG titer becomes undetectable, the patient treated for hydatidiform mole should be followed with monthly titers for a period
of
a. 6 months
b. 1 year
c. 2 years
d. 5 years
Solution. (b) 1 year
Ref: Read the text below
Sol :
- Following evacuation, B-hCG titers are followed weekly and should be undetectable by 12-16 weeks. This will depend partly on the
initial peak level as well as renal blood flow and amount of residual trophoblastic tissue.
- The titer should be followed monthly for one year after hCG is undetectable and hence, it is imperative that the patient should use a
reliable form of birth control.
Correct Answer. a
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(227).
The following are related to internal rotation of the head
a. Rotation occurs mostly in the cervix
b. In majority rotation occurs in the pelvic floor.
c. Rotation occurs commonly after crowning of the head.
d. Rotation is earlier in primiparas than multiparas.
Solution. (b) In majority rotation occurs in the pelvic floor.
Ref.: Read the text below
Sol :
- Internal rotation of the head predominatly occurs on the pelvic floor and less commonly in the cervix.
- Rotation is earlier in multiparas than primiparas.
Correct Answer. b
(228).
The following are the blood values following delivery
a. Immediately following delivery, there is increase blood volume.
b. Cardiac output remains as in prelabour value soon following delivery
c. Fibrinogen level remains high up to 2nd week postpartum
d. There is leucopenia
Solution. (c) Fibrinogen level remains high up to 2nd week postpartum
Ref.: Read the text below
Sol :
- Immediately following delivery, there is slight decrease in blood volume and the cardiac output rises to about 60% above the prelabour
values.
- There is leucocytosis.
Correct Answer. c
(229).
Which of the following congenital anomalies occurs with rubella infection between 6-9 weeks gestation?
a. Cardiac anomaly
b. Deafness
c. Microcephaly
d. Blindness
Solution. (a) Cardiac anomaly
Ref– Read the text below
Sol:
- Rubella causes cardiac anomaly during this period of gestation.
Correct Answer. a
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(230).
Rupture of the uterus is least likely with which of the following ?
a. Syntocinon drip
b. Previous myomectomy scar
c. Utriculoplasty
d. Cornual implantation of the fallopian tube
Solution. (a) Syntocinon drip
Ref– Read the text below
Sol:
- Syntocinon causes through hyperstimulation but rarely reptures
- Utriculoplasty and corneal implantation scars rupture either during late pregnancy or during labour.
Correct Answer. a
(231).
A 19 years old primi para with 32 week of gestation with oligohydramnios management is:a. Bed rest, Lecithin, Tocolytics, Treating asymptomatic bacteriuria & nutritional supplement then review.
b. Plenty of oral fluids
c. Termination of pregnancy
d. Antibiotic prophylaxis & wait & watch
Solution. (a) Bed rest, Lecithin, Tocolytics, Treating asymptomatic bacteriuria & nutritional supplement then review.
Ref– Read the text below
Sol:
- Amniotic fluid is produced by fetus (Urine, Pulmonary fluid, Buccal gland secretion).
- If gestational age is less than 24 weeks - Termination of pregnancy.
- If gestational age > 24 weeks PROM should be ruled out, close observation with biophysical profile at regular interval & nutritional
support with treating PIH & UTI if preexisting.
Correct Answer. a
(232).
A woman starts bleeding in the second week following caesarean section. What is the likely cause ?
a. Dehiscence of the scar
b. Retained placental tissue
c. Choriocarcinoma
d. Puerperal infection
Solution. (a) Dehiscence of the scar
Ref– Read the text below
Sol:
- Dehiscence of the scar due to infection is most likely.
- Choriocarcinoma does not develop that soon,and it is not possible that placental tissue is retained during caesarean section, when the
uterine cavity can be visualized.
Correct Answer. a
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(233).
Lower segment caesarean (LSC) scar is likely to rupture if ultrasound scanning shows the scar thickness less than which of the
following?
a. 2 mm
b. 6mm
c. 8mm
d. 10mm
Solution. (a) 2 mm thick
Ref– Read the text below
Sol:
- Scar < 2mm is more likely to rupture.
Correct Answer. a
(234).
In the usual Cervicograph (by Philpot & Castle), the alert line begins at:
a. 3 cm cervical dilatation.
b. 2.5 cm cervical dilatation
c. 4 cm cervical dilatation
d. Full dilatation.
Solution. (c) 4 cm cervical dilatation.
Ref– Read the text below
Sol:
- Cervicograph is a component of Partogram, which graphically plots the dilatation of the cervix against duration of labor in hours.
- In the usual Cervicograph (by Philpot & Castle), the alert line begins at 4 cm
- In normal labor, the cervicograph should be either on the alert line or to the left of it.
- It is an excellent parameter for intrapartum monitoring.
Correct Answer. c
(235).
Most common cause of sudden death in myocardial infarction is?
a. Ventricular fibrillation
b. Atrial fibrillation
c. Cardiac rupture
d. Cardiac tamponade
Solution. Ans-(a) Ventricular fibrillation
Ref.: Read the text below
Sol :
- Most common cause of sudden death in myocardial infarction is arrthmia, mainly ventricular fibrillation.
- It occurs mainly in first few house of MI.
- The occurrence of Ventricular fibrillation can be reduced by prophylactic administration of intravenous lidocaine.
Correct Answer. a
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(236).
Classical liver lobule is present around :
a. Portal vein
b. Hepatic artery
c. Central vein
d. Bile duct
Solution. Ans-(c) Central vein
Ref.: Liver and Biliary tract : pg. 834
Sol :
- Central vein is present in the centre of hepatic lobule while the six portal triads will be present in the corners.
- Portal triad consists of portal vein, hepatic artery and bile duct; these portal triad will be seen in the corners of hepatic lobule.
Correct Answer. c
(237).
Metaplasia occurs in all of the following except :
a. Stem cells
b. Squamous cells
c. Columnar cells
d. Transitional cells
Solution. Ans- (a) Stem cells
Ref.: Cellular responses to stress and toxic insults; page 11; Robbins and cotran Pathologic Basis of Disease : 8th ed.
Sol :
-Metaplasia is the results of reprogramming of stem cells that are known to exist in normal tissues, or of undifferentiated mesenchymal
cells present in the connective tissue.
- Metaplasia is a reversible adaptive change in which one differentiated epithelial cell type is replaced by another epithelial cell type of
mature type.
- Example of columnar to Squamous Metaplasia : in chronic smokers, the normal ciliated columnar epitherlial cells of trachea and
bronchi are replaced by squamous cells.
- Example of Squamous to columnar Metaplasia; in Barrett esophagus, in which esophageal Squamous epithelium is replaced by
intestinal like columnar cells under the influence of refluxed gastric acid.
- Transitional /uro-epithelium can also undergo Squamous Metaplasia by chronic irritation like in urinary bladder stones.
Correct Answer. a
(238).
Reid index is useful in the diagnosis of :
a. Chronic bronchitis
b. Bronchial asthma
c. Bronchiectasis
d. Emphysema
Solution. Ans-: (a) Chronic bronchitis
Ref.: Robbins and Cotran Pathologic Basis of Disease : 8th ed.
Sol :
- The Reid Index is a mathematical relationship that exists in a human bronchus section observed under the microscope. It is defined as
ratio between the thickness of the submucosal mucus secreting glands and the thickness between the epithelium and cartilage that
covers the bronchi. The Reid index is not of diagnostic use in vivo since it requires a dissection of the airway tube, but it has value in post
mortem evaluations and for research
- A normal Reid Index should be smaller than 0.4, the thickness of the wall is always more than double the thickness of the glands it
contains. A greater value is the most pathognomonic indicator of chronic bronchitis.
- Hyperplasia and hypertrophy of mucous glands as in chronic bronchitis causes them to be present at deeper levels in the bronchial wall
and thicker in size, thus increasing the Reid Index beyond the normal value.
Correct Answer. a
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(239).
Which is not a feature of cerebellar disease?
a. Past pointing
b. Tremors at rest
c. Involuntary movements
d. Pendular knee jerk
Solution. Ans- (b) Tremors at rest
Ref.: Read the text below
Sol :
- In cerebellar disease, the tremors are intentional & not at rest.
Correct Answer. b
(240).
Which location of airway obstruction causes wheezing?
a. Trachea
b. Major bronchus
c. Respiratory bronchus
d. CNS dysfunction
Solution. Ans- (d) CNS dysfunction
Ref.: Read the text below
Sol :
- Wheeze is caused by obstruction of smaller and medium sized bronchi
- A wheeze (formally called ―sibilant rhonchi‖ in medical terminology) is a continuous, coarse, whistling sound produced in the
respiratory airways during breathing.
- For wheezes to occur, some part of the respiratory tree must be narrowed or obstructed, or airflow velocity within the respiratory tree
must be heightened
Correct Answer. c
(241).
Most common cause of hypertension is?
a. Reno vascular
b. Essential
c. Adrenal diseases
d. CNS dysfunction
Solution. Ans- (b) Essential
Ref.: Read the text below
Sol :
- Depending on methods of patient ascertainment, 80-95% of hypertensive patients are diagnosed as having ―essential‖ hypertension
(also referred to as primary or idiopathic hypertension).
- In the remaining 5-20% of hypertensive patients, a specific underlying disorder causing the elevation of blood pressure can be
identified.
Correct Answer. b
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(242).
This type of Kaposi sarcoma was predominantly found in South African children.
a. Classical type
b. Lymphadenopathic type
c. AIDS related type
d. Transplant associated type
Solution. Ans- (b) Lymphadenopathic type
Ref.: Blood vessels : pg. 523
Sol :
There are four types of KS :
- Classic KS (European KS) – not associated with HIV infection
- Lymphadenopathic type (Also known as African or Endemic KS) – not associated with HIV infection ; more common in African Bantu
children; skin lesions are sparse and usually presents with lymph node enlargement. It is most common with lymph node enlargement. It
is most common in Central Africa.
- AIDS related (epidemic) type : Associated with HIV infection; more common in male homosexuals.- Transplant associated type : due to
long term immunosuppression therapy.
Correct Answer. b
(243).
Amyloidosis deposition most commonly occurs in :
a. Renal vessels
b. Knee joints
c. Skin
d. Cornea
Solution. Ans- (a) Renal vessels
Ref.: Ch. 6 Disease of immune system - 254
Sol :
- Amyloid is abnormal pathological protein resulting from improper folding of proteins and deposited extracellularly as fibrils and disrupt
their normal function.
- The most common site of deposition is kidney, followed by, liver, spleen, lymph nodes, adrenals, thyroid, GIT, heart etc.
- In systemic amyloidosis, any organ can show deposition of Amyloid. Among all organs, kidneys are most commonly and most seriously
get affected by Amyloidosis.
Correct Answer. a
(244).
Regarding Cause of fatty liver, true statement about pathogenesis is:
a. Decreased beta oxidation of fat
b. Decreased triglycerides
c. Decreased fatty acid mobilization
d. Increased catabolism
Solution. Ans- (a) Decreased beta oxidation of fat
Ref.: Cell injury- 34
Sol :
- There are various mechanism of triglycerides accumulation in the liver; defect in any step of fat metabolism can cause this; like defect
in uptake, catabolism, secretion can result in lipid accumulation.
- The free fatty acids are esterified in the liver to form triglycerides. Then the triglycerides will be either converted to
cholesterol/phospholipids or oxidized to ketone bodies.
- Excess accumulation off triglycerides within the liver may result from excessive entry or defective metabolism and export of lipids.
Correct Answer. a
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(245).
Patient presented within chest pain to emergency room and dies within 12 hours of arrival. After 5 days, autopsy shows necrosis in
Myocardium. What is the type of necrosis?
a. Coagulative
b. Fibrinoid
c. Caseous
d. Liquefactive
Solution. Ans- (a) Coagulative necrosis
Ref.: Robbins and cotran pathologic Basis of Disease : 8th ed.
Sol :
- Organs with end arterial blood supply will show usually coagulative type of necrosis; solid organs like heart will always show
coagulative necrosis.
- Caseous necrosis is usually seen in tuberculosis and shows associated granulomatous inflammation.
- Liquefactive necrosis is usually seen in brain parenchyma.
- Fibrinoid necrosis is special form of necrosis seen in immune complex mediated destruction of blood vessels like in various types of
vasculitis.
Correct Answer. a
(246).
Which of the following is not a part of metabolic syndrome?
a. Central obesity
b. Hypertriglyceridemia
c. Hypertension
d. Myocardial infarction
Solution. Ans-(d) Myocardial infarction
Ref.: Read the text below
Sol :
- The metabolic syndrome (syndrome X, insulin resistance syndrome) consists of a constellation of metabolic abnormalities that confer
increased risk of cardiovascular disease (CVD) and diabetes mellitus (DM).
- The criteria for the metabolic syndrome have evolved since the original definition by the World Health Organization in 1998, reflecting
growing clinical evidence and analysis by a variety of consensus conferences and professional organizations.
- The major features of the metabolic syndrome include central obesity, hypertriglyceridemia, low HDL cholesterol, hyperglycemia, and
hypertension.
Correct Answer. d
(247).
Most common cause of acute tubular necrosis is?
a. Snake Bite
b. Diuretics
c. Hypovolumia
d. None
Solution. Ans- (c) Hypovolumia
Ref.: Read the text below
Sol :
- Acute tubular necrosis is the most common cause of acute renal failure.
- Acute tubular necrosis is most commonly precipitated by renal ischemia or exposure to nephrotoxic substances, including radiographic
contrast agents.
Correct Answer. c
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102/126
(248).
True about orthostatic proteinuria is?
a. Seen with orthostatic hypotension
b. Benign condition
c. Is medical emergency
d. Is seen in nephritic syndrome
Solution. Ans- (b) Benign condition
Ref.: Read the text below
Sol :
ORTHOSTATIC PROTEINURIA :
- Benign condition.
- Seen in young males
-- Characterized by increased protein in urine in morning or after recumbency
- There is no associated RBC or cast in urine.
- No anomaly in the Kidneys.
Correct Answer. b
(249).
Uncompensated metabolic alkalosis is characterized by?
a. Increased PH, Increased HCO3, Normal CO2
b. Decreased pH, Decreased HCO3, Decreased CO2
c. Decreased pH, Increased HCO3, Decreased CO2
d. Increased pH, Increased HCO3, Increased CO2
Solution. Ans-(a) Increased PH, Increased HCO3, Normal CO2
Ref.: Read the text below
Sol :
- In metabolic alkalosis the compensation is provided by hypoventilation, so that CO2 retention can occur and acid is built up in the body,
hence the patient has increased pCO2.
- However in uncompensated metabolic alkalosis, since the body is unable to compensate the CO2 remains normal or low, the pH is high
and HCO3 is high.
Correct Answer. a
(250).
Dietary fibers decrease serum cholesterol by?
a. Interfering with absorption
b. Interfering in metabolism
c. By decreasing craving
d. By decreasing appetite
Solution. Ans- (a) Interfering with absorption
Ref.: Read the text below
Sol :
- Plant stanol and sterol esters are available in a variety of foods such as spread, salad dressings, and snack bars.
- Plant sterol and sterol interfere with cholesterol absorption and reduce plasma LDL-C levels by – 10% when taken three times per day
Correct Answer. a
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103/126
(251).
Which of the following mimics space occupying lesion in brain?
a. Cerebral Abscess
b. Meningitis
c. Orbital abscess
d. Cavernous sinus thrombosis
Solution. Ans- (a) Cerebral Abscess
Ref.: Read the text below
Sol :
- Cerebral abscess, although an inflammatory process, presents as space occupying lesion with increase ICT.
- Cavernous sinus thrombosis does not present as space occupying lesion.
Correct Answer. a
(252).
Migratory thrombophlebitis is seen in all except :
a. Ca pancreas
b. Ca prostrate
c. Ca lung
d. Ca breast
Solution. Ans-(d) Ca breast
Ref.: Chapter - Neoplasia
Sol :
- Migratory thrombophlebitis or Trousseau syndrome is seen in any tumor associated with systemic hypercoagulability due to production
of procoagulant substances like mucin. Hence, any of the mucin secreting adenocarcinomas can show this syndrome.
- It is very commonly seen with Pancreatic adeno-carcinomas; but can be also seen with bronchogenic carcinoma as a paraneoplastic
syndrome.
- It is rarely seen with gastric and prostatic carcinoma.
- In breast, mucinous adenocarcioma is very rare. Hence, ca breast is the nearest answer.
Correct Answer. d
(253).
Infection associated with Atherosclerosis is?
a. Chlymadia trachomatis
b. Chlymadia pneumonae
c. Chlymadia psittaci
d. Dhlymadia gingivalis
Solution. Ans-(b) Chlymadia pneumonae
Ref.: Read the text below
Sol :
- Epidemiologic studies have demonstrated an association between serologic evidence of C. pneumonia infection and atherosclerotic
disease of the coronary and other arteries.
Correct Answer. b
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(254).
Physiological murmur is associated with all except :
a. Only diastolic murmur
b. Midsystolic murmur
c. Position dependent
d. Not audible without stethoscope
Solution. Ans- (a) Only diastolic murmur
Ref.: Read the text below
Sol :
- A functional murmur (innocent murmur, physiologic murmur) is a heart murmur that is primarily due to physiologic conditions outside
the heart, as opposed to structural defects in the heart itself.
Correct Answer. a
(255).
Anemia in chronic renal failure is due to?
a. Iron deficiency
b. Anemia of chronic disease
c. Vitamin B12 deficiency
d. Erythropoietin deficiency
Solution. Ans-(d) Erythropoietin deficiency
Ref.: Read the text below
Sol :
- A normocytic, normochromic anemia is observed as early as stage 3 CKD and is almost universal by stage 4.
- The primary cause in patients with CKD is insufficient production of erythropoietin (EPO) by the diseased kidneys.
Correct Answer. d
(256).
Most common cause of refractory hypertension is?
a. Noncompliance of patient
b. Obstructive sleep apnea
c. Pheochromocytoma
d. Renovascular disease
Solution. Ans- (b) Obstructive sleep apnea
Ref.: Read the text below
Sol :
- The most common secondary causes of resistant hypertension are obstructive sleep apnea, hyperaldosteronism, renal parenchymal
disease and renal artery stenosis.
- Renovascular hypertension may cause resistant hypertension but is less common than sleep apnea.
- Hyperaldosteronism has been fond in as many as 20 percent of patients with resistant hypertension.
Correct Answer. a
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(257).
Which of the following is a Sino atrial disease?
a. Atrial ectopic
b. Ventricular ectopic
c. Sinus arrest
d. All of the above
Solution. Ans- (c) Sinus arrest
Ref.: Read the text below
Sol :
- SA node dysfunction may be completely asymptomatic and manifest as an ECG anomaly such as sinus bradycardia; sinus arrest and exit
block; alternating supraventricular tachycardia, usually atrial fibrillation, and bradycardia.
Correct Answer. c
(258).
Loud P2 is found in ?
a. Pulmonary HTN
b. MS
c. MR
d. Aotic incompetence
Solution. Ans- (a) Pulmonary HTN
Ref.: Read the text below
Sol :
Loud P2
- Pulmonary hypertension unless proved otherwise
- Eisenmenger‘s syndrome due to ASD, VSD, PDA
- Multiple pulmonary thrombi
Correct Answer. a
(259).
Fainting attacks common in which conditions?
a. Aortic regurgitation
b. Aortic stenosis
c. Mitral regurgitation
d. Mitral stenosis
Solution. Ans-(b) Aortic stenosis
Ref.: Read the text below
Sol :
- Exertional dyspnea, angina pectoris, and syncope are the three cardinal symptoms of aortic stenosis.
- AS is rarely of clinical importance until the valve orifice has narrowed to approximately 1 cm2.
Correct Answer. b
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(260).
In PNDT act 1994, PNDT stands for?
a. Postnatal diagnostic techniques
b. Prenatal diagnostic techniques
c. Prenatal diagnostic tests
d. Postnatal diagnostic tests
Solution. Ans-: (b) Prenatal diagnostic techniques
Ref: Read the text below
Sol :
• The Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994, was enacted and brought into operation from 1st
January, 1996, in order to check female foeticide.
• Rules have also been framed under the Act. The Act prohibits determination and disclosure of the sex of foetus .
• It also prohibits any advertisements relating to pre-natal determination of sex and prescribes punishment for its contravention.
• The person who contravenes the provisions of this Act is punishable with imprisonment and fine.
Correct Answer. b
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(261).
Given 'Logo‘ is related with ?
a. Fight against malnutrition
b. I.A.P.S.M
c. NRHM
d. No Death By Snake Bite.
Solution. Ans : (b) I.A.P.S.M
Ref– Read the text below
Sol:
The Indian Association of Preventive and Social Medicine, founded in 1974, is a "not for profit" professional organization of specialists in
Epidemiology, Health Management, Health Promotion, and Family Medicine, which is dedicated to the promotion of public health by
bringing its members' expertise to the development of public health policies, an advocate for education, research, and programs of
Community Medicine and providing a forum for the regular exchange of views & information.
Objectives of IAPSM
With the realization of the immense value of the science and art of Preventive and Social Medicine for Medical Students, Researchers,
Practitioners, Public and State and in view of the fact that Preventive and Social Medicine forms the basis for the practice of all clinical
specialties, the following are the aims of the society:
1. To improve the teaching standards of Preventive and Social Medicine at all levels.
2. To promote research in the specialty of Preventive and Social Medicine, and the effective application of the knowledge acquired in
teaching, training, research and services.
3. To facilitate co–ordination amongst the Departments of Preventive and Social Medicine and other departments, medical colleges /
institutions and health agencies / organization.
4. To develop co-operation in teaching, training, research and service between the Departments of Preventive and Social Medicine of
various medical colleges / institutions in the country.
5. To facilitate co-ordination amongst the departments of Preventive and Social Medicine in colleges / institutions and health agencies /
organizations.
6. To promote welfare of the teachers of the Preventive and Social Medicine.
7. To publish a journal which will be furtherance of these aims and will be the official organ of the society.
Correct Answer. b
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(262).
Risk modification in CAD is?
a. Primordial prevention
b. Primary prevention
c. Secondary prevention
d. Tertiary prevention
Solution. Ans-: (b) Primary prevention
Ref: Read the text below
Sol :
• Risk factor modification early in life will contribute to primary prevention of CAD
Before emergence of risk
factors
Before disease onset
After disease onset
Ongoing disability
Disability
Primordial prevention
Primary prevention
Secondary prevention
Tertiary prevention
Tertiary prevention
Early diagnosis and
treatment
Disability limitation
Rehabilitation
Health promotion specific
Individual & mass education protection, lifestyle & risk
modification
Correct Answer. b
(263).
The premium of "Community Based Health Insurance scheme" launched during 2003-04 ranges from:
a. 1 per day per year for an individual
b. 2 per day per year for an individual
c. Rs. 1 per day per year for a family of upto seven members
d. Rs. 1.5 per day per year for a family of upto seven members
Solution. Ans-: (a) 1 per day per year for an individual
Ref: Read the text below
Sol :
The scheme comes in three different flavours:
(i) Re 1 per day per year for an individual
ii) Rs. 1.5 per day per year for a family of up to five members, and
(iii) Rs. 2 per day per year for a family of upto seven members. Given this, the bias
towards family enrolment, as opposed to individual enrolment, is obvious
Correct Answer. a
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(264).
Global warming true is
a. CO2 is the major greenhouse gas
b. Stratosphere ozone layer is harmful
c. CFC increases stratosphere ozone layer
d. Kyoto protocol called for 20%reduction in greenhouse effect
Solution. Ans-: (a) CO2 is the major greenhouse gas
Ref: Read the text below
Sol :
Kyoto protocol:
Article 3 states that the Parties included in Annex I shall, individually or jointly, ensure that their aggregate anthropogenic carbon
dioxide equivalent emissions of the greenhouse gases listed in Annex A do not exceed their assigned amounts, calculated pursuant to
their quantified emission limitation and reduction commitments inscribed in Annex B and in accordance with the provisions of this
Article, with a view to reducing their overall emissions of such gases by at least 5 per cent below 1990 levels in the commitment period
2008 to 2012.
Greenhouse gases :
Carbon dioxide (C02)
Methane (CH4)
Nitrous oxide (N20)
Hydrofluorocarbons (HFCs)
Perfluorocarbons (PFCs)
Sulphur hexafluoride (SF6)
Correct Answer. a
(265).
Caloric value of 100 ml of human milk (K Cal) :
a. 67
b. 65
c. 100
d. 80
Solution. Ans- : (b) 65
Ref: Read the text below
Sol :
1.
2.
3.
4.
5.
6.
7.
8.
9.
Fat (g)
Protein (g)
Lactose (g)
Calcium (mg)
Iron (mg)
Vit-C (mg)
Minerals (g)
Water (g)
Energy (kcal)
Cow
Human
4.1
3.2
4.4
120
0.2
2
0.8
87.
67
3.4
1.1
7.4
28
3
0.1
8
65
Correct Answer. b
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110/126
(266).
Current Couple Protection Rate (CPR) in India :
a. 40
b. 50
c. 60
d. 38
Solution. Ans-: (a) 40
Ref: Read the text below
Sol :
Correct Answer. a
(267).
Village health guide scheme was started in :
a. 1974
b. 1977
c. 1986
d. 1989
Solution. Ans-: (b) 1977
Ref: Read the text below
Sol :
• The Village Health Guide scheme was launched on OCtober 2, 1977( under the Rural Health Scheme1977) by the Govt. of India, based
on the principle of "placing people's health in people's hands".
• It is a three- tier system of health carebased on the recommendationof the Shrivatsav Committee in 1975
Correct Answer. b
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(268).
True regarding secular trends :
a. Changes in disease pattern in terms of months
b. Changes in disease pattern seasonally
c. Changes in disease pattern over a short period of time
d. Changes in disease pattern over a long period of time
Solution. Ans-: (d) Changes in disease pattern over a long period of time
Ref: Read the text below
Sol :
• The tern “secular trend” implies changes in the occurrence of disease (i.e. a progressive increase or decrease) over a long period of
time, generally several years or decades.
• Although it may have short-term fluctuations imposed on it, a secular trend implies a consistent tendency to change in a particular
direction or a definite movement in one direction.
• Examples include coronary heart disease, lung cancer and diabetes which have shown a consistent upward trend in the developed
countries during the past 50 years of so, followed by a decline of such diseases as tuberculosis, typhoid fever, diphtheria and polio.
Correct Answer. d
(269).
True about "ROM therapy" is :
a. For single lesion
b. Minocycline is used
c. Single dose is given
d. All the above
Solution. Ans-: (d) All the above
Ref: Read the text below
Sol :
Single-lesioon paucibacillary leprosy
• For patients of single – lesion paucibacillary leprosy one single dose of a combination of 600 mg of rifampicin, 400 mg of ofloxacin and
100 mg of minocycline (ROM) is used.
The treatment duration varies according to the type of disease. The recommendations are as follows :
• Multibacillary leprosy– MB blisterpack for 12 months.
• Paucibacillary leprosy– PB blister packs for 6 months.
• Single skin lesion – ROM for single dose.
Correct Answer. d
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(270).
Seasonal trend is due to:
a. Vector variation
b. Environmental factors
c. Change inn herd immunity
d. All of the above.
Solution. Ans-: (d) All of the above.
Ref: Read the text below
Sol :
Periodic Fluctuation / Trends
Seasonal
Cyclic
Secular
Seen in most
Communicable ds
- Measles
- Varicella
- Hay fever
- Gastroenteritis
Related to environmental (vector-dynamics)
Cycles spreads over short period of time
- Measles (2-3 yrly) in
- Rubella (6-9 yrly) pre vaccine era
- Influenza pandemic
Occurs d/t naturally occurring variations in
level of herd immunity
- Coronary HD
- Lung cancer
- T.B.
- Polio
- Typhoid
- DM
- Diphtheria
Changes in the occurrence of ds over a
long period
Correct Answer. b
(271).
Calculate the Ponderal index of a baby of weight 2000gm and length 50 cm at Birth.
a. 1.6
b. 2.2
c. 2.6
d. 1.0
Solution. Ans-: (a) 1.6
Ref: Read the text below
Sol :
Ponderal index= Height/3√ Weight, where Weight is in pounds and height is in Inches
Or
Ponderal index= Weight×100/height3 , where Weight is in grams and height is in cm
= 2000×100/125000
=1.6
Correct Answer. a
(272).
All the following diseases are spread by hard Ticks except
a. Relapsing fever
b. KFD
c. Tularemia
d. Indian tick typhus
Solution. Ans-: (a) Relapsing fever
Ref: Read the text below
Sol :
Hard tick
Tick typhus, viral encephalitis, viral fevers, Kyasanur forest
Disease, tuleremia, tick paralysis, human babesiosis
Soft tick
Q – fever, relapsing fever
Correct Answer. a
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(273).
In a study of 200 smokers & 600 non smokers were followed up over a period of 10 years to find out incidence of hypertension. Out of
200 smokers, 60 developed hypertension, as compared to 600 non smokers, of which 30 developed hypertension. The risk ratio of the
studya. 3
b. 30
c. 1/3
d. 6
Solution. Ans-: (d) 6
Ref: Read the text below
Sol :
RELATIVE RISKstates by how many times exposure to any specific risk factors increases risk of contracting the disease.
Estimated in a cohort study
RR = Incidence in Exposed
(also termed as Risk Ratio)
Incidence in UN Exposed
- It is direct measure of the Strength of association between the suspected cause and effect.
If RR=1 No association
If RR>1 +ve Association
If RR<1 –ve association
Incidence in exposed: 60/200×1000
Incidence in non exposed: 30/600×1000
RR=6
Correct Answer. d
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(274).
ESI act is not applicable for
a. Educational institutions
b. Power working factory employing 10 people or more
c. Non power working factory employing 20 people or more
d. Newspaper establishments
Solution. Ans-: (a) Educational institutions
Ref: Read the text below
Sol :
THE EMPLOYEES STATE INSURANCE ACT, 1948 (amended in 1975, 1984 and1989)
·
This act extends to all over India.
·
With effect from 1-10-10, this act covers all employees – manual, clerical, supervisory and technical, getting upto Rs 15,000/- per
month. It can be extended to any agricultural or commercial establishment.
·
Using power 10 or more persons
·
Non power using factories 20 or more persons
·
Administration: Autonomous
·
Finance: Employer-4.75% of wage bill, employee: 1.75% of wage bill, State and Center share 1:7 ( Total medical Expenditure).
BENEFITS TO EMPLOYEES
The act has made provision for the following benefits to insured persons or their dependants
·
Medical benefit– Full medical care, also includes – dentures, spectacles, hearing aids, artificial limbs for employment related
injuries.
·
Sickness benefit – 50% of avg daily wages, cassh payment for sickness for a maximum period of 91 days.
·
Maternity benefit – Full wage payment for confinement/pregnancy (duration of benefit is 12 weeks), miscarriage (duration of
benefit is 6 weeks), and sickness arising out of confinement (duration of benefit is 30 days)
·
Disablement benefit – Cash payment and medical treatment for temporary/permanent disability. Rate of payment for temporary
disability is 85% of wage for the duration of disability. For permanent disability – full pension given for lifetime.
·
Dependents benefit - In case of death dependants are eligible for periodical payments.(70% of wages)
·
Extra benefits– these include
- Extended sickness benefit: payable for 2 years, for a set of 34 diseases.
- Enhanced sickness benefit: Full avg daily wage for a duration of 7 days in case of Vasectomy and 14 days in case of Tubectomy
- Artificial limbs, dentures and family planning etc
- Family medical care
- Protection against dismissal or discharge from service, during the period of sickness
- Funeral expenses – not more than 5000/- Rehabilitation allowance
- Retirement benefits
Correct Answer. a
(275).
Penicillin injection is recommended every 3 weeks for diagnosed cases of rheumatic heart disease. This is an example of :
a. Health promotion
b. Specific protection
c. Early diagnosis and treatment
d. Disability limitation
Solution. Ans-: (d) Disability limitation
Ref.:Read the text below
Sol :
• Primary prevention: “Aim of primary prevention is to prevent the first attack of rheumatic fever, by identifying all patients with
streptococcal throat infection and treating them with penicillin.”
• Secondary prevention of rheumatic fever :“Secondary prevention is more practiced approach, especially in developing countries. It
consists in identifying those who have had RF and giving them one intramuscular injection of benzathine benzyl penicillin (1.2 million
units in adults and 600,000 units in children) at intervals of 3 weeks. This must be continued for at least 5 years or unit the child reaches
18 years which ever is later.”
• At first look it appears that the answer must be secondary prevention (or early diagnosis and treatment), however if we look into the
question carefully, it is not about rheumatic fever but rheumatic heart disease so there is no point of secondary prevention.
Correct Answer. d
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(276).
A five-year follow up study was done to determine, whether or not smokers, who had previous heart attacks, were at a risk of dying after
5 years, if they continued smoking or quit smoking. For this purpose a cohort of 156 patients of ischemic heart disease was taken. All of
them were smokers till they experienced heart attack 75 patients continued smoking after heart attack and 81 patients quit smoking. Out
of those who continued smoking 27 died and out of those who quit smoking 14 died. What is the risk ratio amongst those who continued
smoking and those who quit smoking Heart Attack Patients
Status after 5 years
Continued smoking
Quit smoking
Total
Died
27
14
41
Survived
48
67
115
Total
75
81
156
a. 0.17
b. 1.1
c. 2.1
d. 3.1
Solution. Ans-: (c) 2.1
Ref.:Read the text below
Sol :
Relative risk/Risk ratio = Incidence among exposed/Incidence among non-exposed
• = (27/75)/(14/81)
• = 2.082 or 2.1)
Correct Answer. c
(277).
The human genome project is an intervention which can be termed as an example of what type of prevention?
a. Primordial
b. Primary
c. Secondary
d. Tertiary
Solution. Ans-: (a) Primordial
Ref.:Read the text below
Sol :
• The Human Genome Project (HGP) is an international scientific researchproject with a primary goal of determining the sequence of
chemical base pairs which make up DNA, and of identifying and mapping the approximately 20,000–25,000 genesof the human
genomefrom both a physical and functional standpoint
• Potential benefits of sequencing the humangenome expand to many fields from molecular medicine to a better understanding of human
evolution.
• The Human Genome Project through its sequencing of the DNA can help us understand diseases including genotyping of specific
viruses to direct appropriate treatment; identification of oncogenes and mutations linked to different forms of cancer; designing
medications and predicting its response better; advancement in forensic applied sciences; biofuels and other energy applications;
agriculture, livestock breeding, bioprocessing; risk assessment; bioarcheology, anthropology, evolution.
• Another proposed benefit is the commercial development of genomics research related to DNA based products, a multibillion dollar
industry
Correct Answer. a
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(278).
"Incidence" is defined as :
a. Number of new cases occurring in a defined population
b. Total cases (new + old) occurring in a defined population
c. Number of exposed developing the disease in a defined population
d. None of the above
Solution. Ans-: (a) Number of new cases occurring in a defined population
Ref: Read the text below
Sol :
• Incidence rate is defined as “the number of new case occurringin a defined population during a specified period of time”. It is given by
the formula :
x 100
Number of new cases of specific disease during a given time period
Population at risk during that period
• Secondary attack rateis defined as the number of exposed persons developing the disease within the range of the incubation period
following exposure to a primary case.
• The term “disease prevalence” refers specifically to all current cases (old and new) existing at a given point in time, or over a period of
time in a given population.
Correct Answer. a
(279).
HFA is defined as :
a. Essential healthcare made accessible to individuals and acceptable to them
b. Health for all by 2000 AD
c. Attainment of a level of health that will enable very individual to lead a socially and economically productive life
d. Adequate preventive, promotive and curative health services
Solution. Ans-: (c) Attainment of a level of health that will enable very individual to lead a socially and economically productive life
Ref: Read the text below
Sol :
• The fundamental principle of HFA strategy is equity, that is, an equal health status for people and countries, resources. The member
countries of WHO at the 30th World Health Assembly defined Health for all as : “Attainment of a level of health that will enable every
individual to lead a socially and economically productive life.
Correct Answer. c
(280).
Band shaped keratopathy is associated with
a. Amiodarone
b. Hyperparathyroidism
c. Amyloidosis
d. Hypothyroidism
Solution. Ans-: (b) Hyperparathyroidism
Ref: Parsons Disease of the Eye, 20th ed, Page-201
Sol :
• It occurs due to the deposition of hyaline infiltration of superficial parts of stroma followed by deposition of calcareous salts.
• A whitish band appears in the interpalpebral area commencing at the inner and outer sides, progressing until it forms a continuous
band across the cornea, interspersed with round holes or cleaves within the band itself.
• It occurs in :
- Chronic uveitis especially in blind shrunken eyes and Still’s disease.
- Aphakic eyes following vitrectomy with silicone oil.
- Hyperparathyroidism
- Vitamin D toxicity
Sarcoidosis
Correct Answer. b
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(281).
Laser iridotomy is indicated forOpen angle glaucoma
a. Open angle glaucoma
b. Closed angle glaucoma
c. Congenital glaucoma
d. Neovascular glaucoma
Solution. Ans-: (b) Closed angle glaucoma
Ref: Kanski 22
Sol :
• PACG is a conditionin which the peripheral iris moves forwards to block the openings of trabecular meshwork at the angle causing a
rise of intraocular pressure.
• Treatment of choice : Nd YAG laser iridotomy-It has been advocated as initial treatment but may be difficult until the corneal
thickening and iris congestion have settled (usually 48 hrs.)
Correct Answer. b
(282).
Treatment for absolute glaucoma is:
a. Acetazolamide
b. Trabeculectomy
c. Timolol
d. Cyclocryotherapy
Solution. Ans-: (d) Cyclocryotherapy
Ref: Indian Journal of Ophthalmology.
Sol :
Absolute glaucoma
Absolute glaucoma is the end stage of all types of glaucoma. The eye has no vision, absence of pupillary light reflex and pupillary
response, and has a stony appearance. Severe pain is present in the eye. The treatment of absolute glaucoma is a destructive procedure
like cyclocryoapplication, cyclophotocoagulation, or injection of 100% alcohol.
Correct Answer. d
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(283).
Iridodialysis is :
a. Full thickness hole in iris
b. Separation of the sphincter papillae and dilator pupil muscle
c. Tear in the root of the iris; separating the iris from the ciliary body
d. Tear at the papillary border of iris
Solution. Ans-: (c) Tear in the root of the iris; separating the iris from the ciliary body
Ref: Read the text below
Sol :
• Iridodialysis, sometimes known as a coredialysis, is a localized separation or tearing awayof the irisfrom its attachment to the ciliary
body.
• Iridodialyses are usually caused by blunt traumato the eye, but may also be caused by penetrating eye injuries.
• An iridodialysis may be an iatrogeniccomplication of any intraocular surgeryand at one time they were created intentionally as part of
intracapsular cataract extraction. Iridodialyses have been reported to have occurred from boxing, airbagdeployments,high-pressure
water jets, elastic bungee cords, bottle capsopened under pressure, water balloons, fireworks, and various types of balls
Correct Answer. c
(284).
Early features of OAG include all the following except :
a. Mild headache
b. Acute onset
c. Frequent change of presbyopic glasses
d. Blurred vision
Solution. Ans-: (b) Acute onset
Ref: Read the text below
Sol :
• Because OAG has an insidious onset, patient is generallyasymptomatic; until there is marked loss of vision.
Correct Answer. b
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(285).
Most sensitive test for colour defect detection is :a. Ishihara's test
b. Farnsworth-Munsell 100 hue test
c. Fransworth D15
d. Hardy-Rand-Ritter
Solution.
Ans-: (b) Farnsworth-Munsell 100 hue test
Ref: Read the text below
Sol :
·
Ishihara test is used to screen for congenital proton and deuteran defects.
·
Hardy-Rand-Ritter is similar to ishihara but detect all 3 congenital defects. Fransworth D15 is similar to FM100 hue but utilizes
only 15 caps.
Correct Answer. b
(286).
Ramesh 3-year male child is brought with deterioration of vision and deviation of eye. A diagnosis of retinoschisis is made. All of the
following are features consistent with congenital retinoschisis except a. Degenerative etiology
b. Cartwheel maculopathy
c. Vitreous haemorrhage
d. Slow progression
Solution. Ans-: (a) Degenerative etiology
Ref: Read the text below
Sol :
Congenital retinoschisis not degenerative pathology. Unlike acquired retinoschisis, it has X linked inheritance. Its differentiated from
Acq. Retinoschisis by -
- In retinoschisis no treatment is indicated, except in cases of progressive symptomatic retinal detachment.
- When this accompanied by rhegmatogenous retinal detachment, scleral buckling with encirclement done.
Correct Answer. a
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(287).
A 20 years male complained of slight blurring of vision of gradual onset. His visual acuity was 6/18 (BE) on Snellens. On retinoscopic
examination his readings are +6.0 and +4.0 for vertical and horizontal meridians respectively (same for both eyes). His type of refractive
error is a. Hypermetropia
b. Simple hypermetropic astigmatism
c. Mixed astigmatism
d. Compound hypermetropic astigmatism
Solution. Ans-: (d) Compound hypermetropic astigmatism
Ref: Read the text below
Sol :
·
This corresponds to the first figure of strum conoid, where rays of light from more curved vertical meridians have converged more
than that of horizontal meridian, which have diopteric readings of +6 (more convergence) than +4 which is still in less convergence.
·
As at both meridians readings are of convergence, but differ in numerical value, it's compound hypermetropic astigmation.
Correct Answer. d
(288).
Mydriatic which is not a cycloplegic is
a. Cyclopentolate
b. Phenylephrine
c. Atropine
d. Homatropine
Solution. Ans-: (b) Phenylephrine
Ref: Parson’s Diseases of the Eye, 20th ed, Page-147
Sol :
• Phenylephrine is a mydriatic which causes no cycloplegia
• Quickest and briefest action : Tropicamide
• Most potent and longest duration : 1% Atropine ointment
Used in children : 1% atropine ointment
Correct Answer. b
(289).
Ligament of Weigart is
a. Attachment of the vitreous body to the posterior capsule of lens
b. Attachment to the superior oblique tendon
c. Medial palpebral ligament
d. Lateral palpebral ligament
Solution. Ans-: (a) Attachment of the vitreous body to the posterior capsule of lens
Ref: By Thomas H. Williamson Vitreoretinal Surgery, Page-2
Sol :
• Weiger’s ligament is a circular zone 8-9 mm in diameter between the vitreous gel and the posterior lens capsule.
• It is the junction between anterior hyaloids membrane and the expanded anterior portion of the Cloquet’s canal.
• Posterior lens capsule. It is the junction between anterior hyaloids membrane and the expanded anterior portion of the Cloquet’s canal.
Correct Answer. a
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(290).
About meniere‘s disease all are true except
a. Endolymphatic sac is normal
b. Deafness, vertigo, vomiting and tinnitus are present
c. Tympanic membrane is normal
d. None of these
Solution. Ans- (a) Endolymphatic sac is normal
Ref: Dhingra -99
Sol :
- Meniere‘s disease, also called endolymphatic hydrops is a disorder of the inner ear where the endolymphatic system is distended. It is
characterized by vertigo, sensorineural hearing loss, tinnitus and aural fullness.
- Variants of Meneire‘s disease : Cochlear hydrops, vestibular hydrops, drop attacks (Tumarkin‘s otolithic crisis), Lermoyoyez syndrome
(Symptoms of Meniere‘s disease are in reverse order)
Correct Answer. a
(291).
MC sinus infection in neonates is
a. Ethmoid
b. Maxillary
c. Frontal
d. Sphenoid
Solution. Ans- (a) Ethmoid
Ref: Dhingra -183
Sol :
- Acute ethmoiditis is often associated with the infection of other sinues.
- Ethmoid sinuses are more often involved in infants and young children.
Correct Answer. a
(292).
Which one of the following sinus doesn‘t open into the middle meatus
a. Sphenoid
b. Frontal
c. Ethmoidal
d. Maxillary
Solution. Ans- (a) Sphenoid
Ref: Dhingra, -178, 179
Sol :
- Ostium of the maxillary sinus opens in the posterior part of ethmoidal infundibulum into the middle meatus.
Correct Answer. a
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(293).
Nystagmus can be induced by all except
a. Caloric test
b. Patch test
c. Optokinetic test
d. Rotatory chair test
Solution. Ans- (b) Patch test
Ref: Cummings Chapter 140
Sol :
- A patch test is an method used to determine if a specific substance causes inflammation of the skin. It is often used to test for allergens.
- Any individual with suspected allergic contact dermatitis and/or atopic dermatitis needs patch testing.
Correct Answer. b
(294).
About nasopharngeal carcinoma false is
a. MC histology is adenocarcinoma
b. Associated with EBV
c. Presents with mass, deafness and epistaxis
d. Radiotherapy is treatment of choice
Solution. Ans- (a) MC histology is adenocarcinoma
Ref: Dhingra-232
Sol :
Nasopharyngeal carcinoma (NPC) is the most common cancer originating in the nasopharynx, the uppermost region of the pharynx
("throat"), behind the nose where the nasal passages and auditory tubes join the remainder of the upper respiratory tract.
Nasopharyngeal carcinoma, commonly known as nasopharyngeal cancer, is classified as a malignant neoplasm, or cancer, arising from
the mucosal epithelium of the nasopharynx, most
often within the lateral nasopharyngeal recess or fossa of Rosenmüller (the space behind the nose). The World Health Organization
Classifies Nasopharyngeal Carcnioma in three types. Type 1 (I) is squamous cell carcinoma. Type 2a (II) is keratinizing undifferentiated
carcinoma. Type 2b (III) is nonkeratinizing undifferentiated carcinoma
Cervical lymphadenopathy (disease or swelling of the lymph nodes in the neck) is the initial presentation in many patients, and the
diagnosis of NPC is often made by lymph node biopsy. Symptoms related to the primary tumor include trismus, pain, otitis media, nasal
regurgitation due to paresis (loss of or impaired movement) of the soft palate, hearing loss and cranial nerve palsies (paralysis). Larger
growths may produce nasal obstruction or bleeding and a "nasal twang". Metastatic spread may result in bone pain or organ dysfunction.
Rarely, a paraneoplastic syndrome of osteoarthropathy (diseases of joints and bones) may occur with widespread disease.
EBV (Epstein-Barr virus) NPC is the most common epithelial cancer in adults. The detection of nuclear antigen associated with EpsteinBarr virus (EBNA) and viral DNA in NPC type 2 and 3, has revealed that EBV can infect epithelial cells and is associated with their
transformation.
Surgery. Due to the anatomical position of NPC and its tendency to present with cervical lymph node metastases, it is not amenable to
surgery for local control. Biopsy of the involved lymph node is the usual surgical procedure. The nasopharyngeal primary tumor is rarely
biopsied.
Correct Answer. a
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(295).
Radiological sign of acute laryngotracheobronchitis is
a. Thumb sign
b. Steeple sign
c. Rising sign
d. Vallecula sign
Solution. Ans- (b) Steeple sign
Ref: Read the text below
Sol :
A. Signs and Symptoms. Most children have hoarseness of voice and a brassy cough with an associated inspiratory or even an expiratory
stridor. Fever, rhinorrhea, sore throat, and cough usually precede this. Symptoms may vary in intensity and last ~ 3-4 d if mild. Patients
appear apprehensive and tend to lean forward. The child may have tachypnea and might be using accessory respiratory muscles.
Inspiratory or expiratory stridor is prominent. Pulmonary examination may reveal rhonchi, crepitations, or wheezing. Breath sounds may
be diminished if upper airway obstruction is severe and air entry is greatly decreased. B. Laboratory Findings. The white blood cell count
may be normal or mildly elevated. Noninvasive pulse oximetry to monitor the oxygen saturation is recommended. Arterial blood gas
assessment shows hypoxemia and/or hypercapnia, depending on the severity of the disease. C. Imaging. Lateral neck x-rays show
overdistended hypopharynx, subglottic narrowing that is wider on expiration than inspiration, thickened vocal cords, and a normal
epiglottis. Anterior-posterior views of the neck show edematous subglottic walls converging to create a characteristic "steeple sign"
Correct Answer. b
(296).
Greisinger‘s sign is associated with thrombosis of
a. Sagittal sinus
b. Cavernous sinus
c. Mastoid emissary vein
d. Internal jugular vein
Solution. Ans- (c) Mastoid emissary vein
Ref: Read the text below
Sol :
- Griesinger‘s sign is seen in lateral sinus thrombosis. It is due to thrombosis of mastoid emissary vein impeding the venous drainage and
thus causing oedema over the mastoid.
- It is a complication of acute otomastoiditis and may be associated with dural sinus occlusive disease (DSOD).
Correct Answer. c
(297).
Main treatment of congenital laryngeal stridor is –
a. Tracheostomy
b. Steroid therapy
c. Ressurance to the child‘s parents
d. Amputating epiglottis
Solution. Ans- (c) Ressurance to the child‘s parents
Ref: Dhingra 5/e, pg 314
Sol :
- Congenital laryngeal stridor is synonymous with laryngomalacia. Hence management remains the same i.e. reassurance to childs
parent.
Correct Answer. c
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(298).
Woodruff‘s area is
a. Posterior part of middle turbinate
b. Posterior part of inferior turbinate
c. Antero inferior part of cartilaginous septum
d. Posterosuperior part of cartilaginous septum
Solution. Ans- (b) Posterior part of inferior turbinate
Ref: Dhingra -167
Sol :
- The vascular are situated under the posterior end of inferior turbinate where sphenopalatine artery anastomoses with posterior
pharyngeal artery. Posterior epistaxis may occur in this area.
Correct Answer. b
(299).
Dysphonia plica ventricularis
a. Voice with false vocal cords
b. Fatigue of laryngeal muscles
c. Low pitch voice in adults
d. Lack of nasal resonance
Solution. Ans- (a) Voice with false vocal cords
Ref: Read the text below
Sol :
- Dysphonia plica ventricularis is defined as "phonation using false vocal fold vibration rather than true vocal fold vibration, most
commonly associated with severe muscular tension and occasionally may be an appropriate compensation for profound true vocal fold
dysfunction."
Correct Answer. a
(300).
The common cause of episodic vertigo with tinnitus and deafness is :
a. Meniere’s disease
b. BPPV
c. Otosclerosis
d. Basilar migrane
Solution. Ans-: (a) Meniere’s disease
Ref.: Read the text below
Sol :
- Meniere’s disease – it also called endolymphatic hydrops, is a disorder of the inner ear where the endolymphatic system is distended.
- Characterized by episodic vertigo, fluctuating hearing loss, tinnitus, and sense of fullness or pressure in the involved ear.
Correct Answer. a
Test Answer
1.(b)
2.(b)
3.(c)
4.(d)
5.(b)
6.(a)
7.(d)
8.(b)
9.(d)
10.(c)
11.(c)
12.(b)
13.(d)
14.(b)
15.(b)
16.(b)
17.(b)
18.(b)
19.(a)
20.(a)
21.(d)
22.(d)
23.(a)
24.(d)
25.(a)
26.(d)
27.(a)
28.(d)
29.(b)
30.(a)
31.(b)
32.(c)
33.(d)
34.(a)
35.(c)
36.(d)
37.(d)
38.(a)
39.(c)
40.(a)
41.(c)
42.(a)
43.(a)
44.(c)
45.(d)
46.(c)
47.(d)
48.(d)
49.(a)
50.(a)
51.(a)
52.(a)
53.(c)
54.(a)
55.(a)
56.(b)
57.(c)
58.(b)
59.(b)
60.(b)
61.(c)
62.(d)
63.(c)
64.(b)
65.(c)
66.(b)
67.(a)
68.(a)
69.(b)
70.(a)
71.(c)
72.(d)
73.(d)
74.(a)
75.(a)
76.(c)
77.(a)
78.(c)
79.(c)
80.(a)
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81.(d)
82.(c)
83.(a)
84.(d)
85.(d)
86.(a)
87.(a)
88.(a)
89.(a)
90.(b)
91.(b)
92.(a)
93.(a)
94.(a)
95.(c)
96.(d)
97.(d)
98.(d)
99.(d)
100.(a)
101.(c)
102.(b)
103.(a)
104.(a)
105.(c)
106.(a)
107.(a)
108.(b)
109.(c)
110.(a)
111.(d)
112.(d)
113.(b)
114.(-NA-)
115.(b)
116.(a)
117.(c)
118.(a)
119.(-NA-)
120.(c)
121.(b)
122.(a)
123.(b)
124.(b)
125.(b)
126.(b)
127.(b)
128.(d)
129.(c)
130.(b)
131.(b)
132.(b)
133.(c)
134.(a)
135.(b)
136.(d)
137.(c)
138.(d)
139.(b)
140.(a)
141.(a)
142.(a)
143.(c)
144.(d)
145.(c)
146.(d)
147.(c)
148.(d)
149.(c)
150.(c)
151.(b)
152.(b)
153.(c)
154.(b)
155.(a)
156.(a)
157.(a)
158.(a)
159.(c)
160.(a)
161.(a)
162.(c)
163.(b)
164.(d)
165.(a)
166.(a)
167.(c)
168.(b)
169.(a)
170.(c)
171.(b)
172.(d)
173.(c)
174.(d)
175.(c)
176.(b)
177.(b)
178.(b)
179.(a)
180.(d)
181.(d)
182.(c)
183.(d)
184.(c)
185.(a)
186.(b)
187.(a)
188.(c)
189.(b)
190.(a)
191.(b)
192.(d)
193.(b)
194.(a)
195.(c)
196.(a)
197.(b)
198.(d)
199.(b)
200.(b)
201.(a)
202.(a)
203.(b)
204.(b)
205.(c)
206.(c)
207.(a)
208.(b)
209.(c)
210.(c)
211.(c)
212.(b)
213.(a)
214.(b)
215.(c)
216.(b)
217.(b)
218.(d)
219.(a)
220.(c)
221.(a)
222.(d)
223.(a)
224.(c)
225.(a)
226.(a)
227.(b)
228.(c)
229.(a)
230.(a)
231.(a)
232.(a)
233.(a)
234.(c)
235.(a)
236.(c)
237.(a)
238.(a)
239.(b)
240.(c)
241.(b)
242.(b)
243.(a)
244.(a)
245.(a)
246.(d)
247.(c)
248.(b)
249.(a)
250.(a)
251.(a)
252.(d)
253.(b)
254.(a)
255.(d)
256.(a)
257.(c)
258.(a)
259.(b)
260.(b)
261.(b)
262.(b)
263.(a)
264.(a)
265.(b)
266.(a)
267.(b)
268.(d)
269.(d)
270.(b)
271.(a)
272.(a)
273.(d)
274.(a)
275.(d)
276.(c)
277.(a)
278.(a)
279.(c)
280.(b)
281.(b)
282.(d)
283.(c)
284.(b)
285.(b)
286.(a)
287.(d)
288.(b)
289.(a)
290.(a)
291.(a)
292.(a)
293.(b)
294.(a)
295.(b)
296.(c)
297.(c)
298.(b)
299.(a)
300.(a)
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