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Gt 135 (AIPG Mock)
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Section
Test Package
Grand Test Series
2014
Subject Test Series
2014
AIIMS Test Series
DNB Test Series
Grand Test Series
2013
Part
(Q.1) What is the mechanism of Empaglifozim?
(a)
Insulin secretogogue
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
Denial
(b)
Projection
(c)
Undoing
Conversion
(d)
Your Response :
Correct Answer :
Exp:
Undoing.
This is an ego defense mechanism used by OCD patients. By this mechanism anxiety arising out of distressful
obsession is removed by undoing the feared consequents of obsession ego if regarding dirt or contamination then
pt tries to undo this obsession by washing compulsion.
(b)
Menstrual bleeding
(c)
(d)
Your Response :
Correct Answer :
Exp:
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Obstructed labour
(b)
Iatrogenic
(c)
LSCS
(d)
Gestational diabetes
Your Response : a
Correct Answer : A
Obstructed labour
Exp:
McRoberts maneuver
(b)
Zavanelli maneuver
(c)
(d)
Simpson's maneuver
Your Response :
Correct Answer :
Exp:
Simpson's maneuver.
A number of labor positions and/or obstetrical maneuvers are sequentially performed in attempt to facilitate
delivery at this point, including :
McRoberts maneuver; The McRoberts maneuver is employed in case of shoulder dystocia during childbirth and
involves hyperflexing the mother's legs tightly to her abdomen. This widens the pelvis, and flattens the spine in the
lower back (lumbar spine). If this maneuver does not succeed, an assistant applies pressure on the lower abdomen
(suprapubic pressure), and the delivered head is also gently pulled. The technique is effective in about 42% of
cases
suprapubic pressure (or Rubin I)
Rubin II or posterior pressure on theanterior shoulder, which would bring the fetus in an oblique position with
head somewhat towards the vagina
Woods' screw maneuverwhich leads to turning the anterior shoulder to the posterior and vice versa (somewhat
the opposite of Rubin II maneuver)
Jacquemier's maneuver(also called Barnum's maneuver), or delivery of theposterior shoulderfirst, in which the
forearm and hand are identified in the birth canal, and gently pulled.
Gaskin maneuver, named after Certified ProfessionalMidwife,Ina May Gaskin, involves moving the mother to an all
fours position with the back arched, widening the pelvic outlet.[8][9]
More drastic maneuvers include
Zavanelli's maneuver, which involves pushing the fetal head back in with performing acesarean section.[10]or
internal cephalic replacement followed byCesarean section
intentional fetalclavicular fracture, which reduces the diameter of the shoulder girdle that requires to pass through
the birth canal.
maternalsymphysiotomy, which makes the opening of the birth canal laxer by breaking the connective tissue
between the twopubesbones facilitating the passage of the shoulders.
abdominal rescue, described by O'Shaughnessy, where ahysterotomyfacilitates vaginal delivery of the impacted
shoulder
Management
"ALARMER"
Management of shoulder dystocia has become a focus point for many obstetrical nursing units in North America.
Courses such as the CanadianMore-OB programencourage nursing units to do routine drills to prevent delays in
delivery which adversely affect both mother and fetus. A common treatment mnemonic is ALARMER
Ask for help. This involves preparing for the help of an obstetrician, for anesthesia, and for pediatrics for
subsequent resuscitation of the infant that may be needed if the methods below fail.
Leg hyperflexion (McRoberts' maneuver)
Anterior shoulder disimpaction (pressure)
Rubin maneuver
Manual delivery of posterior arm
Episiotomy
Roll over on all fours
The advantage of proceeding in the order of ALARMER is that it goes from least to most invasive, thereby reducing
harm to the mother in the event that the infant delivers with one of the earlier maneuvers. In the event that these
maneuvers are unsuccessful, a skilled obstetrician may attempt some of the additional procedures listed above.
Intentional clavicular fracture is a final attempt at nonoperative vaginal delivery prior toZavanelli's
maneuverorsymphysiotomy, both of which are considered extraordinary treatment measures.
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Hystero laparoscopy
(b)
X-Ray abdomen
(c)
Hysterosalpingography
(d)
Sono salpingography
Your Response :
Correct Answer :
Hystero laparoscopy
Exp:
Hystero-Laparoscopy also called laparo-hysteroscopy is a procedure in which the tubes can be examined under
direct vision with an endoscope and if the pelvis looks inflamed then the best place to take a biopsy for culture is
the tubal end. Same holds true for the diagnosis of endo-salpingitis.
X-Ray abdomen is too gross a procedure and informs mostly anatomical problems of the pelvis.
HSG is a procedure which will inform regarding the tubal patency and outlines the uterine anatomy along with
uterine polyps and fibroids.
There may be some filling defects in the tube recognized with a good HSG if there is Endosalpingitis but it does not
prove the diagnosis as is done by a direct tubal culture.
Sono salpingography is an assessment of the tubal patency by perfusing the uterus and therefore the tubes while
observing the uterus and the pouch of Douglas by an ultrasound. This procedure is good for the diagnosis of tubal
patency but not for infections.
(Q.7) Which of the following is not included in Active management of III Stage of Labor?
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(Q.8) Which of the following is the most common predisposing factor for placenta accreta?
(a)
Myomectomy
(b)
Recent curettage
(c)
(d)
Placenta previa
Your Response :
Correct Answer :
Exp:
Placenta previa
Placenta accreta is an extremely rare condition in which the placenta is directly anchored to the myometrium
partially or completely without any intervening deciduas. The probable cause is defective decidual formation.
This condition is usually seen when the placenta is implanted in the lower segment (placenta praevia) or over the
previously injured sites such as on caesarean section scar, dilatation and curettage operation, manual removal,
synaecolysis or myomectomy.
The diagnosis is made only during attempted manual removal when the plane of cleavage between the placenta
and the uterine wall cannot be made out. Ultrasound imaging, color Doppler and MRI have all been valuable in the
diagnosis of placenta accreta during pregnancy.
Pathological confirmation includes:
Absence of decidua basalis
Absence of Nitabuchs fibrinoid layer, and
Varying degree of penetration of the villi into the
muscle bundles (increta) or up to the serosal layer (percreta).
The risks include hemorrhage, shock, infection and rarely inversion of the uterus.
10% of cases of placenta previa are associated with placenta accreta, an abnormally firm attachment of the
placenta to the uterine wall.
Placenta accreta prevents the placenta from separating from the wall of the uterus at the time of delivery and can
cause severe bleeding that often necessitates a hysterectomy.
Placenta accreta is particularly common in women with placenta previa and one or more previous caesarean
sections and may complicate 1/3 to of all such cases.
More than 50% of the patients with Placenta Accreta require a blood transfusionWilliams obstetrics.
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(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
Salbutamol
(b)
Aminophyllin
(c)
Terbutaline
(d)
Your Response :
Correct Answer :
Exp:
Terbutaline
Bambuterolis along acting beta-adrenoceptor agonist(LABA) used in the treatmentofasthma; it also is
aprodrugofterbutaline.
(Q.11) A Hystero-salpingogram was performed for infertility evaluation and revealed the appearance shown here. The diagnosis is?
(a)
Septate uterus
(b)
Bicornuate uterus
(c)
Unicornuate uterus
Arcuate uterus
(d)
Your Response :
Correct Answer :
Exp:
Bicornuate uterus
Mllerian duct anomalies are an often treatable cause of infertility. Mllerian duct anomalies are estimated to
occur in 01-0.5% of women. However, the true prevalence is unknown because the anomalies usually are
discovered in patients presenting with infertility. Full-term pregnancies have occurred in patients with forms of
bicornuate, septate, or didelphys uteri; therefore, true prevalence may be slightly higher than currently
estimated. An association exists between mllerian duct anomalies and renal anomalies such as unilateral
agenesis.
The bicornuate uterus results from incomplete fusion of the uterovaginal horns at the level of the fundus and
accounts for approximately 10% ofmllerian duct anomalies. Patients with a bicornuate uterus and no
extrauterine infertility issues usually have little difficulty conceiving. A bicornuate uterus consists of two
symmetric cornua that are fused caudally, with communication of the endometrial cavitiesmost often at the
level of the uterine isthmus. The intervening cleft of the complete bicornuate uterus extends to the internal
cervical os (bicornuate unicollis), while the cleft of a partial bicornuate configuration is of variable length. A
bicornuate bicollis uterus is associated with a duplicatedcervix, although a degree of communication is
maintained between the two horns. The bicornuate uterus has been reported to have the highest associated
prevalence38%of cervical incompetence among mllerian duct anomalies.
Deposition of fibrin
(b)
(c)
(d)
Blood vessels
Your Response :
Correct Answer :
Exp:
Deposition of fibrin
There may be inconsistent deposition of fibrin called Rohr's stria at the bottom of the intervillous space and
surrounding the fastening villi.
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(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
Types of placenta in a twin pregnancy : 1.single (monochorionic) placenta. 2. two separate (dichorionic) placenta
.
In monochorionic twins there is one chorion around both babies which means they share one placenta and the
term monochorionic is used. Triplets and Quads can also be monochorionic. The inner membrane is known as the
amnion. If the babies each have their own amnion the pregnancy will be referred to as monochorionic diamniotic
(MCDA). These babies are always identical. In about 1% of monochoronic twin pregnancies, the babies will also
share one inner membrane (amnion). These babies will be referred to as monchorionic monamniotic (MCMA),
and are always identical. In dichorionic twins each baby will have its own placenta, with its own amnion and
chorion. For these twins there will be two chorions and two amnions the term dichorionic diamniotic (DCDA) is
used. If triplets each have their own placenta there will 4 be three chorions and three chorions they will be
referred to as trichorionic triamniotic.
(Q.14) Which of the following hormones does not cross the placenta?
(a)
Chorionic gonadotrophin
(b)
Growth hormone
(c)
Thyroxine
(d)
Calcitonin
Your
b
Response :
Correct
D
Answer :
Exp:
(Q.15) Amniotic membrane contains:
(a)
Blood vessels
(b)
Nerves
(c)
Glycerophospholipids
(d)
Your Response :
Correct Answer :
Exp:
C
Glycerophospholipids
The amnion has got neither blood nor nerve supply nor any lymphatic system. It is a rich source of
glycerophospholipids' containing arachidonic acid precursor of prostaglandin E2 and F2 .
Choanal atresia
(b)
Coloboma of eye
(c)
Ear anomalies
(d)
All of above
Your Response :
Correct Answer :
Exp:
D
All of above
Congenital anomalies are a major cause of stillbirths and neonatal deaths, but they are perhaps even more
important as causes of acute illness and long-term morbidity. Anomalies are discussed in general in Chapters 81
and 108 and specifically in the chapters on the various systems of the body. Early recognition of anomalies is
important for planning care; with some, such as tracheoesophageal fistula, diaphragmatic hernia, choanal atresia,
and intestinal obstruction, immediate medical and surgical therapy is essential for survival. Parents are likely to
feel anxious and guilty on learning of the existence of a congenital anomaly and require sensitive counseling.
Common Life-Threatening Congenital Anomalies
NAME
MANIFESTATIONS
Choanal atresia
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Tracheoesophageal fistula
Gastroschisis, omphalocele
CHARGE, coloboma of the eye, heart anomaly, choanal atresia, retardation, and genital and ear anomalies;
VATER, vertebral defects, imperforate anus, tracheoesophageal fistula, and radial and renal dysplasia.
(Q.17) Wrong match regarding Maternal disorder and its fetal effect is ?
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
MECHANISM
Autoantibody against
folate receptors
Cervical neoplasia
Cholestasis
Preterm delivery
Mild
Fetal hyperglycemiaproduces
hyperinsulinemia; insulin promotes
growth
Severe
Growth restriction
Drug addiction
Endemic goiter
Hypothyroidism
Iodine deficiency
Graves disease
Herpes gestationalis
(noninfectious)
Bullous rash
Unknown
Hyperparathyroidism
Neonatal hypocalcemia
Hypertension
DISORDER
Diabetes mellitus
Idiopathic
Thrombocytopenia
thrombocytopenic purpura
Malignant melanoma
Metastasis
Myasthenia gravis
Immunoglobin to acetylcholine
receptor crosses placenta
Myotonic dystrophy
Genetic anticipation
Obesity
Macrosomia, hypoglycemia
Unknown
Phenylketonuria
Microcephaly, retardation
Poor nutrition
Preeclampsia, eclampsia
Renal transplant
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(Q.18) A 22 years old female Kamala, who had body mass index 18 before pregnancy, was pregnant for first time. She may be allowed to
7kg
(b)
13kg
(c)
18 kg
21 kg
(d)
Your Response :
Correct Answer :
Exp:
18 kg
Ideally weight gain should depend or pre pregnancy body mass index (BMI) level weight gain for a woman with
normal BMI (20-26) is 11 to 16 kg. An obese woman (BMI>29) should not gain more than 7 kg, whereas an under
weight woman (BMI<19) may be allowed to gain upto 18 kg.
ACTH
(b)
Valproic Acid
(c)
Pyridoxine
(d)
Clonazepam
Your Response :
Correct Answer :
Exp:
ACTH
Though there are number of drugs which can be used in Infantile spasms,
ACTH is preferred.
Oral corticosteroids can be used; vigabatrin is emerging as a first choice.
Ovary
(b)
Placenta
(c)
Decidua
Adrenals
(d)
Your Response :
Correct Answer :
Exp:
Ovary
The main source of production of relaxin is the corpus luteum of the ovary but part of it may also be produced by
the placenta and decidua.
Relaxin production refers to production and secretion of one of the well known peptide hormones, relaxin. Dustin
Ensign was the first scientist who described this hormone in the year 1926. The hormone is found both in human
as well as in animal bodies. The hormone is also present in both male and female. Relaxin production
considerably increases during pregnancy.
Relaxin is well known for having more than one function too. During pregnancy relaxin production gradually
increases to make delivery easier. At that time the hormone is produced from different sources of relaxin
production.
Sources of Relaxin production
The sources of relaxin production is different for both men and women. In each case the production takes
place in different organs of the body. The presence of the hormone is relatively higher in pregnant women
than in men.In female bodies relaxin production takes place in the corpus luteum in the ovary. The breasts too
are responsible for production of some amount of the hormone. At the time of pregnancy, adequate amount
of relaxin is also produced by placenta, chorion as well as deciduas. This adds to the increased level of relaxin
production. This additional production of the hormone during pregnancy also results to the increased level of
hormone present in the body of pregnant women.In the bodies of men testes is regarded as the primary
source of relaxin production. In other words, the production of the hormone named relaxin takes place in that
part of a male body which is known as testes. The hormone is generated by breaking an additional chain of
peptide. However, the amount of relaxin present in male body is significantly lesser than women, especially
those who are pregnant.
The level of relaxin production is different at different stages of pregnancy. At the time of ovulation the level of
relaxin production rises in female bodies.
At that time corpus luteum starts producing an increased amount of relaxin. If during that time pregnancy does
not occur, the level of relaxin production again drops to normal. A significant drop in the level of the hormone
takes place during the time of menstruation.
During the first trimester of pregnancy the level of production of relaxin also goes up. At that time an additional
amount of relaxin is also produced by deciduas. This results to an increased amount of relaxin production.
The increased amount of relaxin production facilitates the process of pregnancy in many ways. It softens cervix
and pubic symphysis, prevents contraction of uterine muscle by reducing collagen production. Thus the process of
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(b)
Biparietal diameter
(c)
Femur Length
(d)
Head Circumference
Your Response :
Correct Answer :
Exp:
(Q.22) Fetal biophysical profile used for the assessment of fetal well being does not includes:
(a)
(b)
Fetal tone
(c)
(d)
Fetal blood PH
Your Response : d
Correct Answer : D
Fetal blood PH
Exp:
(b)
(c)
4
5
(d)
Your Response :
Correct Answer :
Exp:
4
How many visits? A recent multi-country randomized control trial led by the WHO and a systematic review
showed that essential interventions can be provided over four visits at specified intervals, at least for healthy
women with no underlying medical problems. The result of this review has prompted WHO to define a new
model of ANC based on four goal-oriented visits. This model has been further defined by what is done in each
visit, and is often called focused antenatal care. The optimum number of ANC visits for limited resource settings
depends not only on effectiveness, but also on costs and other barriers to ANC access and supply.
When? For many of the essential interventions in ANC, it is crucial to have early identification of underlying
conditions for example, prevention of congenital syphilis, control of anaemia, and prevention of malaria
complications. Hence the first ANC visit should be as early as possible in pregnancy, preferably in the first
trimester. The last visit should be at around 37 weeks or
near the expected date of birth to ensure that appropriate advice and care have been provided to prevent and
manage problems such as multiple births (e.g. twins), postmaturity (e.g. birth after 42 weeks of pregnancy, which
carries an increased risk of fetal death), and abnormal positions of the baby (e.g. breech, where the babys head is
not the presenting part at birth).
(Q.24) Fundal pressure method for delivery of placenta is used when baby is:
(a)
Premature
(b)
Large
(c)
Asphyxiated
(d)
Your Response :
Correct Answer :
Exp:
Premature
If the baby is macerated or premature, fundal pressure method is preferable to cord traction as the tensile
strength of the cord is much reduced in both the instances.
(Q.25) A 30 year female presented fever pain abdomen & purulent vaginal discharge after 2 days of abortion. The doctor diagnosed her as a
case of septic abortion. On examination & investigations it was found that infection was localized to the uterus & parametrium.
From which grade of septic abortion she was suffering from?
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Grade I
(b)
Grade II
(c)
Grade III
(d)
Grade IV
Your Response :
Correct Answer :
Exp:
Grade II
Clinically, the cases of septic' abortion are graded as:
(1) Grade I: The infection is localized to the uterus.
(2) Grade II: The infection spreads beyond the uterus to the parametrium, tubes and ovaries or pelvic
peritoneum.
(3) Grade III: Generalized peritonitis and/or endotoxic shock or jaundice or acute renal failure.
(Q.26) During resuscitation of newborn chest compressions are indicated when heart rate is below :
(a)
40bpm
(b)
60bpm
(c)
80 bpm
100bpm.
(d)
Your Response :
Correct Answer :
Exp:
60 bpm
External cardiac massage is indicated in babies in whom heart rate drops below 60/min despite effective
ventilation with 100% oxygen for 30 seconds. There should be 90 compressions and 30 ventilations (3: 1). Chest
compressions are discontinued when HR is above 60/min.
Chest Compressions
Chest compressions are indicated for a heart rate that is <60 per minute despite adequate ventilation with
supplementary oxygen for 30 seconds. Because ventilation is the most effective action in neonatal resuscitation
and because chest compressions are likely to compete with effective ventilation, rescuers should ensure that
assisted ventilation is being delivered optimally before starting chest compressions.
Compressions should be delivered on the lower third of the sternum to a depth of approximately one third of the
anterior-posterior diameter of the chest . Two techniques have been described: compression with 2 thumbs with
fingers encircling the chest and supporting the back (the 2 thumbencircling hands technique) or compression
with 2 fingers with a second hand supporting the back. Because the 2 thumbencircling hands technique may
generate higher peak systolic and coronary perfusion pressure than the 2-finger technique. the 2 thumb
encircling hands technique is recommended for performing chest compressions in newly born infants . The 2finger technique may be preferable when access to the umbilicus is required during insertion of an umbilical
catheter, although it is possible to administer the 2 thumbencircling hands technique in intubated infants with
the rescuer standing at the baby's head, thus permitting adequate access to the umbilicus.
Compressions and ventilations should be coordinated to avoid simultaneous deliveryThe chest should be
permitted to reexpand fully during relaxation, but the rescuer's thumbs should not leave the chest. There should
be a 3:1 ratio of compressions to ventilations with 90 compressions and 30 breaths to achieve approximately 120
events per minute to maximize ventilation at an achievable rate. Thus each event will be allotted approximately
1/2 second, with exhalation occurring during the first compression after each ventilation.
There is evidence from animals and non-neonatal studies that sustained compressions or a compression ratio of
15:2 or even 30:2 may be more effective when the arrest is of primary cardiac etiology. One study in children
suggests that CPR with rescue breathing is preferable to chest compressions alone when the arrest is of
noncardiac etiology.It is recommended that a 3:1 compression to ventilation ratio be used for neonatal
resuscitation where compromise of ventilation is nearly always the primary cause, but rescuers should consider
using higher ratios if the arrest is believed to be of cardiac origin.
Respirations, heart rate, and oxygenation should be reassessed periodically, and coordinated chest compressions
and ventilations should continue until the spontaneous heart rate is 60 per minute.However, frequent
interruptions of compressions should be avoided, as they will compromise artificial maintenance of systemic
perfusion and maintenance of coronary blood flow.
(Q.27) Which type of inheritance does the following pedigree chart denote?
(a)
Mitochondrial inheritance
(b)
Autosomal dominant
(c)
Autosomal recessive
(d)
X-linked dominant
Your Response :
Correct Answer :
Exp:
Mitochondrial inheritance
In contrast to the homologous pair recombination that takes place in the nucleus, mtDNA molecules do not
undergo recombination, and so mutational events represent the only source of mtDNA genetic diversification.
Moreover, with very rare exceptions, it is only the maternal DNA that is transmitted to the offspring. The fertilized
oocyte degrades mtDNA carried from the sperm in a complex process that involves the ubiquitin proteasome
system. Thus, whereas mothers transmit their mtDNA to both their sons and their daughters, only the daughters
are able to transmit the inherited mtDNA to future generations. Accordingly, mtDNA sequence variation and
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CEA
(b)
HMB-45
(c)
S-100
Synaptophysin
(d)
Your Response :
Correct Answer :
Exp:
CEA
"CEA is elevated in adenocarcinoma of colon, pancreas, lung, BREAST and ovary" "S-100 protein is present in
virtually all primary and metastatic melanomas, including the amelanotic variety. However, S-100 positivity is also
found in other tumours of neuro endocrinal origin (e.g. small cell lung cancer, carcinoid, neuro-epithelioma); a
more specific marker for melanoma is the HMB45 (human melanoma black 45) antigen".
Synaptophysin is the marker for neuroendocrine tumours.
(Q.29) A patient has retinoblastoma. He is also likely to develop Mandibular osteosarcoma if the pathogenetic causes are the following
EXCEPT
(a)
(b)
Radiation induced
(c)
Chemotherapy induced
(d)
Mutation of Rb gene
Your Response :
Correct Answer :
Exp:
Chemotherapy induced
Patients with hereditary retinoblastomas have up to 1,000 times greater risk of subsequently developing
osteosarcoma, attributed to germ-line mutations in the RB gene.
Loss of heterozygosity, structural rearrangements, or point mutations in the RB gene is also present in 60 70%of
sporadic tumors.
Abnormalities in genes that regulate cell cycling, such as p53 , CDK4,p16,INK4A,CYCLIN DI, and MDM2 have also
been implicated in the genesis of nonhereditary osteosarcomas
The risk of osteosarcoma developing in facial bones increases greatly if external beam irradiation has been used
to treat the retinoblastoma
Germ-line mutation of the Rb-1 locus (chromosome 13q14) in patients with inherited retinoblastoma is
associated with the development of osteosarcoma in those who survive the retinoblastoma and of soft tissue
sarcomas unrelated to radiation therapy.
2- Microglobulin
(b)
Transthyretin
(c)
SAA
(d)
APP
Your Response :
Correct Answer :
Exp:
2- Microglobulin
Hemodialysis-associated amyloidosis Patients on long-term hemodialysis for renal failure develop amyloidosis
owing to deposition of 2- Microglobulin. This protein is present in high concentrations in the serum of patients
with renal disease and is retained in circulation because it cannot be filtered through the cuprophane dialysis
membranes. In some series, as many as 60 80%of the patients on long-term dialysis developed amyloid deposits
in the synovium, joints and tendon sheaths.
Amyloid Fibril Proteins and Their Clinical Syndromes
Term
Precursor
Clinical Syndrome
Clinical Involvement
Primary or myeloma
associateda
Any
Systemic Amyloidoses
AL
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AA
2-Microglobulin
Secondary; reactiveb
Renal, any
Hemodialysis-associated
Familial (mutant)
Senile systemic (wild type)
2M
ATTR
Transthyretin
AApoAI
Apolipoprotein AI
Familial
Hepatic, renal
AApoAII
Apolipoprotein AII
Familial
Renal
AGel
Gelsolin
Familial
AFib
Fibrinogen A
Familial
Renal
ALys
Lysozyme
Familial
Renal
ALECT2
Renal
Localized Amyloidoses
A
Alzheimers disease;
Down syndrome
CNS
ACys
APrP
Cystatin C
CNS, vascular
Prion protein
Spongiform encephalopathies
CNS
AIAPP
Diabetes-associated
Pancreas
ACal
Calcitonin
Thyroid
AANF
Age-related
Cardiac atria
APro
Prolactin
Endocrinopathy
Pituitary
Amyloid protein
a. Localized deposits can occur in skin, conjunctiva, urinary bladder, and tracheobronchial tree.
b. Secondary to chronic inflammation or infection, or to a hereditary periodic fever syndrome, e.g., familial
Mediterranean fever.
(Q.31) Delayed continuous vascular permeability is due to
(a)
Endothelia contraction
(b)
(c)
(d)
Angiogenesis
Your Response :
Correct Answer :
Exp:
Melanoma
(b)
Schwannoma
(c)
Neurofibroma
(d)
Rhabdomyosarcoma
Your Response :
Correct Answer :
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Melanoma
The cytologic diagnosis of metastatic melanoma can be challenging. Melanoma often manifests with a diverse
cytologic appearance that may include a dys Hesive single cell pattern or a cohesive cellular arrangement.
The cell shape varies from epithelioid to spindled, or a mixture of epithelioid and spindle cell patterns might be
seen. Furthermore, the cytologic features of melanoma often are shared with other poorly differentiated
malignant neoplasms, including carcinomas, lymphomas, and sarcomas.
In addition, metastatic melanoma can be found anywhere in the body and may manifest with a myriad of clinical
signs and symptoms. Nevertheless, it is important to differentiate melanoma from non-melanocytic malignant
neoplasms because prognosis and therapy differ radically among these entities.
Immunocytochemical studies often are used as an aid in the diagnosis of melanoma. The most frequently used
melanocytic markers in clinical practice are S-100 protein and HMB-45
Monoclonal antibody to S-100 protein, a calcium binding F-hand protein originally isolated from the brain, is a
sensitive marker that reacts with more than 90%of melanomas.
However, this protein also is present in adipocytes, chondrocytes, Schwann cells, and myoepithelial cells.
Tumors derived from these tissues usually retain immunoreactivity to S-100 protein.Thus,S-100 protein reacts
with a broad range of benign and malignant neoplasms, therefore limiting its specificity as a melanocytic marker.
In addition, certain epithelial neoplasms such as mammary carcinoma may be positive for S-100 protein.
Monoclonal antibody against HMB-45 antigen recognizes melanosome-specific gp100.Although it is quite specific
for melanocytic neoplasms,HMB-45 is less sensitive than S-100 protein for identifying melanoma.
Immunohistochemical Stains Useful in detecting neoplasms
Tissue Marker
Diagnosis
Breast cancer
BRST-1
Breast cancer
Breast cancer
Thyroglobulin
Thyroid cancer
Neuroendocrine cancer
CDX-2
Gastrointestinal cancer
Calretinin, mesothelin
Mesothelioma
Lymphoma
10
S-100, HMB-45
Melanoma
11
URO-III, thrombomodulin
Bladder cancer
12
-Fetoprotein
Hepatocellular cancer,
Germ cell cancer,
Hepatoblastoma
13
14
Prostate cancer
15
Cytokeratin
Carcinomas
(Q.33) Diphtheria-like colitis with thickening of ascending and transverse colon are seen due to which poisoning
(a)
Phenol
(b)
Arsenic
(c)
Mercury
Lead
(d)
Your Response :
Correct Answer :
Exp:
Mercury poisoning
Mercury poisoning has 2 stages of signs and symptoms.
The first phase is acute and lasts upto about a day.
The second phase is more protracted and starts from one to three days after many days of a patient suffering
from Hg poisoning; membranous colitis develops and produces dysentery, ulceration of the colonic mucosa and
hemorrhage.
On post-mortem examination, a very characteristic appearance seen in the small intestine is the fissuring of the
swollen mucous membrane. These fissures run in all directions, and break up the continuity of the surface,
forming numerous small islands. Such features are characteristic of Hg poisoning and are not observed in Phenol,
Arsenic or Lead poisoning.
(Q.34) If a person under oath gives false evidence in a court of law, then he may be punished with imprisonment upto :
(a)
Seven years
(b)
Nine years
(c)
One year
Three years
(d)
Your Response :
Correct Answer :
Exp:
Seven years
A witness who willfully or with some motive tells lie, suppresses facts partly or fully in a court as a witness, may
be declared a hostile witness. If a person under oath gives false evidence in a court of law, then he may be
punished with imprisonment upto 7 years. In other case for giving false evidence (other than under oath inside a
court) a person may be punished with imprisonment which may extend upto 3 years (per jury)
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The drug used for the experiment must not be a known harmful agent
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
The experiment should not be stopped if any unto wards symptoms starts.
The World Medical Association (WMA) has developed the Declaration of Helsinki as a statement of ethical
principles for medical research involving human subjects, including research on identifiable human material and
data.
1. The Declaration is intended to be read as a whole and each of its constituent paragraphs should be applied
with consideration of all other relevant paragraphs.
2. Consistent with the mandate of the WMA, the Declaration is addressed primarily to physiciAns: The WMA
encourages others who are involved in medical research involving human subjects to adopt these principles.
General Principles
3. The Declaration of Geneva of the WMA binds the physician with the words, The health of my patient will be
my first consideration, and the International Code of Medical Ethics declares that, A physician shall act in the
patient's best interest when providing medical care.
4. It is the duty of the physician to promote and safeguard the health, well-being and rights of patients,
including those who are involved in medical research. The physician's knowledge and conscience are dedicated to
the fulfilment of this duty.
5.
Medical progress is based on research that ultimately must include studies involving human subjects.
6. The primary purpose of medical research involving human subjects is to understand the causes,
development and effects of diseases and improve preventive, diagnostic and therapeutic interventions (methods,
procedures and treatments). Even the best proven interventions must be evaluated continually through research
for their safety, effectiveness, efficiency, accessibility and quality.
7. Medical research is subject to ethical standards that promote and ensure respect for all human subjects and
protect their health and rights.
8. While the primary purpose of medical research is to generate new knowledge, this goal can never take
precedence over the rights and interests of individual research subjects.
9. It is the duty of physicians who are involved in medical research to protect the life, health, dignity, integrity,
right to self-determination, privacy, and confidentiality of personal information of research subjects. The
responsibility for the protection of research subjects must always rest with the physician or other health care
professionals and never with the research subjects, even though they have given consent.
10. Physicians must consider the ethical, legal and regulatory norms and standards for research involving human
subjects in their own countries as well as applicable international norms and standards. No national or
international ethical, legal or regulatory requirement should reduce or eliminate any of the protections for
research subjects set forth in this Declaration.
11. Medical research should be conducted in a manner that minimises possible harm to the environment.
12. Medical research involving human subjects must be conducted only by individuals with the appropriate
ethics and scientific education, training and qualifications. Research on patients or healthy volunteers requires
the supervision of a competent and appropriately qualified physician or other health care professional.
13. Groups that are underrepresented in medical research should be provided appropriate access to
participation in research.
14. Physicians who combine medical research with medical care should involve their patients in research only to
the extent that this is justified by its potential preventive, diagnostic or therapeutic value and if the physician has
good reason to believe that participation in the research study will not adversely affect the health of the patients
who serve as research subjects.
15. Appropriate compensation and treatment for subjects who are harmed as a result of participating in
research must be ensured.
(Q.36) Plastic finger prints are available on :
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(Q.37) A 30-year-old male from West Bengal presents to you with hyperkeratosis, and transverse nail lines. Most likely cause is
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
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Loss of testes
(b)
Loss of an eye
(c)
Loss of a kidney
(d)
Your Response :
Correct Answer :
Exp:
Hydatid cyst
(b)
Aspergillosis
(c)
Tuberculosis cavity
(d)
Your Response :
Correct Answer :
Exp:
Hydatid cyst
Radiographic and related imaging studies are important in detecting and evaluating echinococcal cysts. Plain films
will define pulmonary cysts of E. granulosus usually as rounded masses of uniform density but may miss cysts
in other organs unless there is cyst wall calcification (as occurs in the liver). MRI, CT, and ultrasound reveal well
defined cysts with thick or thin walls. When older cysts contain a layer of hydatid sand that is rich in accumulated
scolices, these imaging methods may detect this fluid layer of different density Floating Water- Lily sign.
However the most path gnomonic finding, if demonstrable, is that of daughter cysts within the larger cyst. This
finding, like eggshell or mural calcification on CT, is indicative of E. granulosus infections and helps to distinguish
the cyst form carcinomas, bacterial or amebic liver abscesses, or hemangiomas.
(Q.40) A dead body is having cadaveric lividity of bluish green colour. The most likely cause of death is by poisoning due to:
(a)
Hydrocyanic acid
(b)
Hydrogen sulphide
(c)
Oleander
(d)
Sodium nitrite
Your Response :
Correct Answer :
Exp:
Hydrogen sulphide
Postmortem Lividity
The incidence, extent and degree of fixation of postmortem lividity is important.
In an advanced case of sudden death, it presents as a series of mottled patches over the dependant parts in about
1-3 hours. These patches coalesce in about 3-6 hours. The lividity is fully developed and fixed in about 6-8 hours.
Lividity will not be seen (1) if the body is constantly altering its position, e.g. drowning (2) if the skin is dark, and
(3) if too much blood is lost. e.g. in massive hemorrhage.
The hypostatic areas have distinct co lour in certain cases of poisoning :
Hydrogen sulphide
Carbon monoxide
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Bluish green
Bright cherry red
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Chocolate or copper
chlorate, nitrobenzene,
brown
acetanilide, bromates
Opium
Almost black
Phosphorus
Dark brown
Potassium cyanide
Pink
Gutter fracture
(b)
Depressed fracture
(c)
Ring fracture
(d)
Sutural separation
Your Response :
Correct Answer :
Exp:
Depressed fracture
This is caused by a heavy weapon with a small striking surface, e.g. hammer.
The fractured bone is driven inward and its shape may indicate the type of weapon with which it is produced. It is
therefore also known as a signature fracture.
A late effect of depressed skull fracture may be post traumatic epilepsy.
Comminuted fracture:
This is caused by vehicular accidents, falls from height, and blows from weapons a with a large striking surface,
e.g. a heavy iron bar.
It is often a complication of a depressed fracture and has a stellate appearance when there is no displacement of
fragment.
Pond or indented fracture: Pond fracture occurs in children due to elasticity of their skull bones.
Fissured fractures may be seen round the periphery of the dent.
Gutter fracture: When a part of the thickness of skull bone is removed, e.g. in glancing bullet wounds, the fracture
is known as a gutter fracture.
Penetrating fracture: This is a clean cut opening due to a penetrating weapon, such as a, dagger or a bullet.
Elevated fracture: This is the result of a blow from a moderately heavy sharp edged weapon, eg, axe, machete,
which elevate one end of bone above the surface of the skull while the other end may dip down in the cranial
cavity injuring dura or the brain.
(Q.42) In methyl alcohol poisoning there is CNS depression, cardiac depression and optic nerve atrophy. These effects are produced due to:
(a)
(b)
Acetaldehyde
(c)
(d)
Acetic acid
Your Response :
Correct Answer :
Exp:
Neonates is :(a)
SGPT
(b)
Prothrombin time
(c)
Albumin
(d)
Bilirubin
Your Response :
Correct Answer :
Exp:
Prothrombin time
Hepatitis in neonate due to specific causes usually is distinguished from the term neonatal hepatitis, which has
been used to designate hepatitis inflammation of unknown cause. The levels of serum aminotransferases and
Bilirubin are poor predictors of outcome. Because of the short half - life of the coagulation proteins, the
prothrombin time (PT) is the best prognostic indicator.
(Q.44) At 28 weeks of age, an infant can perform all of the following tasks except:
(a)
(b)
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(d)
Enjoys mirror
Your Response :
Correct Answer :
Exp:
3m
4m
Bidextrous reach
5m
6m
8m
9m
10m
11m
12m
15m
18m
24m
36m
4 yrs
6 yrs
3- 4 m
4m
5m
Bidextrous grasp,
6m
Transfers object from one hand to another, Unidextrous reach, palmar grasp
7m
Unidextrous/Ulnar grasp
8m
Radial grasp
9m
10m
11m
Mouthing stops
12m
15m
18m
2 yrs
2.5 yrs
Threads a bead
3 yrs
4-5 yrs
Ties shoelaces
LANGUAGE MILESTONES
1m
2m
Vocalizes
3m
4m
Laughs aloud
6m
Monosyllables
9m
Bisyllables
12m
15-18m
Jargon speech
18m
2yrs
Uses pronouns, points 1 part of body, speaks simple sentence with 3 words.
3yrs
4yrs
5yrs
SOCIAL MILESTONES
1m
2m
Social smile
3m
6m
7m
9m
11m
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Comes when name is called, understands phrases, plays simple ball game,
2yrs
1.5 yrs
1.5-2 yrs
Dry by day
2 yrs
50 % dry by night
3 yrs
75 % dry by night
5 yrs
90 % dry by night
PAPER-WORK MILESTONES
18m
Spontaneous scribbling
2yrs
3 yrs
Draws a circle
4yrs
5yrs
6 yrs
Draws a hexagon
7 yrs
Draws a kite
8yrs
9yrs
Draws a cylinder
11 yrs
Draws a cube.
PLAY MILESTONES
10m
Plays peek-a-boo
1yr
2yr
Parallel play
4yr
5yr
Domestic play.
MISCELLANEOUS MILESTONES
3m
4m
10m
18m
Rapproachment develops.
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
Renal failure
(b)
Aplastic anemia
(c)
Severe allergy
(d)
Severe vomiting
Your Response :
Correct Answer :
Exp:
Aplastic anemia
Felbamateis ananti-epileptic drugused in the treatment ofepilepsy. It is used to treatpartial seizures(with
and without generalization) in adults and partial and generalized seizures associated withLennox-Gastaut
syndromein children. However, an increased risk of potentially fatalaplastic anemiaand/orliver failure
limit thedrugsusage to severe refractoryepilepsy.
(Q.47) The success rate for establishing good bile flow following Kasai operation for extrahepatic biliary atresia is about 90% if done before
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2 weeks
(b)
8 weeks
(c)
16 weeks
24 weeks
(d)
Your Response :
Correct Answer :
Exp:
8 weeks
Hepatoportoenterostomy procedure of Kasai which is performed for correction of extrahepatic V biliary atresia
carries a success rate of 90 % ~ if performed before the age of 8 weeks.
Success rate for establishing good bile flow following Kasai operation done after 8 weeks of age goes on
decreasing. Therefore, the importance of early referral and prompt evaluation of infants with suspected biliary
atresia is emphasized.
Kasai operation before the 7th wk of life increases the success rate of this technique significantly. Children with
cirrhosis at the time of diagnosis should be evaluated for primary liver transplantation. gammaGT and bilirubin 5
weeks after Kasai operation may be useful markers for the success of this procedure. Patients with a gammaGT >
100 U/l and a bilirubin level >5mg/dl should be followed closely and should be evaluated for liver transplantation
early.
Increased PAPP-A
(b)
Increased Beta-HCG
(c)
(d)
Your Response :
Correct Answer :
Exp:
Increased PAPP-A
PAPP is decreased in Downs syndrome
First trimester markers (Combined Test)
Pregnancy Associated Plasma Protein-A (PAPP-A)
free -human chorionic gonadotrophin (free -hCG)
Nuchal translucency (NT)
Second trimester markers (Quadruple Test)
Alpha-fetoprotein (AFP) unconjugated oestriol (uE3)
free -human chorionic gonadotrophin (free -hCG) Inhibin-A (inhibin)
Integrated test -when Ist and 2nd trimester tests both done.
In the first trimester of pregnancy the PAPP-A level is, on average, low in Down's syndrome pregnancies (about
half that of unaffected pregnancies), and the nuchal translucency measurement and free -hCG levels are, on
average, high (about double that of unaffected pregnancies). In the second trimester AFP and uE3 levels are, on
average, low (about three-quarters that of unaffected pregnancies) and inhibin and free -hCG levels are, on
average, high (about double that of unaffected pregnancies).
Antenatal USG and Doppler studies
Aneuploidy score, definitions:
Nuchal translucency [NT] according to Nicola ides normal NT < 95thcentileabnormal NT > 95th centile (mild
abnormal NT was below 3,9 mm) in trisomies
Nasal bone normal, visible abnormal, not visible in trisomies
Ductus venosus [DV] Doppler normal: a wave, positive abnormal: a wave absent or reverse in trisomies
(Q.49) Ophthalmic exam to screen for retinopathy of prematurity is mandatory for newborns with birth weight less than:
(a)
1500 grams
(b)
2000 grams
(c)
1000 grams
(d)
2500 grams
Your Response :
Correct Answer :
Exp:
1500 grams
All infants with a birth weight under 1500 grams (gestational age less than 32 weeks) and those between 1500
and 2000 grams (32-34 weeks) who received oxygen therapy should have an eye exam to screen for retinopathy
of prematurity (ROP). Thus screening for Rap is mandatory for newborns with birth weight less than 1500 grams.
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
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x 100
10 mm
(b)
6 mm
(c)
2 mm
4 mm
(d)
Your Response :
Correct Answer :
Exp:
6 mm
Thenuchal fold thicknessis a parameter that is measured in asecond trimester scan(18-22 weeks) and it not to be
confused withnuchal translucency(which is measured in thefirst trimester).
Pathology
The proposed aetiology of increased nuchal thickness is as result ofcongenital heart diseaseand lymphatic
obstruction. Although as the pregnancy progresses excess nuchal thickness or evencystic hygromascan resolve,
the risk of karyotypic abnormalities is not reduced.
Associations
aneuploidy:
thetrisomies
Turner syndrome
congenital heart disease
Natural course
Most thickened nuchal folds tend to resolve towards the third trimester, but that does not decrease the increased
risk of aneuploidy anomalies.
Radiographic assessment
Antenatal ultrasound
The nuchal thickness is measured on an axial section through the head and the level of thethalami,cavum septi
pellucidumand cerebellar hemispheres (i.e in the same plane that is used to assess posterior fossa structures).
One caliper should be placed at the skin, and the other against the outer edge of the bone of the occiput.
It is ideally obtained with the long axis of the head at (or as close as possible to) 45% to the transducer)
An abnormal value is one that is more than 6 mm in thickness.
A thick nuchal fold is often considered the most sensitive1and most specific3(best) 2ndtrimester marker forDown
syndrome1with false positive rates as low as 1%.
Liver
(b)
Spleen
(c)
Adrenals
Ureter
(d)
Your Response :
Correct Answer :
Exp:
Liver
Though intra - Abdominal birth trauma is uncommon; liver is the most commonly injured solid organ during
birth, spleen & Adrenal injuries can occur.
Facial nerve injury is the most common peripheral nerve injury in neonates. clavicle fracture is the most
commonly injured bone during delivery.
(b)
Symmetrical weakness
(c)
(d)
Headache
Your
Response :
Correct
Answer :
Exp:
D
Headache
Clinical features
Symmetric weakness of the muscles
Diminished reflexes
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(b)
Theophylline
(c)
Oral ketotifen
(d)
Your Response :
Correct Answer :
Exp:
Autonomic involvement
(b)
Precipitated by a stimulus
(c)
Gaze
(d)
Frequency of movements
Your Response :
Correct Answer :
Exp:
Precipitated by a stimulus
Jitteriness is defined as rhythmic tremors of equal amplitude around a fixed axis. It is the MC diagnosis in case of
involuntary movements in a healthy full term infant.
Most apparent when infant is crying or being examined.
Clinical features that differentiate seizures from non epileptic events are:
Autonomic events such as tachycardia and increase in (B)P are common with seizures
Non epileptic movements are suppressed by gentle restraints.
Nystagmus, gaze palsy may be seen with epileptic seizures.
There is a significant increase in Prolactin after a true epileptic seizure.
Metaplasia is replacement of mature cells of one type with cells of another type
(b)
(c)
Dysplasia is irreversible
(d)
Your Response :
Correct Answer :
Exp:
Dysplasia is irreversible
Metaplasia
Dysplasia
Anaplasia
Lack of differentiation in
neoplastic cells
Reversibility
Seen
Partially reversible
Not seen
Organization and
orientation
Partially reversible
Not maintained
Not maintained
Polarity
Not lost
Lost
Lost
Other feature
MC epithelial metaplasia
Definition
(Abnormal
differentiation &
Maturation)
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(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
All of above
Hyaline membrane diseasealso known as neonatalrespiratory distress syndrome,lung disease of prematurity,
orsurfactant deficiencyrefers to lung pathology which results from insufficient production of surfactant.
Epidemiology
The incidence is estimated at 6 per 1000 births2.
Clinical presentation
Respiratory distress presents in the first few hours of life in a premature baby. Symptoms include tachypnoea,
expiratory grunting, nasal flaring. The infant may or may not be cyanosed. Substernal and intercostal retractions
may be evident.
Risk factors includematernal diabetes, greater prematurity, prenatal asphyxia and multiple gestation.
Associated abnormalities are those that can occur in prematurity: intracranial haemorrhage,necrotising
enterocolitis,patent ductus arteriosus, delayed developmental milestones, hypothermia and hypoglycaemia.
Pathophysiology
Immature type II pneumocytes cannot producesurfactant. The lack of surfactant lowers the surface tension in
alveoli causing collapse. Patients have a decreased lecithin:sphingomyelin ratio. Damaged cells, necrotic cells, and
mucus line the alveoli.
Radiographic features
Plain film - chest radiograph
Typically gives diffuse ground glass lungs with low volumes and a bell-shaped thorax
Often tends to be bilateral and symmetrical
Amay be evident
Hyperinflation (in a non ventilated patient) excludes the diagnosis
Radiographs may show hyperinflationifthe patient is intubated
RDS can be safely excluded if the neonate has a normal chest X-ray at 6 hours after birth.
If treated with surfactant thereapy there may be asymmetric improvement.
Treatment and prognosis
Exogenous surfactant administration. Supportive oxygen therapy.
Complications
Acute
persistent patent ductus arteriosus (PDA)due to reduced oxygen stimulus
barotrauma(from treatment)
oxygen toxicity (from treatment)
pulmonary haemorrhage(can also included in the differential diagnosis)
Chronic
bronchopulmonary dysplasia
pulmonary interstital emphysema
recurrent pulmonary infection
subglottic stenosis(from intubation)
Differential diagnosis
congenital heart disease
group B Strep pneumonia
pulmonary haemorrhage
pulmonary oedema/pulmonary venous congenstion
neonatal pneumonia
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
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Noninflammatory Inflammatory
Septic
Hemorrhagic
Volume (ml)
<3.5
>3.5
>3.5
>3.5
>3.5
Viscosity
High
High
Low
Mixed
Low
Clarity
Clear
Clear
Cloudy
Opaque
Mixed
Color
Colorless/straw
Straw/yellow
Yellow
Mixed
Red
WBC/mm3
<200
200-2,000
2,000-75,000
>100,000
Same as blood
Polys(%)
<25
<25
>50
>75
Same as blood
Gram stain
Negative
Negative
Negative
Often positive
Negative
(a)
(b)
(c)
Spirometry curve
(d)
Your Response :
Correct Answer :
Exp:
A
SiggaardAndersen curve nomogram
REF : Ganong's Review of Medical Physiology, Twenty-Third Edition, Chap 40
The SiggaardAndersen Curve Nomogram
Use of the SiggaardAndersen curve nomogram to plot the acidbase characteristics of arterial blood is helpful in
clinical situations. This nomogram has PCO2 plotted on a log scale on the vertical axis and pH on the horizontal
axis. Thus, any point to the left of a vertical line through pH 7.40 indicates acidosis, and any point to the right
indicates alkalosis. The position of the point above or below the horizontal line through a PCO2 of 40 mm Hg
defines the effective degree of hypoventilation or hyperventilation. If a solution containing NaHCO3 and no
buffers were equilibrated with gas mixtures containing various amounts of CO2, the pH and PCO2 values at
equilibrium would fall along the dashed line on the left in Figure 407 or a line parallel to it. If buffers were
present, the slope of the line would be greater; and the greater the buffering capacity of the solution, the steeper
the line. For normal blood containing 15 g of hemoglobin/dL, the CO2 titration linepasses through the 15-g/dL
mark on the hemoglobin scale (on the underside of the upper curved scale) and the point where the PCO2 = 40
mm Hg and pH = 7.40 lines intersect, as shown in Figure 407. When the hemoglobin content of the blood is low,
there is significant loss of buffering capacity, and the slope of the CO2 titration line diminishes. However, blood of
course contains buffers in addition to hemoglobin, so that even the line drawn from the zero point on the
hemoglobin scale through the normal PCO2pH intercept is steeper than the curve for a solution containing no
buffers.
For clinical use, arterial blood or arterialized capillary blood is drawn anaerobically and its pH measured. The pHs
of the same blood after equilibration with each of two gas mixtures containing different known amounts of CO2
are also determined. The pH values at the known PCO 2 levels are plotted and connected to provide the CO2
titration line for the blood sample. The pH of the blood sample before equilibration is plotted on this line, and the
PCO 2 of the sample is read off the vertical scale. The standard bicarbonatecontent of the sample is indicated by
the point at which the CO2 titration line intersects the bicarbonate scale on the PCO2 = 40 mm Hg line. The
standard bicarbonate is not the actual bicarbonate concentration of the sample but, rather, what the bicarbonate
concentration would be after elimination of any respiratory component. It is a measure of the alkali reserve of the
blood, except that it is measured by determining the pH rather than the total CO2 content of the sample after
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Aspartate
(b)
Glutamate
(c)
Glycine
Lysine
(d)
Your Response :
Correct Answer :
Exp:
Glycine
Tetrahedral carbon atom with 4 distinct constituents is said to be chiral. The one amino acid not exhibiting
chirality is glycine since it's "R-group" is a hydrogen atom.
H-CH-COOH
I
NH2
Glycine
Chirality describes the handedness of a molecule that is observable by the ability of a molecule to rotate the
plane of polarized light either to the right (dextrorotatory) or to the left (levorotatory).
All of the amino acids in proteins exhibit the same absolute steric configuration as L-glyceraldehyde. Therefore,
they are all L-a-amino acids. D-amino acids are never found in proteins, although they exist in nature. D-amino
acids are often found in polypeptide antibiotics.
(Q.61) Technique which is able to detect posttranslational modification of amino acids such as addition of phosphoryl, hydroxyl group etc.
(a)
Capillary Electrophoresis
(b)
Mass spectrometry
(c)
(d)
Chromatography
Your Response :
Correct Answer :
Exp:
Mass spectrometry
Mass spectrometry, which discriminates molecules based solely on their mass, is ideal for detecting the
phosphate, hydroxyl and other groups on post-translationally modified amino acids. Each adds a specific and
readily identified increment of mass to the modified amino acid.
Uses of Mass spectrometry
Accurate molecular weight measurements:
Sample confirmation, to determine the purity of a sample, to verify amino acid substitutions, to detect posttranslational modifications, to 'calculate the number of disulphide bridges
Reaction monitoring:
To monitor enzyme reactions, chemical modification, protein digestion
Amino acid sequencing:
Sequence confirmation, de novo characterization of peptides, identification of proteins by database searching
with a sequence "tag" from a proteolytic fragment
Oligonucleotide sequencing:
The characterization or quality control of oligonucleotides
Protein structure:
Protein folding monitored by HID exchange, protein-ligand complex formation under physiological conditions,
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is ?
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
C
Myoglobin releases O2 only high at PO2 values
Exp:
(a)
Distance A is 34
(b)
Distance B is 20
(c)
(d)
Your Response :
Correct Answer :
Exp:
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Carbamates
(b)
Bound to albumin
(c)
Bicarbonate
(d)
Free form
Your Response :
Correct Answer :
Exp:
Bicarbonate
Metabolizing cells produce CO2 which diffuses into the blood and enters the circulating red blood cells (RBCs).
Within RBCs the CO2 is rapidly converted to carbonic acid through the action of carbonic anhydrase as shown in
the equation below:
CO2 + H2O ----> H2CO3
--- H+ + HCO3-
The bicarbonate ion produced in this dissociation reaction diffuses out of the RBC and is carried in the blood to
the lungs. This effective CO2 transport process is referred to as isohydric transport.
Approximately 80% of the CO2 produced in metabolizing cells is transported to the lungs in this way. A small
percentage of CO2 is transported in the blood as a dissolved gas.
(Q.65) High energy phosphates are produced in the following EXCEPT
(a)
HMP shunt
(b)
Oxidative pathway
(c)
TCA
(d)
Glycolysis
Your Response :
Correct Answer :
Exp:
HMP shunt
Hexose Monophosphate Shunt Pathway (HMP)produces NADPH that is required for several synthetic pathways,
e.g., for fatty acids and steroid synthesis. However, the NADPH produced is not converted to ATP or used for
energy production (unlike NADH produced in glycolysis and TCA cycle ) Devlin and Rama Rao
The HMP shunt or pentose phosphate pathway serves several purposes, including synthesis and degradation of
sugars other than hexoses, particularly pentoses is necessary for synthesis of nucleotides and other glycolytic
intermediates.
Most important is the ability to synthesize NADPH, which has a unique role in biosynthetic reactions.
The direction of flow and path taken by G6P after entry into the pathway is determined largely by the needs of
the cell for NADPH or sugar intermediates.
When more NADPH than ribose 5-phosphate is required, the pathway leads to complete oxidation of G6P to CO 2
and re-synthesis of G6P from ribulose 5-phosphate.
Alternatively, if more ribose 5-phosphate than NADPH is required, G6P is converted to fructose 6-phosphate and
glyceraldehyde 3- phosphate by the glycolytic pathway.
The distribution of the pentose phosphate pathway in tissues is consistent with its functions. It is present in
erythrocytes for production NADPH, required to generate reduced glutathione, which is essential for
maintenance of normal red cell structure.
It is also active in liver, mammary gland, testis, and adrenal cortex, sites of fatty acid or steroid synthesis that also
require the reducing power of NADPH.
Cholesterol synthesis
(b)
TG transport
(c)
(d)
Your Response :
Correct Answer :
Exp:
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Transcription
(b)
dsDNA replication
(c)
(d)
Translation
Your Response :
Correct Answer :
Exp:
dsDNA replication
Okazaki fragments are short fragments of newly synthesized DNA strands produced during double stranded DNA
replication
All the known DNA polymerases can only synthesis DNA in one direction, the 5 to 3 direction.
However as the strands separate, replication forks will be moving along one parental strand in the 3 to 5
direction and 5 to 3 on the other parental strand.
On the former, the leading strand DNA can be synthesized continuously in the 5 to 3 direction.
On the later, the lagging strand DNA synthesis can only occur when a stretch of single stranded DNA has been
exposed and proceeds in the direction opposite to the movement of the replication fork (still 5 to 3).It is thus
discontinuous and the series of fragments are then covalently linked by ligases to give a continuous strand. Such
fragments were first observed by Okazaki using pulse labeling with radioactive thymidine.
In eukaryotes, Okazaki fragments are typically a few hundred nucleotides long, whereas in prokaryotes they may
contain several thousands of nucleotides.
(Q.68) The structure of a RNA molecule has been shown here. It represents ?
(a)
mRNA
(b)
tRNA
(c)
rRNA
(d)
Your Response :
Correct Answer :
Exp:
tRNA
Ref : Harper's Illustrated Biochemistry, Twenty-Seventh Edition, Chap 34
Transfer RNA (tRNA)
Typical aminoacyl tRNA in which the amino acid (aa) is attached to the 3' CCA terminal. The anticodon, TC, and
dihydrouracil (D) arms are indicated, as are the positions of the intramolecular hydrogen bonding between these
base pairs. tRNA molecules vary in length from 74 to 95 nucleotides. They also are generated by nuclear
processing of a precursor molecule (Chapter 36). The tRNA molecules serve as adapters for the translation of the
information in the sequence of nucleotides of the mRNA into specific amino acids. There are at least 20 species of
tRNA molecules in every cell, at least one (and often several) corresponding to each of the 20 amino acids
required for protein synthesis. Although each specific tRNA differs from the others in its sequence of nucleotides,
the tRNA molecules as a class have many features in common. The primary structureie, the nucleotide
sequenceof all tRNA molecules allows extensive folding and intrastrand complementarity to generate a
secondary structure that appears in two dimensions like a cloverleaf. All tRNA molecules contain four main arms.
The acceptor arm terminates in the nucleotides CpCpAOH. These three nucleotides are added
posttranscriptionally by a specific nucleotidyl transferase enzyme. The tRNA-appropriate amino acid is attached,
or "charged" onto, the 3'-OH group of the A moiety of the acceptor arm. The D, TC, and extra arms help define a
specific tRN(A) Although tRNAs are quite stable in prokaryotes, they are somewhat less stable in eukaryotes. The
opposite is true for mRNAs, which are quite unstable in prokaryotes but generally more stable in eukaryotic
organisms.
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T AQ Polymerase
(b)
d NTP
(c)
Primer
(d)
Your Response :
Correct Answer :
Exp:
Bronchodilatation
Vasoconstriction
Decreased GFR
Vasodilatation
Your Response :
Correct Answer :
Exp:
Bronchodilatation
There are three isoforms of endothelin - Endothelin 1 ,2,3. Endothelin 1 is found in plasma
Endothelin 2 is found in kidney, G.I.T. (functional significance unknown)
Endothelin 3 is found in CNS
These endothelin act through two types of receptors:
Endothelin A
Endothelin B
Both are G protein coupled (Gq type) which act by increasing intracellular calcium ions.
But functionally they exert contrast properties:
Endothelin A causes vasoconstriction ~ decreased GFR Endothelin B causes vasodilatation by increasing NO
release.
Clinical importance: Thus, when we use endothelin antagonist for pulmonary hypertension, it is better to use
endothelin A selective antagonist (sitaxentan) instead of a nonselective antagonist (Bosentan)
Both are pro-mitogenic.
No specific action on bronchial smooth muscle.
Malonyl-CoA
(b)
Pyruvate
(c)
Acetyl-CoA
Citrate
(d)
Your Response :
Correct Answer :
Exp:
Malonyl-CoA
Carnitine Palmitoyltransferase-I (CPT-I) activity is low in the fed state, leading to depression of fatty acid oxidation
and high in starvation, allowing fatty acid oxidation to increase.
Malonyl-CoA, the initial intermediate in fatty acid synthesis is a potent inhibitor of CPT-I.
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(a)
(b)
The DNA is supercoiled in a right-handed helix over the surface of the disk-shaped histone octamer
(c)
The position of histone H1, when it is present, is indicated by the dashed outline at the bottom of the figure.
(d)
1.75 superhelical turns of DNA are wrapped around the surface of the histone octamer
Your Response :
Correct Answer :
Exp:
The DNA is supercoiled in a right-handed helix over the surface of the disk-shaped histone octamer
(Ref. Harper biochemistry 28th, Chap 35)
The diagram depics the structure of the nucleosome, in which DNA is wrapped around the surface of a flat
protein cylinder consisting of two each of histones H2A, H2B, H3, and H4 that form the histone octamer. The 146
base pairs of DNA, consisting of 1.75 superhelical turns, are in contact with the histone octamer. This protects the
DNA from digestion by a nuclease. The position of histone H1, when it is present, is indicated by the dashed
outline at the bottom of the figure.
When the histone octamer is mixed with purified, doublestranded DNA under appropriate ionic conditions, the
same x-ray diffraction pattern is formed as that observed in freshly isolated chromatin. Electron microscopic
studies confirm the existence of reconstituted nucleosomes. Furthermore, the reconstitution of nucleosomes
from DNA and histones H2A, H2B, H3, and H4 is independent of the organismal or cellular origin of the various
components. Neither the histone H1 nor the nonhistone proteins are necessary for the reconstitution of the
nucleosome core. In the nucleosome, the DNA is supercoiled in a left-handed helix over the surface of the diskshaped histone octamer. The majority of core histone proteins interact with the DNA on the inside of the
supercoil without protruding, although the amino terminal tails of all the histones probably extend outside of this
structure and are available for regulatory covalent modifications
The (H3-H4)2 tetramer itself can confer nucleosome-like properties on DNA and thus has a central role in the
formation of the nucleosome. The addition of two H2A-H2B dimers stabilizes the primary particle and firmly binds
two additional half-turns of DNA previously bound only loosely to the (H3-H4)2. Thus, 1.75 superhelical turns of
DNA are wrapped around the surface of the histone octamer, protecting 146 base pairs of DNA and forming the
nucleosome core particle. In chromatin, core particles are separated by an about 30-bp region of DNA termed
"linker." Most of the DNA is in a repeating series of these structures, giving the so-called "beads-on-a-string"
appearance when examined by electron microscopy. The assembly of nucleosomes is mediated by one of several
nuclear chromatin assembly factors facilitated by histone chaperones, a group of proteins that exhibit highaffinity histone binding. As the nucleosome is assembled, histones are released from the histone chaperones.
Nucleosomes appear to exhibit preference for certain regions on specific DNA molecules, but the basis for this
nonrandom distribution, termed phasing, is not yet completely understood. Phasing is probably related to the
relative physical flexibility of certain nucleotide sequences that are able to accommodate the regions of kinking
within the supercoil as well as the presence of other DNA-bound factors that limit the sites of nucleosome
deposition.
(b)
(c)
(d)
Your
Response :
Correct
Answer :
Exp:
D
Four double bonds
Unsaturated fatty acids:
Monoenoic acids (one double bond):
Palmitoleic acid, Oleic acid, Elaidic acid
Dienoic acids (two double bonds): linoleic acid
Trienoic acids (three double bonds): -Linolenic acid, Linolenic acid
Tetraenoic acids (Four double bonds): Arachidonic acid
Pentaenoic acids (Five double bonds): Timnodonic acid
Hexanoic acids (Six double bonds): Cervonic acids
New York
(b)
Geneva
(c)
Rome
(d)
Alma - Ata
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Correct Answer :
Exp:
New York
Millennium development goals were adopted in September 2000 in millennium summit at New York.
On 17 December 1998, the General Assembly adopted resolution 53/202 by which it decided to convene the
Millennium Summit of the United Nations as an integral part of the Millennium Assembly of the United Nations in
order to address the above-mentioned problem. The Summit opened at the United Nations Headquarters in New
York on 6 September 2000. The MDGs consolidated by the Millennium Declaration adopted at the conclusion of
the Millennium Summit as the ever comprehensive international framework which represents the ambitious
quest for bridging the gap among and within world communities. They also represent collective will and resolve of
governments, responding to the world's main development challenges and to the calls of civil society, to address
the issues ranging from eradication of poverty, better health conditions through combating the HIV/AIDS and
other diseases, better education, maternal health, child mortality, gender The MDGs are an agreed set of goals
that were intended to and can certainly be achieved by 2015 deadline, if all actors, public, private and even
individuals work together and do their part. Poor countries have pledged, on their part, to ensure good
governance, and invest in health care and education for their people. Rich countries have pledged to support
them in their efforts, through aid, debt relief, and fairer trade.
The eight MDGs listed below guide the efforts of virtually all organizations working in development and have
been commonly accepted as a framework for measuring development progress:
Eradicate extreme poverty and hunger
Achieve universal primary education
Promote gender equality and empower women
Reduce child mortality
Improve maternal health
Combat HIV/AIDS, malaria, and other diseases
Ensure environmental sustainability
Develop a Global Partnership for Development
(Q.75) In a hospital set-up, the following symbol at the entrance of a room represents te presence of ?
(a)
Biohazardous material.
(b)
Radioactivity
(c)
Magnetic field
(d)
Medical biowaste
Your Response :
Correct Answer :
Exp:
Radioactivity
Ref : Stevens, Christine Dorresteyn. Clinical immunology and serology : a laboratory perspective / Christine
Dorresteyn Stevens. 3rd ed.
Radioactivity is encountered in the clinical laboratory when procedures using radioisotopes, such as
radioimmunoassay, are performed. The amount of radioactivity present in most medical situations is very small
and represents little danger However, the effects of radiation are related to the length of exposure and are
cumulative. Exposure to radiation is dependent on the combination of time, distance, and shielding. Persons
working in a radioactive environment are required to wear measuring devices to determine the amount of
radiation they are accumulating. Laboratorians should be familiar with the radioactive symbol shown. This symbol
must be displayed on the doors of all areas where radioactive material is present. Exposure to radiation during
pregnancy presents a danger to the fetus, and personnel who are or who think they may be pregnant should
avoid areas with this symbol.
Immunization
(b)
Chemoprophylaxis
(c)
Voidance of allergens
(d)
Food fortification
Your
Response c
:
Correct
Answer :
Exp:
(Q.77) World cancer day is on ?
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Feb 4
(b)
Feb 6
(c)
April 7
May 1
(d)
Your Response :
Correct Answer :
Exp:
Feb 4
Global public health campaigns offer great potential to raise awareness and understanding about health issues
and mobilize support for action, from the local community to the international stage.There are many world days
observed throughout the year related to specific health issues or conditions from Alzheimer's to
zoonoses.However, WHO focuses particular attention on the seven days and one week that WHO Member States
have mandated as "official" global public health campaigns. These are:
World TB Day
24 March
7 April
25 April
31 May
14 June
28 July
1 December
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February 4
February 6
February 28
1 March
March 8
March 21
March 21 (Remember as Downs is 21 Trisomy (3rd
month) i;e 21/03)
March 22
March 24
April 2
April 17
April 22
April 25
May 8
May 17
June 1
June 5
June 12
June 14
July 11
July 18
July 28
August 01 to 07
August 12
August 19
September 26
October
October 1
October 10
October 16
October 24
November 14
December 10
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bloating, and diarrhea with six to eight loose stools per day. You suspect antibiotic-associated colitis. False statement regarding
diagnosis of this condition is ?
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
Relative
Comment
++++
+++
+++
++++
Enzyme immunoassay
for toxin A or toxins A
and B in stool
+ + to + + +
+++
Type of Test
Sensitivitya
Specificitya
Enzyme immunoassay + + + to + + + + + + +
for (C) difficile common
antigen in stool
++++
Colonoscopy or
sigmoidoscopy
++++
Despite the array of tests available for (C) difficile and its toxins, no single test has high sensitivity, high specificity,
and rapid turnaround. Most laboratory tests for toxins, including enzyme immunoassays (EIAs), lack sensitivity.
However, testing of multiple additional stool specimens is not recommended. PCR assays have now been
approved for diagnostic testing and appear to be both rapid and sensitive while retaining high specificity.
Empirical treatment is appropriate if CDI is strongly suspected on clinical grounds. Testing of asymptomatic
patients is not recommended except for epidemiologic study purposes. In particular, so-called tests of cure
following treatment are not recommended because many patients continue to harbor the organism and toxin
after diarrhea has ceased and test results do not always predict recurrence of CDI. Thus these results should not
be used to restrict placement of patients in long-term-care or nursing home facilities.
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Hodgkin's disease
(b)
Leukemia
(c)
(d)
Your Response :
Correct Answer :
Exp:
(b)
(c)
(d)
Your
Response c
:
Correct
C
Answer :
Exp:
(Q.82) Cushings disease is characterized by
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(b)
Who have developed a carrier state without suffering fro in overt disease
(c)
(d)
Your Response :
Correct Answer :
Exp:
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(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
D
Until 5 days after onset of parotitis
The scientific evidence from the CDC and AAP review indicates that, although mumps virus can be isolated from
saliva or respiratory secretions 5 or more days after parotitis onset, virus most often is isolated before or around
the time of onset, and viral load decreases rapidly during the 4 days after onset of parotitis. Therefore, the risk for
transmission after 5 days is considered low; most transmission likely occurs before onset of parotitis and within
the subsequent 5 days. Transmission also occurs from persons with subclinical infections who are not isolated. A
longer isolation period of 9 days likely would result in less compliance and more cost and not produce any
substantial decrease in mumps transmission.
Based on this review, CDC, AAP, and HICPAC now recommend a 5-day period after onset of parotitis for 1)
isolation of persons with mumps in either community or health-care settings and 2) use of standard precautions
and droplet precautions. Postexposure recommendations remain unchanged. HCP with no evidence of mumps
immunity who are exposed to patients with mumps should be excluded from duty from the 12th day after first
exposure through the 26th day after last exposure.
(Q.85) Height of the body can be deduced from the length of humerus by following equation:
(a)
(b)
(c)
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Your Response :
Correct Answer :
Exp:
Sensitivity
(b)
Specificity
(c)
Predictive value
(d)
Yield
Your
Response d
:
Correct C
Answer :
Exp:
(Q.87) Strain used in Mumps vaccine?
(a)
Edmonsten Zagreb
(b)
Oka
(c)
Jeryl Lynn
(d)
Danish 1331
Your Response :
Correct Answer :
Exp:
Jeryl Lynn.
(Ref. Parks Textbook of PSM 20th /pg. 141)
Here is comprehensive list of all the specific strains used for vaccination :
VACCINE
STRAIN USED
BCG
Danish 1331
Measles
Edmonston-Zagreb strain
Schwatz strain
Moraten strain
Mumps
Rubella
RA 27/3 strain
HPV 77 strain
Cendehill strain
Yellow fever
17 D strain
Asibi strain
Dakar strain
Varicella
OKA strain
Japanese encephalitis
Nakayama strain MC
Beijing P3 strain
SA 14-14-2 strain
Malaria
Brucella
Typhoral
TY21a
HIV
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Plague
Anthrax
Mazzuchi/Sterne vaccine
Rickettsia
Weigls vaccine{R.prowazeki}
Castaneda formalinized mouse lung vaccine
Live attenuated strain E vaccine
Cox inactivated yolk sac vaccine
HPV
HPV-VLT vaccines
Gardasil quadrivalent {6,11,16,18}
Cervarix bivalent {16,18}
Cholera
Genetic hypothesis
(b)
Mitochondral dysfunction
(c)
Hormonal changes
(d)
Your Response :
Correct Answer :
Exp:
D
All of above
Some Theories of Aging
Hypothesis
Genetic
Oxidative stress
Mitochondrial
dysfunction
Hormonal changes
Accumulation of
senescent cells
(b)
Medical officer
(c)
Laboratory technician
(d)
Health educator
Your Response :
Correct Answer :
Exp:
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EXISTING
PROPOSED
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1(optional)
Total
3/4
2/3
Palm oil
(b)
(c)
Corn oil
Soyabean oil
(d)
Your Response :
Correct Answer :
Exp:
Palm oil
(Ref. Park PSM 20th ed. 528; Table 2)
MAXIMUM IN
MINIMUM IN
Coconut oil
Mono-unsaturated FAs
Groundnut oil
Coconut oil
Poly-unsaturated FAs
Safflower oil
Coconut oil
---------------------------------------------------------------------------------------------------------------------------------------------------------Type of oil
---------------------------------------------------------------------------------------------------------------------------------------------------------Coconut oil
2%
Butter
3%
Margarine
50%
Palm oil
10%
Cottonseed oil
50%
Groundnut oil
31%
65%
65%
Safflower oil
75%
Soyabean oil
62%
(b)
(c)
(d)
JALMA, Agra.
Your Response :
Correct Answer :
Exp:
LOCATED AT
Nagpur
Hyderabad
New delhi
Mysore
Izatnagar
Kasauli
KGMC Lucknow
NICED Kolkata
Port Blait
Pune
AFMC Pune
National TB institute
Bangluru
TB chemotherapy centre
Chetput,Chennai
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Guindy,Tamil nadu
New delhi
Agra
Mumbai
Dhanbad
Lucknow
Ahmedabad
Secunderabad
Mumbai
Dehradun
Kolkata.
(c)
(d)
The nutrient content in a food is stated by weight or as a percentage of the daily value (DV), a variant of the RDA
that, for an adult, represents the highest RDA for an adult consuming 2000 kcal/d.
The RDA is the average daily dietary intake level that meets the nutrient requirements of nearly all healthy
persons of a specific sex, age, life stage, or physiologic condition (such as pregnancy or lactation).
The RDA is defined statistically as 1 standard deviation (SD) above the EAR to ensure that the needs of most
individuals are met.
Your Response :
Correct Answer :
Exp:
The RDA is defined statistically as 1 standard deviation (SD) above the EAR to ensure that the needs of most
individuals are met. (Ref HARRISON 17th Ed Chapter 70)
Recommended Dietary Allowances
The RDA is the nutrient-intake goal for planning diets of individuals; it is used in the MyPyramid food guide of the
U.S. Department of Agriculture (USDA), therapeutic diets, and descriptions of the nutritional content of processed
foods and dietary supplements. The nutrient content in a food is stated by weight or as a percentage of the daily
value (DV), a variant of the RDA that, for an adult, represents the highest RDA for an adult consuming 2000 kcal/d.
The RDA is the average daily dietary intake level that meets the nutrient requirements of nearly all healthy
persons of a specific sex, age, life stage, or physiologic condition (such as pregnancy or lactation).
The RDA is defined statistically as 2 standard deviations (SD) above the EAR to ensure that the needs of most
individuals are met.
The risk of dietary inadequacy increases as intake falls further below the RD(A) However, the RDA is an overly
generous criterion for evaluating nutrient adequacy. For example, by definition the RDA exceeds the actual
requirements
(b)
(c)
Edema is a feature
(d)
Your Response :
Correct Answer :
Exp:
Kwashiorkor
Clinical setting
Energy intake
Time course to
develop
Months or years
Weeks
Clinical features
Starved appearance
Well-nourished appearance
Edema
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standard
Total iron-binding capacity <200 g/dL
Lymphocytes <1500/L
Anergy
Clinical course
Mortality
High
Serum albumin <2.8 g/dL
10
(b)
20
(c)
30
(d)
40
Your Response :
Correct Answer :
Exp:
30
"Although not a direct measure of adiposity, the most widely used method to gauge obesity is Body Mass Index
(BMI), which is equal to weight/height (in kg/ m2). Other approaches for quantifying obesity include
anthropometry (skin fold thickness), densitometry (underwater weighing), CT or MRI and electrical impedance
using data from metropolitan life tables, BMIs for the midpoint of all heights and frames among both men and
women range from 19 to 26 kg/m, at a similar BMI, women have more body fat than men. Based on unequivocal
data of substantial morbidity, a BMI of 30 is most commonly used as a threshold for obesity in both men and
women".
Classification of Weight Status and Risk of Disease
BMI (kg/m2)
Obesity Class
Risk of Disease
Underweight
<18.5
Healthy weight
18.524.9
Overweight
25.029.9
Obesity
30.034.9
High
Obesity
35.039.9
II
Very high
Extreme Obesity
>40
III
Extremely high
Increased
Source: Adapted from National Institutes of Health, National Heart, Lung, and Blood Institute: Clinical Guidelines
on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. U.S. Department of Health
and Human Services, Public Health Service, 1998.
Body Mass Index (BMI) Classification of Children and Adolescents
BMI PERCENTILE FOR AGE
WEIGHT STATUS
<5th percentile
Underweight
5th84th percentile
Normal weight
85th94th percentile
95th percentile
Overweight
Epidemic typhus
(b)
Endemic typhus
(c)
Scrub typhus
(d)
Rickettsial pox
Your Response :
Correct Answer :
Exp:
Rickettsial pox
Rickettsial diseases is a very frequently asked topic in exams.Here is a tell-all table to be remembered about
these diseases.
DISEASE
CAUSATIVE
ORGANISM
INSECT VECTOR
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RESERVIOR
WEIL- NEIL-MOOSER
TransESCHAR MISCELLANEOUS
FELIX REACTION/TUNICA ovarian
TEST REACTION
transmission
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Human louse
Endemic
typhus /
Murine
typhus
R.typhi
(mooseri)
++ OX -19
--
--
Incubation
period 5 15 d.
Only rickettsial
disease showing
recrudescence.
Rodent
++ OX ++
19
--
--
Moosers bodies
Rodent
++ OX -K
++
++
Zoonotic tetrad
++
++
Tache noire
eschar.
++ OX -19
and
OX 2
++
--
Most severe
form.
Scrub typhus R.
Trombiculid mite
/ Chigger
Tsutsugamushi Leptotrombidium
borne
deliensis India.
typhus
L.akamushi Japan
Indian tick
typhus/
Humans
Pediculus humanis
corporis/capitis.
R.conorii
Tick Rhipicephalus
Rodents,Dogs -sanguinis,Haemophysalis
leachi,Amblyomma and
Hyalloma ticks
RMSF
R.rickettsiae
Tick Dermatocentor
andersoni
Rickettsial
pox
R.akari
--
++
++
++
Mildest form
Q fever
Coxiella
burnetti
NIL (airborne
transmission)
--
--
--
--
No rash,
Nonarthropod
airborne
disease,reduced
CD4 : CD8 ratio.
Fever
boutonessi
Rodents
cattle
++
Only rickettsia
causing chronic
disease.
Trench
fever/ Five
day fever
Rochiamlae
Quintana
Human louse
Humans
--
--
--
--
Pediculus humanis
corporis/capitis
(Q.96) When variables are not measurable, which of the following scale is used to be represented:
(a)
Nominal
(b)
Ordinal
(c)
Interval
Ratio
(d)
Your Response :
Correct Answer :
Exp:
Nominal
The calibration used for any measurement qualitative or quantitative - is called the scale. This can be nominal,
ordinal ratio or interval.
1. Nominal scale :- Assessment of a characteristic in terms of names only. Blood group has a nominal scale since
O, A, B and AB are just names with no order or no grading among them. Remember that such names or codes do
not make them quantitative.
2. Ordinal scale :- A polytomous variable where the categories have defined order, such as severity of disease into
mild, moderate, serious and critical. The distance between mild and moderate is underfed.
3. Interval scale :- A polytomous variable where the categories have defined order, along with meaningful equal
intervals.
e.g. Body temperature in colicus / Fahrenheit scale.
4. Ratio scale :- Have the same characteristic as interval scale, but it has an absolute zero.
Primary hyperparathyroid
(b)
Secondary hyperparathyroid
(c)
Tertiary hyperparathyroid
(d)
Hypercalcemia in malignancy
Your
Response d
:
Correct D
Answer :
Exp:
(Q.98) Which of the following is virtually diagnostic of aortitis on chest x-ray?
(a)
(b)
(c)
(d)
Focal oligemia
Your Response :
Correct Answer :
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Exp:
Aortitis
Aortitis cannot usually be recognized at the stage of uniform aortic dilatation, but once ascending aortic wall
calcification, the diagnosis is obvious.
The fine linear calcification of aortitis may be distinguished from the thicker irregular calcification of atheroma,
which, however, may occur secondarily following aortitis.
Atheromatous calcification usually also involves the aortic arch.
Curvilinear calcification confined to the ascending aorta and sparing the arch is usually due to aortitis.
Aortitis of the ascending aorta may cause dilatation of the valve ring, leading to aortic regurgitation.
Aortic root aneurysm
It may be confined by the pericardium or may extend to the arch.
Aortic root aneurysms may vary from being entirely invisible in the frontal and lateral view, to bulging the
superior mediastinum to the right, either forming a shadow continuous with the heart, or separate from it.
Rarely, they extend to the left where the only radiological abnormality may be a prominent pulmonary conus,
displaced to the left by the aneurysm.
(Q.99) If the probability of getting Rh +ve is 0.9 and probability of newborn being male is 0.5, then the probability of new born being a male
with Rh +ve is :
(a)
0.9
(b)
0.5
(c)
0.45
1.3
(d)
Your Response :
Correct Answer :
Exp:
0.45
PROBABILITY AND IT'S RULES Probability is the extent of belief in a phenomenon or a statement.
Addition rule :
P (A or B) = p (A) + P(B) if A and Bare mutually exclusive.
Multiplication rule :
P (A and B) = p (A) x P(B) if A and Bare independent.
e.g. Getting Rh +ve & being male both are independent factors so we apply rule of multiplication to get the
probability.
(Q.100) Which of the following statement about postmortem staining of a dead body which is lying undisturbed, is true?
(a)
(b)
(c)
Disappears in 7 days
(d)
Your Response :
Correct Answer :
Exp:
Diabetic ketoacidosis
(b)
Carcinoma oesophagus
(c)
(d)
Your Response :
Correct Answer :
Exp:
(Q.102) Model for end stage liver disease (MELD) scoring system calculated by using the following criterias except :
(a)
S. bilirubin
(b)
S. Albumin
(c)
(d)
S. Creatinine
Your Response :
Correct Answer :
Exp:
S. Albumin
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External ear
(b)
Middle ear
(c)
Semicircular canals
(d)
Cochlea
Your Response :
Correct Answer :
Exp:
CONFIRM
There are bony and membranous labyrinth in internal ear.
Bony Labyrinth has three parts:
Cochlea
Vestibule
Semicircular canals. CVS
Reissner's membrane(vestibular membrane,vestibular wall) is amembraneinside thecochleaof theinner ear. It
separatesscala mediafromscala vestibuli. Together with thebasilar membraneit creates a compartment in the
cochlea filled withendolymph, which is important for the function of theorgan of Corti. It primarily functions as
adiffusionbarrier, allowing nutrients to travel from theperilymphto theendolymphof themembranous labyrinth.
Histologically, the membrane is composed of two layers of flattenedepithelium, separated by abasal lamina. Its
structure suggests that its function is transport of fluid andelectrolytes.
Reissner's membrane is named after GermananatomistErnst Reissner
Prone position
(b)
Supine position
(c)
Upright position
(d)
Your Response :
Correct Answer :
Exp:
Prone
Hiatal hernias are best demonstrated with the patient prone because the increased abdominal pressure
produced in this position promote displacement of the esophago-gastric junction above the diaphragm.
Gastric acid
(b)
(c)
(d)
Your Response :
Correct Answer :
C
Soluble unionized bile acid
Exp:
The component of duodenal juice thought to be more damaging is bile acids, bile acids should be both non polar
(un-ionized) and soluble (conjugated).
(Q.106) A middle aged female was being treated with high dose steroids for SLE. She had fever for 4 days, followed by otorrhea, deep
seated earache. The ear lobule showed blackish discoloration and bloody discharge for the last 1 day. Looking at the photograph
pick the wrong statement regarding this diagnosis.
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
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Exp:
Malignant external otitis (MEO) is an infection that affects the external auditory canal and temporal bone. The
causative organism is usuallyPseudomonas aeruginosa,and the disease commonly manifests in elderly patients
with diabetes. The infection begins as an external otitis that progresses into an osteomyelitis of the temporal
bone. Spread of the disease outside the external auditory canal occurs through the fissures of Santorini and the
osseocartilaginous junction
Predisposing conditions :
Diabetes (90%) or immunosuppression (illness or treatment related)
Severe, unrelenting, deep-seated otalgia
Temporal headaches
Purulent otorrhea
Possibly dysphagia, hoarseness, and/or facial nerve dysfunction
Treatment includes meticulous glucose control, aural toilet, systemic and ototopic antimicrobial therapy,
andhyperbaric oxygen therapy.
Systemic antibiotic choice: Until the development of third-generation antipseudomonal cephalosporins, longterm intravenous antibiotics using an antipseudomonal penicillin and aminoglycoside were the mainstay of
medical treatment.
Several authors have demonstrated the effectiveness of intravenous ceftazidime monotherapy in the treatment
of malignant external otitis (MEO).
Fluoroquinolones that attain high soft tissue and bone levels with oral doses were then developed.
Subsequently, several authors have demonstrated the efficacy of oral ciprofloxacin monotherapy.
Although no established treatment guidelines are available, case series and anecdotal experience suggest that
initial outpatient therapy with oral ciprofloxacin is efficacious for patients without a fluoroquinolone allergy,
cranial neuropathy, or intracranial complication and who do not require hospital admission for diabetes or pain
management.
The widespread use of fluoroquinolones for upper respiratory infections and simpler ear infections is beginning
to confound the typical clinical spectrum of malignant external otitis (MEO). Ciprofloxacin-resistantP
aeruginosahas been increasingly isolated in patients with malignant external otitis (MEO), accounting for as
many as 33% of isolates in patients who failed outpatient management in a study by Berenholz et al.[18]Most
notably in this patient population, 63% of isolates from 1998-2001 were resistant to ciprofloxacin, whereas only
15% of isolates were found to be resistant in the 10 years before this 3-year period. No increased morbidity or
mortality was found in patients with ciprofloxacin-resistantPseudomonas. Patients with resistantP
aeruginosarequire parenteral antibiotics with antipseudomonal beta-lactam antibiotics with or without an
aminoglycoside.
Duration of therapy
Symptoms and examination findings improve with appropriate therapy, but these changes do not correlate with
the length of needed therapy. Despite symptom relief, prolonged antimicrobial treatment as indicated for
osteomyelitis is still indicated.
Imaging studies are helpful in determining the adequate length of treatment for each patient.
Treatment response should be evaluated with a gallium citrate Ga 67 scan every 4-6 weeks during treatment.
Benecke recommended ending treatment 1 week after the gallium citrate Ga 67 scan findings return to normal
and confirming this with a repeat scan 1 month after the treatment is stopped. Using this protocol for 13
patients, the average duration of treatment was 8.8 weeks with a range of 4-17 weeks.
Hyperbaric oxygen therapy
This should be used only as an adjunct to antimicrobial therapy; it should not be used alone.
Hyperbaric oxygen therapy may be helpful for patients with complications, experiencing a poor response to
therapy, or with recurrent cases.
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(Q.108)
A neutropenic patient presented with severe septicemic shock. However on 2nd day of illness the patient presented with large
painful, reddish, maculopapular lesions that became black and necrotic in couple of days. A biopsy revealed vascular invasion at
that site. Apart from Aspergillosis and Mucormycosis, which of the following bacterium may lead to such a condition ?
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(a)
Pseudomonas
(b)
Mycoplasma
(c)
Streptococcus
(d)
Treponema
Your Response :
Correct Answer :
Exp:
Pseudomonas
Ref : HARRISON 18th Ed Chap 152
The clinical history and photograph provided are suggestive of diagnosis of Ecthyema gangrenosum.
Crude mortality rates exceeding 50% have been reported among patients with P. aeruginosa bacteremia.
Consequently, this clinical entity has been much feared, and its management has been attempted with the use of
multiple antibiotics. Recent publications report attributable mortality rates of 2844%, with the precise figure
depending on the adequacy of treatment and the seriousness of the underlying disease. In the past, the patient
with P. aeruginosa bacteremia classically was neutropenic or had a burn injury. Today, however, a minority of
such patients have bacteremic P. aeruginosa infections. Rather, P. aeruginosa bacteremia is seen most often in
patients on ICUs.
The clinical presentation of P. aeruginosa bacteremia rarely differs from that of sepsis in general. Patients are
usually febrile, but those who are most severely ill may be in shock or even hypothermic. The only point
differentiating this entity from gram-negative sepsis of other causes may be the distinctive skin lesions (ecthyma
gangrenosum) of Pseudomonas infection, which occur almost exclusively in markedly neutropenic patients and
patients with AIDS. These small or large, painful, reddish, maculopapular lesions have a geographic margin; they
are initially pink, then darken to purple, and finally become black and necrotic. Histopathologic studies indicate
that the lesions are due to vascular invasion and are teeming with bacteria. Although similar lesions may occur in
aspergillosis and mucormycosis, their presence suggests P. aeruginosa bacteremia as the most likely diagnosis.
(b)
(c)
(d)
Saddle anesthesia
Your Response :
Correct Answer :
Exp:
Presentation
Reflexes
Knee jerks preserved but ankle jerks Both ankle and knee jerks affected
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Less severe
More severe
More
Less
Sensory
symptoms and
signs
Impotence
Frequent
Sphincter
dysfunction
(b)
(c)
Looser zones
(d)
Proximal myopathy
Your Response :
Correct Answer :
Exp:
(Q.111) Comparison of the value obtained and a predetermined objective is done by:
(a)
Evaluation
(b)
Monitoring
(c)
(d)
Network analysis
Your Response :
Correct Answer :
Exp:
Evaluation
According to WHO expert committee on National Health planning in Developed countries evaluation measures
the degree to which objectives and targets are fulfilled and the quality of the results obtained.
The purpose of evaluation is to assess the achievements of the stated objectives.
Monitoring is confined to day to day activity mostly concerned with the final outcome.
Network analysis is a graphic plan of all events and activities to be completed in order to reach an end objective.
Input-output analysis is an economic technique
Input is resources in terms of manpower, money, material and time and output is like cases treated, lives saved.
An input-output table shows how much of each input is needed to produce an unit amount of output.
(Q.112) For prevention of Neonatal tetanus, all of the following are effective except:
(a)
(b)
(c)
Practice 5 cleans
(d)
Your Response :
Correct Answer :
Exp:
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(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
ACEI
(b)
Bradycardia
(c)
Diuretic
(d)
Your Response :
Correct Answer :
Exp:
Bradycardia
Ivabradine,
It is called as bradycardic drugs, relatively selective If sodium channel blockers, reduce cardiac rate by
inhibiting the hyperpolarization-activated sodium channel in the sinoatrial node.
No other significant hemodynamic effects occurs.
Ivabradine appears to reduce anginal attacks with an efficacy similar to that of calcium channel blockers
and beta blockers.
The lack of effect on gastrointestinal and bronchial smooth muscle is an advantage of ivabradine.
Ivabradine acts by reducing the heart ratein a mechanism different frombeta blockersandcalcium channel
blockers, two commonly prescribedantianginal drugs.
It is classified as a cardiotonic agent
Mechanism of action
Ivabradine acts on the Ifion current, which is highly expressed in thesinoatrial node.
It is a mixed Na+K+inward current activated by hyperpolarization and modulated by the autonomic
nervous system.
It is one of the most important ionic currents for regulating pacemaker activity in the sinoatrial (SA) node.
Ivabradine selectively inhibits the pacemaker current in a dose-dependent manner.
Blocking this channel reducescardiac pacemakeractivity, slowing theheart rateand allowing more time for
blood to flow to the myocardium.
Adverse effects
Luminous Phenomena(by patients described as sensations of enhanced brightness in a fully maintained
visual field). This is due to blockage of Ihion channels in theretinawhich are very similar to cardiac If.
These symptoms are mild, transient, fully reversible and non-severe.
Headaches.
First-degreeAV block
Ventricular Extrasystoles
Dizziness and/or blurred vision.
(Q.115) The deepest and the commonest site of subphrenic abscess is :
(a)
(b)
(c)
(d)
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Correct Answer :
Exp:
Menires disease
(b)
Ototoxicity
(c)
Otospongiosis
(d)
Acoustic neuroma
Your Response :
Correct Answer :
Exp:
Otospongiosis
(Otospongiosis is a primary disease of the bony labyrinth)
Painless deafness (conductive)
Paracusis willisii (better hearing in noise)
Tinnitus, vertigo
Schwartze sign ( Flemingo's flush sign) (Reddish hue on promontory through tympanic membrane)
Negative Rinne test (Bc > AC).
In about 10% of cases of otosclerosis, there is a redness of the promontory of the cochlea seen through the
tympanic membrane due to prominent vascularity associated with an otospongiotic focus
(Q.117) A 45 year old patient presented with bloody nasal discharge and recurrent upper respiratory symptoms. He suddenly developed
palpable purpuric lesions and hemoptysis following which a CT Thorax was performed.
It revealed multiple cavitatory lesions as displayed here. The most likely diagnosis is ?
(a)
Wegeners granulomatosis
(b)
Kawasaki disease
(c)
Tuberculosis
(d)
Cavitatory metastasis
Your Response :
Correct Answer :
Exp:
Wegeners granulomatosis
REF : HARRISON 18th Ed Chap 326
Granulomatosis with polyangiitis (Wegener's) is an uncommon disease with an estimated prevalence of 3 per
100,000. It is extremely rare in blacks compared with whites; the male-to-female ratio is 1:1. The disease can be
seen at any age; 15% of patients are <19 years of age, but only rarely does the disease occur before adolescence;
the mean age of onset is 40 years.
Involvement of the upper airways occurs in 95% of patients with granulomatosis with polyangiitis (Wegener's).
Patients often present with severe upper respiratory tract findings such as paranasal sinus pain and drainage and
purulent or bloody nasal discharge, with or without nasal mucosal ulceration . Nasal septal perforation may
follow, leading to saddle nose deformity. Serous otitis media may occur as a result of eustachian tube blockage.
Subglottic tracheal stenosis resulting from active disease or scarring occurs in 16% of patients and may result in
severe airway obstruction. Pulmonary involvement may be manifested as asymptomatic infiltrates or may be
clinically expressed as cough, hemoptysis, dyspnea, and chest discomfort. It is present in 8590% of patients.
Endobronchial disease, either in its active form or as a result of fibrous scarring, may lead to obstruction with
atelectasis. Eye involvement (52% of patients) may range from a mild conjunctivitis to dacryocystitis, episcleritis,
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(b)
(c)
Colonic diverticulosis
(d)
Sigmoid volvulus
Your Response :
Correct Answer :
Exp:
(Q.119) An elderly patient presented with Cerebellar signs, ipsilateral medial rectus palsy with a fixed dilated pupil and contralateral limb
ataxia (typically affecting only the arm). The area of infarction is shown in the adjoining diagram. Based on location of the infarct
the diagnosis is ?
(a)
Wallenberg syndrome
(b)
Benedickt syndrome
(c)
Parinaud syndrome
(d)
Your Response :
Correct Answer :
Exp:
Benedikt syndrome
REF : Clinical Neurology, 7th Edition, SIMON, ROGER P.. Chap 3
Paramedian Midbrain Infarction
Paramedian midbrain infarction caused by occlusion of the paramedian penetrating branches of the basilar
artery affects the third nerve root fibers and red nucleus. The resulting clinical picture (Benedikt syndrome)
consists of ipsilateral medial rectus palsy with a fixed dilated pupil and contralateral limb ataxia (typically
affecting only the arm). Cerebellar signs result from involvement of the red nucleus, which receives a crossed
projection from the cerebellum in the ascending limb of the superior cerebellar peduncle.
(Q.120) A patient of pneumonia develops septic shock with hypotension. The drug of choice is
(a)
Adrenaline
(b)
Noradrenaline
(c)
Phenylephrine
(d)
Ephedrine
Your Response :
Correct Answer :
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Noradrenaline
"Highest priority is given to aggressive volume expansion and restoration of arterial oxygenation. Former is done
with crystalloid solution to PCWP mm Hg and later is done with inspired oxygen and mechanical ventilation.
If augmentation of cardiac output is required it is done with inotrope like dopamine, nor epinephrine or
vasopressin if there is hypotension or with dobutamine if arterial pressure is normal. Surgical debridement and
antibiotics are given as required.
Since the patient in this case has hypotension and dopamine and vasopressin are not given in the choice, hence
the best answer is nor adrenaline.
(Q.121) The most effective intravesical therapy for superficial bladder cancer is :
(a)
BCG
(b)
Thiopeta
(c)
Mitomycinc
Doxorubicin
(d)
Your Response :
Correct Answer :
Exp:
BCG
Immunotherapy by intravesicular delivery of Bacillus CalmetteGurin (BCG) is also used to treat and prevent the
recurrence of superficial tumors. BCG is a vaccine against tuberculosis that is prepared from attenuated
(weakened) live bovine tuberculosis bacillus,Mycobacterium bovis, that has lost its virulence in humAns: BCG
immunotherapy is effective in up to 2/3 of the cases at this stage, and in randomized trials has been shown to be
superior to standard chemotherapy. The mechanism by which BCG prevents recurrence is unknown, but the
presence of bacteria in the bladder may trigger a localized immune reaction which clears residual cancer cells.
Instillations of chemotherapy, such as valrubicin (Valstar) into the bladder, can also be used to treat BCGrefractory CIS disease when cystectomy is not an option. The drug Urocidin is currently in Phase III of trials for
this procedure.
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
Splenic hilum
(b)
(c)
Tail of pancreas
(d)
Your Response :
Correct Answer :
Exp:
(Q.124) BRCA-1 associated breast cancers have following distinguishing features; except :
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(b)
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Causalgia
(d)
Intermittent claudication
Your Response :
Correct Answer :
Exp:
Causalgia
Lumbar - sympathectomy is seldom indicated as the only treatment for patients with occlusion of major arteries
in the lower extremities.
Sympathectomy is ineffective in the management of gangrene of the toes or foot and d~ not lower the required
level of amputation or delay the requirement for amputation.
Sympathectomy does not improve claudication
May improve ischemic rest pain
Does not improve long--term patency of peripheral vascular term patency bypass grafts
Subjective and objective preoperative assessment of response to sympathetic blockade greatly enhances
response to sympathetic blockade
Three main indications: Three main indications:
Causalgia
Inoperative arterial occlusive disease with limb threatening ischemia causing rest pain, limited ulceration, or
superficial ischemia causing rest pain
digital gangrene
Symptomatic vasospastic disorders.
(Q.126) This neonate had a soft sac like structure protruding from his lower back. The antenatal ultrasound had mentioned a small sized
posterior fossa and dilated ventricles in the brain. In view of the above findings which of the following options best describes the
complete diagnosis in this case ?
(a)
Meningo-myelocele
(b)
Dandy-Walker syndrome
(c)
(d)
Your Response :
Correct Answer :
Exp:
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(Q.127) A child presented characteristic multiple pigmented macules at various sites over his body, along with nodules on his iris. There was
history of impaired vision in his right eye and some freckling in the axillae. What do think these syndromic findings suggest ?
(a)
Tuberous sclerosis
(b)
Neurofibromatosis
(c)
(d)
Your Response :
Correct Answer :
Exp:
Neurofibromatosis
Ref : Nelson 18th Ed Chap 596
The photograph demonstrates Lisch nodules and Caf-au-lait macules. The axillary freckling and vision
impairment that could be due to a Optic nerve glioma all point to the diagnosis of Neurofibromatosis Type I.
Neurofibromatosis (NF), von Recklinghausen disease, is a common autosomal dominant disorder. The condition
is protean, because virtually every system and organ may be affected, and progressive because distinctive
features may be present at birth, but the development of complications is delayed for decades. NF is the
consequence of an abnormality of neural crest differentiation and migration during the early stages of
embryogenesis (see also Chapter 651 ).
Clinical manifestations and diagnosis.
There are two distinct forms of NF. NF-1 is the most prevalent type, with an incidence of 1/4,000, and is
diagnosed when any two of the following seven signs are present: (1) six or more cafau-lait macules over 5 mm
in greatest diameter in prepubertal individuals and over 15 mm in greatest diameter in postpubertal individuals.
Caf au-lait spots are the hallmark of neurofibromatosis and are present in almost 100% of patients. They are
present at birth but increase in size, number, and pigmentation, especially during the 1st few years of life. The
spots are scattered over the body surface, with predilection for the trunk and extremities, and with sparing of
the face. (2) Axillary or inguinal freckling consisting of multiple hyperpigmented areas 23 mm in diameter. (3)
Two or more iris Lisch nodules. Lisch nodules are hamartomas located within the iris and are best identified by a
slit-lamp examination. They are present in >74% of patients with NF-1 but are not a component of NF-2. The
prevalence of Lisch nodules increases with age, from only 5% of children <3 yr of age, to 42% among children 34
yr of age, and virtually 100% of adults 21 yr of age. (4) Two or more neurofibromas or one plexiform
neurofibroma. Neurofibromas typically involve the skin, but they may be situated along peripheral nerves and
blood vessels and within viscera including the gastrointestinal tract. These lesions appear characteristically
during adolescence or pregnancy, suggesting a hormonal influence. They are usually small, rubbery lesions with a
slight purplish discoloration of the overlying skin. Plexiform neurofibromas are usually evident at birth and result
from diffuse thickening of nerve trunks that are frequently located in the orbital or temporal region of the face.
The skin overlying a plexiform neurofibroma may be hyperpigmented to a greater degree than a cafau-lait spot.
Plexiform neurofibromas may produce overgrowth of an extremity and a deformity of the corresponding bone.
(5) A distinctive osseous lesion such as sphenoid dysplasia (which may cause pulsating exophthalmos) or cortical
thinning of long bones with or without pseudoarthrosis. Scoliosis is the most common orthopedic manifestation
of NF-1, although it is not specific enough to be included as a diagnostic criterion. (6) Optic gliomas are present
in 15% of patients with NF-1. These relatively benign tumors consist of glial cells and a mucinous material. Most
patients with optic gliomas are asymptomatic and have normal or near-normal vision, but 20% have visual
disturbances or evidence of precocious sexual development secondary to tumor invasion of the hypothalamus.
Symptomatic optic nerve tumors typically produce symptoms before 6 yr of age. Children are rarely aware of
unilateral visual loss; thus, diagnosis may be delayed. Patients with a unilateral optic glioma typically display an
afferent pupillary defect. To test for this, each eye is alternately stimulated by a bright light source (swinging
flashlight test). The affected pupil dilates rather than constricts, whereas light in the unaffected eye causes both
pupils to constrict equally. NF-1 and a plexiform neuroma of the eyelid have a high association with an ipsilateral
optic glioma. The MRI findings of an optic glioma include diffuse thickening, localized enlargement, or a distinct
focal mass originating from the optic nerve or chiasm. (7) A first-degree relative with NF-1 whose diagnosis was
based on the aforementioned criteria. The majority of mutations in NF-1 occur in the paternal germ line. The NF1 gene on chromosome region 17q11.2 encodes all mRNA of 1113 kb containing at least 59 exons that produce
a protein neurofibromin. More than 300 independent mutations have been reported in the NF-1 gene.
(Q.128) The following statements about thyroglossal cyst are true, except :
(a)
Frequent cause of anterior midline neck masses in the first decade of life -
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
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(b)
(c)
HBc antigen
(d)
HBs antigen
Your Response :
Correct Answer :
Exp:
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
Many methods of treating frostbite have been tried throughout the years. These include massage, warm-water
immersion, or covering the affected area. Rapid warming by immersion in water slightly above normal body
temperature (4044C) is the most effective method; however, because the frostbitten region is numb and
especially vulnerable, it should be protected from trauma or excessive heat during treatment. Further treatment
may include elevation to minimize edema, administration of antibiotics and tetanus toxoid, and debridement of
necrotic skin as needed.
REF HARRISON 17th Ed Chapter 20.
Frostbite: Treatment
Frozen tissue should be rapidly and completely thawed by immersion in circulating water at 3740(C) Rapid
rewarming often produces an initial hyperemia. The early formation of large clear distal blebs is more favorable
than smaller proximal dark hemorrhagic blebs. A common error is the premature termination of thawing, since
the reestablishment of perfusion is intensely painful. Parenteral narcotics will be necessary with deep frostbite. If
cyanosis persists after rewarming, the tissue compartment pressures should be monitored carefully.
Numerous experimental antithrombotic and vasodilatory treatment regimens have been evaluated. There is no
conclusive evidence that dextran, heparin, steroids, calcium channel blockers, hyperbaric oxygen, or
prostaglandin inhibitors salvage tissue. A treatment protocol for frostbiteis summarized in Table 20-4.
Treatment for Frostbite
During Thawing
After Thawing
Remove from
environment
Prevent partial
thawing and
refreezing
Before Thawing
Stabilize core
Immerse part in 3740C (thermometer- Leave hemorrhagic vesicles intact to
temperature and treat monitored) circulating water containing an prevent dessication and infection
hypothermia
antiseptic soap until distal flush (1045
min)
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Address medical or
surgical conditions
Hydrotherapy at 37C
Consider phenoxybenzamine in severe
cases
Unless infection develops, any decision regarding debridement or amputation should be deferred until there is
clear evidence of demarcation, mummification, and sloughing. Magnetic resonance angiography may
demonstrate the line of demarcation earlier than clinical demarcation. The most common symptomatic sequelae
reflect neuronal injury and the persistently abnormal sympathetic tone, including paresthesias, thermal
misperception, and hyperhidrosis. Delayed findings include nail deformities, cutaneous carcinomas, and
epiphyseal damage in children.
Management of the chilblain syndrome is usually supportive. With refractory perniosis, alternatives include
nifedipine, steroids, or limaprost, a prostaglandin E1 analogue.
(Q.131) Due to effect of a chemotherapeutic drug, the DNA of the cells were damaged and due to that p53 gene was activated. Now, the
Go Phase
(b)
G1 Phase
(c)
S Phase
(d)
G2 Phase
Your Response :
Correct Answer :
Exp:
G1 Phase
Exposure of cells to radiation or chemotherapeutic agents induces apoptosis by a mechanism that is initiated by
DNA damage and that involves the tumor suppressor gene p53, p53 accumulates when DNA is damaged and
arrests the cell cycle (at the G1 phase) to allow time for repair.
(b)
Triglycerides
(c)
Cholesterol esters
(d)
Mucopolysaccharide
Your Response :
Correct Answer :
Exp:
(b)
Initiation of carcinogensis
(c)
Promotion of carciogenesis
(d)
Your Response :
Correct Answer :
Exp:
(Q.134) Which of the following enzyme does not help in scavenging free radicals?
(a)
Catalase
(b)
Superoxide dismutase
(c)
Glutathione peroxidase
(d)
NADPH oxidase
Your Response :
Correct Answer :
Exp:
NADPH Oxidase
A series of enzymes acts as free radical scavenging systems and break down hydrogen peroxide and
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Platelet abnormalities
(b)
Immune deficiency
(c)
Eczema
(d)
Your Response :
Correct Answer :
Exp:
(Q.136) . All of the following cause late onset opportunistic infection in renal transplant recipients except?
(a)
Legionella
(b)
Hep B
(c)
Nocardia
Aspergillus
(d)
Your Response :
Correct Answer :
Exp:
Legionella
The Most Common Opportunistic Infections in the Renal Transplant
Recipient
Aspergillus
Wound infections
Nocardia
Herpesvirus
BK virus (polyoma)
Oral candidiasis
Herpes zoster
Hepatitis B
Hepatitis C
Pneumocystis carinii
Cytomegalovirus
Legionella
Listeria
Hepatitis B
Hepatitis C
(b)
Mild dysplasia
(c)
(d)
HIV associated
Your Response :
Correct Answer :
Exp:
(Q.138) Thrifty gene are involved in the pathogenesis of which type of diabetes?
Type I
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Type II
(c)
MODY
LADA
(d)
Your Response :
Correct Answer :
Exp:
Type II
Thrifty Genes
Thrifty genes are genes which enable individuals to efficiently collect and process food to deposit fat during
periods of food abundance.
According to the hypothesis, the 'thrifty' genotype would have been advantageous for hunter-gatherer
populations, especially child-bearing women, because it would allow them to fatten more quickly during
times of abundance.
Fatter individuals carrying the thrifty genes would thus better survive times of food scarcity. However, in
modern societies with a constant abundance of food, this genotype efficiently prepares individuals for a
famine that never comes. The result is widespread chronic obesity and related health problems like type II
diabetes.
Tuberous Sclerosis
(b)
Diabetes insipidus
(c)
Fragile - X syndrome
(d)
Your Response
d
:
Correct Answer D
:
Exp:
(Q.140) Which of the following disorders are not due to mutations affecting collagen synthesis?
(a)
Marfan syndrome
(b)
(c)
Alport syndrome
(d)
Epidermolysis bullosa
Your Response : c
Correct Answer : A
Exp:
Marfan syndrome
Collagen:-most abundant protein in the human body
Types:
a. Type I: Bone, Skin, Tendon
b. Type II: Cartilage
c. Type III: reticulin
d.Type IV: Basement membrane
Collagen synthesis
Inside Fibroblast:
1)Synthesis (RER)
-translation of collagen -chains
2)Hydroxylation(ER)
-requires VIT C
3)Glycosylation(ER)
-form procollagen which is a triple helix of collagen chains
4)Exocytosis of procollagen into extracellular space
Outside Fibroblast:
5)Proteolytic cleavage --> becomes tropocollogen
6)Crosslinking --> becomes collagen fibrils
Disorders of Collagen synthesis
1)Ehler-Danlos
2)Osteogenesis imperfecta
3)Alports syndrome
4)Elastin
Ehler-Danlos
Abnormal type III
Faulty collagen synthesis results in
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(Q.141) In which kind of graph are points plotted over the mid-points of class intervals:
(a)
Bar diagram
(b)
O give
(c)
Frequency polygon
(d)
Histogram
Your Response :
Correct Answer :
Exp:
Frequency Polygon
A frequency distribution may also be represented diagrammatically by the frequency polygon. It is obtained by
joining the mid points of the histogram blocks.
Ogive :- It is a line diagram showing cumulative frequencies.
(Q.142) For a disease caused by several different mutations in a gene, what is the preferred method of diagnosis:
(a)
(b)
(c)
(d)
Linkage analysis
Your Response :
Correct Answer :
Exp:
Linkage analysis
For a disease caused by several different mutations in a gene, direct gene diagnosis is not feasible, and linkage
analysis remains the preferred method. Polymerase chain reaction, reverse transcriptase polymerase chain
reaction and southern blot analysis are methods of direct gene diagnosis.
Macrophage
(b)
Lymphocyte
(c)
Platelets
(d)
Your
d
Response :
Correct
D
Answer :
Exp:
(Q.144) Perforin molecules are found in:
(a)
(b)
(c)
Cytotoxic T cells
(d)
Macrophages
Your
c
Response :
Correct
C
Answer :
Exp:
Cytotoxic T cells
Cytotoxic T cells kill their targets by two principle
mechanisms:
1. Perforin granzyme dependent killing
2. Fas - Fas ligand dependent killing
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(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(Q.146) Which of the following is not true about "Didactic method of communication":
(a)
Learning is authoritative
(b)
Knowledge is imposed
(c)
(d)
Your Response :
Correct Answer :
Exp:
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Transthyretin
(b)
Amyloid Transthyretin
(c)
-Amyloid protein
(d)
2 microglobulin
Your Response :
Correct Answer :
Exp:
Transthyretin
In senile systemic amyloidosis transthyretin is deposited in the heart of aged individuals.
Amyloid
type/Gene
Description
AL
amyloid light
chain
AL amyloidosis / multiple myeloma. Contains immunoglobulin lightchains (,) derived from plasma cells.
AA
SAA
amyloid/APP
ATTR
transthyretin
A2M
AIAPP
amylin
APrP
prion protein
AGel
GSN
ACys
CST3
AApoA1
APOA1
AFib
FGA
Officialabb.
(b)
(c)
(d)
All of above
Your Response :
Correct Answer :
Exp:
All of above
REF : Sabiston : 18th Ed. Chap 77
Transurethral Resection of Prostate
Transurethral resection of prostate (TURP) is a proven surgical technique that significantly improves lower
urinary tract symptoms associated with BPH. This intervention is most commonly recommended in the patient
with symptoms of bladder outlet obstruction and irritability that are moderate to severe, bothersome, and
interfere with the patient's quality of life. Although symptoms constitute the primary reason for recommending
intervention, in patients with an obstructing prostate, there are some absolute indications. These are acute
urinary retention, recurrent infection, recurrent hematuria, and azotemia.
Transurethral resection (TUR) syndrome is an immediate postoperative complication that happens in 2% of TURP
patients. Glycine, which is a hypotonic solution, is used during TURP. Excessive systemic absorption of glycine
can lead to dilutional hyponatremia. The symptoms associated with TUR syndrome include confusion, nausea,
vomiting, hypertension, bradycardia, and visual disturbance. Usually, the patient does not become symptomatic
until the serum sodium concentration reaches 125 mEq/dL. The risk is increased if the gland is larger than 45 g,
the resection time is longer than 90 minutes, or the irrigant fluid is greater than 70 cm H2O above the patient. All
these factors lead to greater fluid absorption and increase the risk for the syndrome. Other potential causes of
TUR syndrome include conversion of glycine to glycolic acid and ammonium. Glycolytic acid and ammonium,
which are byproducts of glycine, may be responsible for some of the side effects of confusion and metabolic
abnormalities observed in these patients.
Furosemide (Lasix) can be used to treat the hyponatremia associated with TUR syndrome. Combination of
diuretic and decreasing fluid overload gradually treats the hyponatremia over 8 to 12 hours. In severe cases,
slow infusion of 3% saline can be used to slowly correct the hyponatremia.
To avoid TUR syndrome associated with the standard TURP, newer technologies that use isotonic saline as
opposed to hypotonic solutions have emerged. Because these newer technologies use isotonic saline, systemic
fluid absorption is not associated with hyponatremia as is the case with standard TURP. Therefore, larger
prostate glands can be resected with less perioperative risk.
Depressed fractures are those in which the patients level of consciousness is diminished or absent
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Compound fractures are those in which the skull is fractured and the underlying brain is lacerated
(c)
Any bone fragment displaced more than 1 cm inwardly should be elevated surgically
(d)
Drainage of cerebrospinal fluid via the ear or nose requires prompt surgical treatment.
Your Response :
Correct Answer :
Exp:
Any bone fragment displaced more than 1 cm inwardly should be elevated surgically
(Schwartz, 7/e, pp 18791880.) Most skull fractures do not require surgical treatment unless they are depressed
or compound. A general rule is that all depressed skull fractures, defined as fractures in which the cranial vault is
displaced inward, should be surgically elevated, especially if they are depressed more than 1 cm, if a fragment is
over the motor strip, or if small, sharp fragments are seen on x-ray (as they may tear the underlying dura).
Compound fractures, defined as
fractures in which the bone and the overlying skin are broken, must be cleansed and debrided and the wound
must be closed. When a skull fracture occurs in an area of the paranasal sinuses, the mastoid air cells, or the
middle ear, a tear in the meninges may result in cerebrospinal fluid drainage from the ear or nose. The presence
of rhinorrhea or otorrhea requires observation and prophylactic antibiotics, because meningitis is a serious
sequel. Otorrhea usually heals within a few days. Persistent cerebrospinal fluid from the nose or ear for more
than 14 days requires surgical repair of the torn dura.
Thrombospondin - 1
(b)
Angiostatin
(c)
Tumstatin
(d)
HIF - 1
Your Response : c
Correct Answer : D
Exp:
HIF-l
HIF - 1, VEGF & bFGF are angiogenic factors.
Thrombospondin -1, angiostatin, endostatin, and tumstatin are anti
angiogenesis factors.
(Q.151) All of the following is true regarding wound healing in GIT except ?
(a)
(b)
Intraluminal bulk transit and peristalsis exert distracting forces on the anastomosis
(c)
(d)
Your Response :
Correct Answer :
Exp:
Wound
pH
Environment
GI Tract
Skin
Collagen
Synthesis
Shear stress
Tissue
oxygenation
Cell type
Fibroblasts
Lathyrogens
Significant inhibition of
cross-linking with
decreased wound strength
Steroids
Collagenase
Activity
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Age
Filariasis
(b)
Malaria of
(c)
Schistosomiasis
(d)
Leprosy
Your Response :
Correct Answer :
Exp:
Filariasis
Meyers-Kouwenaar bodies, the carcasses of microfilariae (mff) covered by deposits of Splendore-Hoeppli (SH)
material, were found in small abscesses of eosinophils and in granulomas. The SH deposits varied from an
eosinophilic, hyaline fringe around intact mff to multilayered deposits surrounding an unrecognizable granular
remnant. In abscesses, peroxidase activity was intense in SH deposits and the surrounding eosinophils. The
presence and localization of IgG were variable in MK bodies, as detected by an enzyme-linked immunohistologic
assay; and antigens of mff were not detected in the SH deposits. Electron microscopy of the MK body
demonstrated a layered, radial deposition of amorphous and granular material on the mff and a structural
heterogeneity which apparently included leukocyte granules and other cell organelles. Leukocytes surrounding
MK bodies in abscesses were often degranulated and degenerate; incorporation of lysosomes of eosinophils and
cellular debris into the SH deposits at the periphery of the MK bodies was indicated.
(Q.153) Maximum permissible dose equivalent of radiations recommended by NCRP for pregnant women is:
(a)
0.1 rem
(b)
0.5 rem
(c)
1 rem
5reni
(d)
Your Response :
Correct Answer :
Exp:
0.5 rem
Maximum permissible doses
Subject exposed
1. Occupationally exposed persons
a. Whole body
b. Prospective annual limit
2. Long term accumulation to age n years
3. Pregnant woman (with respect to fetus)
4. General population
a. Occasional exposed person
Dose
5 rem/year
(n-18) x 5 rem
0.5 rem in gestation period
0.5 rem/year
0.1 rem/year
0.17 rem/year
b. Students
c. Population dose limit
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(b)
(c)
(d)
PNH patients are at increased risk for developing acute myelogenous leukemia.
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Correct Answer :
Exp:
Treponema pallidum
(b)
Cryptococcus
(c)
Streptococcus pneumoniae
(d)
Vibrio cholera
Your Response :
Correct Answer :
Exp:
Vibrio cholera
Negative staining by Indian ink preparation is particularly useful in demonstration of bacterial capsule, very
slender organisms like spirochetes and capsulated fungi (Cryptococcus). It is not useful for vibrio cholera.
(Q.158) A patient Heeralal, 45 years old, having cough from previous 3 months, is suspected to have tuberculosis. His sputum is sent for
culture. Adding of which antiseptic will not affect growth of tubercle bacilli?
(a)
Hypochlorites
(b)
Malachite green
(c)
Chlorhexidine
(d)
Hexachlorophene
Your Response :
Correct Answer :
Exp:
Malachite green
Malachite green has no activity against tubercle bacilli but inhibits gram positive and negative organisms. Hence,
it is used as a selective agent in Lwenstein -Jensen medium.
(b)
It contains charcoal
(c)
(d)
Your Response :
Correct Answer :
Exp:
(Q.160) Which culture method is used for the preparation of bacterial antigens and vaccines?
(a)
Lawn culture
(b)
Stroke culture
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(d)
Liquid culture
Your Response :
Correct Answer :
Exp:
Histoplasma
(b)
Rickettsia prowazekii
(c)
Exotoxins
(d)
Endotoxins
Your Response :
Correct Answer :
Exp:
Endotoxins
Clotting of limulus lysate is used as a test for detection of endotoxins.
Limulus amebocyte lysate(LAL) is an aqueous extract of blood cells (amoebocytes) from thehorseshoe
crab,Limulus polyphemus. LAL reacts with bacterialendotoxinorlipopolysaccharide(LPS), which is a membrane
component ofGram negative bacteria. This reaction is the basis of theLAL test, which is the used for the
detection and quantification of bacterial endotoxins.
(b)
VDRL test
(c)
Kahn test
(d)
Your Response :
Correct Answer :
Exp:
(b)
(c)
Candidiasis
(d)
Meningococci
Your Response :
Correct Answer :
Exp:
Meningococci
Deficiency of C5 to C8 complement components can lead to bacteremia, mainly with Gram-negative
diplococci and toxoplasmosis.
COMPLEMENT SYSTEM
System of proteins that interact to play a role in humoral immunity and inflammation.
Complement defends against gram-negative bacteria.
Activated by IgG or IgM in the classic pathway.
Activated by molecules on the surface of microbes (especially endotoxin) in the alternate pathway.
C1, C2, C3, C4viral neutralization.
C3bopsonization.
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Anti - CD3
(b)
Anti - Ig
(c)
Phytohemagglutinin
(d)
Concanavalin A
Your Response :
Correct Answer :
Exp:
Anti - Ig
T cell undergo blast transformation on treatment with phytohemagglutinin, concanavalin A and anti - CD3 while
anti-Ig, endotoxins, Staphylococcus aureus and EB virus induces blast transformation of B Cell.
Staphylococcus aureus
(b)
Staphylococcus epidermidis
(c)
Pseudomonas
(d)
Bacteroides
Your Response :
Correct Answer :
Exp:
Staphylococcus aureus
Staphylococcus aureus is the most common cause of surgical wound infections and is second only to coagulase
negative staphylococci as a cause of primary bacteremia.
Staphylococcus aureus
(b)
Staphylococcus epidermidis
(c)
Staphylococcus hyicus
(d)
Staphylococcus saprophyticus
Your Response :
Correct Answer :
Exp:
Staphylococcus saprophyticus
Staphylococcus saprophyticus causes urinary tract infection particularly in sexually active young women. It
is novobiocin resistant.
Pyridoxamine
(b)
Ascorbic acid
(c)
Vitamin D
Retinoic acid
(d)
Your Response :
Correct Answer :
Exp:
Pyridoxamine
Nutritionally variant streptococci require supplemental thiol compounds or active fomr as of vitamin B6
(pyridoxal or pyridoxamine) for growth in the laboratory.
Neisseria
(b)
Moraxella
(c)
Veillonella
(d)
Eikenella
Your
Response a
:
Correct
D
Answer :
Exp:
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Palatine paralysis
(b)
Ciliary paralysis
(c)
Pupillary paralysis
(d)
Spontaneous recovery
Your Response :
Correct Answer :
Exp:
Pupillary paralysis
Postdiphtheritic paralysis occurs in the third & fourth week of the disease. Palatine and ciliary but not pupillary
paralysis is characteristic, and spontaneous recovery is the rule.
(Q.170) Which of the following is not a screening test for significant bacteriuria?
(a)
(b)
Catalase test.
(c)
(d)
Eiken's test.
Your Response :
Correct Answer :
Exp:
Eiken's test.
Eiken's test used to differentiate between heat stable toxin and heat labile toxin of Escherichia coil. Tests used
for screening of significant bacteriuria are:
Griess nitrite test.
Catalase test.
Triphenyltetrazolium chloride test.
Microscopic demonstration of bacteria.
Glucose test paper.
Dip slide culture.
(Q.171) A 52 years female presented with fever of 2 weeks. Microscopic examinations of her urine shows pus cells. Staphylococcal
coagglutination showed antibody coated bacteria in her urine. Which is the likely site of infection?
(a)
Kidney
(b)
Ureter
(c)
Bladder
Urethra
(d)
Your Response :
Correct Answer :
Exp:
Kidney
Fever with pus cells in urine suggests the diagnosis of UTI. Absence of dysuria and frequency is against the
diagnosis of cystitis and urethritis. Furthermore bacteria coated with specific antibodies are present in the urine
only when the kidneys are infected. Antibody coated bacteria are detected by immunofluorescence using
fluorescent tagged antihuman globulin or by staphylococcal coagglutination.
Mycobacterium bovis
(b)
Mycobacterium avium
(c)
Serratia
(d)
Staphylococcus aureus
Your Response :
Correct Answer :
Exp:
Serratia
Serratia may grow in sputum after collection and may suggest hemoptysis because of the pigment formed
('Pseudohemoptysis').
Rickettsia typhi
(b)
Rickettsia rickettsi
(c)
Rickettsia conorii
(d)
Rickettsia 'akari
Your
Response b
:
Correct
D
Answer :
Exp:
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Serotype 1
(b)
Serotype 2
(c)
Serotype 3
Serotype 6
(d)
Your Response :
Correct Answer :
Exp:
Serotype 6
Diseases and specific associated serotypes
(B) cereus food poisoning
Emetic 1,3,5
diarrhoeal- 2,6,8,9,10,12
Human botulism
1/2a, 1/2b, 4b
Yersinia pseudotuberculosis
01
Yersinia enerocolitica
03,08,09
S. pyogens glomerulonephritis
49,53-55,59-64,1,12
Pneumococcal pneumonia
Meningococcal meningitis
A,B,C,W,Y
Legionella pneumophilla
Chlamydia trachomatis
Cryptococcus neoformans
Polio virus
Influenza virus
Parainfluenza virus
Rotavirus
Astrovirus
Most common =1
Rhabdoviridea
Adenovirus
H. influenza
Coxsackie virus
Enterovirus
HPV
no Antigenic
(b)
Factor Xa inhibition
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Antithrombin inhibitor
(d)
Thrombin inhibition
Your
Response :
Correct
Answer :
Exp:
B
Factor Xa inhibition
Pentasaccharide
Mechanism of action: Factor Xa inhibition
Example: Fondaparinux, Idraparinux
Extra Edge: Newer factor Xa inhibitor :
a. Rivaroxaban
b. Apixaban (H-18th Pg-1000) Both are given orally.
(b)
(c)
Large platelets
(d)
Thrombocytopenia
Your Response :
Correct Answer :
Exp:
VWF facilitates platelet adhesion by binding to this Fibrinogen facilitates platelet aggregation via sites
receptor
on this receptor.
Loss or defect in above glycoprotein receptors leads to rare platelet disorders causing bleeding
Bernard Soulier syndrome
Glanzmanns thrombasthenia
(Q.177) A woman who pricked her finger while pruning some rose bushes develops a local pustule that progresses to an ulcer. Several
nodules then develop along the local lymphatic drainage. The most likely agent is :
(a)
Cryptococcus neoformans
(b)
Candida albicans
(c)
Sporothrix schenckii
(d)
Aspergillus fumigatus
Your Response :
Correct Answer :
Exp:
Sporothrix schenckii
The conidia or hyphal fragments of S. schenckii are introduced into the skin by trauma. Patients frequently recall
a history of trauma associated with outdoor activities and plants. The initial lesion is usually located on the
extremities but can be found anywhere (children often present with facial lesions). About 75% of cases are
lympho-cutaneous; ie, the initial lesion develops as a granulomatous nodule that may progress to form a
necrotic or ulcerative lesion. Meanwhile, the draining lymphatics become thickened and cord-like. Multiple
subcutaneous nodules and abscesses occur along the lymphatics.
(Q.178) Which of the following drugs crosses blood brain barrier by the process of pinocytosis?
(a)
Thyroxin
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Phenobarbitone
(c)
Penicillin
(d)
Insulin-l
Your Response :
Correct Answer :
Exp:
Insulin
Insulin is a high molecular weight protein which is inactive orally and is unable to cross intact cell membrane. It is
transferred into the CNS by the process of pinocytosis.
(Q.179) Which of the following is a wrong match with respect to the anticancer drug and agents used against its toxicity as a preventive
measure?
(a)
Amifostine : Cisplatin
(b)
(c)
Dexzoxazone : Adriyamycin
(d)
Defibrotide : Busulphan
Your Response :
Correct Answer :
Exp:
PROTECTIVE AGENT
Anthracyclines
(Doxorubicin/Adriamycin/Daunarubicin)
Cardiotoxicity
Dextrazoxane
Cisplastin
Nephrotoxicity
Amifostine
Cisplatin
Glutathione
Cisplatin
Emesis
Ondansetron
Cisplatin
Cardiotoxicity
Dextrazoxane
Cyclophosphamide
Hemorrhagic cystitis
MESNA
Methotrexate
Marrow suppression
Busulphan
ANTICANCER DRUG
(Q.180) Which of the substance increases the permeability of blood-brain barrier and improves penetration of drugs in the brain?
(a)
Substance P
(b)
Neurokinin A
(c)
Enkephalins
Histamine
(d)
Your Response :
Correct Answer :
Exp:
Enkephalins
Bradykinin and enkephalins increase the permeability of blood brain barrier by increasing pinocytosis. This
approach is being evaluated as a mean to improve penetration of anticancer drugs in the brain during
management of brain tumors.
CML
(b)
AML
(c)
T cell ALL
(d)
Burkitt lymphoma
Your Response :
Correct Answer :
Exp:
AGE
SEX
a. Endemic
8-15
M>>>F
b. Sporadic
8-15
M>>>F
c. AIDS associated
Young Adults
M=F
LN,BM
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b. Doxorubicin
d. Methotrexate
f. Ifosfamide
h. Rituximab
SEEN IN
Burkitts lymphoma
ALL FAB Type L3
Immunoblastic B cell lymphoma
t (11;14)
t (14;18)
t (15;17)
Promyelocytic leukemia M3
t (4;11)
t (6;14)
Cystadenocarcinoma of Ovary
t (3;8)
Renal adenocarcinoma
Mixed parotid tumour
t (8;21)
t (11;22)
t (12;22)
(Q.182)
t (12;16)
Myxoid liposarcoma
t (2;13)
Alveolar rhabdomyosarcoma
t (x;18)
t (11;18)
MALToma
t (14;15)
CLL / SLL
t (9;22)
Pre B ALL
B cell ALL
t (2;5)
t (9;14)
Lymphoplasmacytoid lymphoma
T cell ALL
t (10;17)
Which of the following drug produces its effect by blocking GABA gated CI- channels?
(a)
Diazepam
(b)
Amiloride
(c)
Picrotoxin
(d)
Lignocaine
Your Response : a
Correct Answer : A
Exp:
(Q.183) In addition to liver, biotransformation of drugs can also occur in all of the following tissues except:
(a)
Lungs
(b)
Kidney
(c)
Skin
Spleen
(d)
Your Response :
Correct Answer :
Exp:
Spleen
Liver is the principal organ of drug metabolism.
Other tissues that display drug metabolizing activity include the GIT, the lungs, the skin
and the kidneys.
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Competitive antagonism
(b)
Physiological antagonism
(c)
Chemical antagonism
(d)
Pharmacokinetic antagonism
Your Response :
Correct Answer :
Exp:
Chemical antagonism
In chemical antagonism one drug antagonizes the action of a second drug by binding to and inactivating it.
Protamine, a protein that is positively charged at physiological pH interacts with heparin that is negatively
charged and counteracts its effects.
(Q.185) A male patient, 25 years of age was operated by using the technique of balanced anesthesia. In the post operative period he
developed abdominal distension and retention of urine. Which of the following drug can be used to relieve his symptoms? .
(a)
Oral bethanechol
(b)
Injection bethanechol
(c)
Injection neostigmine
(d)
Oral physostigmine
Your Response :
Correct Answer :
Exp:
Injection neostigmine
The patient is having paralytic ileus with urinary retention. Oral administration of a drug is not likely to be very
effective as its absorption will be unpredictable. Bethanechol has a more selective effect on the urinary bladder
but less effect on GIT. Injection neostigmine will relieve both paralytic ileus and urinary retention.
(Q.186) The non-depolarizing skeletal muscle relaxant with a short duration of effect is:
(a)
Mivacurium
(b)
Succinyl choline
(c)
Atracurium
(d)
Vecuronium
Your Response :
Correct Answer :
Exp:
Mivacurium
Mivacurium has a short duration of action as it is destroyed by plasma cholinesterase.
Atracurium is inactivated by a form of spontaneous breakdown known as Hoffman's elimination and vecuronium
is eliminated by hepatic metabolism- both are intermediate acting. Succinyl choline is also destroyed by plasma
Acetyl choline-esterase but is a persistent depolarizing agent.
Fasting glucose
(b)
(c)
HbA1C
(d)
Your Response :
Correct Answer :
Exp:
HbA1C
eAG (Estimated Average Glucose)
HBA1C should be measured in all individuals with DM during their initial evaluation and as part of their
comprehensive diabetes care.
As the primary predictor of long-term complications of DM, the HBA1C should mirror, to a certain extent,
the short-term measurements of Self monitoring of blood sugar (SMBG).
These two measurements are complementary in that recent intercurrent illnesses may impact the SMBG
measurements but not the HBA1C.
Likewise, postprandial and nocturnal hyperglycemia may not be detected by the SMBG of fasting and preprandial capillary plasma glucose but will be reflected in the HBA1C.
In standardized assays, the HBA1C approximates the following mean plasma glucose values:
HBA1C (%) to eAG (mg/dl)
1. 6.0% = 126 mg/dl
(Q.188) Anti-HIV drug known to cause myopathy resembling Mitochondrial myopathy with ragged red Fibers?
(a)
Zidovudine
(b)
Enfuvirtide
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(c)
Tenofovir
(d)
Your Response :
Correct Answer :
Exp:
Zidovudine.
Culprit AntiHIV drug
Adverse effect
Anti-HIV drug causes severe hepatotoxicity with steatohepatitis
Zidovudine.
Zidovudine.
Zidovudine.
Enfuvirtide
(fusion
inhibitor).
Efavirenz,
Abacavir.
Abacavir.
Didanosine,
zalcitabine,
and
stavudine,
indinavir.
Nevirapine.
Pancreatitis
Didanosine,
Zalcitabine.
Nephrotoxic
Tenofovir
Abnormal dreams
Efavirenz
Saquinavir,
Ritonavir,
Nelfinavir,
Indinavir.
Nephrolithiasis
Indinavir
Drug-Induced Myopathies
Drugs
Lipid-lowering agents
Fibric acid derivatives
HMG-CoA reductase
inhibitors
Niacin (nicotinic acid)
Glucocorticoids
Nondepolarizing
neuromuscular blocking
agents
Zidovudine
Drugs of abuse
Alcohol
Amphetamines
Cocaine
Heroin
Phencyclidine
Meperidine
Autoimmune toxic myopathy Use of this drug may cause polymyositis and myasthenia
gravis.
D-Penicillamine
Amphophilic cationic drugs
Amiodarone
Chloroquine
Hydroxychloroquine
Antimicrotubular drugs
Colchicine
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Dalteparin
(b)
Rivaroxaban
(c)
Lepirudin
(d)
Your Response :
Correct Answer :
Exp:
Rivaroxaban
Extra Edge: Dabigatran etexilate, an oral thrombin inhibitor, and Rivaroxaban &, Apixaban both are oral Factor
Xa inhibitor, are used for short-term thromboprophylaxis after elective hip or knee replacement surgery.
Dabigatran etexilate is used as an alternative to warfarin for stroke prevention in patients with atrial fibrillation.
(Q.190) The plasma protein binding of acidic drugs, like sulfonamides, is reduced in which of the following conditions?
(a)
Trauma
(b)
Rheumatoid arthritis
(c)
Celiac disease
(d)
Jaundice
Your Response :
Correct Answer :
Exp:
Jaundice
Jaundice is associated with hyperbilirubinemia which reduces binding of acidic drugs to plasma proteins. In
trauma, rheumatoid arthritis and celiac disease there is an increase in plasma a1 acid glycoprotein which
increases the binding of basic drugs like chlorpromazine, imipramine etc. to plasma proteins.
AR
(b)
AD
(c)
X-link recessive
(d)
X-link dominant
Your Response :
Correct Answer :
Exp:
X-link recessive
Usually, the hereditary form of nephrogenic DI is the result of an X-linked genetic defect which causes the
vasopressin receptor (also called the V2 receptor) in the kidney to not function correctly.
I am providing you with an Over-comprehensive list of various diseases and their mode of inheritance.
Remembering all of them is impractical but revise it again and again and you will not miss out on it in the exam.
AUTOSOMAL DOMINANT
AUTOSOMAL RECESSIVE
Abetalipoprotinemia
Achondroplasia
Cystic fibrosis
Neurofibromatosis
Hirshsprung disease
Phenylketonuria
Marfans syndrome
Albinism
Retinoblastoma
Tay-sachs disease
Hereditary Spherocytosis
Alkaptonuria
Tuberous sclerosis
Galactosemia
Myotonic dystrophy
Beta thallasemia
Osteogenesis imperfecta
Homocystinuria
MEN
Wilsons disease
VHL syndrome
Hemochromatosis
Wilms tumour
Otosclerosis
Freidrichs ataxia
Retinitis pigmentosa
ALS
Kartagener syndrome
Huntingtons chorea
Turcots syndrome
Crouzon syndrome
Fanconi syndrome
Myotonic dystrophy
Gaucher syndrome
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Hemiplegic migraine
Charcot-Marie-Tooth disease
Nonketotic hyperglycinemia
Pigmentary glaucoma
Acrodermatitis enteropathica
Hemophila A and B
G6PD deficiency
Blood group Xg
Hydrocephalus
Retts syndrome
Incontinentia pigmentii
Hunters syndrome
Chronic Granulomatous disease
Wiskott-Aldrich syndrome
Nephrogenic Diabetes insipidus
Lesch-Nyhan syndrome
Fragile X syndrome
Dents disease
Kallman syndrome
Androgen insensitivity syndrome
Fabrys disease
Alport syndrome
MITOCHONDRIAL INHERITANCE (1 Question was asked in AIIMS NOV 09)
Mitochondrial myopathy
Lebers Hereditary Optic Neuropathy (LHON)
MELAS : Metabolic Encephalopathy + Lactic Acidosis + Stroke like episodes
NARP : Neuropathy + Ataxia + Retinitis Pigmentosa
Pearson syndrome : Bone marrow and Pancreatic failure
Kearns-Sayre syndrome : Ophthalmoplegia + Pigmentary degeneration of retina + Cardiomyopathy
MERRF syndrome : Myoclonic Epilepsy + Ragged Red Fibres
MMC : Maternally inherited Myopathy and Cardiomyopathy
CEOP : Progressive External Ophthalmoplegia
ADMIMY : Autosomal Dominant inherited Mitochondrial Myopathy and Mitochondrial Deletion
Leighs disease : movement disorder + regression + respiratory dyskinesia
Navajo Neurohepatopathy and MDS
(Q.192) The drug which exerts its CYP 3 A4 inhibiting effect by a mechanism based inactivation is:
(a)
Erythromycin
(b)
Ciprofloxacin
(c)
Amiodarone
(d)
Diltiazem
Your Response :
Correct Answer :
Exp:
Erythromycin
Most of the drugs cause CYP enzyme inhibition by competitive inhibition wherein two drugs compete with each
other for the same active site on the enzyme. A second type of enzyme inhibition is mechanism based or suicide
inactivation in which the effector compound is metabolized by the enzyme to a reactive form which irreversibly
binds to the enzyme and prevents any further metabolism of the drug. The drug which cause such suicide
inhibition are erythromycin, ticlopidine and disulfiram.
SOME SPECIFIC CYTP450s IN THE BODY :
Most Important Cytochrome in the body
Cytochrome metabolizing Ethanol
Cyt P 3A
Cyt P 2E1
Cyt P 1A1
Cyt P 2C9
Cyt P 2A6
(Q.193) Which of the following alfa adrenoceptor antagonists is relatively more selective for 1A adrenoceptors ?
(a)
Tamsulosin
(b)
Doxazosin
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Phentolamine
(d)
Yohimbine
Your Response :
Correct Answer :
Exp:
Tamsulosin
Alfa adrenoceptors are broadly classified as alpha1 postsynaptic and alpha2 presynaptic. At least three subtypes
of both alpha1 and alpha2 receptors have been identified Viz. alpha1 A, (B) & D and alpha2 A, B & (C) Tamsulosin
exhibits some selectivity for alpha1 A receptors which are rich in the prostate, while alpha1B receptors are
plentiful in vascular smooth muscle. Tamsulosin is used as an agent of choice in the treatment of Benign
prostatic hypertrophy.
(Q.194) Which of the following antihypertensive agent produces its effect by causing release of nitric oxide and opening of K+ channels?
(a)
Hydralazine
(b)
Minoxidil
(c)
Sodium nitroprusside
(d)
Diazoxide
Your Response :
Correct Answer :
Exp:
Hydralazine
The vasodilatation produced by hydralazine depend in part on the presence of an intact blood vessel
endothelium, implying that it causes the release of nitric oxide which acts on the vascular smooth muscle to
cause relaxation. In addition, it may produce vasodilatation by activating K+ channels. Diazoxide and minoxidil
cause relaxation of vascular smooth muscle by opening of potassium channels, while sodium nitroprusside acts
by releasing nitric oxide.
Acromegaly
(b)
Prolactinoma
(c)
Cushings syndrome
(d)
Hyperparathyroid
Your Response :
Correct Answer :
Exp:
Acromegaly
Test
Increase heal pad thickness seen on X-ray lateral view of the heal
Most common cause of increase heal pad thickness is heal injury (AIIMS Nov 2010).
Elevated IGF-I. Usually > 5 times normal.
Serum GH not suppressed following oral glucose. OGTT test (75 gms of glucose given . After 1 hour if GH>1
ng/ml- suggestive of GH tumor.) It is the most definite test.
Confirmation- MRI/CT
(Q.196) Which of the following diuretic does not require access to the tubular lumen for exerting its diuretic effect?
(a)
Spironolactone
(b)
Triamterine
(c)
Hydrochlorothiazide
(d)
Furosemide
Your Response :
Correct Answer :
Exp:
Spironolactone
Epithelial cells in the LDT and CD contain cytosolic mineralocorticoid receptors (MR) that have high affinity for
aldosterone. Aldosterone enters the epithelial cell from the basolateral membrane and binds to MRs the MR
aldosterone complex is translocated to the nucleus where it regulates the expression of aldosterone induced
proteins (ATP) which exert following effects:
(1) Activation of "silent" Na+ channels and Na+ pumps that pre-exist in the cell membrane
(2) Cycling of Na+ channels and Na+ pumps between the cytosol and cell membrane such that more channels
and pumps are located in the membrane.
(3) Increased expression of Na+ channels and Na+ pumps and
(4) Increased activity of enzymes in the mitochondria that are involved in ATP production.
This results in enhanced transepithelial NaCI transport and increased excretion of K+ and H+. Spironolactone and
eplerenone competitively inhibit the binding of aldosterone to the MRs, blocking the biological effects of
aldosterone. MRs antagonists are the only diuretics that do not require access to the tubular lumen to induce
diuresis.
Triamterine is a basic drug that is transferred by the organic base secreting mechanism in the proximal tubule,
while thiazides and furosemide are acidic drugs that gain access to the tubular lumen by organic acid secretory
mechanisms in the proximal tubule.
Growth hormone
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Cortisol
(c)
Oxytocin
(d)
Prolactin.
Your Response :
Correct Answer :
Exp:
Oxytocin
The secretion of chemical messengers (neurohormones) from neurons into the blood is referred to as
neuroendocrine secretion. Thus, in contrast to the local actions of neurotransmitters at nerve endings,
neurohormones circulate in the blood before producing biological effects at target tissues. Oxytocin is
synthesized from magnocellular neurons whose cell bodies are located in the paraventricular and supraoptic
nuclei and whose nerve terminals terminate in the posterior pituitary gland. Target tissues for circulating
oxytocin are the breast and uterus, where the hormone plays a role in lactation and parturition, respectively.
(Q.198) All of the following are inducers of the microsomal enzyme system except:
(a)
Carbamazepine
(b)
Phenytoin
(c)
Phenobarbitone
(d)
Ticlopidine
Your Response :
Correct Answer :
Exp:
Ticlopidines
This is a very very important and frequently asked topic hence just by-heart the following list once and for all
:
MICROSOMAL ENZYME INDUCERS
Phenobarbitone
Cimetidine
Phenytoin
Erythromycin
Carbamazepine
Ciprofloxacin
Rifampicin
INH
Phenylbutazone
Ketoconazole
Griseofulvin
Metronidazole
Glucocorticoids
Disulphiram
Allopurinol
Clofibrate
Ticlopidine
Meprobamate
OC pills
Smoking
Omeprazole
Chloral hydrate
DDT
Charcoal boiled meat
(Q.199) A cross-sectional view of a skeletal muscle fiber through the H zone would reveal the presence of what?
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(Q.200) Which of the following conditions at the A-V node causes a decrease in heart rate?
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(Q.201) Which of the following conditions is normally caused by sympathetic stimulation of the heart?
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(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(Q.202) A decrease in which of the following would be expected to occur in response to a direct increase in renal arterial pressure?
(a)
Water excretion
(b)
Sodium excretion
(c)
(d)
Your Response :
Correct Answer :
Exp:
(Q.203) In normal kidneys, which of the following is true of the osmolarity of renal tubular fluid that flows through that early distal tubule in
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(Q.204) In a patient with very high levels of aldosterone and otherwise normal kidney function, approximately what percentage of the
filtered load of sodium would be reabsorbed by the distal convoluted tubule and collecting duct?
(a)
40 to 60 percent
(b)
20 to 40 percent
(c)
10 to 20 percent
(d)
Your Response :
Correct Answer :
Exp:
Less than 10
Although aldosterone is one of the body's most potent sodium-retaining hormones, it stimulates sodium
reabsorption only in the late distal tubule and collecting tubules, which together reabsorb much less than 10
percent of the filtered load of sodium therefore, the maximum percentage of the filtered load of sodium that
could be reabsorbed in the distal convoluted tubule and collecting duct, even in the presence of high levels of
aldosterone, would be less than 10 percent.
Na+ Reabsorption
The reabsorption of Na+ and Cl plays a major role in body electrolyte and water homeostasis. In addition, Na+
transport is coupled to the movement of H+, glucose, amino acids, organic acids, phosphate, and other
electrolytes and substances across the tubule walls. In the proximal tubules, the thick portion of the ascending
limb of the loop of Henle, the distal tubules, and the collecting ducts, Na+ moves by cotransport or exchange
from the tubular lumen into the tubular epithelial cells down its concentration and electrical gradients, and is
then actively pumped from these cells into the interstitial space. Na+ is pumped into the interstitium by Na, K
ATPase in the basolateral membrane. Thus, Na+ is actively transported out of all parts of the renal tubule except
the thin portions of the loop of Henle. It extrudes three Na+ in exchange for two K+ that are pumped into the
cell.
Transport Proteins Involved in the Movement of Na and Cl Across the Apical Membranes of Renal Tubular
Cells.
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Apical Transporter
Function
Na/glucose CT
Na+/Pi CT
Na+amino acid CT
Na/lactate CT
Na/H exchanger
Cl/base exchanger
Cl uptake
NaK2Cl CT
Na/H exchanger
K+ channels
K+ extrusion (recycling)
NaCl CT
Collecting duct
Na+ uptake
Site
Proximal tubule
Normally about 60% of the filtered Na+ is reabsorbed in the proximal tubule, primarily by NaH exchange.
Another 30% is absorbed via the Na2ClK cotransporter in the thick ascending limb of the loop of Henle, and
about 7% is absorbed by NaCl cotransporter in the distal convoluted tubule. The remainder of the filtered Na+,
about 3%, is absorbed via the ENaC channels in the collecting ducts, and this is the portion that is regulated by
aldosterone in the production of homeostatic adjustments in Na+ balance.
(Q.205) Warthin Finkeledy bodies are seen in ?
(a)
Measles
(b)
Mumps
(c)
Small pox
Chicken-pox
(d)
Your Response :
Correct Answer :
Exp:
Measles
REMEMBER : List of various BODIES seen in various diseases :
BODIES
DISEASE
Hematoxylin body
Filariasis
Rice bodies
Michalis-Guttman body
Malakoplakia
Herring body
Trachomatosis
Picks body
Moosers body
Endemic typhus
Lofora body
Tuftstone body
Metachromatic leukodystrophy
Cystoid body
CMV retinitis
Paschen body
Guarneri body
Molluscum body
LD body
Negri body
Rabies (Intra-cytoplasmic)
Bollinger body
Fowlpox
Henderson-Peterson body
Molluscum contagiosum
Torres body
Yellow fever
Measles
Miyagawa body
LGV
Psittacosis
Copper-penny body
Parappenheimer body
Sideroblastic anemia
Masson body
Sarcoidosis
Multiple myeloma
Globoid body
Krabbes disease
Aschoff body
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Eczema
(b)
(c)
Spring catarrh
(d)
Your Response :
Correct Answer :
Exp:
Chronic graft rejection is a type IV reaction. Rest all options are type I reactions.
All types of HYPERSENSITIVITY REACTIONS :
TYPE II
TYPE I
Local :
Eczema
Hay fever
Asthama {atopy}
Systemic :
Anaphylaxis
Change in cellular
function :
Increase : graves
disease
TYPEIII
Local : Arthus reaction.
TYPE IV
Tuberculin test
Decrease : myasthenia
gravis
Patch test
Theobald smith
phenomenon
Antibody dependant
cell mediated toxicity
Schicks test
Praustnitz Kustner
reaction
Phagocytosis
PSGN
Casoni test
Blood transfusion
reactions
Erythema nodosum
leprosum and Lucios
phenomenon
Hypersensitivity
pneumonitis/Farmers
lung{both III and IV
Spring catarrh
Hemolytic anemias in
IM and mycoplasmal
infection
Hypersensitivity
pneumonitis/Farmers
lung{both III and IV}
Agranulocytosis
Beryliosis
Erythema multiforme
Histoplasmosis
Phlyctenular
conjunctivitis
Giant papillary
conjunctivitis{both I
and IV}
Pernicious anemia
urticaria
GBS
Steven-Johnson
syndrome
Hyperacute rejection of
renal transplamt
Sarcoidosis
Rheumatic fever
HSP
Rheumatoid arthritis
Giant papillary
conjunctivitis{both I and
IV}
Blood transfusion
rection
Reactive arthritis
Schistosomiasis
granuloma formation
Optic neuritis
Erythema multiforme
Sympathetic
ophthalmitis.
JRA
(b)
(c)
Duchenne myopathy
(d)
Your Response :
Correct Answer :
Exp:
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Thyroid cancer
(b)
Laryngeal cancer
(c)
(d)
Tongue calcification
Your Response :
Correct Answer :
Exp:
Thyroid cancer
REF Schwartz 8th Ed Chapter 45
Thyroid Surgery
The prevalence of thyroid disease increases with advancing age. The etiologies, risk factors, and presentations of
thyroid disease are similar across all ages and, therefore, are not discussed in detail. Of note, however, is that
elderly patients more often present with cardiac manifestations of hyperthyroidism such as atrial fibrillation than
do their younger counterparts. A common finding requiring evaluation in elderly patients is the presence of a
thyroid nodule, usually detected by physical examination. These nodules are usually single and four times more
common in women, making them a particular concern for postmenopausal elderly women. Indications for
surgical intervention for thyroid nodules are dependent on the characteristics of the nodule (i.e., whether it is
benign or malignant, or whether the patient is euthyroid or thyrotoxic). In addition, surgical intervention
becomes necessary if the nodule enlarges, producing compressive symptoms.
Papillary carcinoma in elderly patients tends to be sporadic with a bell-shape distribution of age at presentation,
occurring primarily in patients age 30 to 59 years. The incidence of papillary carcinoma decreases in patients
older than 60 years of age. 18 However, patients older than 60 years of age have increased risk of local
recurrence and for the development of distant metastases. Metastatic disease may be more common in this
population secondary to delayed referral for surgical intervention because of the misconception that the
surgeon will be unwilling to operate on an elderly patient with thyroid disease. Age is also a prognostic indicator
for patients with follicular carcinoma. There is a 2.2 times increased risk of mortality from follicular carcinoma
per 20 years of increasing age. 19 Therefore, prognosis for elderly patients with differentiated thyroid
carcinomas is worse when compared to younger counterparts. The higher prevalence of vascular invasion and
extracapsular extension among older patients is in part responsible for the poorer prognosis in geriatric patients.
Advancing age leads to increased mortality risk for patients with thyroid cancer and is demonstrated by the
AMES (age, metastases, extent of primary tumor, and size of tumor) classification system developed by the
Lahey Clinic (Table 45-4).
A:
Age
M: Metastases
E:
Extent of primary
tumor
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Size of tumor
Primary tumor
5 cm in diameter
(b)
(c)
Surface tension is inversely proportional to the surfactant concentration per unit area
(d)
All of above
Your Response :
Correct Answer :
Exp:
Component
Percentage
Composition
Dipalmitoylphosphatidylcholine 62
Phosphatidylglycerol
Other phospholipids
10
Neutral lipids
13
Proteins
Carbohydrate
Surfactant is produced by type II alveolar epithelial cells Typical lamellar bodies, membrane-bound organelles
containing whorls of phospholipid, are formed in these cells and secreted into the alveolar lumen by exocytosis.
Tubes of lipid called tubular myelin form from the extruded bodies, and the tubular myelin in turn forms the
phospholipid film. Following secretion, the phospholipids of surfactant line up in the alveoli with their
hydrophobic fatty acid tails facing the alveolar lumen. Surface tension is inversely proportional to their
concentration per unit area. The surfactant molecules move further apart as the alveoli enlarge during
inspiration, and surface tension increases, whereas it decreases when they move closer together during
expiration. Some of the proteinlipid complexes in surfactant are taken up by endocytosis in type II alveolar cells
and recycled.
Formation of the phospholipid film is greatly facilitated by the proteins in surfactant. This material contains four
unique proteins: surfactant protein (SP)-A, SP-B, SP-C, and SP-(D) SP-A is a large glycoprotein and has a collagenlike domain within its structure. It has multiple functions, including regulation of the feedback uptake of
surfactant by the type II alveolar epithelial cells that secrete it. SP-B and SP-C are smaller proteins, which
facilitate formation of the monomolecular film of phospholipid. A mutation of the gene for SP-C has been
reported to be associated with familial interstitial lung disease. Like SP-A, SP-D is a glycoprotein. Its full function
is uncertain. However, SP-A and SP-D are members of the collectin family of proteins that are involved in innate
immunity in the conducting airway as well as in the alveoli.
(Q.210) False statement regarding LASIK is ?
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
. Keratoconus
Glaucoma
Autoimmune disease
. Dry eye
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Disadvantage
1.
1. More expensive
2.
3.
4.
Surgery
complications include
No residual haze
Neck Injury
(b)
Head injury
(c)
(d)
Knee injury
Your Response :
Correct Answer :
Exp:
(b)
(c)
Femur only
(d)
Your Response :
Correct Answer :
Exp:
(Q.213) A 30 year old male Deepak was having fracture shaft of right femur. After 2 days of injury he was having restlessness and dyspnoea.
On examination he was having tachypnoea and tachycardia & petechial rash. Which of the investigation is not of much use?
(a)
(b)
(c)
(d)
Fundus examination
Your Response :
Correct Answer :
Exp:
(Q.214) Which of the following is not a common site for avascular necrosis after trauma?
(a)
(b)
(c)
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(d)
Your Response :
Correct Answer :
Exp:
(Q.215) Which of the following nerve is most frequently damaged in musculo-skeletal injuries?
(a)
Radial nerve
(b)
Axillary nerve
(c)
Median nerve
(d)
Your Response :
Correct Answer :
Exp:
Radial nerve
The radial nerve is the most frequently damaged nerve in musculo - skeletal injuries.
Most common nerve injured in supracondylar fracture of
humerus
Tardy ulnar nerve palsy
CUBITUS VALGUS
AXILLARY NERVE
RADIAL NERVE
Unstable fractures
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
Unstable fractures
Most frequent indication for internal fixation is, when a fracture is so unstable that it is difficult to maintain it in
an acceptable position by conservation meAns:
Even in the third millennium, the use of nonoperative treatment is still appropriate for certain types of fractures.
The benefits of IF must be balanced against its associated risks. The main advantages of IF are precise restoration
of the osseous anatomy and early mobilization with at least partial weight-bearing. The principal disadvantages
are the increased risk of infection and the fact that healing may be impaired if this demanding technique is not
used properly. Generally speaking, patients are more comfortable after IF than with cast treatment or external
fixation.
Displaced intra-articular fractures are best treated by IF, as it is the only fixation method that allows anatomic
restoration of the articular surface. Early joint motion is possible, with improvement in the range of movement
and the condition of the articular cartilage. Even in the hands of experienced surgeons, displaced fractures of the
diaphysis are often unstable after closed reduction and the application of a cast. Comminuted fractures are not
suitable for nonoperative treatment. Some fractures, such as displaced fractures of the femoral neck, the
femoral head, or the talus, require immediate compression osteosynthesis to reduce the risk of osteonecrosis.
Increasingly, many patients elect to have IF even for nondisplaced fractures, as they may return to their work or
sporting activities at an earlier stage. Nevertheless, the decision to operate or not is often based on the
surgeon's preference and experience.
(b)
(c)
(d)
Your
Response a
:
Correct A
Answer :
Exp:
Use
Radial nerve
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Ulnar nerve
Brachial plexus
(Q.218) Injury to lateral condyle of humerus is included in which type epiphyseal injury according to Salter and Harris classification?
(a)
Type II
(b)
Type III
(c)
Type IV
Type V
(d)
Your Response :
Correct Answer :
Exp:
Type IV
Injury to lateral condyle of humerus is type IV injury. Open reduction and internal fixation is it's treatment of
choice. Growth disturbance is common even after open reduction.
This fracture is the second most common distal humerus fracture in children. They occur between the ages of 4
and 10 years. These fractures occur when a varus force is applied to the extended elbow. They tend to be
unstable and become displaced because of the pull of the forearm extensors.
Since these fractures are intra-articular they are prone to nonunion because the fracture is bathed in synovial
fluid.
Lateral condyle fractures are classified according to Milch. They are Salter-Harris IV epiphysiolysis fractures.
Most are Milch II fractures that travel from the lateral humeral metaphysis above the epiphysis and exit through
the lateral crista of the trochlea leading to an unstable humeral ulnar articulation.
Milch Classification
Type I
Type II
Type 2
Type 3
(Q.219) After a fracture at the junction of middle and outer - thirds of the clavicle, the outer fragment is displaced:
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(Q.220) A 17 year old child hyper-extended the fingers of a 13 year old child while quarreling. Which metacarpo-phalangeal joint is most
likely to dislocate?
(a)
Second
(b)
Third
(c)
Fourth
Fifth
(d)
Your Response :
Correct Answer :
Exp:
Second
The metacarpo-phalangeal joint of the index finger is affected most commonly. Open reduction is required in
most cases.
(Q.221) Which of the following correctly describes a component used as a bone graft substitute that induces differentiation of stem cells
Osteoconduction
(b)
Osteoinduction
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Osteogenesis
(d)
Your Response :
Correct Answer :
Exp:
Osteoinduction
REF : Canale & Beaty: Campbell's Operative Orthopaedics, 11th ed.
Chapter 1.
Classification of Bone Graft Substitutes
Property
Description
Classes
Osteoinduction
Osteogenesis
Combined
Composites
(Q.222) A 30 year male presents with fever, malaise, sore throat. On examination patient has multiple blisters and crusting on the muco-
cutaneous surface. Membrane formation is seen on the conjunctiva. Early Conjunctival scarring is also present. Diagnosis of Steven
Johnson syndrome is made. Following is true about the disease except:
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(b)
(c)
(d)
All of above
Your Response :
Correct Answer :
Exp:
All of above
Differentiating Various Stages of Cataract
Immature
Mature
Hypermature
Vision
6/9 - FC
HM - PL
HM FC
Anterior Chamber
Normal (shallow
inintumescent)
Normal (shallow
inintumescent)
Normalto deep
Color of Lens
Grayish white
Pearly white
Iris shadow
Seen
Not seen
Not seen
Distant
DirectOphthalmoscopy
Purkinje-SansonImages
Features
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Diabetic retinopathy
(b)
(c)
Retinoblastoma
(d)
Your Response : b
Correct Answer : B
Exp:
(b)
Radio therapy
(c)
(d)
Your Response :
Correct Answer :
Exp:
Radio therapy
Ref: Nelson, 18th edition, page 2899
BIOLOGIC EFFECTS OF RADIATION
Stochastic (random)effects are of greater concern because they can occur at any dose; i.e., there is no threshold,
with the probability of an effect increasing with increasing dose. These effects can be caused by any radiation
striking vulnerable tissue (most importantly DNA, but cytoplasm also may be at risk) and causing irreversible
damage. These effects lead to the linear no dose threshold (LNT) concept, which states that radiation damage
increases with increasing dose in a linear fashion. This concept stresses that no level of radiation exposure can be
considered to be absolutely safe.
(Q.226) A 45 yr old lady presents to casualty with pain, redness, watering and photophobia. O/E perilimbal congestion +, slight cornea
Atropine toxicity
(b)
Acute uveitis
(c)
Severe conjunctivitis
(d)
Your Response :
Correct Answer :
Exp:
Caused by D- K serotypes
(b)
Transmission by autoinoculation
(c)
(d)
Your Response :
Correct Answer :
Exp:
ELISA test
PCR
Treatment:
Topical- tetracycline point QID * 6 Wks
Oral
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Endophytic variety
(b)
Exophytic variety
(c)
Bilateral RB
(d)
Your
Response d
:
Correct
D
Answer :
Exp:
(b)
Retinoblastoma
(c)
Choroidal melanoma
(d)
Your Response :
Correct Answer :
Exp:
(b)
Difficult technique
(c)
(d)
Your Response :
Correct Answer :
Exp:
ICCE
Lens removal
Posterior capsule
&zonules
Intact
Removed
Incision
Smaller (8 mm)
Peripheraliridectomy
Not performed
Required to avoidpupillaryblock
glaucoma
Not required
Time taken
More
Less
IOL Implantation
Posterior chamber
Expertise required
Difficult technique
Easier to learn
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More
Less
After-Cataract
Vitreousprolapse& loss
CystoidMacular Edema
Endophthalmitis
AphakicGlaucoma
Fibrous & Endothelialingrowth
NeovascularGlaucoma
inProliferativeDiabetic Retinopathy
Compicationswhich are
decreased
After-Cataract
Indications
Contraindications
Dislocated lens
Subluxatedlens
(>1/3rdzonulesbroken)
Cataract is usually discovered in children by their parents in advanced stages when the pupil appears white or the child
becomes severely visually handicapped.
(b)
If macula is deprived of clear image in the first 6-8 weeks of life then it can lead to failure of development of fixation and
causesnystagmus.
(c)
It is recommended that the child be made hyperme-tropicby about 3dioptre, so that as thechild growthe eye becomes
nearlyemmetropic.
Correct Answer :
Exp:
All of above
Pediatric Cataract
Cataract occurring in a child assumes special importance because of some characteristic differences in the way a
childs developing eye behaves. Following are the main problems to be tackled while managing pediatric
cataract:
Visual Assessment: It is very difficult to assess visual acuity of a pre-verbal child and also young children do not
complain of diminished vision. Therefore, cataract is usually discovered in children by their parents in advanced
stages when the pupil appears white or the child becomes severely visually handicapped.
Vision DeprivationAmblyopia: The young developing visual system of a child needs constant stimulation by a
clear image on the retina in order to develop normally. If visual stimulus is absent or disturbed by poor vision
due to cataract or any other cause then the development of visual system is arrested leading toamblyopia. If
macula is deprived of clear image in the first 6-8 weeks of life then it can lead to failure of development of
fixation and causesnystagmus. Thisproblemsis even worse if only one eye has the problem and the other is
normal.
Therefore, if cataract is detected in a young child it has to be treated urgently and the postoperative visual
rehabilitation also involves treatment ofamblyopia.
Postoperative Inflammation and Fibrosis: The immune system of the child being very active responds violently
to surgery and thereby, leads to severe postoperativeuveitisand fibrosis.This severely marthe results of
operation. To deal with this problem some surgeons advocateParsPlanaLensectomyas the technique of choice
for removal of cataract in children. Butthis technique makeimplantation of IOL difficult.
After-cataract: The epithelialcells of the anterior capsule being very actively dividing a child isvery prone to
develop dense and thick after-cataract. This can be very difficult to treat because the children do not cooperate
for YAG Laser treatment and being thick the laser sometimes fail to penetrate it. Therefore, some surgeons make
an opening in the posterior capsule at the end of operation for cataract (Primary PosteriorCapsulotomy).
IOL Power Calculation: As the eyeball of the child is still growing it poses a problem in calculating the power of
the IOL to be implanted as the later is based on the axial length of the globe. IfaIOL ofemmetropicpower is
implanted this leads to myopia as the child grows up. Therefore, it is recommended that the child be
madehypermetropicby about 3dioptre, so that as thechild growthe eye becomes nearlyemmetropic.
Are decreased
(b)
Are increased
(c)
Remain same
(d)
Are variable
Your Response :
Correct Answer :
Exp:
Are decreased
Disseminated intravascular' coagulation.
- Coagulation is usually confined to a localized area by the combination of blood flow and circulating inhibitors of
coagulation, especially antithrombin III. If the stimulus to coagulation is too great, these control mechanisms can
be
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(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I into angiotensin II.
Angiotensin II is a powerful vasoconstrictor that preferentially affects the vascular tone of the efferent arterioles.
Removal of the tonic vasoconstrictor effect of angiotensin II on the efferent arterioles lowers the glomerular
intercapillary pressure, while preserving renal plasma flow.
Glomerular efferent arteriolar tone is increased in diabetes. Hyaline arteriolosclerosis, the small vessel disease of
diabetes mellitus, is commonly present in both the afferent and efferent arterioles. Increased efferent arteriolar
tone results in increased transcapillary hydrostatic pressure, which interferes with the functional integrity of the
glomerular capillary wall. In addition, nonenzymatic glycosylation contributes to the permanent damage in the
glomerular capillary walls.
(b)
Tachycardia
(c)
(d)
Unconsciousness
Your Response :
Correct Answer :
Exp:
Tachycardia
Ref. Nelson, 18th edition, page 2477
BREATH-HOLDING SPELLS.
A breath-holding spell can be a frightening experience for parents because the infant becomes lifeless and
unresponsive owing to cerebral anoxia at the height of the attack. There are two major types of breath-holding
spells: the more common cyanotic form and the pallid form.
Cyanotic Spells.
A cyanotic breath-holding spell is usually predictable and is always provoked by upsetting or scolding an infant.
The episode is heralded by a brief, shrill cry followed by forced expiration and apnea. There is rapid onset of
generalized cyanosis and a loss of consciousness that may be associated with repeated generalized clonic jerks,
opisthotonos, and bradycardia. Results of an interictal electroencephalogram (EEG) are normal. A breath-holding
spell can occur repeatedly within a few hours or it can recur sporadically, but it is always stereotyped. Breathholding spells are rare before 6 mo of age, peak at about 2 yr of age, and abate by 5 yr of age. The management
of breath-holding spells concentrates on the support and reassurance of the parents. Some parents feel that
whatever the physician recommends, they must splash cold water on the face, turn the child upside down, or
initiate mouth-to-mouth resuscitation and even cardiopulmonary resuscitation. A thorough examination
followed by an explanation of the mechanism of breath-holding spells is reassuring for most parents. The
counseling session should emphasize the need for both parents to be consistent and not reinforce the child's
behavior after the child recovers from the spell. This may be accomplished by placing the child safely in bed and
by refusing to cuddle, play, or hold the child for a given period of time until recovery is complete.
Pallid Spells
These spells are much less common than cyanotic breath-holding spells, but they share several characteristics.
Pallid spells are typically initiated by a painful experience, such as falling and striking the head or a sudden
startle. The child stops breathing, rapidly loses consciousness, becomes pale and hypotonic and may have a tonic
seizure. Bradycardia with periods of asystole of>2sec may be recorded. The interictal EEG is normal. Pallid spells
can in some cases be induced spontaneously in the laboratory by ocular compression that produces the
oculocardiac reflex, afferent stimulation of the trigeminal nerve, and efferent inhibition of the heart by way of
the vagus nerve. This procedure should not be attempted by an inexperienced physician, and appropriate
resuscitation equipment should be readily available. Most children respond to conservative measures as outlined
for cyanotic spells, but a trial of an anticholinergic, oral atropine sulfate 0.01 mg/kg/24hr in divided doses with a
maximum daily dose of 0.4 mg, which increases the heart rate by blocking the vagus nerve, may be considered in
refractory cases.
Retinal tear
(b)
Retinal infarct
(c)
Retinal hemorrhage
(d)
Your Response :
Correct Answer :
Exp:
Retinal tear
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Mycophenolate Mofetil
(b)
Muromonab CD3
(c)
Antithymocyte Globulin
(d)
Methotrexate
Your Response :
Correct Answer :
Exp:
Muromonab CD3
Muromonab CD3 is a murine monoclonal antibody against CD3 glycoprotein on helper T cells initial dose of this
drug can produce cytokine release syndrome with flu like symptoms. This drug is used in induction therapy for
organ transplantation.
As immune-based therapies for cancer become potent, more effective, and more widely available, optimal
management of their unique toxicities becomes increasingly important. Cytokine release syndrome (CRS) is a
potentially life-threatening toxicity that has been observed following administration of natural and bispecific
antibodies and, more recently, following adoptive T-cell therapies for cancer. CRS is associated with elevated
circulating levels of several cytokines including interleukin (IL)-6 and interferon , and uncontrolled studies
demonstrate that immunosuppression using tocilizumab, an anti-IL-6 receptor antibody, with or without
corticosteroids, can reverse the syndrome. However, because early and aggressive immunosuppression could
limit the efficacy of the immunotherapy, current approaches seek to limit administration of immunosuppressive
therapy to patients at risk for life-threatening consequences of the syndrome.
Risks associated with cancer immunotherapy can be broadly classified into autoimmune toxicity and cytokineassociated toxicity. Autoimmune toxicity, so-called on target, off-tumor toxicity, results from antigen-specific
attack on host tissues when the targeted tumor associated antigen is expressed on nonmalignant tissue.
Autoimmune toxicity occurs not uncommonly after treatment with checkpoint inhibitorsand has resulted in fatal
toxicities after infusion of genetically engineered T cells targeting MAGE-A3.Cytokine-associated toxicity, also
known as cytokine release syndrome (CRS), is a nonantigen-specific toxicity that occurs as a result of high-level
immune activation. The magnitude of immune activation typically required to mediate clinical benefit using
modern immunotherapies exceeds levels of immune activation that occurring in more natural settings, and as
immune-based therapies have become more potent, this syndrome is becoming increasingly recognized.
CRS revised grading system
Grade
Toxicity
Grade 1
Symptoms are not life threatening and require symptomatic treatment only, eg, fever,
nausea, fatigue, headache, myalgias, malaise
Grade 2
Grade 3
Grade 4
Life-threatening symptoms
Requirement for ventilator support or
Grade 4 organ toxicity (excluding transaminitis)
Grade 5
Death
Phosphodiesterase 4 inhibitor
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
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few months later he returns with increasing cough and dyspnea. Which treatment category he should be put on now:
(a)
One
(b)
Two
(c)
Three
Four
(d)
Your Response :
Correct Answer :
Exp:
Two
Following are the categories in DOTS to decide the anti tubercular regimen:
Cat.1 new smear + new smear -with extensive involvement; new severe extrapulmonary disease.
Cat.2 smear+ relapse treatment failure; treatment after interruption
Cat.3 new smear- other than category 1 new less severe extra pulmonary disease.
Cat.4 not used these days.
(Q.239) Ramu 53 yrs old, Hindu male, presented to the emergency, complaining severe crushing pain in epigastrium and breathlessness for
the past 20 minutes. On examination, pulse and BP are normal; ECG shows ST segment elevation in leads V2 to V6. All of the
following should be given in the management of the patient, except:
(a)
Aspirin
(b)
LV Beta blockers
(c)
(d)
Hydrocortisone
Your Response :
Correct Answer :
Exp:
Hydrocortisone
The history and examination of the patient suggest that, he is suffering from an attack of acute myocardial
infarction.
Aspirin: Aspirin is essential in the management of a patient of suspected STEM.
I. V blockers: they are useful in a patient of AMI
Due to the following reasons:
1. They are helpful in reducing pain
2. They reduce in hospital mortality, particularly in the high-risk patients.
TP A: TPA helps in limitation of the infarct size by early restoration of blood flow to the ischaemic areas in pts
with STEM!.
Glucocorticoids: glucocorticoids and other NSAIDS except aspirin should be avoided in the setting of STEM. They
can impair infarct healing and increase the risk of myocardial rupture and may also lead to larger infarct
Scar. In addition, they cause, increased coronary vascular resistance, thereby, potentially reducing flow to
ischaemic myocardium.
(b)
Factor Xa inhibition
(c)
Antithrombin inhibitor
(d)
Thrombin inhibition
Your Response : b
Correct Answer : A
Exp:
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(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(Q.242) Normally, fractional excretion of sodium in prerenal ARF is <1.0%. It can be > 1.0% in all of the following conditions, except:
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
Hypocalcemia
(b)
Hypothermia
(c)
Digitalis toxicity
(d)
Hypokalemia
Your Response :
Correct Answer :
Exp:
Hypothermia
A convex elevation of J-point on E.(C)G. is called an OSBORN WAVE. It is seen in cases of
hypothermia.
This is an extremely high yield topic having atleast 1 question in every exam.
Here is a list of almost all important conditions causing specific ECG abnormalities.
ECG ABNORMALITIES :
DIAGNOSTIC ECG FEATURES
QT shortening(Earliest feature)
CONDITION
Therapeutic Digitalization
Increased PR interval
Slowing of heart rate
Decreased amplitude/inverted T wave
ST depression
Prolonged PR interval,
Digitalis toxicity
VPCs,VT,VF,AV block
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Early hypokalemia
ST depression
Prominent U wave
Prolonged QU interval
Prolonged PR
Severe hypokalemia
Hyperkalemia
Loss of P wave
SINE WAVE PATTERN
Widening of QRS and prolonged PR
Sinus arrest
Cardiac arrest-asystole
Ventricular fibrillation
Bradycardia
Hypercalcemia
AV block
Short QT
Prolonged QT
Hypocalcemia
Hypothermia
Pompes disease
CVA-T pattern :
Replarisation Alternans
Tetralogy of Fallot
WPW syndrome
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Torsades-de-pointes
Classical angina
Non-infarction transmural
ischemia(Prinzmetals angina)
NSTEMI
ST elevation
Hyperacute phase MI
Fully evolved MI
ST elevation
Inverted symmetric T wave
Pathological Q wave only
Old infarct
Anterior uveitis
(b)
Posterior uveitis
(c)
Lens subluxation
(d)
Acute glaucoma
Your Response :
Correct Answer :
Exp:
Lens subluxation
Ref: Baily & Love 25th edition, page 650
Iridodonesisis the vibration or agitated motion of the iris (wobbles) with eye movement.This may be caused
bylens subluxation,the incomplete or partial dislocation of the lens; or byaphakia, the absence of a lens.
(Q.245) A 25-year-old male cigarette smoker has a history of respiratory infections and has also been found to have hematuria. A high value
for diffusing capacity is noted during pulmonary function testing. This finding is consistent with which of the following disorders?
(a)
Cystic fibrosis
(b)
Emphysema
(c)
Intrapulmonary hemorrhage
(d)
Anemia
Your Response :
Correct Answer :
Exp:
Intrapulmonary hemorrhage
Carbon monoxide (CO) diffusing capacity provides an estimate of the rate at which oxygen moves by diffusion
from alveolar gas to combine with hemoglobin in the red blood cells. It is interpreted as an index of the surface
area engaged in alveolar-capillary diffusion. Measurement of diffusing capacity of the lung is done by having the
person inspire a low concentration of carbon monoxide. The rate of uptake of the gas by the blood is calculated
from the difference between the inspired and expired concentrations. The test can be performed during a single
10-second breath holding or during 1 minute of steady-state breathing. The diffusing capacity is defined as the
amount of carbon monoxide transferred per minute per millimeter of mercury of driving pressure and correlates
with oxygen transport from the alveolus into the capillaries. Primary parenchymal disorders, anemia, and
removal of lung tissue decrease the diffusing capacity. Conversely, polycythemia, congestive heart failure, and
intrapulmonary hemorrhage tend to increase the value for diffusing capacity. In this patient, the possibility of
Goodpasture syndrome should be considered.
Serum calcium
(b)
(c)
Serum 25 - hydroxycholecalciferol
(d)
Serum 1, 25 - dihydroxycholecalciferol
Your Response :
Correct Answer :
Exp:
25 - hydroxycholecalciferol
The most specific screening test for Vitamin D deficiency in otherwise healthy individual is a serum 25 (OH) D(25hydroxy cholecalciferol) with levels < 15 ng/ML are associated with increasing Parathyroid hormone (PTH) levels
and lower bone density. Rise in PTH levels maintains plasma calcium at the expense of skeleton. Similarly PTH is
a major stimulus for the renal vitamin D hydroxylase, there is increased synthesis of the active hormone. 1, 25 dihydroxycholecaliferol. Therefore measurements of 1, 25 (OH)2D, therefore do not provide an accurate index of
vitamin D store and should not be used to diagnose vitamin D deficiency in patients with normal renal function.
I-hydroxycholecalciferol {l(OH)D} is a synthetic derivative of vitamin D used in treatment of renal
osteodystrophy.
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Foley's catheter
(b)
(c)
Condom catheter
(d)
Incontinence pad
Your Response :
Correct Answer :
Exp:
Condom catheter
Indwelling catheters should not be used for routine management of urinary incontinence. If feasible, less
invasive measures such as incontinence pads (usually in females), intermittent catheterization or penile sheath
(condom) catheterization should be used. Caude catheters has a semi rigid curved tip that facilitate placement in
patients with prostatic enlargement.
(Q.248) A 35 year-old alcoholic male is admitted for nausea, vomiting, and abdominal pain that radiates to the back. The laboratory value
(b)
(c)
Leukocytosis of 20,000/mm3
(d)
Your Response :
Correct Answer :
Exp:
Leukocytosis of 20,000/mm3
The RANSON CRITERIA are used to determine prognosis in acute pancreatitis.
FACTORS THAT ADVERSELY AFFECT SURVIVAL INCLUDE
AT PRESENTATION
Age greater than 55 years
Leukocytosis greater than 16,000/mm3
Glucose greater than 200 mg/dL
LDH greater than 400 IU
AST greater than 250 IU/L
AFTER THE INITIAL 48 H
A fall in hematocrit
Hypocalcemia
Hypoxemia
An increase in BUN
Hypoalbuminemia
Hypotension with systolic BP less than 90 mmHg is also a poor prognostic sign; diastolic hypertension is not
correlated with prognosis.
(Q.249) A 43-year-old female presents with hypertension, edema, hyperlipidemia, and a deep venous thrombosis in her left leg. Which of
Edema
(b)
Hypertension
(c)
(d)
Hyperlipidemia
Your Response :
Correct Answer :
Exp:
Hypertension
While hypertension may occur in diseases causing the nephrotic syndrome, its presence is not necessary for the
diagnosis of this syndrome. Renal loss and catabolism of albumin lead to hypoalbuminemia and edema.
Increased hepatic synthesis of lipoproteins leads to markedly elevated lipid levels.
400Ml
(b)
500mL
(c)
600mL
800mL
(d)
Your Response :
Correct Answer :
Exp:
Massive hemoptysis is generally defined as expectoration of over 600 mL of blood within a 24-hour period. It is a
medical emergency associated with a mortality rate of 30 to 50%. Most clinicians would agree that losing over a
liter of blood via the airway within 1 day is significant, yet use of an absolute volume criterion presents
difficulties. First, it is difficult for the patient or caregivers to quantify the volume of blood being lost. Second,
and most relevant, the rate of bleeding necessary to incite respiratory compromise is highly dependent on the
individual's prior respiratory status. For example, the loss of 100 mL of blood over 24 hours in a 40-year-old male
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(b)
Use of cyclophosphamide
(c)
(d)
Your Response :
Correct Answer :
Exp:
Use of cyclophosphamide
Carcinoma of the bladder typically affects older men. Transitional cell carcinoma is the most common histologic
subtype and is associated with a more favorable prognosis than is adenocarcinoma or squamous carcinoma.
Squamous carcinomas occur more frequently in Egypt and are associated with S. haematobium and not S.
mansoni, which typically causes an infection of the intestines or biliary tract. Risk factors for carcinoma of the
bladder include exposure to the aromatic amines, which result from cigarette smoke or products of the dye,
rubber, and chemical industries, but it is not associated with positive family bistory or a prior diagnosis of renal
carcinoma. Chronic bladder irritation, such as that produced by the metabolites of cyclophosphamide or
ifosfamide as well as by recurrent bladder stones or infections, also leads to a higher incidence of carcinoma of
the bladder.
(Q.252) In acute renal failure, dietary protein should be restricted in which of the following?
(a)
All patients.
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(Q.253) Why do patients with the carcinoid syndrome develop pellagra (loss of appetite, generalized weakness, abdominal pain, vomiting,
stomatitis and bright red glossitis, and a skin rash that is pigmented and scaling in sunlight- exposed areas)?
(a)
(b)
Thiamine deficiency
(c)
Niacin deficiency
(d)
Pyridoxine deficiency
Your Response :
Correct Answer :
Exp:
Niacin deficiency
The amino acid tryptophan is converted to the niacin derivatives nicotinic acid and nicotinamide, coenzymes
required for numerous oxidative and reductive enzymes. Niacin deficiency causes pellagra, which is a
complicated syndrome involving loss of appetite, weakness, irritability, abdominal pain, bright red tongue and
stomatitis, and a skin rash characterized by pigmentation and scaling, particularly in areas exposed to sunlight.
Pellagra can be seen in those whose diet consists primarily of corn in parts of China, Africa, and India; in chronic
alcoholics; in those with congenital defects of tryptophan absorption; and in patients with carcinoid syndrome,
in which there is an increased conversion of tryptophan into serotonin.
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Liver disease
(b)
Renal failure
(c)
Myelofibrosis
(d)
Your Response :
Correct Answer :
Exp:
Liver disease
Spur cells, or acanthocytes, are large erythrocytes covered with spikelike projections that vary in width, length,
and distribution (see image below). Spur cells can be encountered in acquired or inherited disorders.
Spur cells are characterized by diminished deformability, which is responsible for their entrapment and
destruction in the spleen.
Historically, spur cell anemia has been described with advanced alcoholic liver cirrhosis, but it can also be
observed in other severe liver diseases.The inherited disorders associated with significant acanthocytosis are
characterized by an association with neuromuscular disorders. These diseases are presented together in this
article because of the common hematologic feature of peripheral blood acanthocytosis
Acquired acanthocytosis is associated with advanced liver disease regardless of the primary cause. Although
alcohol abuse is the most common cause of chronic liver disease in Western societies, other entities have been
recognized, including nonalcoholic steatohepatitis (NASH) that may progress to cirrhosis.[2]Anorexia nervosa,
hypothyroidism, and myelodysplasia are rare causes of this disorder.
Neuroacanthocytosis is the term used for acanthocytosis associated with inherited disorders. Autosomalrecessive disorders, abetalipoproteinemia/aprebetalipoproteinemia (chromosome 2), chorea-acanthocytosis
syndrome (band 9q21), and the X-linked McLeod phenotype are among the conditions linked with
neuroacanthocytosis.
Formation of acanthocytes
Most acanthocytic disorders are associated with acquired abnormalities of the outer leaflet of the lipid bilayer.
However, some rare conditions have normal lipids and abnormal membrane proteins.
In severe liver disease, free cholesterol in red blood cells equilibrates with abnormal lipoproteins containing a
high free cholesterol-to-phospholipid ratio, resulting in the preferential expansion of the outer leaflet and the
development of the spur cell shape.
A decrease occurs in polyunsaturated versus saturated and monounsaturated fatty acid content in red blood
cells of patients with cirrhosis. This abnormality is more pronounced in patients with spur cell anemia, resulting
in the alteration of the red blood cell shape and a decrease of the cells fluidity.
An increase in the proteolytic activity of the erythrocyte membrane is also reported in spur cell anemia. The
significance and role of this abnormality in changing the shape of the red blood cell and in hemolysis are
unknown.[8]
The plasma of some patients exhibits decreased activity of lecithin cholesterol acyltransferase, resulting in
increased free cholesterol in the outer layer of the red blood cell membrane as a direct consequence of its
increased concentration in the plasma. After acquiring these abnormalities in the plasma, the red blood cells
undergo a remodeling process in the spleen, which gives them the spheroidal shape with longer and more
irregular projections.
Chorea-acanthocytosis
Alteration of band 3, the anion exchange protein, is thought to play a role in the formation of acanthocytes in
chorea-acanthocytosis.[9]According to this hypothesis, the red blood cell shape is controlled by the ratio of the
outward-facing (band 3o) and inward-facing (band 3i) conformations of band 3. Depending on this ratio, there
will be contraction (leading to echinocytosis) or relaxation (leading to stomatocytosis) of the membrane
skeleton.
Abetalipoproteinemia
In abetalipoproteinemia, B-apoproteincontaining lipoproteins (chylomicrons, very low-density lipoproteins
[VLDL], low-density lipoproteins [LDL]) are nearly absent in the plasma. Plasma cholesterol and phospholipids are
decreased, with a relative increase of sphingomyelin at the expanse of lecithin. At equilibrium, the
sphingomyelin concentration in the outer leaflet increases, resulting in its expansion and acanthocytosis.
McLeod phenotype
The expression of the Kell antigen (the product of a single gene on band 7q23) on red blood cells, white blood
cells, and monocytes is under the control of the Kx antigen encoded for by theXKgene on band Xp21.[10]Both
antigens are transmembrane proteins bound by a single disulfide bond. In the McLeod phenotype, theXKgene is
deleted and the Kell antigen cannot be expressed, whereas in the Kell null phenotype, the Kell antigen is missing
and the Kx antigen is present at a normal level. The Kell null phenotype is not associated with hematologic
disorders.
The close proximity on the short arm of band Xp21 of the genes responsible for chronic granulomatous disease
(CGD) of childhood, retinitis pigmentosa (RP), and Duchenne muscular dystrophy (DMD) explains the variable
association of the McLeod phenotype with these diseases. Red blood cells from patients with choreaacanthocytosis syndrome and McLeod phenotype do not show measurable abnormalities of the lipid bilayer
Focal membrane skeleton heterogeneity has been described as characterized by decreased compactness of the
filamentous meshwork in the areas underlying the spikes. This focal weakness allows limited detachment of the
lipid bilayer that does not result in membrane loss. The nature of the membrane skeleton abnormality is not
known.
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Local staging
(c)
(d)
All of above
Your Response :
Correct Answer :
Exp:
All of above
REF SMITHS UROLOGY 17th Ed Chapter22
1. TRUSTRUS is useful in performing prostatic biopsies and in providing some useful local staging information if
cancer is detected. Almost all prostate needle biopsies are performed under TRUS guidance. This allows uniform
spatial separation and sampling of the regions of the prostate and also makes lesion-directed biopsies possible. If
visible, Carcinoma Prostate tends to appear as a hypoechoic lesion in the peripheral zone.
TRUS provides more accurate local staging than does DRE. The sonographic criteria for extracapsular extension
are bulging of the prostate contour or angulated appearance of the lateral margin. The criteria for seminal
vesicle invasion are a posterior bulge at the base of the seminal vesicle or asymmetry in echogenicity of the
seminal vesicle associated with hypoechoic areas at the base of the prostate. TRUS also enables measurement of
the prostate volume, which is needed in the calculation of PSA density.
Typically, a prostate ellipsoid formula is used: (/6) (anterior- posterior diameter) (transverse diameter)
(sagittal diameter). TRUS is also used in the performance of cryosurgery and brachytherapy (see below). Color
or power Doppler TRUS assesses blood flow through prostatic vessels. As cancers may have increased
vascularity, such technology may improve the sensitivity and specificity of U.S. imaging. 3D color Doppler permits
a three-dimensional image to be constructed from a series of 2D images by a computer algorithm. Use of a
microbubble, intravenous contrast agent may also improve visualization of cancers.
Upper esophagus
(b)
Mid esophagus
(c)
Small intestine
(d)
Rectum
Your Response :
Correct Answer :
Exp:
The rectum is the least common site for diverticula because it is surrounded by muscle and has no areas of
weakness in the bowel wall.
Diverticula are subdivided into true diverticula and false (pulsion) diverticula. True diverticula have all layers
present, including the mucosa, submucosa, and muscle wall. False diverticula are created by a weakness in the
underlying muscle wall, such that only the mucosa and submucosa are present in the diverticulum.
In the esophagus, diverticula are three times more common in men than women. A Zenker's diverticulum is the
most common type. It is a false diverticulum located in the upper esophagus. A traction diverticulum is a true
diverticulum that is located in midesophagus at the level of the tracheal bifurcation. It is due to retraction of the
esophagus by scar tissue in the hilar nodes secondary to tuberculosis (mnemonic traction, true, TB = 3Ts).
A Meckel's diverticulum is a true diverticulum located on the antimesenteric border of the ileum 2 feet from the
ileocecal valve. It represents the persistence of the omphalomesenteric duct. Peptic ulceration due to gastric
mucosa (40% to 50%) with bleeding is the most common complication and leads to iron deficiency. It is one of
the most common causes of gastrointestinal bleeding in the newborn (other than swallowed maternal blood
during delivery) and in children. A good mnemonic is the rule of twos: 2 inches long, 2% incidence, and 2 feet
from the cecum. Other small-bowel diverticula are false diverticula. They are frequently the site of bacterial
overgrowth, which, in turn, may predispose to bile salt deficiency (malabsorption) and B12 deficiency
(megaloblastic anemia).
Diverticula involving the colon are false diverticula. They occur as a double row of diverticula near the taenia coli,
where the vessels penetrate the bowel wall. They are most commonly located in the sigmoid colon, which is the
most common site for diverticula in the entire gastrointestinal tract. Diets that are low in fiber and high in fats
have been implicated because intraluminal pressures increase when stool transit time is slow and constipation is
present. The sacs often be come filled with stool, which hardens to form fecaliths, which predispose patients to
mucosal ischemia, damage, and inflammation (similar to appendicitis). Wide mouthed diverticula are a
characteristic feature of progressive systemic sclerosis.
(Q.257) A 32 yr old female asymptomatic not requiring blood transfusion presents with Hb 13g/dl. Her Hbf levels are 95%, HbA2 1.5%.
(b)
(c)
Thalassemia intermedia
(d)
Your Response :
Correct Answer :
Exp:
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Treatment of septicemia
(b)
(c)
(d)
Perforation of intestine
Your Response :
Correct Answer :
Exp:
(Q.259) For patients with Parkinson's disease, which one of the following drugs is most useful in the management of tremors?
(a)
Apomorphine
(b)
Cabergoline
(c)
Amantadine
Benzhexol
(d)
Your Response :
Correct Answer :
Exp:
Benzhexol
Currently accepted practice in the management of patients is to delay treatment until the onset of disabling
symptoms and then to introduce a dopamine receptor agonist. If patient is elderly, levodopa is sometimes used
as an initial treatment
Dopamine receptor agonists :Bromocriptine, apomorphine
NEWER AGENTS:
- Ropinirole, cabergoline, pergolide
LEVODOPA
- Usually combined with a decarboxylase inhibitor (e.g. carbidopa or benserazide) to prevent peripheral
metabolism of levodopa to dopamine
- reduced effectiveness with time (usually by 2 years)
- unwanted effects: dyskinesia, 'on-off effect - no use in neuroleptic induced parkinsonism
SELEGILINE : - MAO-B inhibitor
- Reduces dopamine metabolism
ANTIMUSCARINICS
- Useful for tremor
- Reduces inhibition of excitatory cholingeric neurons
- e.g. procyclidine, benztropine, benzhexol
AMANTADINE
- Prevents reuptake of dopamine
(Q.260) A 54-year-old male with no past medical history is found to be in atrial fibrillation during a consultation regarding a sprained ankle.
If the patient remains in chronic atrial fibrillation what is the most suitable form of anticoagulation?
(a)
Aspirin
(b)
(c)
No anticoagulation
(d)
Your Response :
Correct Answer :
Exp:
Aspirin
Atrial fibrillation: Anticoagulation
The guidelines on the management of atrial fibrillation (AF) suggest a stroke risk stratification approach when
determining how to anticoagulated a patient, as detailed below:
Low - annual risk of stroke = 1 %
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CA prostate
(b)
CA rectum
(c)
CA testis
CA penis
(d)
Your Response :
Correct Answer :
Exp:
CA rectum
Baily and Love 25th edition, Page 1232
Proctosigmoidoscopy
Proctosigmoidoscopy will always show a carcinoma, if present, provided that the rectum is emptied of faeces
beforehand.
Biopsy
Using biopsy forceps via a sigmoidoscope, a portion of the edge of the tumour can be removed. If possible,
another specimen from the more central part of the growth should also be obtained.
Novo Surgical Yeoman Rectal Biopsy Forceps are ideal for obtaining small samples from the rectum. The forceps
feature ring-sized handles for precise and accurate maneuvering of the bite and basket. The forceps are available
with oval or square baskets. The shaft is slightly angled from the handles is available in various lengths to
accommodate a wide range of cases.
Brain
(b)
Mouth
(c)
Heart
Lungs
(d)
Your Response :
Correct Answer :
Exp:
Mouth
Baily and Love 25th edition, Page 743
FLOOR OF MOUTH
Carcinoma of the floor of the mouth can spread to the ventral surface of the anterior tongue or encroach upon
the lower anterior alveolus (Fig. 46.19). Surgical excision may include a partial anterior glossectomy and anterior
mandibular resection. Only very small tumours of the floor of mouth can be managed by simple excision. The
visor procedure provides excellent access.
LIST OF IMPORTANT NAMED OPERATIONS IN GENERAL SURGERY :
NAME
USED FOR
Hirschsprung disease
GERD
Dohlmans operation
Zenkers diverticulum
Delormes procedure
Nesbitts operation
Jaboulays operation
Lords operation
Large hydrocele
Hadfields operation
Trendelenberg operation
GSV varicosity
Ca Esophagus
CHPS
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Miles operation/APR
Ca Lower rectum
Hartmanns procedure
Left ca colon
Burrhenne technique
Grahams repair
Kocks pouch
Puestows procedure
Hiatus hernia
Commandos operation
Ca Tongue
Kraske procedure
Hemorrhoidectomy
Mayos operation
Umbilical hernia
Ureteric reconstruction
Nesovics operation
Sports hernia
Obturatr hernia
Sebrocks operation
Bentalls operation
Achalasia cardia
Ladds procedure
Midgut volvulus
Femoral hernia
Brunschwings operation
(Q.263) Imatinib mesylate is a novel molecularly targeted therapy in cancer treatment. All are true statements about imatinib except :
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
Imatinib inhibits tyrosine kinase an enzyme produced due to DNA translocation of Ph chromosome.
Clinical uses
GIST (Gastrointestinal stromal tumours)
Philadelphia positive ALL
Clonal eosinophilic disorders.
Effective in PDGF platelet derived growth factor mutations.
Usual dosage 400-600 mg per day in adults
Side effects - GI upset. Pancytopenia, arthralgias, myalgias, hepatotoxicity.
(Q.264) Oseltamivir the drug available for the treatment of ' Avian flu' belongs to which pharmacological class?
(a)
(b)
Protease inhibitor
(c)
Neuraminidase inhibitors
(d)
Ribonuclease inhibitor
Your Response :
Correct Answer :
Exp:
Neuraminidase inhibitors
Oseltamivir and Zanamivir are two drugs of neuraminidase inhibitor group which are known to reduce the
severity and duration of illness caused by avian influenza. Oseltamivir is given 75 mg orally bid for 5 days, to be
started within 48 hours of symptom onset. Zanamivir is to be given by inhalation.
(Q.265) A 23-year-old woman presents to the OPD with complaint of lethargy. The blood investigations are as follows:
Beta-thalassanemia major
(b)
(c)
Beta-thalassanemia trait
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Hereditary spherocytosis
Your Response :
Correct Answer :
Exp:
Beta-thalassanemia trait
A microcytic anaemia in a female should raise the possibility of either gastrointestinal blood loss or menorrhagia.
However, there is no history to suggest this and the microcytosis is disproportionately low for the haemoglobin
level. This combined with a raised HbA2 points to a diagnosis of beta-thalassanemia trait
Beta-thalassanemia trait
The thalassaemias are a group of genetic disorders characterised by a reduced production rate of either alpha or
beta chains. Betathalassaemia trait is an autosomal recessive condition characterised by a mild hypochromic,
microcytic anaemia. It is usually asymptomatic
Features
Mild hypochromic, microcytic anaemia microcytosis is characteristically disproportionate to the anaemia
HbA2 raised (> 3.5%)
(Q.266) In a patient with mild hypertension which is not affecting his functional activity, will be classified as:
(a)
ASA I
(b)
ASA II
(c)
ASA III
ASA IV
(d)
Your Response :
Correct Answer :
Exp:
ASA II
American society of anesthesiologist has classified patients in five categories.
ASA Physical Status Classification System
ASA Physical Status 1- A normal healthy patient
ASA Physical Status 2- A patient with mild systemic disease
ASA Physical Status 3- A patient with severe systemic disease
ASA Physical Status 4- A patient with severe systemic disease that is a constant threat to life
ASA Physical Status 5- A moribund patient who is not expected to survive without the operation
ASA Physical Status 6- A declared brain-dead patient whose organs are being removed for donor purposes
If the surgery is an emergency, the physical status classification is followed by E (foremergency) for example
3E. Class 5 is usually an emergency and is therefore usually "5E". The class "6E" does not exist and is simply
recorded as class "6", as all organ retrieval in brain-dead patients is done urgently. The original definition of
emergency in 1940, when ASA classification was first designed, was "a surgical procedure which, in the surgeon's
opinion, should be performed without delay.This gives an opportunity for a surgeon to manipulate the schedule
of elective surgery cases for personal convenience. An emergency is therefore now defined as existing when
delay in treatment would significantly increase the threat to the patient's life or body part.With this definition,
severe pain due to broken bones, ureteric stone or parturition (giving birth) is not an emergency.
Type A Mapleson
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
Type A
(b)
Type B
(c)
Type D
(d)
Type F
Your Response :
Correct Answer :
Exp:
Type F
Anesthetic breathing systems are classified as open, semiopen, semiclosed, and closed according to the presence
or absence of (1) a gas reservoir bag in the circuit, (2) rebreathing of exhaled gases, (3) means to chemically
neutralize exhaled carbon dioxide, and (4) unidirectional valves. The most commonly used anesthetic breathing
systems are the (1) Mapleson F (Jackson-Rees) system, (2) Bain circuit, and (3) circle system.
Mapleson F (Jackson-Rees) System
The Mapleson F (Jackson-Rees) system is a T-piece arrangement with a reservoir bag and an adjustable pressurelimiting overflow valve on the distal end of the gas reservoir bag.The degree of rebreathing when using this
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(Q.269) All of the following are suitable anaesthetic circuits for both controlled and assisted ventilation except ?
(a)
Mapleson A
(b)
Mapleson B & C
(c)
Mapleson D
(d)
Mapleson E
Your Response :
Correct Answer :
Exp:
Mapleson A
Mapleson B & C are no more used in anaesthesia practice but if the characteristic of these circuits are seen they
are almost equally effective for controlled and spontaneous ventilation.
Mapleson E & F (although E is primarily used for spontaneous but controlled ventilation is possible by
intermittently occluding and sealing the end of tube) can be used for controlled and spontaneous ventilation.
Type D (Bain) requires high flow for spontaneous but does work efficiently for spontaneous also.
Mapleson A (Magill) is circuit of choice for spontaneous respiration, for controlled ventilation it may require very
high flows (may be > 3 times minute volume or> 20 L by some studies) and in spite of that, prevention of
rebreathing is unpredictable, so Mapleson A should not used for controlled ventilation.
Sore throat
(b)
Aspiration pneumonitis
(c)
(d)
Tracheal stenosis
Your Response :
Correct Answer :
Exp:
Sore throat
Most common post operative complication of intubation is sore throat which usually subsides in 2-3 days
without any specific treatment.
Complications of intubation
A. Perioperative
1. Esophageal intubation
3. Aspiration
6. Accidental extubation
8. Cardiac arrhythmias
Postoperative
1. Sore throat
C. Delayed complications
1. Vocal cord granuloma
3. Tracheal stenosis
2. Laryngotracheal web
4. Tracheal collapse
(Q.271) All of the following features distinguish infant larynx from adult EXCEPT:
(a)
(b)
(c)
Large tongue
(d)
Your Response :
Correct Answer :
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Exp:
1.
2.
3.
Larynx is placed at a higher level (in adults, it is placed at the level of C3-C6 vertebrae).
Adult's larynx
Size
Smaller
Larger
Shape
Location
Higher, closer to the tongue base; vertical extent is opposite Vertical extent is lower,
C3, C4, C5 vertebrae; more anterior
opposite C4, C5, C6
vertebrae
Epiglottis
Vocal cords
Rigidity
More rigid
Response to
trauma
(Q.272) The laryngeal mask airway used for securing the airway of a patient in all of the following conditions except:
(a)
In a difficult intubation
(b)
In cardiopulmonary resuscitation
(c)
(d)
Your Response :
Correct Answer :
Exp:
Atypical pseudocholinesterase
(b)
(c)
Dual block
(d)
Duration of block
Your Response :
Correct Answer :
Exp:
Atypical pseudocholinesterase
Atypical pseudocholinesterase is a genetic disease in which the patient's pseudocholinesterase can not
metabolize succinylcholine and there can be very prolonged block.
Dibucaine a local anaesthetic that can inhibit 80% of normal enzyme and 20% of abnormal enzyme.
So normal dibucaine number is 80.
The dibucaine number (DN) is the percent of pseudocholinesterase (PChE) enzyme activity that is inhibited by
dibucaine. Together, the DN and the PChE enzyme activity results can help to identify individuals at risk for
prolonged paralysis following the administration of succinylcholine. Decreased PChE enzyme activity in
conjunction with a DN less than 30 suggests high risk for prolonged paralysis. Normal to decreased PChE enzyme
activity in conjunction with a DN 30-79 suggests variable risk. Although decreased PChE activity in conjunction
with DN greater than or equal to 80 suggests variable risk, these results may be caused by exposure to
organophosphates, the presence of liver disease, pregnancy, or circulating succinylcholine. Specimens should be
collected 48 hours after the administration of succinylcholine.
Laryngeal muscles
(b)
Diaphragm
(c)
Thenar muscles
(d)
Intercostals
Your Response :
Correct Answer :
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Exp:
First muscles to be blocked by muscle relaxants (both depolarizing and non depolarizing) are central muscles i.e.,
muscles of head and neck (face, jaw, pharynx, larynx), respiratory, abdominal muscles and muscles of trunk.
After the central muscles, muscles of limbs (peripheral muscles) are blocked.
The sequence of recovery is in the same way as it goes i.e., first to recover are central muscles like larynx and
diaphragm and then limb muscles.
(Q.275) In Erb-Duchenne palsy all of the following Imuscle are paralyzed except :
(a)
Supraspinatus
(b)
Biceps brachii
(c)
Pectoralis major
(d)
Deltoid
Your Response :
Correct Answer :
Exp:
Pectoralis major
Erb-Duchenne palsy
It results from injury to upper trunk of brachial plexus (C5,6).
Muscles paralysed: Mainly Biceps, Deltoid, Brachialis & Brachioradialis; Partly Supraspinatus, Infraspinatus &
Supinator.
The pectoralis major is not paralyzed because it is supplied both by the lateral and medial pectoral nerves and
not merely by branches from the upper trunk of the lateral cord.
(Q.276) Which of the following structures pass between the External and Internal carotid arteries ?
(a)
Styloglossus
(b)
Stylopharyngeus
(c)
(d)
All of above
Your Response :
Correct Answer :
Exp:
All of above
ORDER OF ARRANGEMENT AT SPECIFIC SITES
FEMORAL TRIANGLE
POPLITEAL FOSSA
CUBITAL FOSSA
Medial to lateral
Arteries- Maxillary and Superficial temporal
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PROSTATE
Left to RightAorta
Thoracic duct
Azygous vein
ROOT OF LUNG
IN BRONCHOPULMONARY SEGMENT
AT HILUM
CAVERNOUS SINUS
Styloid process
Styloglossus
Stylopharyngeus
IXth nerve
Pharyngeal branch of vagus nerve
Part of parotid gland
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(SLIO)
Symphatetic trunk
Lumbosacral trunk
Iliolumbar artery
Obturator nerve
HILUM OF KIDNEY
Anterior to posterior(VAP)
Vein
Artery
pelvis
(TALC)
Thoracoacromial vein
Lateral pectoral nerve
Cephalic vein
AT PORTA HEPATIS
Radial nerve
Profunda brachial artery
Stylopharyngeus muscle
Glossopharyngeal nerve
Ascending palatine artery
1. Pyriformis
(Q.277) All of the following tissues are derived from the dorsal mesentery EXCEPT
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
The anterior border of the epiploic foramen is formed by the free edge of the lesser omentum. The lesser
omentum is derived from the ventral mesentery. The parietal peritoneum to the right of the descending colon is
derived from the dorsal mesentery of this part of the hindgut, but fuses to the posterior wall of the peritoneal
cavity during the process of retro peritonealization of the descending colon. The greater omentum is the
expanded portion of the dorsal mesogastrium. After the spleen develops in the dorsal mesentery, the portion of
the mesentery covering the spleen becomes the visceral peritoneum of the spleen; the portion of the mesentery
dorsal to the spleen becomes the splenorenal ligament.
(Q.278) Tingling or painful sensations in the lateral region of the thigh may occur in the older, overweight individual as a result of a bulging
abdomen, compressing a nerve beneath the inguinal ligament. Which of the following nerves is most likely to be involved?
(a)
(b)
(c)
(d)
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Correct Answer :
Exp:
Entrapment site
Named as
carpal tunnel
median
pronator teres
median
ulnar
cubital tunnel
ulnar
Guyon's canal
radial
axilla
radial
spiral groove
radial(posterior interosseous)
proximalforearm
radial(superficial radial)
distalforearm
Wartenberg's Syndrome
suprascapular
suprascapular notch
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fibular neck
tibial
tarsal tunnel
piriformis
iliohypogastric
lower abdomen
obturator
obturator canal
pudendal
pelvis
abdominalcutaneous nerves
abdominal wall
(Q.279) At the knee joint, all of the following structures are intraarticular except :
(a)
Menisci
(b)
(c)
Cruciate ligaments
(d)
Your Response :
Correct Answer :
Exp:
(Q.280) A hydrocele can be tapped by inserting a needle into the distended tunica vaginalis. In this procedure the following is not pierced :
(a)
(b)
Tunica albuginea
(c)
(d)
Cremasteric fascia
Your Response :
Correct Answer :
Exp:
Tunica albuginea
Hydrocele is collection of fluid between the layers of the tunica vaginalis.
The tunica albuginea is a dense, fibrous capsule covering the testis. In turn it is covered by a layer of peritoneum,
the tunica vaginal is. Thus it is not a part of the scrotal wall.
(Q.281) Which cranial nerve is likely to be damaged if the direct and consensual light reflexes are absent in a patient assumed to have
normal eyesight?
(a)
Optic
(b)
Oculomotor
(c)
Abducent
Trochlear
(d)
Your Response :
Correct Answer :
Exp:
Oculomotor
Light reflexes (direct & consensual) involve the sphincter pupillae supplied by the ciliary ganglion which receives
preganglionic fibres from the Edinger-Westphal part of third nerve (oculomotor) nucleus.
(Q.282) Following tonsillectomy, one of the main sources of prolonged postoperative bleeding is from :
(a)
(b)
Pharyngeal veins
(c)
Maxillary artery
(d)
Sphenopalatine artery
Your Response :
Correct Answer :
Exp:
(Q.283) Out of the following signs the most significant sign in establishing the diagnosis of rosacea
(a)
Edema
(b)
(c)
Papules
(d)
Telangiectasia
Your Response :
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Exp:
Flushing
(b)
Rhinophyma
(c)
(d)
Genital ulcerations
Your Response :
Correct Answer :
Exp:
Genital ulcerations
Rosacea is a chronic cutaneous disorder of the central portion of the face such as cheeks, chin, nose and central
forehead. It is characterized by remissions and exacerbations. Rosacea is a syndrome comprising of a
combination of cutaneous signs as flushing, erythema, telangiectasia, edema, papules, pustules, nodules, ocular
lesions and rhinophyma. There are no genital lesions in rosacea.
(Q.285) Which of the following topical agent has the properties of remodeling connective tissue and posses antiinflammatory activity?
(a)
Benzoyl peroxide
(b)
Metronidazole
(c)
Gentamycin
(d)
Tretinoin
Your Response :
Correct Answer :
Exp:
Tretinoin
Topical tretinoin promotes connective tissue remodeling in the papillary and reticular zones of the dermis. Longterm tretinoin therapy reduces the dermal inflammation. Thus, topical tretinoin is useful for the treatment albeit
it takes about 2 months for the clinical response to become apparent.
Desmopressin
(b)
Conivaptan
(c)
Fludrocortisone
(d)
Your Response :
Correct Answer :
Exp:
Fludrocortisone
Treatment
While CSWS usually appears within the first week after brain injury and spontaneously resolves in 24
weeks,
It can sometimes last for months or years.
While fluid restriction is used to treat SIADH, CSWS requires aggressive hydration and correction of the low
sodium levels using sodium chloride tablets. (volume for volume) (Ref: Nelson 18th edition 2302)
Sometimes,fludrocortisone(amineralocorticoid) improves the hyponatremia.
(Q.287) In case of acute bacterial wound infection after surgical procedure the first and most appropriate action would be ?
(a)
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
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Unlike cutaneous disease systemic involvement with neutrophilic dermatoses does not clear with steroids or
immunosuppressive agents
Your Response :
Correct Answer :
Exp:
(b)
(c)
Gastrointestinal hemorrhage
(d)
Your Response :
Correct Answer :
Exp:
(Q.290) During a biopsy of annular nodular lesion on elbow region it was noticed that the patient neither felt the entry of the needle nor
Psoriasis
(b)
Lichen planus
(c)
Leprosy
(d)
Granuloma annulare
Your Response :
Correct Answer :
Exp:
Skin lesions
Intermediate between BT
and LL type lesions; illdefined plaques with an
occasional sharp margin; few
or many in number
Nerve lesions
Acid-fast bacilli
(BIa)
01+
35+
46+
Lymphocytes
2+
1+
01+
Macrophage
differentiation
Epithelioid
Langhans' giant
cells
13+
Lepromin skin
test
+++
Lymphocyte
Generally positive
110%
12%
Feature
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0.50
M. leprae PGL-1
antibodies
85%
95%
60%
Affective symptoms
(b)
Memory impairment
(c)
Delusions
(d)
Obsessions
Your Response :
Correct Answer :
Exp:
Affective symptoms
Electroconvulsive therapy is most effective in reducing affective symptoms, i.e. major severe depression
especially when it is associated with suicidal risk, this is the first 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.
(Q.292) A patient of schizophrenia taking anti Psychotic drug haloperidol was brought to Psychiatry OPD with complaints of turning of neck
to one side, excessive salivation, decreased body movements and tremors of hands. His diagnosis would be:
(a)
Allergic reaction
(b)
(c)
Akathisia
(d)
Tardive dyskinesia
Your Response :
Correct Answer :
Exp:
(Q.293) A31 yr. old man complaints of a 6 months history of malaise, fatigue, depressive rumination, sleep disturbances and weight loss. He
also complains of difficulty in concentrating on tasks. He admits to occasional intravenous opioid abuse. Psychological testing
reveals mild cognitive deficits. Which of the following is the most appropriate next step for management of this patient:
(a)
Initiate Imipramine
(b)
(c)
(d)
Your Response :
Correct Answer :
Exp:
(b)
Motor symptoms like flapping tremor and multifocal myoclonus may present
(c)
(d)
Your Response :
Correct Answer :
Exp:
(Q.295) The psychogenic stupor can be differentiated from organic stupor by all except :
(a)
(b)
(c)
(d)
Your Response :
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Exp:
Simple schizophrenia
(b)
Paranoid schizophrenia
(c)
Catatonic schizophrenia
(d)
Hebephrenic schizophrenia
Your Response :
Correct Answer :
Exp:
Catatonic schizophrenia
Among various subtypes of schizophrenia catatonic schizophrenia responds best to electroconvulsive therapy.
With E.(C)T. Pt. shows improvement even before drugs show their effect.
(Q.297) Which of the following antipsychotic drug is completely free of extra pyramidal side effects:
(a)
Thioridazine
(b)
Loxapine
(c)
Clozapine
All of the above
(d)
Your Response :
Correct Answer :
Exp:
Clozapine
Most of the anti psychotics due to blocking dopamine receptors in nigrostriatal tract produce parkinsonian like
side effect known as EPS (extra pyramidal syndrome), whereas clozapine is the drug which does not have any
action on dopamine receptors so it does not produce EPS. It acts via blockade of serotonin receptors.
(Q.298) A Patient who recently suffered myocardial infarction developed symptoms of depression. Which of the following antidepressant
Imipramine
(b)
Amitriptyline
(c)
Sertraline
Dothiepin
(d)
Your Response :
Correct Answer :
Exp:
Sertraline
Imipramine, Amitriptyline & Doxepin are tricyclic antidepressant drugs. These drugs have cardiac side effects in
the form of tachycardia, conduction time defects and can precipitate arrythmias in post M.I. patients leading to
sudden death. Sertraline is a selective serotonergic reuptake inhibitor and do not have any anti cholinorgic side
effects and so are considered safe for cardiac patients.
(Q.299) Dysthymia is :
(a)
Severe depression
(b)
(c)
Bipolar depression
(d)
Your Response :
Correct Answer :
Exp:
Hypertension
(b)
CHF
(c)
CAD
(d)
Atrial fibrillation
Your Response :
Correct Answer :
Exp:
CHF
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