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MH Pgcet 2011 Qa
MH Pgcet 2011 Qa
PG CET 2011
A COMPILATION OF QUESTIONS AND EXPLANATORY ANSWERS
foreword
The objective of this is to help students grasp the content in a very easy manner and so I have incorporated a lot of tables & flow charts --- the way I used to learn things. Plus it has been written taking references from the latest editions of books like Harrisons 18th ed. , Grays anatomy 40 th ed. , Williams Obs 23rd etc. to assure the latest medical information .I would wish a very good luck to all the students.In case of any doubt you can write to me on : yashant_aswani@rediffmail.com
Dedicated to my parents Mrs Laxmi aswani & Mr JK Aswani & my brother Nishant Aswani.
Acknowledgements: Dr Pallavi Jha Dr Shashank Raut Dr Chetan Gadekar Dr Ramesh Patil Dr Nikhil Saxena Dr Ankit Bhalani Dr Ankit Solanki
ANATOMY
1.Nucleus ambiguous gives rise to motor fibres A)Glossopharyngeal B)Vagus C)Cranio accessory D)All of the above
of following nerve(s):
2.Corpora Arenacea is characteristically found in A)Spinal neuron B)Amygdaloid body C)Pineal gland D)Posterior pituitary gland
3.Anorectal ring is formed by all except? A)Puborectalis B)Superficial external sphincter C)Deep external sphincter D)Internal anal sphincter
4.Following are the nerves of posterior cord of the Brachial Plexus except: A)Thoracodorsal B)Musculocutaneous
5.Knee joint cavity communicates with the following bursa: A)Subcutaneous Infrapatellar B) Subcutaneous Prepatellar C)Suprapatellar D)Deep Infrapatellar
6.Following vein drains into IVC Directly? A)Left Renal Vein B) )Left Adrenal Vein C) )Left Gonadal Vein D) ) )Left Inferior Phrenic Vein
8.Muscle insertion on anterior surface of Greater Trochanter of femur is: A)Gluteus maximus B) Gluteus minimus
C) Pyriformis D) Gluteus medius 9.All of the following statemants about paneth cell are true except: A)Rich in RER B)Rich in zinc C)Contains lysozyme
D)Foamy appearance
10.Killians dehiscence is present between: A)Middle & Inferior constrictor B)Superior & Middle constrictor C)Superior & Inferior constrictor D)Thyropharyngeus & Cricopharyngeus
11.The anterior margins of Epiploic foramen is a free peritoneal fold that contains: A)Portal vein,hepatic artery & bile duct B)caudate lobe C)IVC D)1st part of duodenum
called
D)Morula
13.The following are derivatives of Paramesonephric duct except: A)Uterus B)Ovary C)fallopian tube D)Upper part of vagina
synthesized by:
PHYSIOLOGY 15.Capacitation is the process of conditioning within: A)Vas deferns B)Epididymis C)Seminiferous tubules D)Female genital tract of sperms before fertilisation that occurs
16.During ventricular phase of depolarisation, which part is depolarised in the end: A)Papillary muscle B)Posterior basal part of LV
17.All of the following are the actions of hormone Insulin except? A)Neoglucogenesis B)Lipogenesis C)Amino acid transport into cell D)Inhibition of hormone sensitive lipase
18.Which of the following receptors hertz? A)Pacinian corpuscles B)Ruffinis ending C)Merkels disc D)Meissners corpuscle
of 30 to 800
19.The voltage in mV(of membrane potential)when voltage gated Na channels are activated: A) -50 to -70 B) -70 to -90 C) -90 to -100 d) -100 to -130
20.The Equilibrium potential calculated by Nernst equation at 37 degree C for Chloride is A) Ecl = + 62.5 log [ Cl o ] / [ Cl I ] B) Ecl = - 61.5 log [ Cl I ] / [ Cl o ] C) Ecl = + 61.5 log [ Cl I ] / [ Cl o ]
21.Which of the following factor causes a shift to the right in oxygen hemoglobin dissociation curve? A) Increase in fetal haemoglobin B)Increase in pH C)Decrease in CO2 D)Increase in CO2
22.Which of the following is/are true for Oxygen debt mechanism functioning during vigorous muscle contraction: A)Excess accumulation of lactate and its rapid diffusion in blood B)Energy is predominantly extracted by anaerobic mechanisms C)Phosphoryl creatine is the source of ATP D)All
23.Which of the following is true as regards to action of somatostatin,insulin and glucagon? A)Glucagon blocks insulin and somatostatin B)Insulin blocks glucagon and somatostatin C)Somatostatin stimulates insulin D)Somatostatin blocks release of both insulin and glucagon
24.Folliculostatin usually binds and inhibits which of the following hormone? A)Estrogen B)FSH C)Progesterone
D)LH
26.The transport maximum is defined as: A)Maximum tubular secretion B) Maximum tubular reabsorption C) Maximum tubular secretion and reabsorption D)All
27.Which of the following is related to appetite and satiety? A)Leptin B)Ghrelin C)Neuropeptide D)All
28.The absorption of which of the following is dependent on Na dependent co-transporter mechanism in the gut? A)Glucose B)Galactose C)Peptide D)all
29.Factor present in the final common terminal pathway of complement system is: A)C3 B)C4 C)C5 D)Protein B
30.the slow wave sleep predominating in the first third of night sleep is a feature of which phase? A)REM B)NREM-1 C)NREM-2 D)NREM -3&4
31(b). Glucocorticoids suppress the production of: A)Lymphocytes B)Platelets C)Neutr ophils D)RBCs
32.In isometric exercise all are increased except? A)Heart rate B)Cardiac output C)Mean arterial pressure D)Systemic vascular resistance
33.Half life of monocytes is: A) 1-3 days B) 1-3 weeks C) 1-3 months D) 1-3years
BIOCHEMISTRY
34.The type of mutation that leads to the replacement of valine for glutamate in Sickle cell disease is: A)Nonsense B)Point C)Silent D)Missense
35.Which of the following amino acid participates in urea cycle as well as formation of nitric oxide:\?
36.Which of the following lipoproteins has the highest content of phospholipids? A)Chylomicrons B)VLDL c)LDL d)HDL
37.Proof reading is a function of A)DNA polymerase 1 B) DNA polymerase 2 C)restriction endonuclease D)Exonuclease
38.Glucose 6-phosphate has all possible fates within the cell except? A)Glycolysis B)HMP shunt C)Glycogenesis D)Neoglucogenesis
39.Which of the following complexes is not involved in the generation of proton gradient? A)Cytochrome oxidase
40.Deficiency of the following vitamin would lead to excretion of xantheurenic acid in urine: A)Folate B)Pyridoxine C)Thiamine D)Ascorbic acid
41Parathormone exerts its bone resoptive action on its receptors present on all except A)Osteoblast B)Osteocyte C)Osteoclast D) Osteocyte membrane
42.Which is untrue about HGPRTase deficiency? A)Its deiciency produces Lesch Nyhan syndrome in males B)The enzyme is involved in salvage pathway of nucleotide metabolism C)It predominantly affects hepatocytes D)PRPP is the substrate
43.The 4 pyrrole rings in haemoglobin structure are joined together by : A)Hydrogen bonds B)Methylene bridges C)Alpha linkage
D)Disulfide linkage
44.Enzyme deficient in Alkaptonuria is A)Cystathionine synthase B)Tyrosinase C)homogentisic acid oxidase D)Phenyl alanine hydroxylase
45.Following properties favour water as an ideal bio solvent except? A)Hydrogen bonding capacity helps dissolve organic molecules B)Water is a polar solvent C)Capacity for covalent bonding D)high dipole moment causes dissolution of salts
46.Which of the following has fastest electrophoretic motility? A)Chylomicrons B)VLDL c)LDL d)HDL
PHARMACOLOGY
47.All of the following are selective beta blockers except? A)Pindolol B)Bisoprolol C)Atenolol
D)Nebivolol
48.Drug of choice for legionella infection is: A)Azithromycin B)Ceftriaxone C)Vancomycin D)Imipenem
50.Anti platelet action of aspirin lasts for A)28 days B)7 days C)14 days D)21 days
51.Dobutamine is agonist on the following receptors A)D1 B)Alpha & beta C)Beta D)All
53.The drug associated with Coronary steal : A)Nicorandil B)dipyridamole C)Ranolazine D)Diltiazem
54.Peliosis hepatis is caused by all except: A)Anabolic steroids B)OC pills C)Danazol D)analgesics
55.Ganciclovir is more effective than acyclovir against: A)Herpes B)Hepatitis C)CMV D)Influenza
57.Following are uses of phentolamine : A)Antidote to nerve agents B) In Adrenergic crises C)For high altitude pulmonary edma D)All
59.The microsomal enzymes CYP2B &CYP3A are induced by all except A)Primidone B)valproate C)Phenobarbitone D)Phenytoin
60.Which drug acts by inhibiting DNA dependent RNA polymerase? A)Isoniazid B)Streptomycin
C)Ethambutol D)Rifamycin
61.Which of the following is least likely to cause increase in bradykinin concentration ? A)Benazipril B)perindopril C)Irbesartan D)All
63.Erythromycin acts by interfering with _______in protein synthesis of bacteria. A)Transduction B)transcription C)Translation D)Translocation
65.Hepatic necrosis is caused by: A)Carbon tetrachloride B)Yellow phosphorus C)Amanita phalloides D)all
66)Apparent volume of distribution for a drug is 5 litres per kg .In which of the following compartments will the drug be seen predominantly? A)Intravascular compartment B)Total body water C)Intra cellular fluid D)Extra cellular fluid
67)which of the following cannabinoid receptor blocker is used as an anti-obesity drug? A)Mazindol B)Orlistat C)rimonabant D)none
68.Which of the following is very effective in treatment of acute exacerbation of asthma & status asthmaticus? A)beclomethasone
PATHOLOGY
70.The following are major free radical scavenging systems except? A)Glutamine B)catalase C)Superoxide dismutase D)Glutathione
71(a).Mallory hyaline is characteristically seen in A)Yellow fever B)hepatitis B infection C)Primary sclerosing cholangitis D)Alcoholic hepatitis
72.Crescentic glomerulonephritis is seen with all except: A)Thromboangitis obliterans B)Wegeners granulomatosis C)polyarteritis nodosa D)All
74.Which of the following is not an acute phase reactant protein: A)CRP B)Fibrinogen C)SAA protein D)Tissue factor
C)CCR-5 & CXCR-4 D)All 76.Idiopathic nephrotic syndrome is seen in all except: A)Membranous nephropathy B)Focal segmental glomerulosclerosis C)Membrano proliferative glomerulo nephritis D)Minimal change disease
77.In which of the following linear IgA deposits are seen? A)Henoch Schonlein Purpura B) Focal segmental glomerulosclerosis C) Membranous nephropathy D)Wegners granulomatosis
78.Intrinsic cell wall defect in RBC is a feature of A)Paroxysmal nocturnal hemoglobinuria B)Sickle cell disease C)Heredity spherocytosis D)All
79All are true for a choriocarcinoma except: A)Aggressive malignancy B)Common below 20 years of age C)Raised HCG levels D)Gonadal type is chemosensitive
80.Which type of thyroid neoplasms are associated with calcitonin induced amyloid deposition? A)Medullary B)Anaplastic C)Follicular D)Papillary
81.Ectopic rest of normal tissue is known as: A)Choristoma B)Lymphoma C)Pseudotumor D)Hamartoma
82.Pancreatic carcinoma is associated with raised levels of which of the following? A)CA-19-9 A)CA-125 C)CA-15-3 D)All
83.Following is the most reliable feature to differentiate a benign pheochromocytoma from a malignant one? A)capsular invasion B)Presence of mitoses C)Vascular invasion D)None
84(b).The major transgene to achieve growth of 2 nd heart field is : A)VEGF B)FGF C)HIF-1-alpha D)TGF-beta
86.Most common cause of hyperpitutarism is: A)Prolactinoma B)GH-secreting adenoma C)FSH- secreting adenoma D)ACTH- secreting adenoma
87.Which of the following is the single most important indicator of likelihoodness of progression of Hepatitis B to liver cirrhosis ?
A)Etiology B)Associated serological findings C)Presence of bridging necrosis D)Presence of Mallory Hyaline
MICROBIOLOGY
88.Which of the following test is useful to differentiate micrococci from Staphylococci? A)Catalase test B)Hugh Leifsons test C)Oxidase test D)All
89. Which of the following is not true about Sabin vaccine ? A)3 doses as primary immunization are given. B)Doses given at an interval of 4-6 weeks C)Given I.M. D)Contains all 3 strains of viruses
90.Fish is one of the host for the following except: A)Paragonimus westermanii B)Clonorchis sinensis C)Ophisthorchis viverini
D)Diphyllobothrium latum
92.LGV is caused by: A)Chlamydia trachomatis B)Calymmatobacter granulomatis C)Hemophilus ducreyi D)Treponema pallidum
93.Transfer of a portion of DNA from one bacterium to another by the agency of a bacteriophage is known as: A)Transformation B)Transduction C)Conjugation D)Lysogenic conversion
94.True about bacterial capsule is all except: A)Stains by Grams stain B)Lost by repeated subcultures C)Protects bacteria from phagocytosis
95.Which is the alive part of Hydatid cyst? A)Ectocyst B)Pericyst cyst C) Endocyst D)None
96.Regression metamorphosis is a feature of : A)Hydatid cyst B)Cysticercoid C)cysticercus cellulosae D) cysticercus bovis
97.The Formol-Ether concentration technique ,the layer that contains parasites is A)Supernatant B)Formol water C)Ether D)Sediment
98.Iso hemagglutinin (anti-A & anti-B) are which type of antibodies? A)IgG B)IgA
C)IgM D)IgD
99.In Hot Air oven , a holding period of 1 hour is prescribed for a temperature of : A)100 degree C B)120 degree C C)140 degree C D)160 degree C
101.White Piedra is caused by: A)Piedraia hortae B)Pityriosporum orbiculare C)Malassezia furfur D)Trichosporon beigelii
104.Weil-Felix reaction is useful for all except: A)Epidemic typhus B)Trench fever C)Endemic typhus D)Scrub typhus
105.The Fc piece of which immunoglobulin fixes C1? A)IgA B)IgG C)IgM D)IgE
106.Which of the following needs cholesterol and other lipids for growth? A)Mycobacterium TB
107.Filariform larva is seen in A)Enterobius vermicularis B)Necator americanus C)Ascaris lumbricoides D)Trichuris trichura
108.Cutaneous larva migrans is seen in: A)Ankylostoma braziliense B)Ankylostoma duodenale C)Necator americanus D)None
111.In schwann cells .mycobacterium leprae divides in how many days? A)2-3 days B)11-13 days C)22-23 days D)32-33 days
112.The following can occur in death due to 12-14 hours of salt water drowning except: A)Acute fulminant pulmonary edema B)Hypovolemia/hemoconcentration C)Hemolysis with hyperkalemia D)Circulatory collapse
113.In death due to police firing ,inquest is done by: A)Magistrate B)Metropolitan magistrate
114.Cut off age for juvenile offender is A)16 years B)18 years C)21 years D)15 years
115.The path of which of the following bullet can be followed after shot from the gun? A)Incendiary B)Tracer C)Yawning D)Tandem
116.Final authority on disciplinary action for professional misconduct is: A)MCI B)SMC C)Judicial magistrate D)None
117.Suit of negligence against doctor can be filed within what duration of negligent treatmant? A) 1/2 year B) 1 year
C) 1 years D) 2 years
118.Preservative used commonly for viscera preservation : A)10% formalin B)Saturated NaCl C)Rectified spirit D)Thymol
119Cupper sulfate is used as an antidote for A)Phosphorus poisoning B)Arsenic poisoning C)Mercury poisoning D)Lead poisoning
120.Le Facie Sympathique indicates: A)Antemortem hanging B)Suicidal hanging C)Homicidal hanging CD)Postmortem hanging
PSM 121. The study of physical, social & cultural history of man is known as-
A. B. C. D.
122. Which of the following units of measurement should be used in order to compare variation between two variables? A. Standard deviation B. Percentile C. Mean deviation D. Coefficient of variation
123. Under NLEP, leprosy status of Maharashtra state corresponds to which of the following category? A. Category 1 B. Category 2 C. Category 3 D. Category 4
124.(A) Soft tick transmitsA. KFD B. Q Fever C. Relapsing fever D. Indian tick typhus
125. Which of the following method of assessment of protein quality gives complete assessment of protein quality? A. Biological value B. NPU C. Digestibility co-efficient D. amino acid score
126. The denominator of positive predictive value hasA. True positive + false negative B. True negative + false positive C. True positive + false positive D. True negative + false negative
127. In the calendar method, the first day of fertile period is calculated byA. Shortest cycle -18 B. Shortest cycle +18 C. Shortest cycle +10 D. Shortest cycle -10
128. Assessment & aiding for development of funds for the National Blindness Control Program was done byA. UNICEF
129. When ortho-toluidine is added to water, which color is produced? A. Blue B. Red C. Yellow D. Green
130. Which of the following is most sensitive index foe recent malaria transmission? A. Infant parasite rate B. Spleen rate C. Average enlarged spleen D. Parasite density index
131. In MDG, the numbers of goals directed towards health are? A. 1 out of 8 B. 2 out of 8 C. 3 out of 8 D. 4 out of 8
132. A patient who has come with a new , clean wound with tetanus immunization 6 yrs back needs to takeA. Observe B. 1 toxoid
133. According to International standards, still birth is defined as death of fetus weighing ________ or more dying in 1 yr in every 1000 total births. A. 500gms B. 750gms C. 1000gms D. 1250gms
134. If the annual growth rate of population is 1.5-2% what will be the numbers of years for the population to get doubled? A. 35 to 47 years B. 28 to 35 years C. 23 to 28 years D. 47 to 70 years
135. Which of the following studies was conducted to determine that Community Health Education contribute to reduced risk of cardio vascular diseases A. Stanford -3- community study B. North Karelia Project C. MRFIT D. Oslow international study 136. In WHO growth chart, the upper reference curve corresponds toA. 80th percentile of boys B. 80th percentile of girls C. 50th percentile of boys
137. Sullivans index is an indicator ofA. Burden of disease B. Disability rate C. Literacy rate D. Mortality rate
138. According to Bio Medical waste, 1998, the yellow color code is forA. Human anatomical waste B. Chemical waste C. Incineration ash D. Disinfectants & insecticides
139. Which of the following is not a fundamental aspect of disease management? A. Disease response B. Disease mitigation C. Disease awakening D. Disease preparedness
140. PERT & CPM are components ofA. Work sampling B. Network analysis C. Input analysis D. System analysis
141. PQLI does not includeA. Literacy B. Per capita income C. Life expectancy D. Infant mortality
143. The time interval between reception of infection & maximum infectivity of the host isA. Generation time B. Incubation period C. Latent period D. Serial interval
OPHTHALMOLOGY 144. Drug of first choice for primary open angle glaucoma : a. Latanlprost b. Dorzolamide c. Brimonidine d. Timolol
145. Anti glaucoma drug that is long acting and used once daily: a. Latanoprost b. D Dorzolamide c. Brimonidine d. Timolol
147. Sea fans configuration of retina is seen in : a. Retinopathy of prematurity b. SLE c. CRAO d. Sickle cell disease
148. If a neonate is suffering from bilateral dense lenticular opacities since birth , the ideal time to operate so as to avoid stimulation deprivation amblyopia : a. 6 weeks b. 6 months c. 12 weeks d. 12 months
149. Keratic precipitates and cells in the anterior chamber of eye are suggestive of ? a. Conjunctivitis b. Keratitis c. Scleritis d. Iridocyclitis
150. The radius of curvature of anterior surface of cornea is : a. 6.8 mm b. 7.8 mm c. 5.8 mm d. 4.8 mm
151. The visible spectrum of light is : a. 200 280 nm b. 280 320 nm c. 320 400 nm d. 400 700 nm
152. Angular conjunctivitis is caused usually by : a. C. diphtheriae b. Moraxella axenfield c. C. trachomatis d. Staphylococcus aureus
153. On SAFE strategy false is : a. Screening b. Antibiotics c. Facial hygiene d. Environmental modification
154. Laser used in LASIK is : a. Excimer b. Nd YAG c. Krypton red d. Argon green
155. Rosette shaped cataract is sen in : a. Trauma b. Diabetes c. Complicated cataract d. Wilson disease
156. Blue sclera is seen in : a. Osteogenesis imperfecta b. Osteopetrosis c. Achondroplasia d. Cleido cranial dysostosis
ENT 157. All of the following are extrinsic laryngeal membranes/ligaments except,
158. For which of the following frequencies , the normal transmission has the greatest sensitivity, a. 3000Hz b. 800-1600Hz c. 500-3000Hz d. 500-2000Hz
159. Which of the following is the only intrinsic muscle of larynx that lies in the laryngeal framework ? a. cricothyroid b. posterior cricoarytenoid c. lateral cricoarytenoid d. aryepiglotticus
160. Mucocoele most commonly affects which of the following paranasal sinus? a. frontal b. ethmoid c. sphenoid d. maxillary
a. posterior root of zygoma b. external auditory canal c. digastric triangle of neck d. angle of jaw
162. Which of the following is associated with metaplasia a. atrophic rhinitis b. rhinitis sicca c. rhinoscleroma d. rhinitis caseosa
163. Following is false as regards to acute retropharyngeal abscess a. extends into paranasal space b. torticollis is not uncommon c. present to the one side of midline d. caries of the cervical spine is the common cause
MEDICINE
164. Chediak Higashi syndrome is associated with all except: a. delayed microbial killing b. defective degranulation c. neutrophilia d. giant granules are seen
165. AFP is present in all except a. seminoma b. yolk sac tumor c. embronal carcinoma d. immature teratoma
166. Most common type of diabetes associated neuropathy a. mononeuropathy b. distal symmetric polyneuropathy c. autonomic neuropathy d. polyradiculopathy
167. Which of the following retroviral drugs cause nephrolithiasis ? a. zidovudine b. tenofovir c. efavirenz d. indinavir
168. Which of the following histopathological subtypes of emphysema is associated with alpha-1 antitrypsin deficiency a. centriacinar b. panacinar c. distal acinar d. irregular variant
170. Libman Sachs endocarditis is seen in a. bacterial endocarditis b. SLE c. non bacterial thrombotic endocarditis d. rheumatic heart disease
171. Cork Screw appearance of esophagus is seen in a. monilial esophagitis b. achalasia c. diffuse esophageal spasm d. carcinoma esophagus
172. Which of the following drug should be given to a pregnant lady as chemoprophylaxis while she is travelling in chloroquine resistant malaria endemic zone a. proguanil/atovaquine b. mefloquine c. primaquine d. doxycycline
173. For the following malignancies, staging is not only an important prognostic factor but also helps in guiding therapy
174.HRCT is investigation of choice for a.Mediastinal masses b.Interstitial Lung Disease c.Bronchogenic carcinoma d.Traumatic Chest lesions
175.Which of the following does not play role in production , maintenance & activation of lymphocytes? a. IL 1 b. IL 2 c. IL 4 d. IL 12
176. Which of the following antibody is associated with Hepatitis C ? a.Anti LKM 1 b. Anti LKM 1&2 c. Anti LKM 2 d. Anti LKM 3
177. Which of the following is associated with niacin deficiency a. Riboflavin deficiency
178.Inheritance pattern of ABO blood group system is : a.Autosomal dominant b.Pseudo dominant c. Autosomal recessive d.Co dominant
180. Which of the following is untrue for Cholorrheic enteropathy? a.Response to low fat diet is good b.Bile acid pool is normal c.Fecal loss of fat is insignificant d.Responds well to cholestyramine
182.Following is /are the ECG criteria for LVH: a.RaVL + SV 3 > 20 mm b. RaVL + SV 3 > 28 mm c.SV1 + RV 6 > 35 mm d.All
183. Which of the following can be given a single intravenous bolus over a period of 10 seconds? a. t PA b. TNK c. r PA d. All
184.Causes of bilateral facial palsy is / are : a. GBS b.Sarcoidosis c.Lymes disease d.All
c.Infliximab d.Anakinra
186.The most common organism isolated from ABPA is : a.Aspergillus nigra b. Aspergillus nidularis c. Aspergillus fumigatus d. Aspergillus flavus
187.Thermoactinomyces is not a cause for: a.Mushroom workers disease b.Farmers lung c.Millers lung disease d.Bagassosis
188. Which of the following is an autosomal dominant disorder? a.Hemochromatosis b.Wilsons disease c.MEN 2 d.All
190. Which of the following types of RTA is associated with hyperkalemia? a.RTA 1 b.RTA 1 & 2 c.RTA 2 d.RTA 4
191.Henoch schonlein purpura is characterised by all except : a.Palpable purpura b.Arthralgia c.Renal failure d.Thrombocytopenia
193.in which of the following ,prominent Y descent is not seen ? a.Restrictive cardiomyopathy b.Constrictive pericarditis c.Cardiac tamponade d.RVMI
194.Prazosin is effective for treatment of : a.Naja naja b.Viper snake c.Mesobuthus tamulus d.All
195.Characteristic EEG pattern in absence seizure is a.3 HZ spike waves b.Hypsarrhythmia c.Generalised polyspikes d. 1 2 Hz spike waves
197.Neutropenic FUO is defined as neutrophil count less than ) per ml ): a.200 ml b.350 ml c.500 ml d.750 ml d. Post mastectomy irradiated limb
SURGERY
198. Most common location of spleenunculi is : a. Tail of pancreas b. Mesocolon c. Hilum of spleen d. Spleenic ligaments
199. Most common benign tumor of spleen is : a. Lymphoma b. Lymphangioma c. Hemangioma d. Angiosarcoma
200. Most common cause of chylothorax in children is : a. Congenital b. Post surgery c. Malignancy
d. Trauma
201. An adrenal mas is removed when the size starts growing beyond : a. 1.5 cm b. 4 cm c. 7.5 cm d. 10 cm
202. Treatment of choice for stage 1 non seminoma: a. Orchidectomy & RPLND b. Orchidectomy & radiotherapy c. Orchidectomy & radiotherapy d. Chemotherapy & radiotherapy
203. All of the following are indications for thoracotomy except: a. Initial blood loss > 1500 ml b. Cardiac tamponade c. Continuing blood loss > 100 ml / hour d. Persistent air leak
204. Ormands disease is a. Idiopathic retroperitoneal fibrosis b. Idiopathic mediastinal fibrosis c. Idiopathic thyroiditis d. Idiopathic mesenteritis
205. Most common site for Lymphangiosarcoma is : a. thoracic duct b. Retroperitoneum c. Uterus d. Post mastectomy irradiated limb
206. All of the following are criteria for admission to a burns unit except: a. Any burn in a unmarried woman b. Inhalational injury caused due to burns c. Burns > 15 % of total body surface d. Chemical burns / acid burns
208. Charles Philip procedure is for a. Urethral stricture b. Solitary rectal ulcer c. Recurrent intestinal obstruction d. Small bowel atresia
209. Most common site for Angiodysplasia is : a. Ascending colon b. Tranverse colon c. Descending colon d. Sigmoid colon 210. Most common site for Posterior Urethral Valve is : a. Proximal to veromontanum b. At the veromontanum c. Distal to veromontanum d. None
211. Which of the following is correct regarding Peyrronies disease ? a. Fixed deformity of penis b. Bowing deformity of erect penis c. Fibrosis of corpora spogiosa d. None
212. Which of the following conditions when identified on a plain X ray and necessitates cholecystectomy ? a. Cholesterolosis b. Porcelain gall bladder c. Cholelithiasis d. Emphysematous cholecystitis
213. Which of the following is the earliest manifestation of renal tuberculosis? a. Increased urinary frequency
214. Most common site of ulcer in Solitary Rectal Ulcer Syndrome (SRUS )? a. Posterior wall b. Right lateral wall c. Left lateral wall d. Anterior wall
215. Carcinoma prostate is common in : a. Central zone b. Transition zone c. Peri urethral zone d. Peripheral zone
216. Deleromes operation is done for : a. Solitary rectal ulcer syndrome b. Rectal prolapse c. Rectal stricture d. Rectal carcinoma
d. 5 - 15
218. Spigelian hernia occurs a. Through the obturator canal b. At the level of arcuate line c. Above / below umbilicus through linea alba d. Through the posterior parietal peritoneum
219. In Ulcerative colitis , diagnosis of toxic megacolon is confirmed if the diameter of colon on X ray is more than : a. 4.5 cm b. 5.5 cm c. 6 cm d. 7 cm
220. Which of the following has worst prognosis? a. Cystadenolymphoma b. Muco epidermoid carcinoma c. Adenoid cystic carcinoma d. Acinic cell carcinoma
221. Following polyp does not have malignant potential : a. Juvenile polyp b. Hamartomatous polyp in Peutz Jeghers syndrome c. Juvenile Polyposis syndrome d. Famalial Adenomatosis Polyposis syndrome
222(A). The most common type of degeneration seen in uterine fibroid is : a.Cystic degeneration b.Red degeneration c. Calcific degeneration d. Hyaline degeneration
222(B). The most common type of degeneration seen in uterine fibroid during pregnancy is : a.Cystic degeneration b.Red degeneration c. Calcific degeneration d. Hyaline degeneration
223. Indications for colposcopy include all except: a. Women with abnormal Pap smear b. Clinically suspicious cervical lesion with history of contact bleeding c. For conservative treatment of Cervical Intraepithelial Neoplasia d. Obvious visible growth
224. Which of the following diameters is engaged in face to pubis delivery? a. Occipito frontal
225.As per ACOG criteria to diagnosis GDM using GTT ; plasma glucose at 2 hours post oral glucose consumption should be more than ( mg / dl): a. 180 b. 140 c. 95 d. 155
226. Diagnosis of ectopic pregnancy can be made with hCG level more than________ at 4 weeks of amenorrhea? a. 1000 m IU / ml b. 1500 m IU / ml c. 2000 m IU / ml d. 2500 m IU / ml
227. Using Mifepristone , therapeutic abortion can be induced until__________ weeks of gestation? a. 6 b. 7 c. 8 d. 9
228. Breast self examination by females should be done at what time in relation to the monthly cycle: a. Pre- menstrually b. During menses c. Following menses d. During ovulatory period
231. Fetal tachycardia is defined as heart rate more than ( beats per minute): a. 140 b. 150 c. 160 d. 170
232. During repair of cervical tear, the first stitch is placed: a. At the angle b. Above the angle c. Below the angle d. Anywhere
233. Which is the longest diameter among the following? a. Bitemporal b. Biparietal c. Occipito mental d. Occipito frontal
235. Most common cause of acute renal failure during pregnancy is: a. Abruptio placentae b. HELLP syndrome c. Pre eclampsia / eclampsia d. Abortion
236. The following is / are complication of intra uterine fetal death : a. Hypofibrinogenemia
238. The dose of radiation at point B in treatment of cervical carcinoma is : a. 5000 rads b. 2000 rads c. 3000 rads d. 8000 rads
239. If a lady presents with complaints of vomiting and PV bleed with fundal height more than period of gestation , is likely suffering from : a. Hydatidiform mole b. Poly hydramnios c. Abruptio placenta d. Threatened abortion
240. The type of abortion in which Os is open and abortus is present in uterus is: a. Threatened abortion
241.Criteria for Twin to Twin transfusion syndrome are all except ? a. Fetal weight discrepancy more than / equal to 25 % b. Hemoglobin concentration difference equal to/ more than 5 gm % c. Oligohydramnios & anemia in donor twin d. Oligohydramnios & anemia in recipient twin
242. Following change is first to occur on administration of Iron therapy? a. Decreased irritability b. Reticulocytosis c. Increased serum iron d. Replenished iron stores
243. Which is the most sensitive criteria for fetal well being in 2 nd trimester of pregnancy? a. Head circumference b. Abdominal circumference c. Femur length d. Bi parietal diameter
245.In a 1 year old child hypogltcemia should be treated with which of the following? a. 100 ml /kg , 25% dextrose b. 4 ml / kg ,25 % dextrose c. 2 ml / kg , 25 % dextrose d. 2ml / kg , 10 % dextrose
246. Which of the following is ideal for maintenance of body temperature of a newborn during transportation? a. Transport incubator b. Thermocol box c. Kangaroo Mother Care d. Hot water bottle
247. In which of the following Mucopolysaccharidoses is cloudy cornea not seen? a. Maroteaux Lamy syndrome b. Hurler syndrome c. Hunters syndrome d. Morquio syndrome
248. Apple peel bowel with loss of dorsal mesentery is a feature of which type of ileal atresia?
249.When are the chances of HIV transmission from a mother to her baby maximum ? a. Ante natal period b. Intra partum ( Cesarean section ) c. Intra partum ( Vaginal delivery ) d. Breast feeding
250. What is the amount of citrate present in WHO ORS 2002 formula? a. 1.5 gm b. 2.5 gm c. 2.9 gm d. 3.9 gm
251. The amount of WHO ORS required in first 4 hours in a 1 year old child with some dehydration ( weight of the child is not known ) is : a. 200 400 ml b. 400 600 ml c. 600 800 ml d. 800 1200 ml
252. All of the following are true for Regurgitation except ? a. There is no nausea b. Effortless regurgitation of meals post feeding c. Can lead to failure to thrive d. Seen in 3 5 year old children.
253. A 2 year old child was brought to PHC with a history of cough and fever for 4 days with inability to drink for last several hours .The respiratory rate is 45 / minute. The child will be classified as : a. Very severe disease b. Severe pneumonia c. Pneumonia d. No pneumonia
ORTHOPAEDICS
255. Sequestrum is best defined as A) A piece of dead bone surrounded by infected granulation tissue. B) A piece of dense sclerotic bone surrounding infected granulation tissue.
C) A piece of dead bone surrounding infected granulation tissue. D) A piece of dead bone.
256. Most common ligament injured in ankle sprain A) anterior talofibular B) posterior talofibular C) deltoid D) spring
257. What is the percentage mortality in first rib fracture? A) 5% B) 10% C) 20% D) 36%
258. Hill sachs lesion is seen in A) posterior shoulder dislocation B) recurrent shoulder dislocation C) inferior shoulder dislocation D) anterior shoulder dislocation
259. In congenital dislocation of knee, what is the attitude in which knee joint is found? A) flexion B) genu varus C) genu valgus D) hyperextension
260. Avascular necrosis of femoral head is seen most commonly with A) intracapsular fracture neck femur B) extracapsular fracture neck femur C) dislocation of hip D) fracture femur shaft
261. All of the following about Giant Cell Tumor are false except A) seen in <15 years of age B) usually present as lytic lesion with sclerotic rim C) epiphyseal in location D) nature is always benign
262. Deformity most common in primary osteoarthritis of knee A) genu valgus B) genu recurvatum C) genu varus D) none
263. Tension band wiring is done for all except A) fracture patella B) fracture olecranon C) fracture medial malleolus D) Colles fracture
264. Winging of scapula is seen in injury of A) bells nerve B) thoracodorsal nerve C) median nerve D) radial nerve
DERMATOLOGY 265. Max Joseph space is seen in A) Pityriasis rosea B) Lichen planus C) Psoriasis D) Darriers disease
266. Koebners phenomenon is not seen in A) Molluscum contagiosum B) Scleromyxedema C) Erythema multiforme D) Darriers disease
267. Which of the following vesiculobullous disorder exhibit intraepidermal split? A) Bullous pemphigoid B) Pemphigus vulgaris C) Dermatitis herpetiformis D) All 268. Dennie Morgan folds are seen in A) Dermatitits herpetiformis
269. Pedal botryomycosis is caused by A) Actinomycosis somaliensis B) Staphylococcus aureus C) Nocardia asteroids D) Madura madurella
270. A sexually active male presents with an ulcer on glans that is painless and bleeds on touch. He is suffering from A) chancre B) donovanosis C) chancroid D) lymphogranuloma venereum
271. Auspitz sign is a feature of A) Pemphigus vulgaris B) Psoriasis C) Lichen planus D) Pityriasis alba
C) HIV D) Parvo
ANAESTHESIA
273. Which of the following is the most effective treatment for post dural puncture headache? A) drip of Hartmans solution in epidural space B) NSAIDs C) epidural blood patch D) intravenous fluids
274. Maximum plasma protein binding is seen in which of the following local anaesthetics A) procaine B) bupivacaine C) mepivacaine D) tetracaine
275. Following are contraindicated in renal failure except A) enflurane B) pethidine C) pancuronium D) midazolam
276. Which of the following may result in sudden increase in ET CO2 A) hypoventilation B) malignant hyperthermia
C) hyperthyroidism D) all
277. Which of the following is the use of capnography ? A. Determining vaporizer malfunction B. Determining circuit hypoxia C. Detecting concentration of O2 in anaesthetic circuit D. Determining appropriate placement of endotracheal tube.
278. Which of the following is the longest acting aneasthetic ? A. Lignocaine B. Dibucaine C. Chlorprocaine D. Prilocaine
279. Following is known to potentiate actions of succinyl choline. A. Sevoflurane B. Nitrous oxide C. Halothane D. Isoflurane
280. The colour of NO ( nitric oxide ) cylinder is A. Black B. Blue C. Black with white shoulder
281. Obliteration of right heart border on chest X-ray, with base of the opacity towards heart & apex directed laterally suggest pathology of A. Apical segment of the right lower lobe B. Right lower lobe medial segment C. Right middle lobe D. Apical segment of right upper lobe.
282. Which of the following is not emitted by radio active isotope? A. X-ray B. Alpha particle C. Beta particle D. Gamma rays
283. Which among the following is the most stable radio-isotope ? A. O-18 B. I-125 C. P-32 D. C-14.
284. String of beads appearance is seen in A. CHPS B. Sigmoid volvulus C. Large bowel obstruction D. small bowel obstruction.
287. X-ray of which of the following would be the most appropriate for determining for bone age at 1113 yrs? A. Shoulder B. Medial end of clavicle C. Wrist D. Knee 288. Which of the following is the most potent derivative of Cannabis ? A. Charas B. Ganja C. Bhang D. Majun.
290. Shrilankan lady which was saved in tsunami presents with complaints of recalling the events during the disaster, remembering the apathy & sufferings of the sufferer, she is most likely suffering from A. PTSD B. MDP C. OCD D. Specific phobia.
291. Avoiding awareness of pain of reality ( from conscious awareness ) involuntarily is which type of defense mechanism. A. Dissociation B. Denial C. Displacement D. Distortion.
292. Manchausen syndrome by proxy is defined as A. Illness caused by care-giver B. Toxin mediated psychiatric illness C. Drug abusal D. All.
293. Early morning awakening & reduced latency of REM sleep is suggestive of
295. A seven year old child has destructive behaviour, difficulty in organizing things, not playing with peers, interrupts others in school and easily gets distracted. The likely diagnosis is A. Learning disorder B. Autistic disorder C. Attention deficit hyperactivity disorder D. Conduct disorder
296. In an alcoholic man, Blackouts are seen in A. Alcohol abstinence B. Alcohol intoxication C. Alcohol withdrawl D. Hepatic encephalopathy.
300. A 20 yr old female presents with complaints of reduced sleep with disorganized behaviour since 9 mnths , she feels there is a camera fixed behind her head which always follows her. What is the likely diagnosis ? A. Psychotic depression B. Paranoid Schizophrenia C. Delusional disorder D. Paranoid Personality disorder.
ANATOMY
ROSTRAL FIBRES
CAUDAL FIBRES
RELATED QUESTION Nucleus accumbens is related to basal ganglia (2002) Nucleus globosus is present in cerebellum
CORPORA AMYLACEA Lipoprotein + lipofuschin deposits In lysosomes of ageing neurons,esp. spinal neurons
The Ano-rectal ring is formed by A.) puborectalis + B.) internal anal sphincter + C.) deep part of external anal sphincter.
MUSCLES FORMING ANAL SPHINCTER 1. External anal sphincter a.)Subcutaneous external sphincter b.)Superficial external sphincter c.)Deep external sphincter 2. Internal anal sphincter 3. ---------
MEDIAL CORD
LATERAL CORD
POSTERIOR CORD
1.Medial pectoral nerve 2.Medial cutaneous nerve of arm 3. Medial cutaneous nerve of forearm 4.Medial branch of median nerve 5.Ulnar
BURSAE 1. Subcutaneous pre patellar 2. Subcutaneous infra patellar 3. Deep infra patellar 4.Supra patellar
Other bursae that communicates with knee joint cavity: a.) Semimembranosus bursa b.) Bursa between lateral head of gastocnemius & knee joint capsule.
6.Ans A (LEFT RENAL VEIN ): BDC 2/4th/297,316,307 DRAINAGE OF a.)Renal vein b.)Gonadal vein c.)Adrenal vein d.)Inferior phrenic vein ON RIGHT SIDE Into IVC Into IVC Into IVC Into IVC ON LEFT SIDE Into IVC Into left renal vein Into left renal vein Into left renal vein
MAJOR CHARACTERISTICS FUNCTION Brunners glands Alkaline secretion Crypts of Leiberkhun (also present in other parts of small intestine) Peyers patches Refer ans 3 of 2010
c.)Ileum
Lymphoid aggregates
MUSCLE INSERTION ON GREATER TROCHANTER SURFACE MUSCLE 1.Anterior surface Gluteus minimus (lateral part ) 2.Lateral surface Gluteus medius 3.Medial surface 4.Apex 5.Trochanteric fossa Obturator internus Superior-inferior gamelli Pyriformis Obturator externus
A P F O E
RELATED QUESTION: Muscle attached to ischial tuberosity infero-medially is biceps femoris(2002) Gluteus maximus is chiefly inserted into ilio-tibial tract (2003)
PANETH CELL Granulated secretory epithelial cells Found at the base of crypt Are exocrine glands Contains rough endoplasmic reticulum Rich in zinc
Killian dehiscence is present between Thyropharyngeus & Cricopharyngeus. Formed as a result of neuro-muscular incoordination between the PROPULSIVE Thyropharyngeus & SPHINCTERIC Cricopharyngeus. Protruding esophageal mucosa through this forms Zenkers diverticulum.
KILLIANS DEHISCENCE
Nerve:pharyngeal plexus
(Gateway of tears)
Nerve:recurrent laryngeal
Action:propulsive
Action:sphincteric
11.
POSTERIOR a.) IVC b.) Right suprarenal gland c.) T12 vertebra FORAMEN OF WINSLOW
ANTERIOR (right free margin of lesser omentum) a.)Portal vein b.)Hepatic artery c.)bile duct
INFERIOR a.) 1ST part of duodenum b.) horizontal part of hepatic artery It is the connection between greater & lesser sac.
PROCESS OF GASTRULATION
PROCESS:
NEUROGLIA 1. Astrocytes
FUNCTION Provide supporting framework Are electric insulators Take up excess K+ ions Form blood-brain-barrier Store glycogen Fills in sites of lost parenchyma(replacement gliosis) Myelination in CNS Phagocytic
Circulation of CSF Transport of substances from CSF to hypophyseal portal system Production of CSF
Oligodendrocytes form myelin sheath in CNS neurons. Schwann cells form myelin sheath in peripheral neurons.
PHYSIOLOGY
CAPACITATION
Lasts 1 -10 hours Neutralization of inhibitory substances Weakening of sperm membrane Whipping motility of tail
Moves to
Activates
Endocardium to epicardium
Pulmonary conus
EFFECTS OF INSULIN
CARBOHYDRATE METABOLISM
FAT METABOLISM
PROTEIN METABOLISM
Facilitates glucose storage Inhibits hormone sensitive lipase Facilitates translation of m-RNA.
Inhibits neoglucogenesis
Facilitates transcription .
18. Ans A ( PACINIAN CORPUSCLE ): Guyton 12th/561-562 ;Gannong 23rd/121-127 Pacinian corpuscle:Detects vibration from 30-800 hertz because they respond extremely rapidly to minute & rapid deformations of tissues.They transmit signals via A beta fibres. DETECTION OF VIBRATION FUNCTION Rapidly adapting Vibration of 30-800 hertz can be detected Less rapidly adapting Vibrations from2-80 hertz can be detected LOCATION Beneath skin In deep fascial structure Non-hair bearing areas
PACINIAN CORPUSCLE
MEISSNERS CORPUSCLE
OTHER RECEPTORS:
RECEPTORS 1.Ruffini
LOCATION Joint capsule Deeper skin Deep tissues Hair bearing parts
FUNCTION Pressure
Movement of object on body Detects initial contact with body Localises touch Detects texture Detects touch Detects pressure
RELATED QUESTION: Slowly adapting mechanoreceptors sensitive to perpendicular indentation are Merkels discs(2006).
The action potential at which the Na channels open (the threshold),is around -50 to -70 mV.
THE ACTION POTENTIAL SEQUENCE: EVENT RESTING STATE 1.)MEMBRANE -90 POTENTIAL 2.)Na CHANNEL ACTIVATION Close GATE 3.)Na CHANNEL INACTIVATION Open GATE 4.)DIAGRAM
Open
Open
Open
Close
close
close
open
Nernst equation calculates the potential (equilibrium potential) at which the influx of an ion into the cell equals its efflux out of the cell)
E cl = - 61.5 log [ Cl o ] / [ Cl i ]
E k = - 61.5 log [ K i ] / [ K o ]
Where : i= concentration of ion inside o= concentration of ion outside Note:Equations are different for Cl & K because Cl is chiefly in ECF and K is chiefly in ICF.
TRICK: MiKi is superior: where Mi = minus sign Ki = K ion intracellularly Superior = denotes that[Ki] is in numerator
SHIFT
TO
R I G H T
Releases
gas (O2)
at tissues
Whatever happens at tissue level will cause a shift to right of the oxy-hemoglobin curve 1. Increase in CO2 Because of metabolism CO2 is generated at tissue level.So increase in CO2 will cause a rightward shift. 2. Increase in H+/decrease in pH CO2 dissolves in water to give carbonic acid which gives H+ ions.So increase in H+ causes right shift 3. Increase in temperature Metabolic activities generate heat energy at tissue level.So increase in temperature causes Right shift.
CONCEPT OF O2 DEBT: When muscles exercise vigourously for shorter duration,energy is released predominantly via anaerobic pathway.During rest excess O2 is consumed to remove the wastes generated as a result of anaerobic cycles.(So payment of debt of O2 taken at the time of need exercise)
LITTLE EXERCISE
VIGOROUS EXERCISE
VESSLES DIALATE
situation of O2 debt
ATP + LACTATE
Extra O2
SOMATOSTATIN
Inhibits
INSULIN
GLUCAGON
CCK
PANCREATIC POLYPEPTIDE
GASTRIC MOTILITY
Somatostatin In Excess
somatostatin in excess
somatostatin in excess
DIABETES MELLITUS
GALL STONES
DYSPEPSIA
Like somatostatin means Somatotroph( i.e. growth hormone ) inhibitor (statin ) ; in a much similar way folliculo statin means Folliculo (FSH ) inhibitor (statin ).
SOMATO STATIN
FOLLICULO STATIN
GH
inhibitor
FSH
inhibitor
Platelets contribute directly to clot retraction byy activating platelet thromasthenin ,actin and myosin molecule ,which are all contractile in nature --------thereby bringing the opposing ends of vessel in close proximity.
Hemostasis
Tm i.e. transport maximum is the maximum rate at which glucose or any other substance can be resorbed by the tubular epithelium.
So glucose would not come in urine until filtered load exceeds 375 mg/min
375 mg/min Overall transport maximum for kidneys All nephrons have reached their maximal capacity to reabsorb.
250 mg /min Treshold value for glucose Some nephrons have reached maximum capacity to reabsorb ,so glucose appears in urine
27. Ans D (ALL): Guyton 12th/1847 ARCATE NUCLEI IN ARCUATE NUCLEI IN HYPOTHALAMUS
Arcuate nuclei of hypothalamus has POMC neurons (that decrease food intake ) & neurons that increase the food intake--orexigenic neurons. Substances like leptin, peptide YY , etc. activate POMC neurons while orexigenic neurons are stimulated by ghrelin / NPY,AGRP.
POMC NEURONS
OREXIGENIC NEURONS
DECREASE IN FOOD INTAKE INCREASE IN FOOD INTAKE 1. 2. 3. 4. 5. 6. 7. Leptin peptide YY CART CCK Insulin serotonin MSH 1. 2. 3. 4. 5. 6. 7. 8. NPY AGRP MCH AGRP Ghrelin cortisol endorphin orexins
ABSORPTION OF MONOSACCHRIDES GLUCOSE Na dependent active transport (SGLT-1) Carrier mediated diffusion (GLUT-5) GALACTOSE Na dependent active transport (SGLT-1) Carrier mediated diffusion (GLUT-5) FRUCTOSE -----
ABSORPTION OF AMINO ACIDS & PEPTIDES AMINO ACIDS DI / TRIPEPTIDES LARGE PEPTIDES Na dependent active Enter brush border to get Transcellular path transport hydrolysed to amino acids Paracellular path
RELATED QUESTION: Glucose at intestinal level is absorbed by secondary active transport. GLUT-4 is insulin dependent glucose transporter (2003) Insulin controls entry of glucose into myocytes (cardiac/skeletal) & adipocytes (2003) In extensive small intestinal mucosal inflammation protein digestion & absorption is not affected (2008)
Convergence onto C 3
C3 activation
Poly C9
C5-9 /MAC
All 3 pathways converge onto C3 for its activation. The 1st factor of terminal common pathway is C5.
NREM/SLOW WAVE /ORTHODOX SLEEP (70-80 % of sleep) Stage 1: Dozing First & lightest stage of sleep Predominantly theta waves 3 6 % of sleep Stage 2: Unequivocal characetrised by sleep spindles & k complexes 40 50 % of sleep Stage3: Deep sleep transition First appearance of delta waves 5 8 % of slep Stage4: cerebral sleep Predominant delta activity 10 -20 % of sleep It is called dreamless sleep but dreams do occur . Dreams are not registered in memory. No increase in autonomic activity Regular respiration Fall in BP & heart rate Sleep disorders seen : 1.sleep walking(somnambulism) 2.Sleep talking(somniloquy) 3.night terror(pavor nocturnes) 4.Teeth grinding(bruxism) 5.bed wetting(nocturnal enuresis)
REM /PARADOXICAL SLEEP (30-40 % of sleep) Light phase of sleep but arousal is difficult Mixed frequency ,low amplitude waves on EEG Active sleep Also known as desynchronisation sleep Dreaming is seen. Dreams are associated with bodily activity Recall of dreams possible Increase in autonomic activity Penile erection is seen Bursts of eye movement are seen Muscle tone decreases Respiration is irregular BP & heart rate are variable Sleep disorders seen : 1.Nightmares 2.Narcolepsy 3.Nocturnal penile tumescense
RBC
WBC
PLATELETS
Eosinophil
Basophil
Neutrophil
Lymphocyte
CONCEPT: Gluco-corticoids
1.)reduce immunity ( by decreasing lymphocytes ) ; 2.)are anti-inflammatory (by decreasing basophils which release histamine & eosinophils which cause allergic reactions )
ISOMETRIC EXERCISE All parameters of the above given equation INCREASE except Resistance & Stroke volume Increases Increases UNCHANGED Increases Increases UNCHANGED
ISOTONIC EXERCISE All parameters of the above equation INCREASE except BP & Rresistance Increases Increases Increases Increases UNCHANGED / DECREASES DECREASES
TRICK: ISOMETRIC
HALF LIFE OF MONOCYTE - MACROPHAGE IN BLOOD (it is monocyte) It is 3 days IN TISSUES (it becomes macrophage) It is 3 months
POINT MUTATION ( Replacement or changes in single base) SILENT YES YES NO (since mutation is silent) Hb VARIANTS: 1.milwaukee 2.bristol 3.sydney MISSENSE YES YES YES (i.e. the property of protein is lost) 1.sickle cell 2.Hb M(boston) NONSENSE YES YES Termination of protein synthesis i.e. nonsense
4.EXAMPLES
CONCEPT: 1. In silent mutation ,mutation does not manifests itself i.e. remains silent. 2. In nonsense mutation,mutation causes premature end of protein synthesis. 3. In missense mutation,mutation causes clinically apparent disorder.
NO SYNTHASE
CITRULLINE+NADP+NO RELAXATION
TRICK: 1. ALL POLAR SUBSTANCES ARE MAXIMUM IN HDL EXCEPT CHOLESTEROL. 2. All non polar substances are maximum in chylomicrons.
RELATED QUESTIONS: 1. Lipids are transported from intestine via chylomicron.(2003) 2. LDL is most atherogenic lipoprotein(2003) 3. LDL is associated with apo protein B-100.(2006)
FUNCTION Gap filling and synthesis of lagging strand DNA proofreading & repair Processive Leading strand synthesis
NEO-GLUCOGENESIS G L Y C O G E N E S I S G L Y C O G E N O L Y S I S
GLUCOSE 6- PHOSPHATE Other than Being used in HMP SHUNT Is also Used in:
GLYCOLYSIS
FADH2 to FAD
Co-Q
CYT C
O2
(CYT b-c1) NADH to NAD proton gradient generated proton gradient generated
The complex 2 of electron transport chain is not involved in generation of proton gradient across the inner mitochondrial membrane.
RELATED QUESTION: 1.Oxidation reduction system with maximum positive redox potential is:(O2/H2O) > (H+/H) > (NAD/NADH) > ( LIPOATE ). (2008)
Xantheuranate in urine is a marker of pyridoxine deficiency as pyridoxine mediated degradation of 3-OH kynurenine (a metabolite formed during trytophan metabolism) does not occur.
B-6 In plenty
DEGRADATION
PASSED IN URINE
RELATED QUESTION: 1. Niacin is produced from tryptophan.(2007) 2. 60 mg trytophan gives 1 mg niacin (2005)
Parathyroid hormone receptor is absent from osteoclast. GUTTON 12TH/964: The cell membranes of both the osteocyte & osteoblasts have receptors for binding PTH. Osteocytic Membrane System:connection between osteocytes & osteoblasts throughout the bone(except adjacent to osteoclasts)via long filmy processes.
BONE FORMATION
BONE RESORPTION
LESCH NYHAN SYNDROME ETIOLOGY 1.genetic lack of HGPRTase 2.X-linked recessive 3.seen in males LESCH NYHAN SYNDROME CLINICAL 1.self-mutilating tendency 2.mentally retarded 3.manifests by 2 years
PATHOGENESIS PRPP ,as a result of blocked salvage pathway due to absent HGPRTase is diverted to the other pathway i.e. the de-novo synthesis,leading to hyperuricemia and gout.
PRPP (substrate)
hyperproduction of purines
pathway blocked
hyperuricemia & gout SALVAGE PATHWAY IS CHIEFLY OPERATIONAL IN BRAIN AND THIS MAY ACCOUNT FOR BRAIN DAMAGE.
1. Lesch Nyhan syndrome results due to complete lack of HGPRTase. 2. Kelley Siegelmann syndrome results due to partial lack of HGPRTase.
HEMOGLOBIN =
HEME +
GLOBIN
Fe2+
4pyrrole rings
Coordinate
A.) In hemoglobin ,the methylene bridges join the 4 pyrrole rings to form a tetra pyrrole ring(protoporphyrin type 9) B.) The centre of protoporphyrin ring has Fe 2+ which combines via coordinate bonds.
RELATED QUESTIONS: 1. Iron in Heme is linked to globin via amino acid histidine(2009) 2. Porphyrin in Heme is protoporphyrin 9 (2006)
PHENYLALANINE METABOLISM
BENZOQUINONE
DEGRADED
DEPOSITS IN CONNECTIVE TISSUES a.) arthritis b.) pigmentation (ochronosis) c.) dark urine (when sample kept for sometime)
dissolves
On an electrophoretic run ,chylomicron remains at the origin i.e. the cathode while the HDL particles run fastest and reach the anode.
CATHODE(the origin)
CHYLOMICRON
SLOWEST
LDL
VLDL
HDL
FASTEST
BETA-BLOCKERS 1.) NON-SELECTIVE A.) Without intrinsic sympathomimetic Activity Propranolol Sotalol Timolol B.) With sympathomimetic Activity pindolol C.) With additional alpha blocking Property Labetalol Carvedilol BETA -1 SELECTIVE Metoprolol Atenolol Acebutolol Betaxolol Bisoprolol Esmolol Celiprolol Nebivolol
AZITHROMYCIN as a 1st choice drug: 1. 2. 3. 4. 5. Legionnaries pneumonia Chlamydia trachomatis Donovanosis Chancroid PPNG urethritis
AGONIST (exenatide)
INHIBITOR (sitagliptin)
Therefore action of low dose aspirin lasts 5-7 days 51. Ans B (alfa & beta ):KDT 6th/126
DOBUTAMINE ACTS ON
a.) At clinically employed doses ,dobutamine acts as a relatively selective beta -1 agonist. b.) Althiugh a dopamine derivative ,yet does not act on D-1/D2 receptors.
SELECTIVE ALPHA BLOCKERS ALPHA -1A/1B/1D Prazosin Terazosin Doxazosin ALPHA 1A/1D Tamsulosin Timazosin ALPHA 1 Alfuzosin Indoramine Urapidil ALPHA 2 Yohimbine Rawolscine
RELATED QUESTION: a. Anti-hypertensive drug that is glucose neutral(does not affect the glucose metabolism) is prazosin.
A.) Dipyridamole is not used as an anti-anginal drug inspite of it being a dilator. B.) It prevents reuptake /degradation of adenosine thereby causing dilation of resistance vessels C.) Dipyridamole dilates vessels of all areas (ischemic as well as non-ischemic----ischemic vessels are already dilated;normal zone vessels are also dilated) D.) This causes shunting of blood from ischemic to non-ischemic zone resulting in therapeutic failure.
Ischemia
Dipyridamole
dipyridamole
No effect
Dilation occurs
PRIMARY
SECONDARY
ETIOLOGY OF PELIOSIS HEPATIS: DISEASE DRUGS Cancer Anabolic steroids AIDS TB Oral contraceptives Bartonellosis Post transplant danazol immunodeficiency
a.) Ganciclovir is more active than acyclovir against CMV. b.) Anti-viral drugs for CMV: ganciclovir foscarnet
56.
Amphotericin B is 1st choice drug for all systemic mycoses except : a.) Paracoccidiodomyces b.) Chromomycosis
RELATED QUESTION: Dose of amphotericin B for non AIDS cryptoccocal meningitis is 0.6 to 0.7 mg/kg /day for 10 weeks. Tuberculate spores are found in Histoplasma.(2010) Reynolds Braude phenomenon is shown by Candida albicans.(2001)
USES OF PHENTOLAMINE: A.) In high altitude pulmonary edema B.) As an antidote for nerve agents C.) In adrenergic crises.
COLCHICINE A.) Neither analgesic nor anti-inflammatory B.) Suppreses gouty inflammation C.) It is not uricosuric. MECHANISM OF ACTION:
Phagocytosis by PMNs
Release of P-glycoprotein
(inhibited by colchicine)
bloody diarrhea abdominal cramps renal damage aplastic anemia agranulocytosis CNS depression respiratory failure
DRUG Phenobarbitone
Phenobarbitone is an enzyme inducer: a.) Phenobarbitone affects metabolism of a lot of drugs on account of it being an enzyme inducer b.) It enhances degradation of phenytoin & carbamazepine.
Primidone can also induce cytochrome enzymes: a.) Primidone,a deoxy-barbiturate is converted to phenobarbitone. (so it is an enzyme inducer) b.)this conversion occurs in liver
Phenytoin inducesmicrosomal enzymes: a.) It increases degradation of steroids(failurwe of OC pills) b.) Phenytoin induces metabolism of phenobarbitone,doxycycline,theophylline,digoxin.
60. Ans D (rifampicin):KDT6th/741 MECHANISM OF ACTION OF RIFAMPICIN: Rifampicin inhibits DNA dependent RNA synthesis. Mycobacterial DNA
Inhibited by rifampicin
Mycobacterial RNA
Mycobacterial proteins
A FEW OTHER DRUGS: DRUG 1.Isoniazid/pyrazinamide 2.Ethambutol 3.chloramphenicol 4.Erythromycin 5.Tetracyclin 6.Aminoglycoside MECHANISM OF ACTION Inhibition of mycolic acid synthesis (defective cell wall synthesis) Inhibits mycolic acid incorporation into cell wall. Inhibits arabinosyl transferase Inhibits peptide bond formation(inhibits peptidyl transferase) Inhibits translocation Inhibit attachment of aminoacyl t-RNA to m-RNA ribosome complex Freeze initiation Disaggregate ribosomes Causes misreading of codons
BRADYKININ
DEGRADATION
A.) DEGRADATION OF BRADYKININ IS NOT AFFECTED BY ANGIOTENSIN RECEPTOR BLOCKER/ANTAGONISTS. B.) ACE inhibitors block this degradation pathway.
C.) The un-degraded bradykinin.in excess causes brassy cough ---a well known ADR of ACE inhibitor.
Degraded COMT inhibited by tolcapone L-dopa DCASE Dopamine COMT Degradation MAO-B (inhibited by Selegiline) Degradation COMT
Degraded
a.) L-dopa is freely permeable across BBB b.) It is decarboxylated in periphery by decabboxylase which is inhibited by carbidopa c.) Within CNS ,dopamine degradation is inhibited by MAO-B & COMT enzymes d.) Dopamine so formed causes dopaminergic drive in dopamine depleted patients of parkinsonism.
MECHANISM OF ACTION OF ERYTHROMYCIN: Erythromycin binds 50 s subunit of ribosomes and hinder translocation of elongated peptide chain from A to P site. The ribosome ,thus ,does not move along m RNA to expose the next codon
Peptide at A site
TRANSLOCATION
inhibited by erythromycin
Peptide at P site
Translocation is inhibited
DRUGS ACTING ON MU RECEPTORS PARTIAL ANTAGONISTS AGONISTS Morphine Pentazocine Pentazocine Methadone Butarphenol Naloxone Codeine Buprenorphine Naltrexone AGONISTS
DRUGS ACTING ON KAPPA RECEPTORS AGONISTS ANTAGONISTS Morphine Naloxone Nalorphine Naltrexone Pentazocine buprenorphine
PATTERN OF HEPATIC NECROSIS CENTRILOBULAR NECROSIS Carbon tetrachloride Trichloro ethylene acetaminophen
VOLUME OF DISTRIBUTION OF A DRUG DEPENDS ON: a.) lipid solubility b.) plasma protein binding c.) tissue protein binding
INTRA VASCULAR
CHARACTERISTIC OF A DRUG 1.)lipid insoluble(do not enter cells) 2.)plasma protein bound (cannot easily leave intravascular compartment) 3.)Tissue protein bound(tissue sequestration)(volume of distribution is more than total body water)
ICF
3.5 to 6 L/kg
67.Ans C (rimonabant):KDT6th/131
CANNABINOID RECEPTORS
CB-1
CB-2
Antagonist:Rimonabant a.)anti obesity drug b.) anti smoking drug c.) ADR:depression nausea anxiety
68.Ans D (none)
CYTOPROTECTIVE ROLE OF PROSTAGLANDIN ANALOGUE IN PEPTIC ULCER DISEASE Increases Mucus Increases Mucosal blood flow decreases Gastrin
decreases Acid
1.)REDUCTION OF GASTRIC ACID SECRETION a.) Proton pump inhibitors Omeprazole,lancoprazole etc b.) H2 blockers Ranitidine,famotidine etc c.) Prostaglandin analogues Misoprostol etc d.) Anticholinergics Pirenzepine,propantheline etc
2.)ULCERO-PROTECTIVE AGENTS sucralfate,CBS 3.)NEUTRALISATION OF GASTRIC ACID NaHCO3,Mg(OH)2,Al(OH)3 4.)ANTI H.PYLORI DRUGS Amoxicillin,clarithromycin,tetracyclin Metronidazole,tinidazole
70. Ans A [GLUTAMINE] Robbins 8th/21 FREE RADICAL SCAVANGING SYSTEM Toxin: superoxide ion O2
.
H2O2
Enzyme: Glutathione peroxidase Reaction: decomposes H2O2 to water using reduced glutathione (GSH)
Superoxide free radical formed during metabolism is converted to hydrogen peroxide by SOD and subsequently decomposed by catalase/glutathione peroxidase.
71 (A). Ans D [alcoholic hepatitis] Robbins 8th/858 MALLORY HYALINE Intrahepatocyte accumulation of proteins Cytokeratin 8, 18 Appear as eosinophilic clumps. Found in: Alcoholic steatohepatitis Non-alcoholic fatty liver disease (NAFLD) Wilsons disease Ubiquitin
Alpha-1 antitrypsin deficiency Hepatocellular tumors Primary biliary cirrhosis (PBC) Chronic cholestatic syndromes
72. Ans B [Wegeners granulomatosis] Robbins 8th/920 Crescents in glomerulus -proliferation of parietal cells in glomerulus -migration of macrophages/monocytes within glomerulus Rapidly progressive/ Crescentic glomerulonephritis: Type I (anti GBM antibody) -renal limited -Goodpasture syndrome
-microscopic polyangitis
73. Ans D [all] Robbins 57, 58, 199 Histamine Sources: mast cell granules(in connective tissue adjacent to blood vessels) Basophils Platelets Actions: smooth muscle contraction Increased vascular permeability Increased mucus secretion(nasal, bronchial, gastric) Primary mediators of anaphylaxis histamine and serotonin while secondary are prostaglandin and TNF (2006) Eotaxin recruits and directs migration of eosinophil (2006)
74. Ans D [tissue factor] Robbins 8th/74,75 Three of the best known acute phase plasma proteins are CRP (C-reactive protein), fibrinogen and SAA (serum amyloid associated protein). Their concentration increases during inflammation. Upregulation Action CRP IL-6 Opsonin Fibrinogen IL-6 Binds RBC(raises ESR) hypercoagulability SAA IL6, IL1, TNF -opsonin -diverts HDL to macrophages for energy secondary amyloidosis
-Is also increased in acute phase response -Reduces iron availability to red cells, if chronically increased -Chronic elevation causes anemia of chronic disease
Co-receptor CCR5, CXCR4 binds with Gp120 that has combined with CD4
HIV infects cells by using the CD4 molecule as receptor and various other chemokine receptors (CCR5, CXCR4) as co-receptors. 76. Ans D ( MINIMAL CHANGE DISEASE ) : Robbins 8th /922,926,928
MEMBRANO PROLIFERATIVE GLOMERULONEPHRITIS Idiopathic variety has 2 subtypes: a.) MPGN 1 b.) MPGN - 2
RELATED QUESTION: Most common cause of Nephrotic syndrome in children is Minimal change disease.(2002)
78. Ans A=C [PNH=HS] Robbins 8th/640 HEMOLYTIC ANEMIA Intrinsic causes Extrinsic causes Defects limited to RBC membrane and External factor leading to hemolysis intracellular contents Inherited: Antibody mediated Membrane disorders- HS, HE -Rh disease -transfusion reaction -autoimmune disorders Enzyme deficienciesG6PD deficiency, Hexokinase deficiency Mechanical trauma -microangiopathy -cardiac traumatic hemolysis Hemoglobin abnormalities Infections of RBC Thalassemia, Sickle cell anemia -Malaria -Babesia Acquired: Toxins Deficiency of phosphatidylinositol linked glycoproteins(in membrane) PNH
79. Ans D ( GONADAL TYPE IS CHEMOSENSITIVE ):Robbins 8th /1060 CHORIOCARCINOMA Seen in first 3 decades of life Seen as unilateral tumor GERM CELL ORIGIN
Malignancy of trophoblast cells of previously normal / abnormal pregnancy Rapidly invasive No villi seen Frequent mitoses seen High hCG titres Most common site of metastasis is lung Responds very well to chemotherapy
Origin : placental Exists in combination with other germ cell tumors Aggressive High hCG titres seen Resistant to chemotherapy Often fatal
RELATED QUESTION: Among thyroid tumors psammoma bodies are present in papillary thyroid carcinoma(2009)
Choristoma Hamartoma
Well developed & normally organized heterotopic rest of cells Disorganized but benign appearing masses composed of cells indigenous to a particular site. OR Tumor like growths composed of mature tissues that are normally present at the site in which they develop
82. Ans A ( CA_19_9 ): Robbins 8th/327 a. Mucin / glycoprotein CA 19 -9 CA 125 CA 15 -3 b. Oncofetal antigens AFP CEA Pancreas , colon Ovary Breast Liver cell cancer Non seminomatous germ cell tumor Colon,pancreas Lung,heart stomach Trophoblastic tumors Non seminomatous germ cell tumor Medullary carcinoma thyroid Pheochromocytoma Prostate cancer Neuroblastoma Small cell carcinoma lung Multiple myeloma
c. Hormones hCG Calcitonin Catecholamines d. Isoenzymes Prostatic acid hydrolase Neuron specific enolase e. Specific proteins Immunoglobulins
BENIGN
MALIGNANT
ABSENCE OF METASTASES
PRESENCE OF METASTASES
There is no histologic feature that predicts clinical behaviour in Pheochromocytoma Features common to both benign & malignant forms are :
a. Number of mitoses b. Confluent necrosis c. Spindle cell morphology d. Presence of giant cells
RELATED QUESTION: PHEOCHROMOCYTOMA ARISES FROM CHROMAFFIN CELLS OF ADRENAL MEDULLA(2002) Pheochromocytoma of malignant potential exclusively secretes dopamine (2002)
ACHIEVES ANGIOGENESIS
84(b). Ans B ( FGF ): Robbins 8th/537,538 DEVELOPMENT OF HEART Cardiac precursors (from lateral mesoderm)
Move to midline in 2 migratory waves: 1st Heart field/ 1st Crescent of cells Genes involved are: TBX 5 Hand 1 Forms future left ventricle 2nd Heart field/ 2nd Crescent of cells Genes involved are: FGF 10 Hand 2 Forms rest of the heart
EVENTS Day 15 : 1st & 2nd heart fields are established Day 20 : Crescents develop in beating tube Day 28 : Tube loops to right & begins ti form chambers Formation of endocardial cushions Formation of septations & aortic arches ( from neural crest cells ) Day 50 : 4 chambered heart
85. Ans B ( ROLLING ): Robbins 8th/44 LEUCOCYTE ADHESION TO ENDOTHELIUM MARGINATION Redistribution of WBCs to assume a more peripheral position along the vessel wall endothelial surface
ROLLING Transient attachment of leucocytes to the endothelium to the endothelium involving detach and bind again & again.
FIRM ADHESION Mediated by Integrins. a. ICAM 1 : Adhesion Arrest Transmigration b. VCAM 1 : Adhesion
Most common type of pituitary adenoma: 1st Prolactinoma 2nd Growth hormone adenoma
In all instances of chronic hepatitis, etiology is the single most important indicator of likelihood to progress to cirrhosis.
Robbins 7th/898
Robbins 8th/850
FROM NOW ON if a question is asked regarding the BEST / SINGLE MOST important indicator to predict likelihood to CHRONICITY / CIRRHOSIS , answer would be age at the time of infection.
STAPHYLOCOCCUS MORPHOLOGY OXIDASE HUGH LEIFSONS TEST O2 REQUIREMENT PATHOGENIC ON Bunch of grapes Fermentative
RELATED QUESTION: Pseudomonas aeroginosa is an obligate aerobe (2001) Toxic shock syndrome is caused by Staphylococcus (2001) UTI in sexually women is most commonly caused by S. saprophyticus(2001) 89. Ans C ( given i. v.) : Ananthnarayan 8th/486,487 ; Park 20th / 180
SABIN / LIVE 1. STRAINS 2. PRIMARY IMMUNISATION 3. BOOSTER 4. ROUTE 5. IMMUNITY (SERUM) All 3 3 doses Yes ( 1) oral IgM IgG IgA IgA IgA yes yes Both local & systemic immunity
SALK / KILLED All 3 4 doses Yes ( multiple) I.M. IgM IgG IgA ---- Useful in pregnancy Can be used in immunodeficient
6. IMMUNITY ( NASAL) 7. IMMUNITY (INTESTINAL) 8. CONTRIBUTION TO HERD IMMUNITY) 9. USEFUL DURING EPIDEMICS 10.ADVANTAGES
TRANSMISSION OF TREMATODE INFECTION : EXAMPLE ROUTE OF TRANSMISSION 1. All Schistosoma Skin penetration 2. All Fasciola / Fasciolopsis 3. Paragonimus 4. Clonorchis Opisthorchis Heterophtes Fern ( aquatic plants) Cray fish / crab
Fish
Cray fish is not a fish ; its a crustacean ( arthropod ) Diphyllobothrium latum is caused due to consumption of raw fish (called fish tapeworm ) 91. Ans D (ENRICHED ) : Ananthnarayan 7th/37
An enriched media is enriched with blood ( BLOOD AGAR ) ; glucose ( LOEFFLERsMEDIUM ) ; egg ( DORSET s MEDIA ) etc. Loefflers has dextrose ( glucose ) added to it ( enriched media ).
92. Ans A ( CHLAMYDIA TRACHOMATIS ): Harrisons 18yth/154 ORGANISM 1.) Treponema pallidum 2.) Calymmatobacter granulomatis DISEASES Condyloma lata Syphilis chancre Donovanosis (Granuloma inguinale ) Chancroid Trachoma Inclusion conjunctivitis Lymphogranuloma venereum Condyloma acuminate
3.) Hemophilus ducreyi 4.) Chlamydia trachomatis (A , B , C ) 5.) Chlamydia trachomatis (D to K ) 6.) Chlamydia trachomatis (L1 ,L2 ,L3 ) 7.) HPV
TRANSFORMATION
TRANSDUCTION
LYSOGENIC CONVERSION
Male/donor bacteria transfers genetic material into female /recipient bacteria by making physical contact
Functions / features of capsule: Stained by Indian ink preparation /usage of mordants Capsule is antigenic Quellung reaction : capsule antigen + capsule antibody Protects bacteria from lytic enzymes Contribute to virulence Inhibits phagocytosis Repeated subculture causes loss of capsule
95. Ans C ( ENDO CYST ) :LB 25th/56 LAYERS OF HYDATID CYST OUTERMOST Pericyst Compressed hort tissue & fibroblastic reaction Non infective Acellular laminated layer Alive layer
MIDDLE
INNERMOST
96. Ans A ( HYDATID CYST ) :Medical Parasitology 1st/117 Regression :Reverting back to a previous (low ) developed state from a higher / more developed state.
Regression Metamorphosis
releases eggs
CONCEPT: Normally hydatid cyst is formed in intermediate host ( shhep) ; adult form in definitive host ( dog) But in Regression metamorphosis hydatid cyst forms from protoscolices ( in the definitive host ) that actually were destined to form adult worm.
97. Ans D ( SEDIMENT ) : FORMOL ETHER CONCENTRATION TECHNIQUE 1 gm of faeces + 7 ml formol saline 10 minutes Strain through wire gauze
98. Ans C ( Ig M ) : Ananthnarayan 7th/ 89 The isohemagglutinins (anti A ,anti B ) are usually IgM.
TYPE Ig M Ig M ---IgM
CLINICAL Since Ig M cannot cross placenta ;less trouble to the developing fetus in utero.
Anti Rh antibody is IgG type that can cross placenta, so harmful to fetus .
RELATED QUESTION: Earliest Ig to appear in fetus is If M(2001) Predominant Ig in body secretions is Ig A (2001) Transplacental transfer of antibodies from immunized mother to her newborn is acquired passive immunity(2003) Prozone phenomenon is due to antibody excess(2008) Jernes hypothesis of immune regulation is based on sequential anti idiotype antiboby formation (2009) 99. Ans D (160 DEGREE C ) : Ananthnarayan 8TH/25
MATERIALS Glass Forceps Scissors Swabs Liquid paraffin Dressing powder Fats/oils
TIME 1 hour
Prions are infectious proteins that cause CNS degeneration. Only infectious pathogens that lack nucleic acid Composed largely of PrPsc proteins (which markedly differs from its precursor PrPc ) Prions reproduce by binding to normal cellular isoform of prion protein & converting it into prion form. PRION IN ANIMALS Scrapie in sheep/goats Bovine spongiform encephalopathy(Mad cow disease) Transmissible mink encephalopathy Chronic wasting disease
PRION IN HUMANS Creutzfeldt Jacob disease Familial Fatal Insomnia Gerstmann Straussler Scheinker disease Kuru
RELATED QUESTION: Prions do not evoke an inflammatory response(2005) Prusiner got the Noble Prize in 1997 for prion proteins(2006) Prion disease can be sporadic /familial /inherited (2009)
These nodules are aggretates of mycelia + anthroconidia Infection may affect hair of scalp , body , & genitalia.
Pathogenecity of diphtheria is due to exotoxin(2002) Meningococcal rash is due to endotoxin(2002) Shigella dysentery due to exotoxin is seen with S. dysenteriae.(2002)
WEIL-FELIX REACTION
105. Ans C > B ( Ig M > Ig G ): Ananthnarayan 7th/112 ; Harrisons 18th /1010,2667 ; Robbins 8th /6
1 2
4 5 +
Inactive C 1 molecule
Immunoglobin
Inactive C1 must combine with antibody to get activated . C1 has 6 binding sites ; of which atleast 2 should be occupied. 1 molecule if Ig M OR 2 molecules of Ig G activate C 1 . So Ig M appears to be more appropriate answer
Unique among prokaryotes is the requirement of most Mycoplasma for cholesterol & related sterols.
ANANTHANARAYAN
FEATURE For surface membrane For cell wall Gives stalactite growth pattern For outer membrane layer
Filariform larva is seen in Hookworm (Ankylostoma duodenale & Necator americanus) And Strongyloides .
HOOKWORM STRONGYLOIDES TRICHURIS ENTEROBIUS Filariform larva Percutaneous + Egg in fresh feces Larvae in old feces Filariform larva Percutaneous Autoinfection + Larva in duodenum /stool Egg Oral Egg in stool Egg Oral Egg from perianal area
A. braziliense larva
RELATED QUESTION: Strongyloids is ovoviviparous (2008) Route of transmission of strongyloides is NOT fecoal rather Percutaneous / autoinfection(2001)
Larval form of Taenia solium is cysticercus cellulosae(2003) Parasite that causes duodenal stricture is Strongyloides(2006) Bile stained eggs are seen in Taenia ,Trichuris , fertilized eggs of ascaris(2007) Day time blood sample is collected for Loa Loa microfilaria (2005) Rhabditiform larva of Strongyloides is passed in feces that can transform into infectious Filariform larva either directly or after a free living phase of development .(2010)
H A C E K
In schwann cells, M. leprae divide in 11 -13 days. ORGANISM 1. Mycobacterium leprae 2. Tubercle bacilli 3. Colliform bacillus GENERATION TIME 11- 13 days 14 hours 20 minutes
Blood Vessel
hemodilution
hemoconcentration
Fresh water is hypotonic to plasma ,so water quickly enters from alveoli to plasma leading to hemodilution
salt water being hypertonic draws water from plasma into alveoli leading to hemoconcentration and pulmonary edema..
RBC Swell and burst MORPHOLOGY IONS Hyperkalemia(as RBCs burst) Hyponatremia( hemodilution) Hypochloremia ( hemodilution) CAUSE OF DEATH Ventricular fibrillation
POLICE INQUEST 1.)most common 2.)investigating officer is not below the category of (senior)head constable and usually is a subinspector.
2.)indications: a.)death in police custody 3.)conducted by an b.)death during police firing advocate/ c.)dowry deaths attorney/ d.)death in psychiatric class1 magistrate hospitals (with 5 years of experience)/ e.)exhumation cases metropolitan magistrate.
Medical examiners inquest (in which a medical practitioner is appointed to perform functions of coroner)is not practiced in India.
RELATED QUESTIONS:
1.) EXHUMATION can be ordered by district magistrate.(2008) 2.) Inquest refers to legal inquiry into the cause of death.(2007) 3.) The post mortem report in case of death in police custody should be recorded as video recording.(2005) 4.) Limit for exhumation in India is no time limit (2003)
JUVENILE
FOUND GUILTY
DONE 1.) To participate in group counseling 2.) Perform community service 3.) Released on probation of conduct 4.) Pay fine 5.) To be sent to a special home
NOT DONE 1.) life imprisonment 2.) committed to prison 3.) death sentence
RELATED QUESTIONS: 1.) Juvenile court is presided over by class 1 woman magistrate.(2003)
TYPES OF BULLETS:
The base is ignited by flame of the propellent;this provides a visible pyrotechnic display during bullets flight. One which before striking the object aimed at ,strikes some intervening object 1st,andthen after ricocheting & rebounding from this,hits the object. One which travels in irregular fashion instead of traveling nose on & cause a key hole entry wound. Two bullets are ejected one after the other ,when 1 st bullet failed to leave the barrel & is ejected by subsequently fired bullet. Intended to ignite inflammable materials such as phosphorus & gasoline(contains a charge of chemical incendiary object) A bullet left in the body for long time & gets surrounded by dense fibrous tissue. A jacketed bullet with its nose cut off to expose the core & it expands on impact. One that rotates in end on end during its motion.
PROFESSIONAL MISCONDUCT A.) any conduct of doctor that might reasonably be regarded as disgraceful or dishonourable B.) the doctors conduct is judged by men of good repute & competence C.) the RMP ia required to observe certain prescribed rules of the conduct contained in the code of medical ethics,published by MCI & by several SMCs AUTHORITY ON DISCIPLINARY ACTION If anyone is found guilty of any offences mentioned in warning notice issued by MCI,his name can be erased from the medical register.
Limitations of law for punishment for negligence: a.) a suit filed against a doctor after 2 years stands dismissed as it is beyond the period of limitation. b.) When breach of duty to provide care as per contract between a patient and a doctor is committed ,legal action can be initiated upto 3 years from the date of alleged negligence.
POISONING 1. All poisons including carbolic acid but Excluding other acids 2. Poisoning with acids except carbolic acid 3. Urine
PRESERVATIVE Saturated NaCl Rectified spirit Saturated saline Rectified spirit Thymol Conc. HCL Sodium floride + potassium oxalate Sodium nitrate + potassium oxalate Liquid paraffin Sodium floride + sodium citrate
4. Blood for alcohol poisoning 5. Blood for floride poisoning 6. . Blood for CO poisoning 7. Blood for oxalic acid poisoning
RELATED QUESTIONS: A.) best biological fluid for post mortem examination is vitreous humor (2009) B.) The component of vitreous that helps determine time since death is K+(2006)
TREATMENT OF PHOSPHORUS POISONING (avoid oils/fats as they enhance more phosphorus absorption)
STOMACH a.)lavage with 1:5000 KMnO4 b.)0.2% CuSO4 solution c.)activated charcoal
RELATED QUESTIONS: 1.) Gastric lavage for phenol poisoning is given using 10 % glycerine(2001)
120. Ans A ( ANTEMORTEM HANGING ): Reddys 29th/306 ; Modis 22nd /275 ; Parikh 6th/360
LE FACIES SYMPATHIQUE Pressure on ipsilateral sympathetics by ligature knot causes ipsilateral eye & pupil to wide open
DRIBBBLING OF SALIVA Cannot occur after death( Modi) Can occur after death ( Parikh)
Study of physical, social & cultural history of man Study of human relationships & human behaviour for better understanding of pattern of human life The scientific examination of human behaviour. Mixing of 2 cultures when person of one culture comes in contact with a person of different culture.
RELATED QUESTION: A.) tendency of some members of a group to identify & interact with selected members only leading to formation of a sub group is called sociometry .(2003) B.) the example of primary social relationship is that of a husband & a wife.(2003)
Measures of variability It tells us that a particular value is how much away from the mean value(i.e. variability)
COEFFICIENT OF VARIATION: It is dimensionless(i.e. has a value but has no units like kg or metre etc.) It is used to compare variability of 2 distributions with different units of measurements.
RELATED QUESTION: A.) standard deviation equals square root of variance(2003) B.) histogram is used for quantitative continous data.(2003)
Leprosy prevelance in various Indian states: CATEGORY PREVELANCE STATES / UNION TERRITORIES Some districis in Delhi
>5 per 10000 Bihar Chattisgarh Dadra & Nagra haweli Rest all states including MAHARASHTRA
RELATED QUESTION : Lepromin test is read in 4 th week .(2001) Lepromin test is positive in Tuberculoid leprosy & negative in Lepromatous type indicating a failure of CMI.(2010) Only Indian classification has Pure Neuritic type of leprosy (2003)
124(a). Ans C (relapsing fever) : Park 21st/721 please refer question 108 of 2010
124(b). Ans D (all) : Park 21st/721 Ticks transfer Q fever in extra human hosts. 125. Ans B (NPU) : Park 21st/586
NET PROTEIN UTILISATION a.)gives more complete expression of protein quality b.)If NPU is low ,protein requirement is high c.) NPU of Indian diet is 50-80 d.)its a product of digestibility coefficient & biological value.
AMINO ACID SCORE It is a measure of concentration of each essential amino acid in the test protein expressed as a percentage of that amino acid in the reference protein.
Amino acid score of starch is 50-60 while that of animal food is 70 -80.
SENSITIVITY
SPECIFICITY
TN/(TN + FP )
X100
TP/(TP + FP)
X100
TN/(TN + FN ) X100
RELATED QUESTION: Rhythm method is not classified as a natural family planning method.(2009)
ASSISTANCE TO Cataract blindness control program NPCB Assistance to Prevention of blindness Support of vision 2020
NOTE: Although assistance toby DANIDA to National Blindness Control Program ended in 2003 ; the question says assistance was provided to the National Program(WHO simply provides assistance for prevention of blindness---be it national or international.) 129Ans C (yellow): Park 21st/662
YELLOW COLOR
SPLEEN RATE
RELATED QUESTIONS: A.) mosquito whose larvae lie horizontal to water surface is anopheles (2006) B.) modified plan of operation divides endemic areas on the basis of Annual Parasite Index.(2005) C.) culex is a nuisance mosquito.(2005) D.) Plasmodium species affecting older RBCs is malariae & falciparam (2005) E.) Ring forms (other than plasmodium) are seen in babesia(2005) F.) Highly anthrophilic & transmitting malaria parasite even at low density is A. fluvitalis(2003)
MILLENNIUM DEVELOPMENT GOALS,2000 a.) Base year of calculation of targets is 1990. b.) Target year is 2015 c.) Has 8 goals;18 targets;48 indicators d.) 3/8 goals, 8/18 targets ; 18/48 indicators ade directed towards health GOALS 1.) Eradicate extreme hunger & poverty 2.) Universal primary education 3.) Dispel gender disparity 4.) Reduce child mortality TARGET: reduce child mortality by 2/3 rd of 1990 INDICATOR: IMR & % of under 5 Children vaccinated for Measles 5.) Improving maternal health TARGET: reduce MMR by 3/4th Of 1990 INDICATOR:MMR & % attended Deliveries 6.) Combat HIV-AIDS,malaria & other diseases 7.) Ensure environmental sustainability 8.) Global partnership for development
RELATED QUESTION: The target year for achievement of Millennium development goals is 2015 .(2010)
PREVENTION OF TETANUS BOOSTER WITHIN <5 YEARS 5 10 YEARS >10 TEARS ? NEW,CLEAN WOUNDS -1 toxoid 1 toxoid Complete course of toxoid OTHER WOUNDS -1 toxoid 1 toxoid Complete course of toxoid + Ig
Still Birth Rate Death of a fetus weighing 100g (this is equivalent to 28 weeeks of gestation) or more occurring during one year in every 1000 total births.
ANNUAL GROWTH RATE No growth < 0.5 0.5 to 1.0 1.0 to 1.5
NO. OF YEARS REQUIRED FOR THE POPULATION TO DOUBLE IN SIZE ->139 70 to 139 47 to 70
1.5 to 2.0 2.0 to 2.5 2.5 to 3.0 3.0 to 3.5 3.5 to 4.0
35 to 47 28 to 35 23 to 28 20 to 23 18 to 20
Intervention trials 1.) STANDFORT 3 COMMUNITY STUDY 2.)NORTH KERELIAN PROJECT 3.) MRFIT
Strategy to prevent CHD Community health education Mass community action against risk factors & advice on their avoidance Cessation of smoking Controlling BP Altering diet to reduce hypercholesterolemia Cessation of smoking Lowering serum lipids Lowering serum cholesterol
137. Ans B (disability rate): Park 21st/25,26 INDEX 1.)Sullivans index DESCRIPTION a.)Expectation of life free of disability b.) [LIFE EXPECTANCY - DURATION OF DISABILITY] A.)life expectancy at birth but includes an adjustment for time spent in poor health
B.)Years in full health that a newborn can be expected to live based on current rates of illhealth & mortality a.)it is a measure of burden of disease b.)measure of effectiveness of intervention c.)years of life lost to premature death d.)years of life lived with disability
RELATED QUESTION: 1.) Birth & death registration should be in 21 & 21 days (2001) 2.) DALY is a measure of effectiveness of an intervention(2009)
138. Ans A(human anatomical waste): Park 21st/734,735 CATEGORIES OF BIO-MEDICAL WASTE:
1.) 2.) 3.) 4.) 5.) 6.) 7.) 8.) 9.) 10.)
Human anatomical waste Animal waste Microbiology/biotechnology waste Waste sharps Discarded/cytotoxic medicines Solid waste(blood/fluid contaminated) Solid waste Liquid waste Incineration ash Disinfectants/insecticides
ANIMAL (cat 2)
LABORATORIES (cat 3)
SHARP (cat 4)
PILLS (cat 5)
DISASTER RESPONSE
DISASTER MITIGATION
DISASTER PREPAREDNESS
NETWORK ANALYSIS Graphic plan of all events & activities to be completed in order to reach an end objective
PERT
Gives information about a.)logical sequence of events b.)time consumed in each activity c.)critical activities
If any activity along critical path gets ,delayed the whole project gets delayed
141.Ans B (Per capita income) : Park 21st/16 please refer question 128 of 2010 PHYSICAL QUALITY OF LIFE INDEX (PQLI) b.) Infant mortality c.) Life expectancy at age 1 d.) Income PQLI value ranges from 0 to 100
HUMAN DEVELOPMENT INDEX (HDI ) a.)Longevity ( life expectancy at birth ) b.)Knowledge ( adult literacy rate & mean years of schooling ) c.)Income HDI Value ranges from 0 to 1 For India = 0.612 (2007) World rank of India for HDI = 128
142. Ans A (Flourine) : Park 21st/558 Please refer question 133 of 2010
Nalgonda technique is for defloridation of water. Developer : NEER institute ,Nagpur Utilizes lime & alum It involves various processes : Flocculation
Sedimentation
Filteration
RELATED QUESTION: Fluoride in drinking water should be less than 1.5 mg /L , recommended is 0.8 mg /L & optimal is 1 2mg/L (2007) Softening of water is recommended when the hardness exceeds 150 mg /L .
143. Ans A (generation time): Park 21st/95 Please refer question 139 of 2010
Interval of time between receipt of infection by host & maximal infectivity of that host Gap in time between the onset of primary case & the secondary case The time interval between invasion by an infectious agent & appearance of first sign / symptom in 50 % of the cases Time interval between first possible diagnosis & final critical diagnosis.
Topical B blocker
Latanoprost
Dorzolamide
Brimonidine
Neither 1st choice nor 2nd choice in POAG 1. Pilocarpine 2. Epinephrine 3. Dipivefrine NOTE : Latanoprost is superior to once daily Timolol gel for intraocular pressure reduction.( Beckers & schaffers book on Glaucoma ;8th/361) Related question : Chronic simple glaucoma is a type of POAG. (2009) Phacolytic glaucoma is a 2ndary OAG, occurs in hypermature cataract & is due to lens proteins. (2008). Polychromatic luster (2008)/Bread crumb appearance is seen in complicated cataract. Treatment of Congenital glaucoma (Buphthalmos ) is Goniotomy
145) ans:A (Latanoprost) :KDT 6th /144,Khurana 4th /223 drug Timolol Levobunolol Betaxlol Cartiolol Latanoprost Pilocarpine Dorzolamide Epinephrine/Dipivefrine Brimonidine Frequency per day Khurana KDT 1-2 1 1-2 1 2 1-2 1 1 3-4 3-4 2-3 3 1-2 2 2 3
Squint
Heterotrophia /Manifest Squint Manifest deviation in which visual axes do not intersect at fixation point
Related question: Diplopia seen in paralytic squint.(2002) For Measurement of angle of deviation in squint Hirschberg test , Prism bar reflex test & test with Synaptophore are done.(2009) Squint caused due to excess convergence with sustained accommodation is seen in hypermetropia.(2006) 147) ans:D(Sickle cell retinopathy ):/ Kanski 6th 603 Sea fans configuration
1. 2. 3. .seen in sickle cell retinopathy. Seen in stage 3 Sprouting of new vessels from peripheral A-V anastomosis leads to sea- fans.
Related question: Bulls eye maculopathy is caused by Chloroquine (2006). 148) ans : A (6 weeks) :Kanski 6th /365,366.
Unilateral
Bilateral
Dense
Partial
Dense
Operate within 4 to 6 weeks
Partial
Observe
Observe
Dense Opacity : 1 Occludes pupil 2 Retinal vessels visualized only by indirect ophthalmoscopy. 3 Central opacity more than 3mm. Partial Opacity : 1 Retinal vessels visualized both by direct & indirect ophthalmoscopy. 2 Central opacity less than 3mm. Related question : Maximum visual Disturbance is seen with nebula .(2009) Intraocular lens made up of PMMA, Silicon ,Hydrophilic acrylic.(2003) Recovery in cataract is fastest following Phako . (2002)
149) ans: D Iridocyclitis : Khurana 5th /271 Signs of Anterior uveitis A Lid edema B C Circumcorneal congestion Corneal Signs:
1. 2. 3. Edema Keratic Precipitates Post corneal opacity Aqueous cells Aqueous flare Hypopyon Hyphema Changes in depth /Angle of Anterior Chamber Iris Nodules(Koeppe/Busaca) Post Synechiae( Segmental /annular(Iris bomb )/Total) Neovascularisation of Iris (rubeosis iridis) Narrow pupil Festooned pupil Ectropion pupillae Occlusio pupillae Sluggish pupillary reaction
Iris Signs:
1. 2. 3.
Pupillary Signs:
1. 2. 3. 4. 5.
Changes in lens:
1. 2. 3. Pigment dispersal Exudates Complicated Cataract (Bread crumb polychromatic) Exudates Inflammatory cells
Changes in vitreous:
1. 2.
A}Mutton-fat 1. Macrophage epitheloid cells 2. fluffy, lordaceous, waxy. e.g. Granulomatous iridocyclitis B}Small & medium + 1.
Types of Keratic precipitates are C}Red type RBC + Inflammatory cells. D}Old Irregular , crenated , Pigmented . e.g. Healed uveitis
Lymphocytes
present. 2. Small,
CORNEAL DIMENSIONS
ANTERIOR SURFACE 1.] Horizontal diameter : 11.7 mm 2.] Vertical diameter : 11 mm CORNEAL THICKNESS 1.] Center : 0.52 mm 2.] Periphery : 0.70 mm Related question : Gonococcus ( 2006 ) , C.diphtheriae & Fungi can penetrate intact cornea. 151. ans: D ( 400-700nm) Khurana 4th / 19 Light in visible portion of electromagnetic spectrum lies between 400 nm (violet) to 700 nm (red) POSTERIOR SURFACE 1.] Horizontal diameter : 11.5 mm 2.] Vertical diameter : 11.5 mm RADIUS OF CURVATURE 1.] Anterior : 7.8 mm 2.]Posterior : 6.5 mm
Related questions : 1. UV light for treatment of skin diseases : 200-400 nm.(2001) 2. Maximum sensitivity for rods & cones is 498 & 555 nm respectively.(2007) 3. Appreciation of colour is a function of cones.(2003)
152. ans: B ( Moraxella axenfield ) Khurana 4th / 61 Angular conjunctivitis is caused by Moraxella axenfield.
Type of conjunctivitis 1. Adult inclusion 2.Acute membranous 3.Acute hemorrhagic 4.Epidemic keratoconjunctivitis 5.Pharyngoconjunctival fever 153.ans: A.( Screening ) Parsons 19th / 595.
Organism C. trachomatis D K C. diphtheriae , virulent S. hemolyticus Picorna virus Adeno 8,19 Adeno 3.7
SAFE strategy has been developed by WHO to combat Trachomatous blindness. SAFE strategy
LASERS IN OPHTHALMOLOGY Laser 1.) Excimer 2.)Nd-YAG Application LASIK PRK Posterior capsulotomy in after cataract Iridotomy
Related questions : 155.ans: A ( Trauma ) refer question no. 155 of ( 2010 ) 156.ans: A ( Osteogenesis imperfecta ) Robbins 18th / 1351 Blue sclera Thinning of sclera Brown uvea becomes visible Then it appears blue [ due to optical tyndall effect ] Blue sclera is seen in Staphyloma Episodes of scleritis High intraocular pressure Osteogenesis imperfecta Congenital melanosis oculi Elschnig pearl in papillary aperture is a sign of After cataract. (2009) It is removed by Nd-YAG Laser posterior capsulotomy. (2006)
157.ans: B ( Cricothyroid ligament ) Grays 39th & Disorders of larynx 2nd / 41.
B. INTRINSIC
These connect laryngeal cartilage & epiglottis with each other. E.g. 1. Quadrangular membrane Aryepiglottic ligament, Vestibular ligament 2. Triangular membrane Vocal ligament, Cricotyroid ligament 3. Thyroepiglottic ligament 158. ans : C ( 500- 3000 Hz ) Dhingra 5th/ 18. Natural resonance of external & internal ear : External auditory canal Tympanic membrane Middle ear Ossicular chain 3000 Hz 800-1600 Hz 800 Hz 500-2000 Hz
So, sound frequency of as low as 500 hz & as high as 3000 hz have greatest sensitivity of transmission & they are the frequencies of day to day conversation.
159.ans : A ( Cricothyroid ) The only intrinsic muscle lying outside laryngeal network is Cricothyroid. Previously asked question : The only abductor of vocal cord is Posterior cricoarytenoid.( 2010 ) 160.ans : A ( Frontal sinus ) Dhingra 5th / 211.
Pathology
1.) Sinusitis / Cancer 2.) Osteoma / Mucocoele 3.) Fungal ball
E >
F > M > S
161.ans : B ( Abscess involving external auditory canal ) Dhingra 5th / 87. ABSCESS 1.] Wilds SITE Postauricular (mastoid) MC TRICK P : Posterior A : Auricular W : Wilds
2.] Zygomatic
3.] Bezolds
Front & above pinna. (Posterior Root of Zygomatic arch ) 1.Tip of mastoid 2. Angle of jaw 3. Post. Triangle of neck 4.Parapharyngeal space. Between antrum & external auditory meatus 1. over occiput 2. in digastric triangle of neck
RHINITIS SICCA
CAUSATIVE SURROUNDING Hot Dusty Dry e.g. bakers goldsmith PATHOLOGY Crust formation in anterior third of nose. Removal of crusts cause bleeding & ulcers / septal perforation. HISTOPATHOLOGY Squamous metaplasia of ciliated columnar epithelium TREATMENT 1. bland ointment 2. antibiotic / steroid ointment 3. nasal douches
162B. None 163. D ( Caries of spine is a common cause ) Dhingra 5th / 280. RETROPHARYNGEAL SPACE 1. 2. 3. 4. 5. Space between buccopharyngeal fascia & prevertebral fascia. Divided into two compartments. ( space of Gillete ) Extends from skull base to tracheal bifurcation. communicates with parapharyngeal space. contains retropharyngeal lymph nodes.
ACUTE RETROPHARYNGEAL ABSCESS Common in less than 3 yrs of age group. ETIOLOGY : 1. Suppurative lymphadenopathy, 2. Penetrating injury of posterior pharyngeal wall / cervical esophagus Clinical : 1. dysphagia 2. dyspnea 3. stridor 4. croupy cough 5. torticollis 6. bulge in posterior pharyngeal wall ( one sided ) Treatment : 1. Incision & Drainage , 2. Antibiotic course.
164. C ( Neutrophilia) Robbins 8th/ 55 Ans. CHEDIAK HIGASHI SYNDROME Characterized by defective fusion of lysosome with phagosome. Autosomal recessive Pathogenesis: There is defective fusion of phagosome with lysosome leading to defective degranulation of lysosomal contents which are seen on electron microscopy as dense granules. Findings: 1.Neutropenia 2.Albinism ( Due to defective melanocytes) 3.Bleeding tendency
+ +/ +/ +
+/ + +
5. 6.
FEATURES a.)most common type b.)distal sensory loss is seen . c.)neuropathic pain + d.)dysesthesia,paresthesia,hyperesthesia e.)sensory deficit persists
2.Polyradiculopathy
3.Mononeuropathy
4.Autonomic neuropathy
a.)pain along the distribution of a particular nerve root. b.)motor manifestations seen.c.)self limiting d.)resolve in 12 months a.)isolated cranial or peripheral nerve involvement b.)pain & motor distribution along a single nerve distribution c.)most commonly affects 3rd cranial nerve a.)resting tachycardia b.)gastroperesis c.)hyperhidrosis d.)anhidrosis (hands) (feet) e.)sudden death f.)orthostatic hypotension g.)hypoglycemic h.)bladder unawareness abnormalities
TENOFOVIR renal osteomalacia fanconi like syndrome hypophosphatemia ZIDOVUDINE granulocytopenia anemia myopathy lactic acidosis nail pigmentation
168. Ans B (panacinar) : Robbins 8th/684 Emphysema Affects centriacinar Central /proximal acinus Seen in Site smokers upper lobe chronic bronchitis apical segments Concept Upper lobe is well aerated so cigarette rises up in the lung Lower lung better perfused, so more elastase to destroy the lung
panacinar
DRUGS CAUSING VIT B-6 DEFIENCY Isoniazid Penicillamine Cycloserine L-dopa Hydralazine Phenelzine
SITES Upper surface of AV valves Under surface of AV valves Valvular endocardium On the chords Mural endocardium
171. C (DIFFUSE ESOPHAGEAL SPASM ): Harrisons 18th/2432 ESOPHAGEAL DISORDER 1.diffuse esophageal spasm 2.monilial esophagitis 3.leiomyoma 4.achalasia RADIOGRAPHIC APPEARANCE Cork screw appearance Nut cracker esophagus Irregular plaque-like filling defects Smooth filling defect It is present at right angles to esophageal wall. Dilated esophageal body Air-fluid level Closed esophageal sphincter(birds beak)
RELATED QUESTION: ACCCOLE forms are seen in peripheral blood smear of P. falciparam(2001)
RELATED QUESTION: Solid second malignancy in hodgkins lymphoma may be due to radiation therapy.(2008) Most common lymphoma in AIDS is large cell immunoblastic lymphoma(2006)
1.Interstitial lung disease 2.Bronchiectasis 1.Cholesteatoma 2.Petrositis 3.Mastoiditis 4.ossicular chain disruption
Il-4 Stimulates B-cells to differentiate into IgE secreting cells Secreted by Th-2 cells
IL 12 function
INF-gamma Macrophage
IL 4 function
IL 2 function
2 3
CAUSES OF NIACIN DEFICIENCY Alcoholics Hartnup disease Corn eating(predominantly) Deficiency of Fe Deficiency of B-2 Deficiency of B-6
b.) c.)
Genes determine A & B phenotype of blood group . They are expressed in a Mendelian Co-dominant manner They are located on chromosome 9p.
BCL stands for B-cell lymphoma ,so obviously it causes limitless growth & not apoptosis. GENE 1. N-myc 2. p 53 SPECIAL FEATURE Seen in neuroblastoma Seen in most of the carcinomas Acts at G1/S and G2/M checkpoints of the cell cycle Known as molecular policeman of genome Seen in colon carcinoma Seen in pancreatic adenocarcinoma Seen in thyroid cancer Seen in AML
3.
RAS
RELATED QUESTION: Specific feature of apoptosis is (activation of caspase) > ( inter nucleosomal cleavage ) (2006)
Liver
Bile acids
R E S O R P T I O N
Ileum,colon
BILE ACID DIARRHOEA (cholorrheic anteropathy) 1.BILE ACID ABSORPTION (lesser ileal length) 2. FECAL BILE ACIDS ( lesser reabsorption) 3. FECAL LOSS COMPENSATION BY LIVER 4. BILE ACID POOL 5. STEATORRHOEA 6. RESPONSE TO CHOLESTYRAMINE 7. RESPONSE TO LOW FAT DIET
NO
> 20 gm +
As spleic macrophages pluck out Heinz bodies (denatured hemoglobin),Bite cells are produced in G-6PD deficiency.
Heredity spherocytosis
BLOOD SMEAR Bite cells Heinz bodies Punctate basophilia Target cells Elliptocytes Microcytes Spherocytes
RELATED QUESTION: Sickle cell trait does not cause leg ulcers(2002) (Leg ulcer are seen in Sickle cell disease ).Trait shows anemia & normal osmotic fragility of cells. Hemoglobin level required to be maintained by Bete-thalassemia patients for body growth & normal activities is 10-12 gm % Phototherapy following jaundice in newborns gives rise to Bronze baby syndrome(2005) Hair on end appearance is seen in thalassemia(2001) Genes responsible for thalassemia are located on chromosome 11 (2006) 182. Ans D (all): Harrisons 18th/1835
SV 1 + RV 6 >35mm
RELATED QUESTION : During ECG the lead 2 negative terminal is connected to right upper limb(2008) Patients with ASD with secondum defect have right bundle branch block. In hexa-axial reference system continous lines are generated from standard leads(2003)
183. Ans
FIBRINOLYTIC IN MI 1. TISSUE PLASMINOGEN ACTIVATOR (t-PA) 2 STRPTOKINASE 3. TENECTEPLASE (TNK) 4. RETEPLASE (rPA)
INFUSION DOSE
RELATED QUESTION: TPA is most effective if given within 1-3 hours of ischemic injury(2003)
SPECIAL Chimeric human-mouse monoclonal antibody TNF-alpha IgG fusion protein Fully human derived monoclonal body
CONCEPT:
Name of antibody has 4 parts: PREFIX inf ada Prefix is different for each antibody TARGET li lim Li/lim is used to denote rheumatoid arthritis ORIGIN xi U Xi denotes chimeric U denotes human SUFFIX mab mab M= monoclonal Ab=antibody
RELATED QUESTION: Drug used in rheumatoid arthritis that acts by inhibition of T cell production is leflunomide (2008) Bamboo spine is seen in ankylosing spondylitis(2005)
186: Ans: C. Aspergillus fumigatus. Harrisons 18th 2120. Aspergillus fumigatus is the most common cause of ABPA. Main diagnostic criteria for ABPA: Immediate wheal flare to A. Fumigates. Bronchial asthma Peripheral eosinophilia Elevated IgE Central bronchiectasis Serum precipitins to A. fumigatus Other diagnostic features: Elevated IgE (IgG) specific for A. fumigatus Culture of the organism from sputum History of brownish plugs in the sputum.
187: Ans C (millers lung disease) Harrisons 18th 2117 Millers lung disease is caused by Sitophilus granarius infesting wheat flour. Thermophilic actinomycetes cause i. ii. iii. iv. v. RQ: Thermomyces is used for sterilisation standardisation (2002) Bagassosis Farmers lung Ventilation pneumonitis (Air conditioner lung) Mushroom workers lung Potato riddlers lung
189: Ans A. Von Willebrand disease Harrisons 18th / 971 Most common inherited bleeding disorder: Von Willebrand disease. Most common inherited cause of hypercoagulability: Factor 5 leiden mutation, prothrombin mutation RQ: Factor 5 leiden is resistant to inactivation by activated protein C. (2009) Gp IIb/IIIa deficiency causes Glanzman thrombasthenia (2009) Clotting factor deficiency that is asymptomatic: Factor XII
Unable to acidify urine, pH <5.5 Stone formation Urine Ca++ raised, citrate decreased Rickets/osteomalacia Hypokalemia
Impaired bicarbonate excretion, pH>5.5 and bicarbonate excretion >15% Fanconi syndrome All increased: Phosphate, urate, Ca++, amino acids, glucose Rickets/osteomalacia Hypokalemia
191. Ans D (thrombocytopenia) Henoch Schonlein Purpura: A small vessel vasculitic disease Characterised by :palpable purpura, arthralgia, GI involvement, glomerulonephritis. Incidence: more in children, male:female = 5:1 Pathology: immine complex deposition, with IgA deposited in renal mesangium. Clinical: i. ii. iii. iv. palpable purpura, mostly over buttocks,legs. poly arthralgia, with no arthritis GI involvement (Nausea, vomiting, diarrhoea, constipation, PR bleed) Glomerulonephritis
Lab findings: Leukocytosis, Elevated IgA, with normal platelets Diagnosis: Based on clinical picture. Biopsy of renal tissue showing IgA in mesangium is rarely needed. Treatment: Steroids. For Renal disease, Plasmaexchange. Prognosis is excellent.
1.) AGE 2.) CATAPLEXY 3.) NIGHT SLEEP Duration Awakenings Snoring Morning drunkeness 4.) DAYTIME NAPS Frequency Time of day Duration
Adult No
Young Yes
Young No
a wave c wave
Due to distension produced by right atrial systole Bulge of tricuspid valve into right atrium during ventricular isovolemic systole. Atrial relaxation & downward displacement of tricuspid valve Accentuated in Reduced in Constrictive pericarditis Right ventricle dilation Tamponade Restrictive cardiomyopathy
Ax Descent
v wave
Due to increasing blood volume in right atrium when tricuspid is closed & ventricle is contracting By opening of tricuspid valve & inflow of bloor into right ventricle Accentuated in Tricuspid regurgitation Constrictive pericarditis Reduced in Tricuspid stenosis Atrial myxoma
vy descent
ya ascent
Due to continuous diastolic inflow of blood from great veins into right atrium
RELATED QUESTION: Kussmauls sign is seen in Constrictive pericarditis.(2003) Characteristic of RVMI is hepatomegaly with raised JVP. Acute pericarditis has effusive & fibrinous variants(2001).
Bites of Mesobuthus , Leiurus Androctonus & Tityus are associated with massive catecholamine release leading to adrenergic crisis ---may benefit from prazosin administration. Treatment of Scorpion Bite: LOCAL DISCOMFORT Analgesics HYPERTENSION / PULMONARY EDEMA Nifedipine Nitropruside Hydralazine Prazosin BRADYCARDIA Atropine NEUROMUSCULAR MANIFESTATIONS Midazolam
EEG PATTERN 1. Triphasic 2. Bilateral periodic bursts of high voltage tri / polyphasic bursts < 200 milli sec occurring every 1-2 sec 3. Periodic stereotype sharp slow complexes in temporal lobe at regular 2 3sec 4. Normal alpha waves
HSV encephalitis
5. Periodic high voltage sharp slow waves every 3 -8 sec followed by periods of
attenuated background 6. Generalised , symmetric 3 spike wave that begins & end abruptly.(superimposed on normal background) 7. Generalised slow spike wave less than or equal to 2.5 per sec 8. Isoelectric 9. Focal inter ictal epileptiform discharges 10. Symmetric slowing
Atypical absence seizure Brain death Focal seizure Diffuse cerebral dysfunction ( delirium )
RELATED QUESTION: Most common type of seizure in childhood is GTC (2003) Risks for febrile seizures include 2 4 years of age , positive family history & uncontrolled High grade fever (2003) Neonatal seizures are most commonly associated with deficiency of pyridoxine. Juvenile myoclonic epilepsy has onset between 8 -18 years , 90 % seizures are tonic-clonic & response to valproate is excellent.(2007)
DRUG OF FIRST CHOICE IN MAC INFECTION: INDICATION CD 4 + count < 50 / micro L Prior documented disseminated disease ( may stop prophylaxis if CD 4 + is > 100 / micro L for 3 or more months ) 1 ST CHOICE Azithromycin OR Clarithromycin Clarithromycin + Ethambutol + Rifabutin
RELATED QUESTION: Under passive T.B. surveillance ,a cough of 2 or more weeks is an indication for sputum microscopy (2005)
FUO
CLASSIC FUO
HIV FUO
Yes
Yes
> 3 week
3 OPD visits OR 3 day hospital stay OR 7 days of intelligent & invasive ambulatory investigations
>3 days)IPD patients) OR > 4 week ( OPD ) patients 3 days of 3 days of investigation investigation ( with 2 days ( with 2 days of incubation of incubation of cultures) of cultures
> 3 week
Neutropenia < 500 micro L RELATED QUESTION: FUO is body temperature of 101 F (2009)
CHYLOTHORAX
ETIOLOGY IN CHILDREN Cardiothoracic surgery (most common ) Thrombosis of subclevian veins Malformed pulmonary / thoracic lymphatics
ETIOLOGY IN ADULT Thoracic / neck trauma (most common) Malignancy at thoracic aperture
CLINICAL Dyspnea Pleural effusion DIAGNOSTIC TESTS Triglycerides in effusion > 1.2 mg% Milky effusion Presence of chylomicrons Presence of lymphocytes TREATMENT OPTIONS Chest tube with octreotide Pleuroperitoneal shunt / ligation of leaking duct.
INCIDENTALOMA Clinically unapparent mass detected incidentally by imaging techniques Detected in 4 % of patients on imaging
Surgery
TREATMENT OF NON-SEMINOMA AFTER ORCHIDECTOMY STAGE 1 No clinical evidence of disease No radiological evidence of disease AFP / hCG levels normal or declining
Observe ---
STAGE 2
Limited ,ipsilateral lymphadenopathy ( retro-peritoneal ) Nodes 3 cm or less in largest diameter a. 2 cm or less in size b. AFP /hCG normal c. Less than 6 nodes a. 2 -3 in size b. AFP /hCG levels high c. More than 6 nodes
Bilateral RPLND
STAGE 2c 3
EASIER VERSION: STAGE 1 2 TREATMENT RPLND or observe Bilateral RPLND +/ 2 cycles of chemotherapy Chemotherapy
2C & 3
UNSTABLE
STABLE
Thoracotomy
Tube Thoracostomy
Observe if :
Thoracotomy if:
Stable
>1500ml initial blood in the draining tube > 200 ml blood / hour for 3 hours cardiac tamponade /arrest tracheo-bronchial injury esophageal perforation vasculature injury persistent air leak retained foreign body > 1.5 cm in diameter
ORMANDS DISEASE Progressive retroperitoneal fibrosis involving one / both ureters Etiology is unknown Symptoms: a.) Unremitting backache b.)Renal failure USG : hydronephrosis Excretory urogram : ureters displaced towards midline Treatment :
LYMPH ANGIOSARCOMA (Stewart Treves Syndrome ) Etiology : chronic lymphedema ( esp. post lymph node dissection ) Presentation : multiple subcutaneous nodules Site :upper limb Prognosis : poor Treatment : forequarter amputation
Suspected airway / inhalational injury. Any burn likely to require fluid resuscitation / surgery. Any burns to hands / face / feet / perineum. Patients whose psychiatric / social background makes it inadvisable to send them home. Any suspicion of non-accidental injury. Any burns in patients of extremes of age. High tension electric burns. Concentrated hydro fluoric acid burns.
207. Ans D ( 45 ) : LB 25th/1077 CRITERIA FOR MORBID OBESITY A.) Body Mass Index > 45 kg /m2 B.) Weight for Height > or equals 100% over ideal
208. Ans C ( RECURRENT INTESTINAL OBSTRUCTION ) : LB 25th/1198 Treatment of Recurrent Intestinal Obstruction caused by Adhesions Charles Philip transmesentric plication. Nobles plication. Repeat adhesiolysis(enterolysis). Intestinal intubation.
209. Ans A ( ASCENDING COLON ): Robbins 8th/793 ANGIODYSPLASIA Occurs in 6 th decade Most often in caecum & right colon PATHOLOGY Malformed mucosal / submucosal blood vessels Ecstatic nests of tortuous veins ,venules & capillaries It is separated from the gut lumen by vascular wall & a layer of attenuated epithelial cells ASSOCIATIONS Age (increasing) Aortic stenosis Meckels diverticulum CLINICAL Presence of hemorrhage
210. Ans C ( DISTAL TO VEROMONTANUM ): LB 25th/1362 POSTERIOR URETHRAL VALVE Folds of urothelium causing urethral obstruction Flap valves : urine flow is obstructed but urethral catheter can pass Found in boys POSITION Distal to veromontanum (more common) Proximal to veromontanum ( less common ) DIAGNOSIS Antenatally : USG Postnatally : UTI (urinary track infection ) May present even in adulthood / adolescence.
CLINICAL Bladder hypertrophy Bladder diverticula UTI / VUR (vescico-ureteral reflux) Renal failure
PEYRONNIES DISEASE
A plain X ray may show calcification of the gall bladder (Porcelain gall bladder ) It is an indication for cholecystectomy. CHOLELITHIASIS 10 % of stones are radioopaque Mercedes benz /Seagull sign ( tri radiate gas in the centre of the stone ) Calcification of the gall bladder wall Radiolucent gas in the gall bladder wall Cholecystectomy ,if indicated
Tubercles in pyramid
Abscess formation fibrosis of : a.) renal pelvis b.) neck of calyces Pyonephrosis
Peri-nephric abscess
Putty kidney ( caseous contents ) CLINICAL Incidence : Males > females Right > left kidney Frequency ( EARLIEST SYMPTOM ) Sterile pyuria Hematuria Pain
INVESTIGATION Cystoscopy : GOLF hole orifice of the ureter IVP : Indistinct renal papillae Calyceal stenosis Hydronephrosis TREATMENT Medical : AKT Surgical : 6 12 weeks after AKT 214.Ans D ( ANERIOR WALL ): LB 25th/1227
Internal intussception
Occurs on anterior rectal wall Heals with formation of inflammatory polyp Benign but difficult to treat PR bleed & mucus discharge present Treatment : abdominal rectopexy / intrarectal stapling
Central
Note : If lobes are mentioned instead of zones , BPH occurs in median lobe hyperplasia.
TREATMENT OF FULL THICKNESS RECTAL PROLAPSE A.)Perineal approach: Patient is elderly & very frail 1.Deleromes operation anal mucosa is sutured to unprolapsed rectal mucosa AND MUSCLE IS PLICATED. A coloanal anastomosis is created it has become obsolete as it causes chronic perineal sepsis & anal stenosis
B.)Abdominal approach: Patient is in otherwise good health 1.Wells operation 2.Ripsteins operation the rectum is fixed to sacrum the rectosigmoid junction is fixed to sacrum
As abdominal approach risks damage to pelvic autonomic nerves,resulting in possible sexual dysfunction, the PERINEAL approach is also usually preferred in young men.
217. Ans B (10-25 ): LB 25TH/1010 The normal lower esophageal sphincter is 3 4 cm long & has a pressure of 10 25 mm Hg.
SPIGELIAN HERNIA Its a variety of inter-parietal hernia Occurs at the level of arcuate lines(lateral to rectus muscle) Incidence in males is equal to that in females Diagnosis:USG / CT It may undergo strangulation
RELATED QUESTION: Richters hernia involves a part of circumference of the intestine (2001) A femoral hernia has more chances to undergo strangulation than inguinal hernia(2010) ( Although inguinal hernia is 10 times more common than femoral hernia)
The diagnosis of toxic megacolon is confirmed by a dilatation of colon > 6 cm on plain X-ray film BAILEY & LOVE,25th/1164
Toxic megacolon is confirmed by loss of haustrations & a dilation of transverse /right colon > 6 cm
HARRISONS,18th/
RELATED QUESTION: Earliest sign of ulcerative colitis on barium enema is granularity of mucosa (2005)
220. Ans C (ADENOID CYSTIC) :Robbins 8th/758-760 TUMOR 5 YEAR SURVIVAL 1. Adenoid cystic 60 -70 %
2.Acinic cell
90%
3.Mucoepidermoid(low grade)
90%
50%
5.Cystadenolymphoma
Benign
RELATED QUESTION: Acinic cell tumor is a tumor of parotid.(2002) Most common parotid gland is pleomorphic adenoma.(2007) Treatment of choice for pleomorphic adenoma is excision of tumor[superficial parotidectomy](2007)
TYPE 1.Inflammatory
SITE Rectum
MALIGNANCY no
2.Hamartomatous A.)juvenile rectum jejunum Polyp may be dysplastic Juvenile polyposis syndrome has adenocarcinoma Polyps are nonneoplastic GI adenocarcinoma no Dilated glands with mucin PR bleed Prolapse of rectum
B.)peutz jeghers
Skin pigmentation
3.Hyperplastic
Left colon
OBSTETRICS AND GYNECOLOGY 222(a). Ans D (HYALINE DEGENERATION ): Duttas gynecology 5th/265
DEGENERATIONS IN FIBROID Most common type = hyaline degeneration Most common type in pregnancy = red degeneration
TYPE 1. Hyaline
MORE COMMON IN APPEARANCE Fibroids with high Loss of whorled connective tissue pattern content Occurs in the central most part of fibroid Common in Liquefaction is interstitial fibroid seen Fat globules in muscles Common in CaCO3 subserous fibroid (Ca)3(PO4)2 deposition is seen (womb stone)
SEEN IN
5.Red
RELATED QUESTION: Most common presentation of anterior wall fibroid is urinary retention(2006)
INDICATIONS OF COLPOSCOPY
Guiding biopsies
Women with clinically suspicious cervical lesion with history of contact bleeding.
DELAYED ENGAGEMENT
MOULDING
PERINEAL TEAR
TENTORIAL TEAR
Time elapsed After oral glucose ( 75 or 100 g) A. Fasting B. 1 hour C. 2 hours D. 3 hours
ACOG prefers 100 g glucose value at 3 hour in OGTT WHO prefers 75 g glucose value at 2 hour in OGTT Carried by 100 g /75 g of oral glucose Fasting of 8 -14 hours 2 or more values to be positive for GDM 3 days of unrestricted diet 3 days of unrestricted activity
RELATED QUESTION: Most common anomaly in a baby of a diabetic mother is cardiac anomalies(2006) Search for GDM is carried out at 24-28 weeks of gestation.(2003)
DIAGNOSIS OF ECTOPIC PREGNANCY GESTATION a.) 4 5 weeks b.) 5 6 weeks hCG 1500 IU/L 6000IU/L USG TVS TAS
RELATED QUESTION: Medical management of ectopic pregnancy is indicated if gestational sac is less than than 4 cm , hCG levels are lower than 2000 IU /L & patient is unstable(2007) Surgical management of ectopic pregnancy involves Conservative approaches ( Salpingostomy , Salpingotomy & Fimbrial expression of ectopic pregnancy ) and Radical approach ( Salpingectomy) (2010)
MIFEPRISTONE
USES Therapeutic abortion(effective upto 7 weeks) Post coital contraception Cervical ripening Shrinkage of fibroids Termination of ectopic pregnancy
CONTRAINDICATIONS Adrenal insufficiency Age > 35 years Heavy smoker Corticosteroid therapy
Release of prostaglandins
Increased PV bleed
Pregnancy is terminated
FREQUENCY Monthly following menses (as breasts become less tender & less engorged
Inspection in front of a mirror Palpation with opposite hand (sitting/supi ne position) Palpate axillary & supraclavic ular areas Compress nipples for any discharge
SIZE 34.5 cm 32 cm
230. Ans C ( 0 ): Williams 23rd/392 ; Dutta obstetrics 7th/133 STATION Level of presenting fetal part ( in birth canal ) in relationship to ischial spines.
ACOG CLASSIFICATION STATION INTERPRETATION a.) - 5 to - 1 - 5 cm to 1 cm above ischial spine b.) 0 At ischial spine c.) + 1 to + 5 + 1 cm to + 5 cm below ischial spine
Bradycardia tachycardia
232. Ans B ( ABOVE THE ANGLE ) : Williams 23rd/783 ; Dutta Obstetrics 7th/424
Because the hemorrhage usually comes from the upper angle of the wound, the first suture is placed proximal to angle.
Stitches
GARDENELLOSIS White Fishy > 4.5 Increased Clue cells Decreased lactobacillus Whiff test +
OTHERS
Strawberry vagina
In immunocomprised patients
CANDIDA :ACIDpH
RELATED QUESTION : Clue cells are seen in Gardenellosis (2005) 235.Ans C (PRE ECLAMPSIA ) : Williams 23rd/1045,1046
ACUTE RENAL FAILURE IN PREGNANCY ETIOLOGY 1.Severe pre eclampsia- eclampsia 2. HELLP syndrome 3.Obstetrical hemorrhage (placental abruption) 4.Abortion related 5.Septicemia 6.Acute fatty liver of pregnancy MANAGEMENT Medication dose adjustment Hemofiltration/dialysis
RELATED QUESTION: MgSO4 is not cardiotoxic (2002) In MgSO4 therapy patellar reflex disappears at 10 meq /L ( respiratory paralysis at 12 meq /L ). (2008 ) MgSO4 is used to treat pre-eclampsia because it has additional anti-hypertensive action.(2001)
COMPLICATIONS OF INTRA-UTERINE DEATH 1. Blood coagulation disorders a.) Hypofibrinogenemia b.) DIC 2. Infections (esp. by Clostridium welchii) 3.Uterine inertia 4.Retained placenta 5.Post partum hemorrhage 6.Psychological upset
a. b. c. d.
TIMING OF DIVISION IN EMBRYONIC MASS < 4 DAYS 4 8 DAYS > 8 DAYS > 2 WEEKS
TYPE OF TWIN
POINT A POINT B
Point A = 2 cm above fornix & 2 cm lateral to uterine axis Point B = 2 cm above fornix & 5 cm lateral to uterine axis & 3 cm lateral to point A
Uterine axis
Tube
2 cm A 2 cm
3 cm B
fornix
vagina
STAGE 0
Carcinoma in Situ
STAGE 1 1 a = Micro invasive Depth of stromal invasion equal to less than 5 mm Lateral spread equal to less than 7 mm 1 a 1 = < 3 mm X < 7 mm 1 a 2 = 3 5 mm X < 7 mm
1 b = Clinically visible but confined to cervix or microscopic but > 1 a . 1 b 1 = equal to / less than 4 cm 1 b 2 = > 4 cm
STAGE 2 Disease beyond cervix but not to pelvic wall or lower 1/ 3rd of vagina.
Tumor T U M O R
STAGE 4
RELATED QUESTION: Manchester point A & B are used for radiotherapy for cervical carcinoma(2003) Conventional daily dose regimen in external beam radiotherapy is 180- 200 c GY (2003) Carcinoma cervix is caused by HPV (2005) Stage of carcinoma cervix with involvement of parametrium; upper 2/3rds of vagina & no free space on per rectal examination is STAGE 3A Stage of carcinoma cervix when microscopic length involvement is > 3mm but < 5 mm with invasion no wider than 7 mm is STAGE 1A.
239. Ans A (H. MOLE ) :Duttas Obstetrics 7th/190-198 HYDATIDIFORM MOLE Abnormal condition of ovum with partly degenerative ,partly hyperplastic changes in young chorionic villi. Benign neoplasia of chorion with malignant potential INCIDENCE Highest in Philippines ( 1: 80) In India 1: 400 ETIOLOGY Teenage pregnancy > 35 years of age racial factors PATHOLOGY Villi are seen with absent blood vessels Marked proliferation of syncitio & cytotrophoblast Hydropic degeneration of stromal tissue CLINICAL FEATURES Vaginal bleed (most common symptom) :WHITE CURRENT IN RED CURRENT Passage of grape like vesicles Vomiting Size of uterus is more than the gestational age Abdominal pain Thyrotoxicosis History of quickening absent INVESTIGATIONS USG :Snow storm appearance in uterus Theca lutein cysts in ovary Rapidly increasing Beta hCG titre. TREATMENT Suction evacuation
RELATED QUESTION: 70 % of patients with hydatidiform mole have fundal height more than expected(2005).
TYPES OF ABORTION FEATURES 1. PV bleed THREATENED INEVITABLE INCOMPLETE COMPLETE Yes yes yes no MISSED Persistent brown discharge Firm;closed No Dead & retained in uterus
2. Os 3. Pain 4. Conceptus
TYPES OF ABORTION
Conceptus In utero
Threatened Abortion
Inevitable abortion
Incomplete abortion
Complete abortion
RELATED QUESTION: Treatment for missed abortion at 14 16 weeks is misoprostol(2007).This is the most safe & most effective method.
241. Ans D (OLIGOHYDRAMNIOS & ANEMIA IN RECEPIENT ): please refer question 227 in 2010 242. Ans A ( DECREASED IRRITABILITY ): Duttas obstetrics 7th/265 Response is evidenced by a sense of welll being / decreased irritability. RELATED QUESTION: Fetal demand for iron is evident after 25 weeks of gestation (2007) Amount of Iron required for fetus in pregnancy tenure is 0.3 g (200). 243. Ans B ( AC ): Duttas Obstetrics 6th/646
In 2 nd trimester USG : Abdominal circumference is the single most sensitive parameter for assessment of fetal growth.
244. Ans D ( DUHRSSEN OPERATION ): please refer question 222 of 2010. 245. Ans D ( 2ml/kg 10 % DEXTROSE ) :Ghai 7th/155
HYPOGLYCEMIA IN NEONATES
> 20 mg / dl
< 20 mg / dl
I. V. INFUSION OF GLUCOSE
After hour
Hypoglycemia persistent
246. Ans C (KMC ) : Ghai 7th/122,123 KMC is best to provide thermal protection to baby esp. while transportation.Hot water bottle can cause accidental burns to baby.
KANGAROO MOTHER CARE Given to preterm / LBW infants Suggested by Edgar Ray POSITION OF BABY Skin to skin contact Baby held in vertical position Baby between breasts & under mothers clothing TYPES OF KMC There are 2 types of KMC:
BABYS DRESS Front open sleeveless shirt Cap Socks Nappy STOPPAGE OF KMC Weight attained 2500 g Gestation of 37 week Baby starts wriggling out/fusses/cries. BENEFITS Thermal protection Stimulates breast milk production Encourages exclusive breast feeding Helps in bonding
247. Ans
B (HURLER ) : Nelsons 18th/622 MUCOPOLYSACCHARIDOSES 1 HURLER SCHIE HURLER SCHIE HUNTERS (a hunter needs a clear vision) SANFILLIPO (types A,B,C,D) MORQUIO MAROTEAUX LAMY CORNEAL MORPHOLOGY CLOUDING
FEATURES OF HURLERS: H = hepatosplenomegaly U = ugly faces R = recessive(Autosomal) L = L-iduronidase deficiency E = eyes(cornea) clear R = retardation (mental) S = short,stubby fingers
GRADE
The proximal loop continues into distal The cause of reduced calibre is intra luminal diaphragm Ends as a blind loop Ends as a blind loop Ends as a blind loop Ends as a blind loop Ends as a blind loop Ends as a blind loop Loss of dorsal mesentry APPLE PEEL: Distal loop( the ileum) Coils around ileo colic Artery
2 3a 3b
249. Ans C (vaginal delivery): Ghai 7th//203 The highest percentage of HIV infected children acquire the virus intrapartum. RISK FACTORS FOR VERTICAL TRANSMISSION: Preterm delivery < 34 weeks Low maternal antenatal CD4 count Use of illicit drugs during pregnancy > 4 hours duration of rupture of membranes Birth weight < 2500g.
INGREDIENT LOW OSMOLARITY ORS (g/L) NaCl 2.6 KCl 1.5 Citrate 2.9 Glucose 13.5
REHYDRATION THERAPY (in first 4 hours) 75 ml/kg ORS AGE < 4 mon ORS(ml) 200-400 or 4-11mon 400-600 12-23 mon 600-800 2-4 years 800-1200 5-14 years 1200-2200 >15years >2200
252 (a). Ans D( seen normally in 3-5 years of age ): Nelsons 18th/1521 REGURGITATION Normal gastro-intestinal event Occurs in 1st year of life Etiology: a result of gastro-esophageal reflux Volume of emesis:15-30 ml Vomit can be effortless/forceful Resolves in 80% children by 6 mo of age Resolves in 90% children by 12 mo of age Persistence beyond 1 year of age is pathological Complications:aspiration/esophagitis/failure to thrive
EVENT
PHYSIOLOGICAL REGURGITATION
PATHOLOGICAL REGURGITATION
1 YEAR
RUMINATION DISORDER a.) Repeated regurgitation without nausea/GI illnesss b.) Leads to weight loss/failure to thrive c.) Seen in males d.) Seen in 3-14 mon of age
PSYCHOLOGIC Infants with disturbed parentchild relationship. Seen in infancy TREATMENT a.) behaviour therapt b.) family therapy c.) positive reinforcement of eating d.) negative reinforcement of rumination
SELF STIMULATING Parent-child relationship is fine. Seen at any age Chidren are mentally retarded
SIGNS 1.Any general danger sign: a.) vomiting b.) convulsion c.) lethargy/unconscious ness d.) unable to feed 2.Chest indrawing 3.Stridor 1.Fast breathing: <2 mon :60 or more/min 2mo-12mo :50 or more/min 12mo-5year:40or more/min
CLASSIFIED AS
pneumonia
COMPOSITION OF BREAST MILK(per 100 ml) MACRO NUTRIENTS Lactose 7g A Fat 3.5g C Protein 1.1g 5.2 mg Ca P 35 mg 15 mg Zn 120 micro g 60micro gm K 1.4 mEq MAJOR IONS TRACE ELEMENTS
VITAMINS
Na
RELATED QUESTIONS:
1.) 100 ml of breast milk provides 67 Kcal of energy 2.) exclusive breast feeding is done uptill 6 mon of age(2005) 3.) protein content of breast milk is 7 to 20 g per L (2005)
ORTHOPEDICS 255. Ans A ( PIECE OF DEAD BONE SURROUNDED BY INFECTED) Robbins 8th/1222
When the newly deposited bone forms a sleeve of living tissue around the segment of devitalized bone,it is known as involucrum. The dead piece of bone is known as sequestrum.(It is surrounded by infective granulation tissue)
Anerior talo-fibular ligament is most commonly sprained. MEDIAL COLLATERAL/DELTOID LIGAMENT Superiorly attached to apex & margins of medial malleolus Consists of 2 sets of fibres:
Superficial 1. Tibionavicular 2. tibiocalcaneal 3. Posterior tibio-talar LATERAL COLLATERAL LIGAMENT 1. Anterior talo-fibular 2. posterior talo-fibular 3. Calcaneo-fibular
RELATED QUESTION: Ligament supporting the head of talus is Spring ligament (2008)
SITE OF FRACTURE
MORTALITY
36%
INCIDENCE
MECHANISM
ASSOCIATED INJURIES
COMPLICATIONS
SHOULDER DISLOCATION Most common ANTERIOR Most common SUBCORACOID BANKARTS LESION Stripping of glenoid labrum & [eriosteum so that humeral head lies in front of scapula HILLS SACH LESION Depression on postero-lateral part of humeral head due to anterior glenoid rim
INTRISIC CAUSES a.) ehlers danlos syndrome b.) AMC c.) Larsen syndrome
EXTRINSIC CAUSES a.) abnormal fetal position (breech) b.) quadriceps fibrosis
ATTITUDE OF LIMBS: A.) forward displacement of proximal tibia over femoral condyles . B.) hyperextension at knee.
LATE PRESENTATION RECALCITRANT CASES Casting in Bryants cast/prone Open reduction position for 1-2 week) followed by closed reduction
FRACTURE/DISLOCATION Intracapsular fracture of femur head a.) undisplaced b.) displaced Dislocation a.) posterior b.) anterior
RELATED QUESTIONS: a.) typer of avascular non-union of fracture are torsion wedge,comminuted and defect nonunion.(2006)
OSTEOCLASTOMA A.)1/3rd benign B.) 1/3rd locally malignant C.) 1/3rd frankly malignant PATHOLOGY
Undifferentiated spindle cells Multinucleate giant cell Vascular stroma CLINICAL Age is 20-40 years Epiphyseal Most commonly around knee RADIOLOGY Lytic lesion(sclerotic margins are rare) Abutting epiphysis/subchondral Soap bubble appearance TREATMENT Excision with reconstruction Curretage PROGNOSIS Recurrence is a serious problem After every recurrence ,tumor becomes more aggressive
262. Ans C (genu varus): Osteoarthritis affects 1st the medial compartment of knee joint causing genu varus.
A fracture opens up
Distraction forces
Healing of fracture
RELATED QUESTIONS: a.) b.) c.) d.) e.) f.) g.) h.) Pointing index finger is seen in median nerve nerve palsy(2009) Wrist drop is caused by damage to radial nerve(2005) Saturday night palsy is caused by damage to radial nerve(2005) Nerve involved in fracture of surgical neck of humerus is axillary(2002) Nerve involved in fracture shaft humerus is radial(2003) Claw hand is caused by ulnar nerve palsy(2002) Erbs palsy occurs at C5-C6(2002) Klumpkes palsy occurs at C8-T1.(2002)
DERMATOLOGY
LICHEN PLANUS CUTANEOUS LESIONS MUCOSAL LESIONS a.) purple,plaina.) Commonly topped,pruritic,poly involves buccal gonal papule mucosa b.) wickhams b.) A white lace like striae(white lace pattern is like pattern) seen/white c.) predilection for macule wrist,shin,genitalia( c.) May complain of face not commonly intolerance to involved) spicy food d.) koebners d.) Genital mucosal phenomenon+ lesions are e.) scalp involvement annular. causes scarring alopecia. NAIL LESIONS a.) pterygium formation (proximal nail fold prolongs onto nail bed) b.) destruction of nail plate c.) onychorrhexia:thi nning,tenting,dista l splittingroughnes s with longitudinal ridging d.) anychia:absence of nail
HISTOLOGY OF LICHEN PLANUS 1.) Aggregation of lymphocytes at dermo-epidermal(DE) junction 2.) Squamatisation of basal cells 3.) Saw-toothing of DE junction 4.) Civatte/colloid bodies 5.) Max Joseph space 6.) Hyperkeratosis 7.) Hypergranulosis
Development of lesions following trauma over previously uninvolved skin of patients suffering from a particular cutaneous disease.
TRUE 1.) psoriasis 2.) lichen planus 3.) vitiligo PSEUDO 1.) warts 2.) molluscum 3.) pyoderma gangrenosum OCCASIONAL 1.) dariers disease 2.) kyrles disease 3.) Kaposi sarcoma 4.) Erythema multiforme 5.) Pellagra QUESTIONABLE 1.) DLE 2.) Bullous pemphigoid 3.) Morphea 4.) Pityriasis rubra pilaris REVERSE 1.) psoriasis
Pemphigus vulgaris SITE OF BLISTER AUTO-ANTIBODIES TYPE OF AUTOANTIBODY Suprabasal (acantholytic) Intra epidermal (fish-net appearance) IgG
TRICK: 1.) pemphiGus /pemphiGoid has IgG. 2.) dermAtitis has IgA
268.Ans C (atopic dermatitis):Harrisons 18th/395 CUTANEOUS STIGMA OF ATOPIC DERMATITIS a.) Dennie morgan fold (extra fold of skin beneath the lower eyelid) b.) Increased incidence of cutaneous infections(esp. with staphylococcus) c.) Increased palmer markings d.) Perioal pallor
BOTRYOMYCOSIS
a.)chronic ,suppurative bacterial infection b.)affects soft tissue/visceral tissue c.)characteristic is clumps of bacteria (resembles granules of actinomycosis) d.)causative organism is S . aureus
270.Ans B (donovanosis) : Harrisons 18th/1320,1381,1425 DONOVANOSIS 1.) caused by calymatobacterium donovanosis 2.) causes bleeding,painless,indurated ulcer 3.) pseudo-bubo is seen 4.) pseudo-elephantiasis is seen 5.) microscopy:safety pin appearance(Donovan bodies) 6.) drug of choice:doxycyclin azitromycin(pregnancy) LGV 1.) Caused by C, trachomatis L1/L2/L3 2.) Causes painless,single ,non-bleeding ulcer 3.) Bubo(matted lymph nodes)is seen 4.) Esthiomine is seen 5.) Frie test + 6.) Groove sign+ 7.) Drug of choice:doxycycline CHANCRE 1.)caused by T,pallidum 2.)causes single,painless,indurated ulcer 3.)rubbery painless lymph nodes are seen 4.)diagnosis by dark field microscopy,VDRL,FTA-ABS 5.)drug of choice:penicillin G CHANCROID 1.)caused by Hemophilus ducreyi 2.)causes multiple ,painful, bleeding ,nonindurated ulcer 3.)microscopy shows gram ve coccobacilli & school of fish pattern 4.)drug of choice:ceftriaxone
271.Ans B (psoriasis ) : Robbins 8th/1191 HISTOPATHOLOGY OF PSORIASIS Neutrophil infiltrates in Munros micro abscess parakeratotic stratum corneum 1 2 Spongiform pustule of Kogoj 3 Acanthsis 4 Auspitz sign 5 Thinning of stratum granulosum Neutrophil infiltrates in spongiotic superficial epidermis Marked epidermal thickening Multiple bleeding points when scale is lifted from the psoriatic plaque
RELATED QUESTION: a.) Streptococcal infection may lesd to guttate psoriasis.(2008) b.) Arthritis mutilans is associated with psoriasis.
272.Ans A (HPV )
POST DURAL PUNCTURE HEADACHE ETIOLOGY FEATURES a.)Breach of dura in : a.)Onset in 12-72 hours lumbar puncture b.)Lasts for weeks myelography c.)Pain is Bilateral frontal spinal anesthesia , retro-orbital,occipital & wet epidural tap extending into neck b.)There is reduction of ICP d.)Hallmark is aggravation of due to CSF leakage post pain with change in body dural puncture. position
SITTING STANDING
MANAGEMENT A.)Supine position Analgesia , I.V. Fluids B.)Epidural blood patch With 10-20 ml venous Blood is most effectiv C.)Drip of Hartmanns Solution in epidural Space D.)Vasopressor of choice :EPHEDRINE
274. Ans B (bupivacaine )clinical anaesthesia 5th /458 PLASMA PROTEIN BINDING IN LOCAL ANAESTHETICS: B > R = E = T >M >L Where, B=bupivacaine; R=ropivacaine; E=etidocaine; T=tetracaine;M=mepivacaine; L=lidocaine.
RELATED QUESTION: a.) Maximum safe dose of plain lignocaine is 300 mg (2003)
275.
METABOLISM/CLEARANCE Clearance reduced in hepatic & renal failure In renal failure ,accumulation of nor-pethidine occurs that has excitatory effects Renal excretion is found Hepatic clearance is found
RELATED QUESTION: A.) a few drugs that are safe in porphyria are propofol,midazolam and alfentanyl. 276. Ans D (all) :Pauls 5th /24-1
INCREASES IN ET CO2
DECREASES IN ET CO2
CAPNOGRAPHY
Method of monitoring partial pressure of O2 in expired gas. Concept: a)dead space air(i.e. air in conducting airway )does not contain CO2. b)CO2 absorbs infra-red rays & gets detected in capnography.
3 Pp CO2 2 1 time 4
Expiratory Inspiratory
CONCEPT Dead space air comes out first Dead space air + alveolar CO2 Alveolar CO2 Fresh air comes in
USES OF CAPNOGRAPHY: a.)verification of ET tube in position. b.)adequacy of cardio-pulmonary resuscitation c.)evaluation of asthma treatment d.)avoiding secondary injury in head injury patients e.)assessment of return of spontaneous respiration.
RELATED QUESTION: Dead space air is the first to be expired (2001) 278. Ans B (dibucaine) : KDT 5TH/320
LONG DURATION Dibucaine Tetracaine Bupivacaine ropivacaine (in that order) trick: delhi to Bombay rail)
SUCCINYL CHOLINE non-competitive muscle relaxant depolarizing type of relaxant shortest acting(due to pseudo cholinesterase) causes biphasic blocks: PHASE 2 BLOCK potentiated by 1.enflurane
PHASE 1 BLOCK potentiated by 1. isoflurane 2. Mg2+ 3. Li+ 4. anti cholinestrase ADVERSE REACTIONS: a. post operative myalgia b. malignant hyperthermia c. hyperkalemia RELATED QUESTION:
a.) Adverse effects of scoline are greater in spinal cord trauma patients.(2007) b.) Scoline causes muscle fasciculations(2005) c.) Apnea is seen in presence of abnormal plasma cholinesterase following scoline administration.
281.Ans C (Right middle lobe):Suttons 7th/14 SILHOUETTES SIGN If aerated alveolar spaces (radiolucent) are replaced by fluid/soft tissue (radio opaque),there is no difference of radiodensity between heart (radio-opaque)and the fluid/soft tissue.
STRUCTURE OF HEART 1. Right heart border 2. Left heart border 3. Aortic knuckle 4. Hemidiaphragm
PATHOLOGIC LOBE OF LUNG Right middle lobe Lingular lobe Apicoposterior segment of left upper lobe Basal segments of lower lobe
282.Ans A (X-rays)
1.
Intra -nuclear
1. 2. 3. 4.
STABILITY yes no no no
RELATED QUESTION: Small bowel obstruction presents with triad of vomiting,abdominal distention and string of beads sign on X-ray(2009)
285. Ans A (Osteosarcoma):robbins 8th/1226,1228 ;Maheshwari 3rd/218 X-RAY FINDINGS IN OSTEOSARCOMA 1. Codmans triangle:triangular area of new subperiosteal bone formation 2. Sunray appearance:new bone laid along blood vessels within tumor growing centrifugally 3. Periosteal reaction:irregular and intense 4. Irregular metaphyseal destruction 5. Erosion of cortex
OSTEOSARCOMA ON X-RAY 1. Sunray/sunburst periosteal reaction 2. Codmans triangle OSTEOID OSTEOMA ON X-RAY 1. Nidus radiolucency with central mineralization 2. Tremendous bone formation around the nidus CHONDROSARCOMA ON X-RAY 1. Endosteal scalloping 2. 2.Calcified matrix appears as foci of flocculent densities.
RELATED QUESTIONS 1. The tumor with which osteosarcoma is most commonly associated is retinoblastoma(2001) 2. 2.Young boy complains of pain in leg,worst at night and relieved by salicylates is suffering from osteoid osteoma.(2005)
286. Ans C (O2): Rozers radiotherapy 3rd/161 RADIOSENSITISERS 1. hyperbaric O2 2. Hydroxyurea 3. Cisplatin 4. Doxorubicin 5. Metronidazole 6. Buthinione
287. Ans C [Wrist] Shoulder - <1year Hand & wrist 11-13yrs Elbow 12-14yrs
DERIVED FROM Lipid soluble plant extract Resinous extract from flowering tops and leaves Dried female inflorescence Dried leaves
Majoon is a sweet prepared from bhang. RELATED QUESTION: Cannabis causes amotivation syndrome , run amok & flash backs ( 2009) Earliest sign of cocaine toxicity is bitter taste ( 2006) Cocaine does not cause pin point pupil( 2009)
MODE OF SEXUAL PLEASURE Sexual pleasure on infliction of pain to the sexual partner Sexual gratification on receiving painful stimulus from sexual partner Gratification by contact and sight of central parts of female body or even clothing or any other object. Sexual intercourse by a human being with a lower animal
A) POST TRAUMATIC STRESS DISORDER 1. Recollections of stressful images/thoughts(flash backs) 2. Re-experiencing of stressful events 3. Hyperarousal 4. Anxiety 5. Avoidance of situations that arouse recollections of stressful events
B)
ACUTE STRESS DISORDER (symptoms till 1 month) 1. Immediate onset with clear temporal relation 2. Symptoms resolve within few hours if stress is removed.
291.Ans B(Denial) :Kaplan & Saddocks 10th/201-204 Please refer question 294 of 2010
DEFENCE MECHANISM
DEFINITION 1. Involuntary exclusion of unpleasant realities from conscious awareness. 2. Involves negating sensory data 3. Patient behaves as if he is unaware of something he may be expected to know.
Denial
Grief
Psychosis
RELATED QUESTION: 1. Humor is a mature defence mechanism(2009) 2. Blaming others for ones own mistakes is projection type of defence mechanism.(2003) 3. Defence mechanism shown by addicts is denial(2001)
MANCHUSEN SYNDROME BY PROXY Care giver (mother )fabricates /produces illness in the child by: a. Fabrication b. Severe physical harm c. Even Killing the child To Achieve
Care and attention from the health providers through the sick child
CHARACTERISTICS OF THE AFORESAID MOTHER: 1. Behaves as model parent 2. Highly knowledgeable about medical field 3. Non psychotic 4. Cognitively unimpaired
MAJOR DEPRESSION (It affects biological rhythms) a. Decreases REM sleep latency b. Increases REM sleep time c. Decreases delta wave sleep d. Early morning awakenings
RELATED QUESTIONS: 1. Disruption of biological rhythm is seen in depression(2009) 2. Daily depressed mood for minimum 2 weeks is necessary for classifying it as major depression. 3. Most common side effect of SSRI in long term is sexual dysfunction.(most common side effect is nausea)(2009)
294.Ans C(20) : Harrisons 18th/3235,3236 Please refer question 300 of 2010 MINI MENTAL STATE EXAMINATION (MMSE) 30 POINT TEST OF COGNITIVE FUNCTION HELPS TO CONFIRM Presence of cognitive impairment Progression of dementia IT INCLUDES TESTS ON Level of consciousness Orientation Speech Language Memory Fund of information Insight & judgement Abstract thoughts Calculation ability INTERPRETATION OF SCORE Total score = 30 Possible cognitive impairment = below 25 Definitive cognitive impairment = below 20
DIAGNOSTIC CRITERIA FOR ADHD A. either (1) or (2) (1) >6 symptoms of INATTENTION for atleast 6 months : a. b. c. d. e. f. g. h. i. Often makes careless mistakes Often has difficulty sustaining attention Often does not listen Often fails to follow instructions/finish tasks Often has difficulty organizing activities Often avoids tasks requiring sustained attention Often loses things Often is distracted Often is forgetful
HYPERACTIVITY a. Often fidgets b. Often leaves seat c. Often moves excessively d. Often has difficulty playing/engaging in leisure activities e. Is often on the go f. Often talks excessively
IMPULSIVITY g. Often blurts out answers h. Often has difficulty awaiting turn i. Often interrupts/intrudes on others. B. symptoms present before 7 years of age
C. D.
symptoms present in 2 or more settings clinically significant impairment in social ,academic or occupational functioning.
296.
SYMPTOMS
TRICK
D J
was 100-150 Confused Dementia but Drunk 150-300 Incoordination Disorientation 300-400 Stupor D I D sing confused
RELATED QUESTIONS:
1. Alcohol can cause erectile dysfunction(2005) 2. A person is called drunk if alcohol levels are 150-300 mg/dl(2007) 3. Alcohol intoxication is a form of alcohol dependence(2003) 4. At 150-300 mg/dl concentration of blood alcohol body incoordination occurs(2001) 297. Ans D (Flight of ideas ): Kaplan & Saddocks 10th/
252
Flight of ideas
Rapid speech with sudden shifts in ideas without loosing logical connections Perseveration Persistent repetition of words/phrases beyond point of relevance Neologism Are fabricated words whose derivatives cannot be understood easily Echolalia Repetition or echo or mimicking of phrases or words heard
1.mania
1.schizophrenia 2.autism 1.schizophrenia 1.schizophrenia 2.autism 3.tourettes syndrome 4.stupor & catatonic syndrome
TYPE OF BEHAVIOUR THERAPY 1.Exposure & response prevention 2.Aversion therapy 3.Flooding 4.Operant conditioning for increasing a behaviour 5.Operant conditioning for decreasing a behaviour
BASED ON Reciprocal inhibition Pairing of pleasant stimulus with an unpleasant response Direct exposure to phobia but escape not possible 1.positive reinforcement 2.negative reinforcement 3.modelling 1.time out 2.punishment 3.satiation
USED IN 1.phobia 2.OCD 1.drug abuse 2.sexual deviations 1.phobia 1.for augmenting an adaptive behaviour 1.for demoting a maladaptive behaviour
On confrontation with an assignment beyond residual intellectual capacity of patient. Found in dementia.
DISEASE
CORRECT REASON ANSWER 1.Delusional disorder no In DD the patient is not (DD) disorganized.He is able to maintain his daily routine. 2.Psychotic no Features of depression like depression anhedonia ,weight loss,anergia,crying etc. are absent. 3.Paranoid yes There is delusion(camera fixed and schizophrenia following ) &disorganized behaviour(schizophrenia) 4.Paranoid personality no 1.Personality develops in adolescence 2.Absence of delusions
RELATED QUESTION: Globally prevelance of Schizophrenia is 0. 85 % (2008 ) ( Life time prevelance of Schizophrenia is 1 1.5 % )2006) Bleuler s 4 A s of Schizophrenia are Ambivalence , Autism , Affect disturbance & association disturbance.(2010)