Professional Documents
Culture Documents
Test Information
1. Which of the following structures in the scapula is palpable in the infraclavicular fossa?
a. A
b. B
c. C
d. D
Solution. C
Sol :
A-Infraglenoid tubercle
B-Acromian process
C-Coracoid process
Its located between the clavicular origins of pectoralis major and deltoid, at the junction of the convex medial and concave lateral portions of the
clavicle
The apex of the coracoid process lies approximately 2.5 cm below the clavicle immediately lateral to this fossa, and is covered by the anterior fibres
of deltoid. (Can be palpated in this fossa, the tip of coracoid process to be exact)
LANDMARKS OF SCAPULA
Coracoid process: The apex of the coracoid process lies approximately 2.5 cm below the clavicle.
Acromian process: It lies subcuateously forming the top of shouder. (not in the infraclavicular fossa)
Answer. c
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2. In Pemphigus vulgaris, autoantibodies are formed against which cell adhesion molecule:
a. Selectin
b. Cadherin
c. Integrin
d. IgSF CAM
Sol : in Pemphigus vulgaris (Intraepithelial), autoantibodies are formed against Desmosomes(Cadherin) whereas in Bullous pemphigoid(Subepithelial),
autoantibodies are formed against Hemidesmosomes
Answer. b
3. Development of diaphragm begins at 4 weeks of gestation. Diaphragm has contributions from different structures. Central tendon of diaphragm
develops from?
a. Dorsal mesooesophagus
b. Septum transversum
d. Cervical myotomes
Sol :
Development of Diaphragm
- Septum transversum : it is a mass of mesodermal tissue arising from coelomic wall at the 4rd week of gestation. It forms the central tendon of
diaphragm.
- Dorsal mesooesophagus forms the median portion of diaphragm & the crurae.
- Cervical myotomes (from C3-C5 somites) of lateral body wall form the peripheral parts of diaphragm.
- Pleuro-peritoneal membranes.
- During the initial period of development, it lies at a higher level (cervical) and then migrates caudally and hence the nerve supply is from C3, C4, C5
(Phrenic nerve).
Answer. b
4. A 29-year-old man presents with duodenal peptic ulcer and complains of cramping epigastric pain. Which of the following structures harbors the cell
bodies of abdominal pain fibers?
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b. Anterior horn of the spinal cord
Solution. (c)
Sol:
Cell bodies of the abdominal pain fibers are located in the dorsal root ganglion. The lateral horn of the spinal cord contains cell bodies of sympathetic
preganglionic nerve fibers; the anterior horn contains cell bodies of general somatic efferent (GSE) fibers.
The sympathetic chain ganglion contains cell bodies of sympathetic postganglionic fibers, which supply blood vessels, sweat glands, and hair
follicles.
The celiac ganglion contains cell bodies of sympathetic postganglionic fibers, which supply the visceral organs such as stomach and intestine
Answer. c
c. Subcostal artery
Solution. (a)
Sol:
The musculophrenic artery gives rise to anterior intercostal arteries for intercostal spaces 79.
Answer. a
6. A 35-year-old woman presents with abdominal tenderness and acute pain. On examination, her physician observes that an abdominal infection has
spread retroperitoneally Which of the following structures is most likely affected?
a. Stomach
b. Transverse colon
c. Jejunum
d. Descending colon
Solution. (d)
Descending colon
Sol:
The descending colon is a retroperitoneal organ. The rest of the organs are surrounded by peritoneum.
Answer. d
7. Which of the following bones articulates with the fibula, tibia, calcaneus, and navicular?
a. Talus
b. Lateral cuneiform
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c. Intermediate cuneiform
d. Medial cuneiform
Solution. (a)
Talus
Sol:
The talus articulates with the fibula, calcaneus, navicular, and tibia.
Answer. a
8. A 29-year-old man comes in with a stab wound, cannot raise his arm above horizontal, and exhibits a condition known as winged scapula. Which of the
following structures of the brachial plexus would most likely be damaged?
a. Medial cord
b. Posterior cord
c. Lower trunk
d. Roots
Solution. (d)
Roots
Sol:
Winged scapula is caused by paralysis of the serratus anterior muscle that results from damage to the long thoracic nerve, which arises from the roots of
the brachial plexus (C5-C7).
Answer. d
a. Apocrine glands
b. Merocrine glands
c. Holocrine glands
d. Endocrine glands
Solution. (c)
Holocrine glands
Sol :
The given slide in the figure is taken from a section of skin, showing sebaceous glands.
In holocrine glands, the secretions are produced in the cytoplasm of the cell and released by the rupture olf the plasma membrane,which destroys
the cell and results in the secretion of the product into the lumen.
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Examples; Sebaceous gland (skin), meibomian glands (eyelid).
Answer. c
a. Os trigonum of talus
c. Head of femur
d. Tibial tuberosity
Solution. (d)
Tibial tuberosity
Sol :
Attached to the tip are the origins of short head of biceps & coracobrachialis.
Greater tubercle & tibial tuberosity are examples of traction epiphysis, head of femur is a type of Pressure epiphysis.
Answer. d
11. All of the following statements correctly apply to a bronchopulmonary segment except
c. It is not resectable.
Solution. (c)
It is not resectable.
Sol:
A bronchopulmonary segment is a pyramidshaped segment of the lung with its apex facing the lung root and its base at the pleural surface.
It is the largest subdivision of a lobe and is sepa-rated from adjacent segments by connective tissue.
It is surgically resectable
Answer. c
12. Dorsal pancreatic bud does not form one of the following -
a. Head
b. Neck
c. Body
d. Uncinate process
Solution. (d)
Uncinate process
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Sol :
The dorsal bud forms the upper part of head, neck & body of pancreas.
The ventral bud forms the lower part of head & uncinate process.
Answer. d
b. Inferior mesentric
c. Internal pudendal
Solution. (c)
Internal pudendal
Sol:
Inferior mesentfric is ventral branch from abdominal aorta at the level of L3.
Answer. c
c. Popliteal artery
d. Peroneal artery
Solution. (d)
Peroneal artery
Sol :
Popliteal artery is a continuation of Femoral after it pierces the adductor magnus muscle.
It divides into an Anterior tibial ( Anterior compt ) & Posterior tibial ( Posterior Compt ) of leg.
Answer. d
c. Epiblast
d. Hypoblast
Solution. (a)
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Ref: Read the text below
Sol :
The outer layer of cells from the primary umbilical vesicle (yolk sac) forms a layer of loosely arranged connective tissue, the extraembryonic
mesoderm.
The origin of the extraembryonic mesoderm is by no means clear: it may arise from several sources, including the caudal region of the epiblast, the
parietal hypoblast: trophoblast or a new germinal population which is yet to be established (Grays Anatomy ed 41).
Answer. a
16. Which of the following is least useful in bupivacaine induced cardiac toxicity
a. 20 % lipid emulsion
b. Atropine
c. Epineprine
d. Amiodarone
Answer. d
a. Coccaine
b. Benzocaine
c. Chlorprocaine
d. Tetracaine
Answer. c
18. Induction agent of choice in patient with known history of malignant hyperthermia is
a. Propofol
b. Etomidate
c. Thiopentone
d. Ketamine
Answer. a
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a. A alpha
b. A beta
c. A delta
d. C fibres
Answer. c
a. Propofol
b. Ketamine
c. Thiopentone
d. Midazolam
Answer. a
Sol:
Desflurane is most pungent smelling inhational agent.
Its B/G coff is .42 which is lowest among fluronated inhational agent.
It forms CO with dry CO2 absorbent,minimally metabolised, maximum green house effects, MAC is 6.6 in 100% O2, and2.3 in 66% nitrous oxide.
Sudden increase causes sympathetic stimulation .
Answer. c
a. Lignocaine
b. Procaine
c. Mepivacaine
d. Bupivacaine
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Ref: Read the text below
Sol:
Procaine is LA of choice of in pts with history of MH, lignocaine and mepivacaine are intermeidiate acting while bupivacaine is long acting.
Answer. b
23. Choose most appropriate statement regarding Post dural puncture headache
Answer. c
a. 2 hrs
b. 4 hrs
c. 6 hrs
d. 8 hrs
Answer. c
a. 6-8/min
b. 8-10/min
c. 10-12/min
d. 12-14/min
Answer. b
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c. Thymine is present in place of uracil
Answer. a
27. All of the following types of porphyrias are autosomal dominant except -
d. Hereditary coproporphyria
Answer. c
a. Isomerization of glucose
Answer. d
c. Tyrosinemia type 1
d. None
- Tyrosinemia type 1 is due to defect of hydrolase enzyme in this disorder there occurs cabbage odour urine.
Answer. c
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a. LDH 1
b. LDH 2
c. LDH 3
d. LDH 5
Answer. a
a. Hydroxyproline
b. Methionine
c. Cystine
d. Lysine
Answer. a
32. Modifications to the nucleotides of the pre-tRNAs, pre-rRNAs and pre-mRNAs occur
a. Postprandially
b. Postmitotically
c. Pretranscriptionally
d. Postranscriptionally
pre-tRNAs: cytosol
pre-rRNAs: nucleolus
pre-mRNAs: nucleus
Answer. d
a. Lysosomes
b. Proteasomes
c. Macrophages
d. Emdoplasmic reticulum
Answer. b
a. 5-3 direction
b. 3-5 direction
c. Direction nonspecific
d. None
Answer. a
35. The first reaction involved in degradation of most of the amino acid involves the participation of
a. NAD+
b. Thiamine pyrophosphate(TPP)
d. FAD+
Answer. c
b. Glycine is often present at a region where a polypeptide is forming a sharp bend reversing the direction of a polypeptide
Solution. (a) The side chain of cysteine and methionine absorb light at 280 nm
Ref: Read the text below
Sol:
Amino acids which absorb uv light at 280nm are:
Tryptophan
Tyrosine
phenylalanine
Answer. a
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37. Which of the following statement is not correct?
a. Metabolic disorder are only infrequently associated with defects in catabolism of purines
b. Immune dysfunction are associated both with defective adenosine deaminase and defective purine nucleoside phosphorylase
d. Hyperuricemia can result from conditions such as cancer characterized by enhanced tissue turnover
Solution. (a) Metabolic disorder are only infrequently associated with defects in catabolism
of purines
Ref: Read the text below
Sol:
Metabolic disorder are only infrequently associated with defects in catabolism of
purines
There are number of metabolic disorders which are associated with defect in purine catabolism. To name they are as follows:
Immune dysfunction are associated both with defective adenosine deaminase and defective purine nucleoside phosphorylase
Answer. a
38. The initiator tRNA is placed within the active 80S complex at which of the three canonical ribosomal sites dueing protein synthesis
a. E site
b. I site
c. P site
d. A site
Answer. c
a. Different km value
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e. Immunological characteristics
f. Substrate affinity
Answer. a
a. Pyriodoxine
b. Riboflavin
c. Biotin
d. Thiamine
Answer. c
41. A child is diagnosed having psoriasis associated with streptococcal sore throat. The lesions are likely to be:
d. Photo distributed plaques with pigmented borders and carpet tack scales
Solution. (b) Small red papules with mild scaling widely distributed over trunk.
Sol :
Both genetic as well as external factors are at play. In a genetically predisposed individual, external triggering factors may precipitate psoriasis.
Amongst the genetic factors HLA-Cw6 has strongest association. Amongst the external precipitating factors drugs, infections and trauma are
important. The classical drugs known to precipitate psoriasis include lithium, -blockers, antimalarials and salicylates.
Psoriasis is classically well defined erythematous plaques with silvery white scales.
Guttate psoriasis is strongly associated with streptococcal sore throat in children. Guttate psoriasis is characterized by small red papules widely
scattered over trunk with little scaling.
Violaceous plaques with criss-crossing white lines on surface (Wickhams striae) are seen in lichen planus.
Centrally crusted annular lesions may be seen in leishmaniasis. Carpet tack scales are seen in discoid lupus erythematosus.
Answer. b
42. Which test is based on the principle of type 4 delayed type hypersensitivity:
a. Patch test
b. Prick test
Sol :
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Allergic contact dermatitis is confirmed with patch test.
Patch test is aimed for identification of allergens by applying them on skin under occlusion for 48 hours to elicit delayed type hypersensitivity.
IgE and radioallergen sorbent test as well as prick test are used for acute type I hypersensitivity, whereas allergic contact dermatitis is a type IV
hypersensitivity.
Answer. a
a. Propionibacterium
b. Staphylococcus aureus
c. Staphylococcus epidermidis
d. Streptococcus viridans
Sol :
Miliaria, the retention of sweat is a result of occlusion of eccrine sweat ducts. Staphylococcus epidermidis, which produces an extracellular
polysaccharide substance, induces miliaria. This polysaccharide substance may obstruct the delivery of sweat to the skin surface produces an eruption that
is common in hot, humid climates, such as in the tropics and during the hot summer months in temperate climates.
Depending on the level of the injury to the sweat gland or duct, several different forms are recognized- Miliaria crystalline, miliaria rubra (prickly
heat) and miliaria profunda
Answer. c
a. Secukinumab
b. Ustekinumab
c. Etanercept
d. Rituximab
Answer. d
45. A patient presents with asymptomatic, gradually expanding, infiltrated plaque with central scarring as shown in image. Likely diagnosis is:
a. Lupus vulgaris
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b. Tinea corporis
Sol :
DLE has carpet tack scales, follicular plugging and pigmented borders.
Answer. a
a. Panniculitis
b. Mastocytosis
c. Dermatitis
d. Vasculitis
Sol :
It is septal panniculitis by histology and may be associated with drugs like OCP, sulfonamides etc., pregnancy, TB, streptococcal infections, other
infections including histoplasmosis, coccidiodocomycosis, sarcoidosis, Behcets syndrome etc.
Answer. a
b. Erythema marginatum
d. Erythema multiforme
Sol :
Erythema annulare centrifugumis characterized by annular or polycyclic lesions that grow slowly (23 mm/day). Characteristically, there is a
trailing scale at the inner border of the annular erythema
Erythema toxicum neonatorum is physiological in day 2-3 old child. Characteristically, the broad erythematous flare is much more prominent than
the small follicular papule or pustule it surrounds and heals on its own by day 10.
Erythema multiformeis associated with HSV infections most commonly. However, other infections like mycoplasma may also be associated. The
lesions are known as target lesions or iris lesions or bulls eye lesions. These are made of concentric rings of varying colors from purplish in center, whitish
in middle and red in outer ring.
Answer. d
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48. Which is correctly matched:
Sol :
Nikolsky sign is negative in bullous pemphigoid and positive in pemphigus. Auspitz sign is seen in psoriasis while apple jelly nodules are seen on
diascopy in lupus vulgaris. Dimpling sign is typical of dermatofibroma.
a. Diascopy (VITROPRESSION) consists of pressing a transparent slide over a skin lesion. Examiner will find this of special value to distinguish
erythema or purpura. It is useful to detect the yellow-brown appearance of papules in sarcoidosis, tuberculosis(Apple Jelly Nodules) and other granuloma.
b. Darier's sign is positive when a brown macular or papular lesion of urticaria pigmentosa (cutaneous mastocytosis)becomes palpable wheal after being
rubbed with the blunt end of an instrument.
c. Grattage test & Auspitzs sign is positive when slight scratching or curetting of a scaly lesion reveals initially fine candle wax scales followed by red
Berkleys membrane; which then gets removed to reveal punctate bleeding points(Auspitz's sign) within the lesion which suggests of psoriasis.
d. Nikolsky's sign is positive when a new blister is generated with ease by applying shearing force to skin or epidermis is dislodged ( pemphigus, SSSS,
TEN)
e. Asboe Hansen (Bulla spread) sign: Spread of bulla to normal skin by vertical pressure over in Pemphigus (~ to Nikolskys)
f. Carpet Tack Sign: or carpet en tack sign: removal of adherent scales in DLE reveals downward projection of scales which are follicular plugs.
g. Buttonholing sign: Neurofibroma (with central vertical pressure the lesion disappears under the skin)
i. Koebners phenomenon: Spread of lesions of same morphology (isomorphic phenomenon) at the site of trauma. Characteristically seen in Lichen
planus, psoriasis, vitiligo and by auto-inoculation in verruca, molluscum contagiosum
etc..
Answer. d
49. An elderly patient has developed a slowly enlarging lesion as shown in the image. Likely diagnosis is:
b. Melanoma
Sol :
Pigmentation is common in people with pigmented skin like Indians. Then it is called pigmented BCC.
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Answer. d
a. Vasodilation
b. Melanin deposition
c. Albumin deposition
d. Porphyrin deposition
Sol :
1) HALF AND HALF NAILS: Proximal portion is white and distal portion is brown with a sharp demarcating line. The pigmentation is a result of
melanin deposition (and capillary proliferation). Seen in renal diseases with azotemia.
2) TERRYS NAILS: Distal 1-2 mm of nail is pink and the rest is white. Seen in cirrhosis, CHF, Diabetes.
3)MEES LINES: Single or multiple white transverse bands on nail seen in chronic arsenic poisoning,septicemia, chemotherapy, renal failure.
5) Longitudinal white lines with V-shaped nicks at free margin of nails: Dariers disease.
Answer. b
a. Transnasal endoscopic
b. Transpalatal
c. Lateral rhinotomy
d. Transmaxillary
Answer. a
b. Air embolism
c. Epistaxis
d. Coagulopathy
Answer. b
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a. Nasopharyngeal carcinoma
b. Hypertrophied adenoids
c. Allergic Rhinitis
d. Velopharyngeal insufficiency
Answer. d
54. The best tool for hearing screening for NICU or high risk babies
a. OAE
b. AABR
c. ECOG
d. Impedance Audiometry
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Answer. b
a. Maxillary
b. Sphenoid
c. Frontal
d. Posterior ethmoid
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Answer. d
Solution. (d) Noise induced trauma is at 4000 Hz also known as U shape audiogram.
Ref: Read the text below
Sol:
1.Speech frequencies are 500,1000,2000 Hz
2.Air Bone Gap is feature of conductive deafness
3.Carhart Notch is at 2000 Hz in Bone conduction graph
4.Noise induced trauma is at 4000 Hz also known as acoustic Dip or Boiler's Notch
5. 'U' Shape audio gram is feature of congenital deafness.
Answer. d
57. Study the given image and comment on the best possible combination:
Answer. a
58. Fetal nasal bone assessment is a non-invasive procedure that helps provide even greater assurance to patients undergoing their first trimester risk
assessment for aneuploidies, The gestational period must be
a. 11 to 13 wks
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b. 2 to 3 wks
c. 3 to 5 wks
d. 5 to 9 wks
Fetal nasal bone assessment is a non-invasive procedure that helps provide even greater assurance to patients undergoing their first trimester risk
assessment for aneuploidies
The gestational period must be 11 to 13+6 weeks - the nasal bones first appear at a crown-rump length of 42 mm.
Answer. a
59. Which of the following structure is not removed during Vertical Partial Laryngectomy
a. Ventricle
b. Paraglottic space
c. Vocal cord
d. Arytenoid
Answer. d
a. Nasopharynx
b. Oropharynx
c. Laryngopharynx
d. Hypopharynx
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Answer. a
61. Medical examination of accused can be allowed at his request under which section?
a. 53 CrPC
b. 54 CrPC
c. 53(A) CrPC
d. 164(A) CrPC
Answer. b
a. Shotgun entry
c. Stab wounds
d. Lacerated wounds
Answer. a
a. Forensic medicine
b. Medical jurisprudence
c. Medical Ethics
d. Medical Etiquettes
Sol:
Forensic medicine is the application of medical knowledge in administration of law and justice.
Answer. a
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Answer. c
a. Rigor mortis
b. Hypostasis
c. Algor mortis
d. Putrefaction
Answer. a
a. Mixoscopia
b. Klismaphilia
c. Partialism
d. Urolagnia
Answer. b
a. Hemlock
b. Calotropis
c. Plumbago
d. Blister beetle
Answer. a
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a. Burst injury of skull
Answer. a
a. 10 blast injury
b. 20 blast injury
c. 30 blast injury
d. 40 blast injury
Answer. c
70. Study the picture given below and comment on the posture shown:
a. Rigor mortis
b. Cadaveric spasm
d. Pugilistic attitude
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Answer. d
a. 21 hydroxylase deficiency
c. Partial AIS
Solution. A
Explanation
21hydroxylase deficiency causes ambiguous genitalia in an XX child and not XY
5 alpha reductase deficiency does not allow the formation of active form of testosterone called as DHT and hence the external genitalia do not convert into
male like structures. In partial AIS the androgen receptor is partially sensitive to androgens and hence even in the presence of testosterone the external
genitalia are only partially virilized and hence appear ambiguous
The deficiency of enzyme 17 beta hydroxysteroid dehydrogenase type 3 causes defects in testosterone biosynthesis, the serum testosterone levels in these
patients are towards lower normal which leads to impairment in virilization of external genitalia
Answer. a
72. A study was done on a group of girls with delayed puberty. All have hypergonadotropic hypogonadism, what is next best investigation
a. MRI brain
b. DHEAS
c. Karyotype
Solution. C
Hypergonadotropic hypogonadism indicates cause in the gonadal tissue most commonly gonadal dysgenesis and hence the feedback inhibition is defective
leading to high levels of LH and FSH The best investigation to establish the cause is karyotyping
The most common type of gonadal dysgenesis is turners syndrome or monosomy X Gonadal dysgenesis presents as primary amenorrhoea without
secondary sexual characters The investigation of choice for primary amenorrhoea is Karyotyping
Answer. c
73. All the following may be used for diagnosis of cervical incompetence except
d. No8 foley catheter with bulb filled with 2cc saline can be pulled out easily
Solution. D
Explanation
The diagnosis of cervical incompetence in pregnancy is cervical length in second trimester less than 25mm is diagnostic of cervical incompetence
An internal os diameter of more than or equal to 1.5cm in first trimester and more than or equal to 2cm in second trimester is diagnostic of cervical
incompetence
Membrane protruding at a distance 20mminto the cervical canal is diagnostic of incompetence Passage of number 8 hegars dilator without resistance
through the internal os is diagnostic of cervical incompetence in non pregnant state and this test has to be done in the premenstrual phase.
Foley catheter no.16 passed into uterine cavity and bulb filled with with 2cc normal saline can be pulled out easily
Answer. d
74. Primigravida with 39 weeks pregnancy has a persistent blood pressure of 150/110 and also has albuminuria, she has no other symptoms. Her blood
pressure was normal in early pregnancy nut had one record of 150/90 at 30 weeks. What is the diagnosis?
a. Gestational hypertension
b. severe preeclampsia
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c. mild Preeclampsia
Solution. B
It is not chronic hypertension as her blood pressure was normal in early pregnancy
It is also not gestational hypertension as she also has albuminuria
It is a case of severe preeclampsia because the diastolic blood pressure is 110 mmhg Criteria to say it is severe preeclampsia areany one or more of the
following
1) Systolic blood pressure greater than or equal to 160mmhg or diastolic blood pressure more than or equal to 110mmhg on two occasions 4 hrs apart
2) Serum transaminases more than twice the upper limit of normal or severe persistent right upper quadrant pain or epigastric pain not responsive to
medication
3) Platelet count less than 1 lakh
4) Serum creatinine greater than 1.1
5) Pulmonary edema
6) New onset cerebral or visual symptoms
Answer. b
a. Manchester
b. Shirodkar
c. Khanna
d. Abdominocervicopexy
Solution. A
EXPLANATION
Manchester is not a sling surgery, it is a conservative surgery which preserves the menstrual functions in a patient of prolapse. The basic surgical principle
of Manchester repair also called a sfothergills repair is to maintain anteversion of uterus by placating the cardinal ligaments in front of cervix so that the
cervix is pulled upwards and backwards along with amputation of cervix. After these steps anterior colporrhaphy and pelvic floor repair may be done in
order to correct
cystocoele, rectocoele and perineal defect.
Rest of the threes surgeries shirodkar, Khanna and abdominocervicopexy are sling surgeries done for prolapse. The most common sling surgery that is
done is modified shirodkars abdominal sling surgery.
Answer. a
76. Which of the following is not true about physiological changes of pregnancy
b. Hyperinsulinemia
d. TSH increases
Solution. D
EXPLANATION
In pregnancy the TSH levels reduce in the first trimester and in the second and third trimester the TSH value may gradually return to nonpregnant normal
range.
TBG levels increase in pregnancy. In general pregnancy is considered a euthyroid state.
Compression of IVC by the gravid uterus causes reduction of venous return and hence cardiac output decreases. This is called as supine hypotension
syndrome
Pregnancy is characterized by hyperinsulinemia because of insulin resistance which is primarily caused by HPL
The movement of diaphragm increases in pregnancy which is the diaphragmatic excursions. Diaphragm rises in pregnancy by 4cm. The total lug capacity
slightly decreases but the vital capacity remains unchanged .
Answer. d
c. Initiation of LH surge
Solution. B
EXPLANATION
The ERalpha is found in endometrium, breast cancer cells, ovarian stroma cells, and hypothalamus
The ERbeta has been documented in ovarian granulosa cells, kidney brain,bone, heart, lungs Prostate and endothelial cells
The estrogen receptors are intranuclear receptors
High levels of estrogens are required to initiate the LH surge the minimum requiremen for 48 hrs.
Estrogens bring about ferning of cervical mucus
In PCOS the E1 increases while total E2 is usually in normal range. The ratio of E2/E1 is reversed.
Answer. b
a. 40ml
b. 60ml
c. 80ml
d. 100ml
Solution. B
EXPLANATION
This is a MVA syringe which has a capacity of 60 ml and is used for MTP upto 12 weeks It is an alternative to suction evacuation when electronic
machine is not available
Answer. b
79. What is the contraception of choice in a woman with menorrhagia and hypertension
a. OCP
b. Transdermal patch
c. Vaginal ring
d. mirena
Solution. D
Since the patient is a known case of hypertension combined E+P compounds are avoided and only progestational agents are preferred so mirena is the
contraception of choice here also it will reduce the menstrual blood loss as it brings about endometrial atophy.
Transdermal patch and vaginal ring are also E+P agents and hence they have the same absolute contraindications as OCP.
Answer. d
80. Wertheims hysterectomy is done for which of the following stage of cancer cervix
a. Stage 1a2
b. Stage 1b1
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c. Both A and B
d. Stage 1A1
Solution. C
Wertheims hysterectomy or type 2 is done in stage 1a2 and 1b1 if the tumour is less than 2 cm For tumours larger than 2 cm we will do radical
hysterectomy or type 3 hysterectomy For tumours larger than 4 cm chemoradiation is the preferred primary treatment For stage 1a1 simple hysterectomy
is done if family is complete
Answer. c
81. All the following are first trimester findings of downs except
a. Decreased AFP
b. Decreased PAPPA
c. Increased HCG
Solution. A
Serum AFP is a marker of second trimester downs screening not first trimester
The other three tests are done as first trimester screening and when done together are called as combined test.
Serum beta hcg and PAPPA are called as dual test.
Answer. a
a. Broad ligament
b. POD
c. Rectovaginal septum
d. Uterosacral ligaments
Solution. B
The most common site of endometriosis is ovary followed by the POD.
Endometriosis is typically seen in the age group of 25-35 years and may present with any combination of symptoms of pain, infertility and adnexal mass.
The IOC is laparoscopy and it also helps to confirm the diagnosis by taking a biopsy from the endometrial deposits
Answer. b
a. Artery forceps
b. Needle holder
c. Kochersforcep
d. Green armytage
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Solution. A
Answer. a
a. Dermoid
b. Endometrioma
c. Ovarian cancer
d. Follicular cyst
Solution. A
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EXPLANATION
The ultrasound image is characteristic of a dermoid cyst also called as mature cystic teratoma The cyst shows a white structure at one edge and this is
called as rokitanskyprotruberance Dermoid is the most common ovarian tumour in reproductive age woman and is usually unilateral although it may be
bilateral in 10%cases.
Answer. a
Solution. D
HELLP syndrome although is a feature of severe preeclampsia but in upto15% females the blood pressure may be normal, it is more common in
multigravida. It is characterized by pain which is classically epigastric or right upper quadrant pain.
It is also characterized by hemolysis and it is the unconjugated bilirubin which is raised not conjugated. Although there is haemolysis LDH is not a
component of diagnostic criteria .
The diagnostic criteria include
1) Schistocytes on peripheral smear
2) Total serum bilirubin grater than or equal to 1.2mg/dl
3) AST greater than or equal to 70IU
4) Platelet count less than 1 lakh
Answer. d
b. Nuchal translucency
Solution. B
EXPLANATION
Soft markers are second trimester ultrasound findings that may be seen in normnal babies but their presence increases the risk of aneuploidy
The most important soft markers are absent nasal bone and increased nuchal fold the thickness The other markers of aneuploidy on ultrasound
2) Abnormal Doppler markers like reversed end diastolic flow , abnormal flow in ductus venosus and tricuspid regurgitation.
3) structural anomalies
4) fetal growth restriction
5) single umbilical artery
Answer. b
Solution. D
EXPLANATIONS
Appearance of pubic and axillary hair although are secondary sexual characters in females but are not dependent on estrogen they are brought about by
androgens
Precocious puberty is defined as appearance of the secondary sexual characters in females before the age of 8 years and in boys before the age of 9 years
In central precocious puberty the cause is premature activation of hypothalamic pituitary axis and hence the levels of LH and FSH are high while in
peripheral precocious puberty the level of gonadotropins is low.
Answer. d
88. A woman taking OCPs is at an increased risk stroke with which of the following
a. Smoking
b. Hypertension
c. Diabetes mellitus
d. Hypercholesterolemia
Solution. B
EXPLANATION
Although all the mentioned options are increasing the risk of stroke in an OCP user the highest association is with hypertension
Answer. b
a. Motility
b. Semen fructose
c. Concentration
d. Volume
Solution. B
The most important semen analysis parameters are sperm concentration and sperm motility The most important parameter for IVF is motility while the
most important parameter for ICSI is morphology
The following are WHO parameters for semen analysis
1) Volume more than 1.5ml
2) Ph more than 7.2
3) Total count more than 39 million per ejaculate
4) Sperm concentration more than equal to 15million per ml
5) Total motility greater than equal to 40%
6) Forward motility greater than equal to 32%
7) Sperm morphology more than equal to 4%
8) Sperm vitality more than equal to 58%
9) Leucocyte count less than 1 million /ml
Answer. b
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90. True statement regarding partial mole is
b. It is monospermic
Solution. D
The placenta of partial mole on ultrasound shows focal hydropic change which are seen as cystic spaces along with fetal tissue in the uterus
While in complete mole there is no fetal tissue and complete hydropic change of placenta The partial moles are dispermic and triploid and 90% of them
have karyotype of 69XXY The medical complications like preclampsia, thyroid storm, hyperemesis, pulmonary embolism are seen in complete mole only
not in partial mole
Answer. d
91. A 26 year old lady for her infertility evaluation has bilateral cornual block on HSG what is the most appropriate management for this patient
a. IVF
b. GIFT
c. Laprohysteroscopy
d. IUI
Solution. C
Bilateral blocks on HSG need confirmation which is done by laparoscopy and we will do the therapeutic part with it as a single procedure which is
hysteroscopic cannulation.
Hsg is the IOC for tubal patency while the best investigation for tubal assessment is is diagnostic laparoscopy .
HSG is to be done in the postmenstrual phase and can be done anytime between day 5 to day 11 of the cycle
Out of all the blocks on hysteroscopy the corneal block has best prognosis as many cases are physiological.
Suspected pregnancy and active pelvic infection are absolute contraindications to do the procedure
Answer. c
92. A primigravida presents at 8 weeks with pain and spotting, on examination the os is closed and ultrasound shows a intrauterine sac with cardiac
activity. What did you want to next for the patient
a. Give misoprostol
c. Bed rest
Solution. C
She is a case of threatened abortion and should be managed by rest and progesterone therapy and follow up with ultrasound
Closest differential diagnosis is missed abortion but in it the cardiac activity is absent on ultrasound, missed abortion needs MTP
While in inevitable abortion the os is open and no products of conception have been expelled
Answer. c
93. A Patient presents with post hysterectomy vault prolapse, this represents what level loss of support
a. Level 3
b. Level 2
c. Level 1
d. Both a and b
Solution. C
Vault prolapse is considered as level 1 defect.
Vault prolapse is seen in post hysterectomy patients and can be prevented by uterosacral suspension if done at the time of hysterectomy
The best surgery of vault prolapse treatment is abdominal sacrocolpopexy
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Enterocoele and uterocervical descent are also considered as level 1 defect
While cystocoele is level 2 and rectocoele is a level 3 defect
Answer. c
b. Progressive dyspnoea
c. Cardiomegaly
Solution. D
Respiratory rate shows no change in pregnancy
Although exrertional dyspnea is physiologic but progressive dyspnea represents worsening oh NYHA grade and is pathological
Cardiac silhouette on Xray appears big because eof rotation oh heart but there is no cardiomegaly.
Cardiomegaly is pathologic
Diaphragm rises in pregnancy by 4cm and the excursions increase.
Answer. d
d. Uterine massage
Solution. D
Uterine massage is done for treatment of PPH not prophylaxis
The component of AMTSL is intermittent uterine tone assessment instead
Oxytocin is the drug of choice for AMTSL when injectables cannot be given then misoprostol 600mcg per oral can be given
Early cord clamping is done when the baby needs resuscitation and in rh negative pregnancy Else the universal recommendation is delayed cord clamping.
Answer. d
a. Pneumatoceles
b. Facial dysmorphism
Answer. d
97. Each of the following is an indication for surgical intervention in those patients who present with endocarditis except
a. Organism isolated
b. Recurrent embolism
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c. Extravalvular infection
d. Aortic regurgitation
Answer. d
98. All of the following are features of Juvenile Myoclonic Epilepsy except :
a. Myoclonus on awakening
b. GTCS
c. Automatism
d. Absence seizures
Answer. c
99. Deep brain stimulation for drug-resistant epilepsy targets which of the following structures?
c. Cingulate gyrus
d. Hippocampus
Answer. a
100. Cerebral ischemia occurs when cerebral blood flow is less than :
a. 10ml/100 g/min
b. 20ml/100g/min
c. 40ml/100g/min
d. 50 ml/100g/min
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Ref: Read the text below
Sol:
Resting cerebral blood flow is 54ml/100 g/min
Decrease in cerebral blood flow to zero causes death of brain tissue within 4-10 min
Values <16-18 ml/100 g tissue per minute cause infarction within an hour
Values <20 ml/100 g tissue per minute cause ischemia without infarction unless prolonged for several hours or days
Answer. b
101. A 60-year-old woman develops generalized seizure activity lasting 10 minutes; seizure activity appears to arrest after administration of 4 mg of
IV lorazepam. She has chronic kidney disease but is otherwise in good health. Which of the following is the best next pharmacological step in
management?
c. IV fosphenytoin
d. IV ketamine
Answer. c
102. A child was being evaluated by an endocrinologist for precocious puberty. His mother was also giving history of psychomotor delay and
uncontrollable laughing episodes in the child. An MRI was ordered. What is the likely diagnosis ?
a. Craniopharyngioma
b. Prolactinoma
c. Hypothalamic hamartoma
d. Pinealoma
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Solution. (c) Hypothalamic hamartoma
Ref: Read the text below
Sol:
Hypothalamic hamartoma presents with gelastic seizures/laughing associated seizures
Answer. c
103. All of the following antiarrhythmic agents interact predominantly with the fast sodium channels except
a. Procainamide
b. Flecainide
c. N-Acetyprocainamide (NAPA)
d. Lidocaine
Antiarrhythmic agents can be broadly grouped according to their electrophysiologic effect on the heart, known as the Vaughan Williams
classification.
Class I drugs are those that act predominantly on the fast sodium channels, including lidocaine, mexiletine, tocainide, procainamide, quinidine,
disopyramide, flecainide , encainide, or propafenone.
Class II drugs are B-blockers. Class III drugs are those that prolong repolarization by increasing the action potential duration, including bretylium,
amiodarone , sotalol, and NAPA.
Class IV drugs are calcium channel blockers.
This classification is very simplistic and has multiple flaws. Several attempts to reclassify antiarrhythmic agents have been proposed, but at the
present time none have been widely adopted.
Answer. c
b. Pheochromocytoma
c. Carcinoid tumor
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Answer. c
a. MEN 1
b. MEN 2A
c. MEN 2B
d. MEN 3
- Facial angiofibromas
- Collagenomas
- Lipomas
Answer. a
106. A patient presented with a history of prolonged fever of 3 weeks duration. Given below are the fundus finding and a general examination
finding. What is the diagnosis ?
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a. Tuberculosis
b. Syphilis
c. Infective Endocarditis
d. HIV
Answer. c
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a. Rheumatic heart disease
d. Hypothyroidism
Answer. d
108. All of the following are typical features of mitral stenosis found on physical examination except
a. Presystolic murmur
b. Loud S1
c. Soft S3
Answer. c
a. Rheumatoid nodules
b. Heberdenss nodes
c. Jaccouds arthropathy
d. Pseudogout tophi
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Jaccoud's arthropathy was initially described in relation to rheumatic fever, but now more cases are seen in association with SLE, other connective
tissue diseases and neoplasias.
Answer. c
110. Which of the following is the best initial treatment for symptomatic hypercalcemia?
b. Mithramycin (plicamycin)
It is best to hydrate a patient with isotonic saline, because saline stays in the vascular system
longer than other solutions, normalizes the glomerular filtration rate, and increases renal tubular sodium and calcium clearance.
Mithramycin (plicamycin) and calcitonin can be used to decrease serum calcium but should be used only if hydration and dieresis are not effective.
A diuretic should only be used after the patient is well-hydrated , and it should be a loop diuretic.
Mithramycin can take up to 48 hours for its maximum effect.
Answer. d
Answer. c
112. A patient with which of the following conditions should not be placed on a ketogenic diet?
a. Diabetes
b. Hyperlipidemia
c. Pancreatitis
d. Rett syndrome
Answer. c
113. In addition to a risk of major congenital malformations, which of the following antiepileptic drugs is also associated with an elevated risk of autism
spectrum disorders and lower IQ at age 6
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a. Carbamazepine
b. Lamotrigine
c. Phenobarbital
d. Valproate
Answer. d
114. All of the following cardiac abnormalities should receive endocarditis prophylaxis for the appropriate indication except
b. Hypertrophic cardiomyopathy
Answer. c
Answer. a
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Solution. (b) Brisk jaw jerks
Ref: Read the text below
Sol:
Trigeminal/Vth cranial nerve has its nucleus in pons as well has a spinal nucleus which extends down through the lower pons and medulla into spinal
cord as far as C3/C4.Through which sensory fibres will pass thus carrying sensations of the face.Hence due to high cervical cord lesion till C3/ Facial
sensory impairement will occur.
Jaw jerk-Afferent impulse of this reflex are carried through sensory portion of the trigeminal nerve the efferent impulse through trigeminal nerve with its
reflex centre in PONS.So this jerk like any other jerk will become brisk in a UMN esion/supranuclear lesion OR a lesion above pons,never in a lesion
with the spinal cord.So normal jaw jerk happens in cases of myelopathy
PECTORALIS REFLEX-With patients arm in midposition between abduction and adduction,the examiner places her finger as nearly as possible on the
tendon of pectoralis major muscle near its insertion on the greater tuberosity of the humerus.Tapping the finger causes adduction and slight internal
rotation of the arm of the shoulder.The contraction of the muscle may be felt but usually not seen in normal indivisual.In patients with cervical
spondylotic myelopathy ,a hyperactive/brisk pectoralis reflex indicates spinal cord compression at C2-3 and C3-4 levels.This reflex is mediated by
the medial and lateral(anterior thoracic) nerves (C5-T1).
Answer. b
a. Astrocytoma
b. Glioblastoma
c. Meningioma
d. Metastatic.
Answer. d
c. Both of these.
Answer. b
119. A 17-year old girl who was evaluated for short height was found to have an enlarged pituitary gland. Her T4 was low and TSH was increased.
Which of the following is the most likely diagnosis?
a. Pituitary adenoma
c. Thyroid resistance
d. Primary hypothyroidism
Answer. d
120. Rapid, repetititve, coordinated and stereotyped movements, most of which can be mimicked are known as:
a. Chorea
b. Ballism
c. Athetosia
d. Tics
Answer. d
a. Adenovirus
c. Orthomyxovirus
d. Rabies virus
Answer. d
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122. A teenaged boy suffered a foot laceration while swimming in a polluted water area in a river. He did not seek medical treatment, and the wound
developed a foul-smelling exudate. One of the bacteria isolated from the abscess exudate was missing superoxide dismutase, catalase, and a
peroxidase. Which of the following statements best describes this microorganism
a. It is a capnophile
b. It is a facultative anaerobe
c. It is a microaerophile
d. It is an anaerobe
Answer. d
Answer. a
124. All of the following immunodeficiency diseases are due to chromosomal instability or defective repair of genes except?
a. Ataxia telangiectasia
b. Bloom syndrome
c. Chediak-Hegashi syndrome
d. Seckel syndrome
Answer. c
125. A hospitalized patient developed severe diarrhoea and pseudomembranous colitis within five days after antibiotic therapy was initiated. These
occurred as a result of which of the following:
a. Collagenase
b. Vacuolating toxin
c. Toxin A and B
d. Lecithinase
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Clostridium difficile produces two toxins A and B.
Both toxins are present in stool samples.
Toxin A is enterotoxin causing the severe diarrhea, whereas toxins B is cytotoxic leading to the destruction of enterocytes resulting in
pseudomembranous colitis.
Answer. c
126. Which of the following best describes the characteristics of the mycoplasma?
Answer. a
a. They are very stable and resist most physical and chemical agents
b. Highly antigenic
Answer. b
d. viridans streptococci
Answer. c
a. Paramyxovirus
b. Orthomyxovirus
c. Rhabdovirus
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d. All of the above
Answer. d
130. Which are the special laboratory conditions needed to recover C jejuni?
Answer. c
b. Stuart medium
c. Pikes Medium
Answer. c
a. Free coagulase
b. Bound coagulase
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Answer. b
a. Cytomegalovirus
c. Parvovirus
d. Rubella virus
- Among the choices CMV is the most common cause of congenital infections that can lead to various symptoms in the new-born.
Answer. a
134. An individual is known to have chronic hepatitis disease. Which serological marker should be monitored to determine if the blood contains the
infectious virus?
a. HBcAg
b. HBeAg
c. HBsAg
d. IgG HBs
Answer. b
135. A 6 month old infant has had watery diarrhoea for 6 days; he vomited a couple of times. The stools have no blood and no pus. He is
dehydrated. What is most likely causing this?
b. Giardia lamblia
c. Rotavirus
Answer. c
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136. Yersinia pestis may be transferred by
d. Respiratory droplets
The common mode of transmission is bite of Rat flea (X. cheopsis) that choice not given here
The other route of transmission is through respiratory droplets from patients who have Pulmonic plague.
Answer. d
137. A 36-year-old male from Bihar has a cough that has been bothering him for several weeks. He has also lost 12 Kg weight. Sputum acid fast
stain shown in the picture. Which of the following factors is known to be most important in triggering the granulomatous reaction to wall off and
contain the infection?
a. Cord factor
b. Mycolic acid
d. Sulfatides
Sol:
Cord factor helps trigger the Th1 response, which helps contain the infection.
Answer. a
a. Temperate bacteriophage
b. R-factor plasmid
c. Replicon
d. Lytic bacteriophage
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Solution. (b) R-factor plasmid
Sol:
R-factor (resistance) plasmidscontain genes for proteins that degrade antibiotics or alter antibiotic transport, thus conferring antibiotic
resistance.
They also carry transfer genes, which facilitate their intercellular transfer to other genomes.
Answer. b
139. Medium shown in the picture (Baird Parker Agar) used to detect the following pathogen
a. Corynebacterium diphtheriae
b. Legionella pneumophila
c. Cryptococcus neoformans
d. Staphylococcus aureus
Sol:
Baird Parker Agar mediumis formulated on the principle that staphylococci are able to reduce tellurite to tellurium.
Lithium chloride and potassium telluriteacts as inhibitor agent for contaminating microflora.
Answer. d
b. It has no carriers
Solution. (c) The source of infection- patient in late phase of the disease
Sol:
The source of infection was a patient in the early phase of the disease though infectivity extended from the appearance of buccal mucosal
lesions to the disappearance of all the skin lesions.
There were no carriers as the virus was eliminated from the patient on recovery.
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Answer. c
a. 2microns
b. 3microns
c. 4microns
d. 5microns
Answer. c
a. Pseudoexfoliation syndrome
b. Malignant glaucoma
c. Neovascular glaucoma
d. Iridocorneal syndrome
Answer. b
a. MLF Lesion
b. PPRF Lesion
c. Both
d. None
Answer. c
a. Photophobia
b. Blepharospasm
c. Decreased vision
d. Decreased accommodation
- Since the inflammation starts in the retrolental area first ,so the first symptom is difficulty in near vision due to involvement of ciliary muscles .
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Answer. d
a. "< 700"
b. "< 400"
c. "< 500"
d. "< 600"
Answer. c
a. Moraxella axenfeld
b. Moraxella catarrhalis
c. Moraxella lacunata
Answer. d
a. Inferonasal conjunctiva
b. Superonasal conjunctiva
c. Inferotemporal conjunctiva
d. Superotemporal conjunctiva
Answer. a
a. 1mm
b. 2mm
c. 3mm
d. 4mm
Answer. a
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149. Crossed diplopia is a feature of
a. LR Palsy
b. MR palsy
c. SR palsy
d. IR palsy
Answer. b
a. 0.1mm
b. 0.2mm
c. 0.3mm
d. 0.4mm
Answer. a
151. Identify the muscle being tested in the illustration shown here.
a. Subscapularis
b. Suprascapularis
c. Infraspinatus
d. Supraspinatus
Solution. A
Subscapularis
The Lift Off Test (also knows as Gerbers Test) is commonly used in orthopedic
examinations to test for a tear in subscapularis tendon or subscapularis tendonitis. It can also show scapular instability.
In this position, the patient attempts to move the hand away from the lower back by
extending and further internally rotating the arm. The examiner can also provide
resistance to this movement if the patient is able to complete the movement.
Answer. a
152. Which of the following nerve injury shows the worst prognosis ?
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a. Radial Nerve
b. Ulnar Nerve
c. Axillary Nerve
d. Median Nerve
Solution. B
Ulnar Nerve
Best Prognosis : Radial Nerve
Worst Prognosis : Ulnar Nerve
Worst Prognosis despite Surgical Repair : Sciatic Nerve
Answer. b
153. Which of the following is the most common direction of epiphyseal slip in SCFE ?
a. Posteromedial
b. Posterolateral
c. Anteromedial
d. No slip
Solution. D
No Slip
Actually due to Anterolateral disruption of Physis , There is an apparent Posteromedial
Slip. But in true sense , There is no slip.
Answer. d
154. Which of the following is the most common Giant Cell Variant ?
a. Chondroblastoma
c. Fibrous Dysplasia
Solution. D
Non Ossifying Fibroma
Most Common GC Variant : Non Ossifying Fibroma
Closest GC Variant : ABC
Answer. d
Solution. A
Posterior Hip Dislocation
Maximum Shortening : Posterior Hip Dislocation
Least Shortening :Fracture Neck Femur
Answer. a
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a. Denham's Pin
b. Steinmann's Pin
c. Rush Pin
d. Ender's Pin
Solution. A
Denham's Pin
The central grooves in this image suggest Denham's Pin as these grooves help in
penetrating in cancellous bones like Calcaneum
Answer. a
157. A 25 year old soccer player complained of injury to right knee 6 months ago. Now he says that there is a feeling of sudden giving away of knee joint
with knee in 90 degree flexion which completely disappears when the knee is taken into complete extension. Which of the following ligament needs to be
checked ?
Solution. A
Anteromedial bundle of ACL
Anteromedial Bundle ACL - KNEE 90 degrees flexion
Posterolateral Bundle ACL - KNEE COMPLETE EXTENSION
Answer. a
158. Most Common Cause of Failure of Conservative treatment of Manipulation and Casting in CTEV is :
b. Overcorrection of deformity
Solution. D
Non Compliance with Bracing and Shoes is the Most Common Cause of Failure of
Conservative treatment of Manipulation and Casting in CTEV
Answer. d
a. Scaphoid
b. Lunate
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c. Talus
d. Navicular
Solution. A
Panner's disease : Capitellum
Kohler's disease : Navicular
Kienbock's disease : Lunate
Preiser disease : Scaphoid
Answer. a
a. Cobb's Angle
b. Baumann's Angle
c. Gissane's Angle
d. Southwick's Angle
Solution. B
Baumann's Angle is the angle between a line along the shaft humerus and the other
along the superior capitellar physis.
Answer. b
a. 3 months
b. 4 months
c. 5 months
d. 6 months
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5 months Bidextrous grasp
7 months Transfer object, palmar grasp
9 months Pincer grasp
13 months Casting
15 months Self feed with a spoon
18 months Self feed with a cup
tower of 4 cubes
24 months turns pages of a book one at time
6-7 cubes
3 yrs makes circle, tower of 10 cubes
4 yrs Square, + sign
5 yrs Triangle x sign
Social
2 months Social smile
3 months recognizes mother
6-7 months smiles at mirror image
9 months waves bye-bye
Stranger anxiety
15 months hugs parents
Answer. d
a. 7p
b. 7q
c. 17p
d. 17q
Solution. (b) 7q
Sol :
CF is the major cause of severe chronic lung disease in children and is responsible for most exocrine pancreatic insufficiency in early life.
It is also responsible for many cases of salt depletion, nasal polyposis, pansinusitis, rectal prolapse, pancreatitis, cholelithiasis, and insulin-
dependent hyperglycemia.
CF occurs most frequently in white populations of northern Europe, North America, and Australia/New Zealand. The prevalence varies by report
but, in general, approximates 1/3,500 live births.
The CF gene codes for a protein of 1,480 amino acids called the CF transmembrane regulator (CFTR). CFTR is expressed largely in epithelial cells
of airways, the gastrointestinal tract (including the pancreas and biliary system), the sweat glands, and the genitourinary system.
CFTR has ion channel and regulatory functions that are perturbed variably by the different mutations.
More than 1,500 CFTR polymorphisms are associated with the CF syndrome.
The most prevalent mutation of CFTR is the deletion of a single phenylalanine residue at amino acid 508 (F508). This mutation is responsible for
the high incidence of CF in northern European populations and is considerably less frequent in other populations, such as those of southern Europe and
Israel.
Approximately 50% of individuals with CF who are of northern European ancestry are homozygous for F508, and >70% carry at least one F508
gene.
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The membranes of CF epithelial cells are unable to secrete chloride ions in response to cyclic adenosine monophosphate (cAMP)mediated signals
and, at least in the respiratory tract, excessive amounts of sodium are absorbed through these membranes
Another puzzle is the propensity for P. aeruginosa to undergo mucoid transformation in the CF airways. The complex polysaccharide produced by
these organisms generates a biofilm that provides a hypoxic environment and thereby protects Pseudomonas against antimicrobial agents.
Answer. b
Sol :
- A gain of approximately 2 kg (4-5 ib) in weight and 7-8 cm (2-3 in) in height per year is seen during pre school years.
Answer. a
164. Failure to pass meconium with 48 hrs of birth in a newborn with no obvious external abnormality should lead to the suspicion of
a. Anal atresia
c. Congenital aganglinosis
d. Meconium ileus.
Sol :
Hirschsprung disease (HD) is a motor disorder of the gut, which is caused by the failure of neural crest cells (precursors of enteric ganglion cells) to
migrate completely during intestinal development.
The predominant gene affected is the RET proto-oncogene. RET malfunction accounts for at least 50 percent of familial and 20 percent of sporadic
cases, and is especially seen in patients with long segment disease
Answer. c
b. Tonsillitis
c. Myocarditis
d. Septicemia
Sol :
The most common cause of death in diphtheria is either due to mechanical obstruction of airways in bull neck or due to myocarditis.
Answer. c
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166. All of the following are characteristics features of tricuspid atresia except
d. Splitting of S2
Sol :
Tricuspid Atresia
- In tricuspid atresia, no outlet from the right atrium to the right ventricle is present. The entire systemic venous return enters the left side of the heart by
means of the heart by means of foramen ovale or an associated ASD. Left ventricle blood usually flows into the right ventricle via a VSD.
- If ventricular septum is intact, the right ventricle is completely hypoplastic and pulmonary atresia is present. In such conditions pulmonary blood flow
is totally depends on PDA.
- Left axis deviation and left ventricular hypertrophy are noted on ECG.
Clinical Manifestation :
Answer. d
a. MR
b. AR
c. MS
d. AS
Solution. (a) MR
Sol :
The valves most affected by rheumatic fever, in order, are the mitral, aortic, tricuspid, and pulmonary valves.
In most cases, the mitral valve is involved with 1 or more of the other 3.
In acute disease, small thrombi form along the lines of valve closure.
In chronic disease, there is thickening and fibrosis of the valve resulting in stenosis, or less commonly, regurgitation.
Answer. a
a. ACTH
b. Phenytoin
c. Valproate
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d. Vigabatrin
Sol :
Infantile spasms usually begin between the ages of 4 and 8 mo and are characterized by brief symmetric contractions of the neck, trunk, and
extremities. There are at least three types of infantile spasms: flexor, extensor, and mixed.
The EEG that is most commonly associated with infantile spasms is referred to as hypsarrhythmia, which consists of a chaotic pattern of high-
voltage, bilaterally asynchronous, slow-wave activity or a modified hypsarrhythmia pattern.
Infantile spasms are typically classified into two groups:cryptogenic and symptomatic.
Prenatal and perinatal factors include hypoxic-ischemic encephalopathy with periventricular leukomalacia, congenital infections, inborn errors of
metabolism, neurocutaneous syndromes such as tuberous sclerosis, cytoarchitectural abnormalities including lissencephaly and schizencephaly, and
prematurity. Postnatal conditions include CNS infections, head trauma (especially subdural hematoma and intraventricular hemorrhage), and
hypoxic-ischemic encephalopathy.
Infants with cryptogenic infantile spasms have a good prognosis, whereas those with the symptomatic type have an 8090% risk of mental
retardation.
One hypothesis implicates corticotropin-releasing hormone (CRH), a putative neurotransmitter, metabolized in the inferior olive.
Exogenous ACTH and glucocorticoids suppress CRH synthesis, which may account for their effectiveness in treating infantile spasms. In Europe
and Canada, infantile spasms associated with TS are treated with vigabatrin (rather than adrenocorticotropic hormone) with good results.
Vigabatrin is not available in the United States.
Answer. a
169. Which of the following is not a common organism responsible for neonatal sepsis in India?
a. E. coli
b. Staph aureus
c. Gp B Streptococcus
d. Klebsiella
Sol:
The incidence of neonatal sepsis according to the data from National Neonatal Perinatal Database (NNPD, 2002-03) is 30 per 1000 live births.
Among intramural births, Klebsiella pneumoniae was the most frequently isolated pathogen (32.5%), followed by Staphylococcus aureus (13.6%).
Among extramural neonates (referred from community/other hospitals), Klebsiella pneumoniae was again the commonest organism (27%), followed
by Staphylococcus aureus (15%) and Pseudomonas (13%).
Answer. c
170. A 2-day old neonate in the neonatal ICU develops seizures. Which of the following would be the next best investigation for the child?
a. Transcranial ultrasound
b. Skull X-ray
c. CT scan
d. MRI
Sol:
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Their presence is often the first sign of neurologic dysfunction, and they are powerful predictors of long-term cognitive and developmental
impairment.
Most seizures in the neonate are focal, although generalized seizures have been described in rare instances.
Video electroencephalogram (EEG) studies have demonstrated that most subtle seizures are not associated with electrographic seizures.
Seizures occur when a large group of neurons undergo excessive, synchronized depolarization.
Depolarization can result from excessive excitatory amino acid release (eg, glutamate) or deficient inhibitory neurotransmitter (eg, gamma amino
butyric acid [GABA]).
Preterm neonates <32 gestational weeks and/or <1500 g are highly susceptible for HIE and/or IVH.
Thus, special medical care, including post-labor hospitalization in well equipped special baby care units (SCBU) and routine transcranial
ultrasound (TCUS) screening is recommended for those preterm neonates.
Answer. a
171. In an Autosomal recessive disorder, one parent is normal and the other is carrier and the child is also affected. What is the reason?
a. Germline Mosaicism
b. Genomic imprinting
c. Penetration
d. Uniparental disomy
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Sol :
- Uniparental disomy(UPD) occurs when a person receives two copies of a chromosome, or of part of a chromosome, from one parent and no copies
from the other parent.
- UPD can be the result of heterodisomy, in which a pair of non-identical chromosomes are inherited from one parent (an earlier stage meiosis I error) or
isodisomy, in which a single chromosome from one parent is duplicated (a later stage meiosis II error).
- Because it may lead to the duplication of lethal recessive genes, isodisomy is potentially dangerous, while heterodisomy is essentially benign.
Answer. d
172. After 5 days of birth, baby developed poor feeding, convulsions, fever with low protein, low sugar and high chloride (in CSF) is most likely due
to
a. Listeria monocytogenes
b. Mycoplasma pneumoniae
c. T.B.
d. Leptospira
Sol :
E. Coli
Streptococci group b
Listeria monocytogens
Out of the given options only L. Monocytogenes can cause menginitis in 5 days old baby
Answer. a
173. A child presents with antimongoloid shant, pulmonary stenosis, short stature and undescended testis. The likely diagnosis is :
a. Hypoparathyroidism
b. Noonan syndrome
c. Klinefelter syndrome
Sol :
Noonan syndrome(NS) is a relatively common autosomaldominantcongenital disorderthat affects both males and females equally[1]:550.
It used to be referred to as the male version of Turner's syndrome[2](and is still sometimes described in this way);however,the genetic causes of
Noonan syndrome and Turner syndrome are distinct.
The principal features include congenital heart defect(typically pulmonary valve stenosis) also ASD, hypertrophic cardiomyopathy, short
stature, learning problems, pectus excavatum, impaired blood clotting, and a characteristic configuration of facial features including a webbed neck
and a flat nose bridge. The syndromeis named after Dr. Jacqueline Noonan.
Answer. b
174. The earliest indicator of response after starting iron in a 6 year old girl with iron deficiency
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b. Increased hemoglobin
c. Increased ferritin
Sol :
o With iron therapy, the activity of iron containing enzyme in the cell improve.
o The child become less irritable and his appetite improve within 24 hrs.
o Body iron stores are repleted after correction of the hemoglobin level.
o Out of the given options, reticulocyte count increased first by second to third day.
Answer. a
175. Late onset hemorrhagic disease of newborn is characterized by all of the following features except
Sol :
Breast milk is a poor source of vitamin k, and hemorrhagic complications have appeared more frequently in breast fed than in formula fed
infants.
Answer. a
176. A 3-year old boy is brought to the casualty by his mother with progressive shortness of breath for 1 day. The child has history to bronchial
asthma. On examination, the child is blue, gasping and unresponsive, what will you like to do first
a. Intubate
Sol :
Child has H/O bronchial asthma. Child is blue, gasping and unresponsive suggest, that he is suffering from life threatening asthma.
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o Cyanosis
o Silent chest
o Altered sensorium
Answer. c
Sol :
Answer. a
178. All of the following are considered criteria used to diagnose attention deficit hyperactivity disorder except
a. Inattention
b. Hyperactivity
Sol :
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According to the DSM-IV, the core clinical features of this disorder include impulsivity, distractibility, an inability to sustain attention and/or
concentration, and developmentally inappropriate activity levels.
Answer. c
179. Webbing of neck, increased carrying angle, low posterior hair line and short fourth metacarpal are characteristics of :
a. Klinefelter syndrome
b. Turner syndrome
d. Noonan syndrome
Sol :
Answer. b
b. De-pan syndrome
c. Downs syndrome
Sol :
Fetal ultrasonographymay reveal increase nuchal fold thickness in case of Down syndrome.
Answer. c
181.
All of the following are features of haemolytic anemia except
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a. Hemoglobinuria
b. Jaundice
d. Hemosiderinuria
Solution. C
Haptoglobulin levels are decreased when there is haemolytic anemia. When daily turnover of Hb exceeds twice the normal rate, haptoglobulins tend to get
depleted. Low concentrations of haptoglobulins in absence of increased hemolysis may be found in hepatocellular diseaseIncreased. haptoglobulin levels
may be found in pregnancy, chronic infections, malignancy, tissue damage, Hodgkin disease, rheumatoid arthritis, SLE and biliary obstruction and as a
consequence of steroid therapy or the use of OCPs. Under these circumstances normal haptoglobulin does not exclude hemolysis.
Answer. c
182. Philadephia chromosome seen in chronic myeloid leukemia produces a protein called
a. P170
b. P210
c. P190
d. P230
Solution. B
Due to BCR ABL1 fusion in CML, the new protein formed is 210 kD or p210. P190 is seen in ALL.
Answer. b
183. A 62 year old woman presented with headache, chest pain and weak pulses in the upper limb. A biopsy from aortic arch showed granulomatous
inflammation with fragmentation of internal elastic lamina and narrowed lumen. The diagnosis is
a. Takayasu arteritis
c. Polyarteritisnodosa
d. Kawasaki disease
Solution. B
The histological findings and site is consistent with that of large vessel vasculitis and granulomatous inflammation. Since the age of the patient is more
than 50 years, the diagnosis will be Giant cell aortitis.
Answer. b
a. Aorta
b. Right atrium
c. Coronary artery
d. Left atrium
Solution. D
MacCallum plaques are seen in left atrium of a heart damaged by rheumatic heart disease due to valvular dysfunction leading to regurgitation jets.
Answer. d
185. Loss of which of the following protein is implicated in aiding metastasis of tumor cells?
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a. Integrins
b. Cadherins
c. Matrix metalloproteases
d. Cathepsin
Solution. B
Integrins are components of ECM which help in binding of cells to ECM. Although implicated in metastasis, E and N cadherins (part of desmosomes) are
more recognised in the mechanism of invasion of metastasis, the former, when lost, playing a role in epithelial-mesenchymal transition. Matrix
metalloproteases and cathepsin help breakdown stroma and aid invasion. Loss of E cadherin is also characteristically noted in Lobular carcinoma breast
and diffuse gastric carcinoma.
Answer. b
186. Ductal carcinoma in situ can be differentiated from invasive ductal carcinoma by all of the following except
a. Nuclear pleomorphism
Solution. A
DCIS shows nuclear pleomorphism just like an invasive carcinoma. But the presence of basement membrane invasion, loss of myoepithelial cells favour
IDC whereas central areas of necrosis are more characteristic of DCIS (called comedo type of DCIS). Hence, nuclear pleomorphism does not help to
differentiate between the two entities.
Answer. a
187. All of the following points are true about Lynch syndrome except
Solution. A
Warthin Lynch syndrome or Hereditary non polyposis coli cancer is the most common familial cause of colorectal carcinoma. Patients affected are
younger and usually involve the right colon. Mucinous, signet ring cell features are more common and intra tumoral lymphocytes are increased. Increased
incidence of other cancers like endometrial (most common), gastric, ovarian and transitional cell is also noted.
Answer. a
188. Which of the following is the most reliable feature of malignancy in a paraganglioma?
a. Presence of metastasis
b. Nuclear pleomorphism
Solution. A
Unfortunately, it is almost impossible to predict the clinical course of a carotid body tumormitoses, pleomorphism, and even vascular invasion are not
reliable indicators. Hence, presence of metastasis is the only reliable indicator of malignancy.
Answer. a
189. Which of the following is not true regarding genetics of thyroid tumors
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b. BRAF mutations are the most common mutations seen in papillary carcinoma
Solution. C
RET mutations are seen in medullary carcinoma and RET/PTC rearrangements are seen in papillary carcinoma.
Answer. c
c. Reticulocytosis is present
d. Unconjugated hyperbilirubinemia
Solution. C
Answer. c
a. Reticulocytes
b. HbH inclusions
d. Heinz bodies
Solution. C
Howell Jolly bodies are recognised on routine peripheral smearing, no special stain is needed.
Answer. c
192. Reduced beta globin chain production in thalassemia occurs due to which of the following genetic change?
a. Nonsense mutations
b. Gene deletions
c. Splicing mutations
d. DNA methylation
Solution. C
Most common cause of reduced beta chain production in thalassemia is splicing mutations and most common cause of absent beta chain production in
thalassemia is nonsense mutations. Gene deletions are seen most commonly in alpha thalassemia.
Answer. c
a. t(8;22)
b. t(8;14)
c. t(8;21)
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d. t(2;8)
Solution. B
In Burkitt lymphoma, c-myc amplification leading to its overexpression is noted. Different translocations involving the gene locus on chromosome 8 have
been identified- t(8;14), t(2;8) and t(8;22)- out of which the first accounts for more than 70% cases.
Answer. b
194.
A child presents with protrusion of eyes, increased thirst and diuresis and bony defects in the calvarium. A biopsy was performed and electron microscopy showed the
following. Which marker would confirm the diagnosis of this condition?
a. S-100
b. MHC II
c. CD 207
Solution. D
The clinical features and electron microscopy picture are consistent with Hand Schuller Christian triad- which is a multifocal unisystem occurrence of
Langerhans cell histiocytosis. The markers for LCH are all mentioned (CD 207 is Langerin)
Answer. d
a. Hepatic angiosarcoma
b. Rhabdomyosarcoma
Solution. A
Thorium used in contrast dyes and polyvinyl chloride are both implicated in causation of hepatic angiosarcoma
Answer. a
196. All of the following can occur due to asbestos exposure except
a. Mesothelioma
b. Laryngeal carcinoma
c. Ovarian carcinoma
d. Testicular tumors
Solution. D
Mesothelioma (most typical), lung carcinoma (most common), laryngeal, ovarian, colorectal carcinomas have all been implicated in asbestos exposure.
Answer. d
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197. A young patient with cough, wheezing, abdominal pain and deranged liver function tests is being evaluated. Liver biopsy stained with a special stain
shows the following. What finding will you expect in the lung?
Solution. A
The picture is that of a PAS stained liver biopsy. PAS positive inclusions can be seen within the hepatocytes. The patient is a young child with respiratory
and hepatic derangement symptoms. It is a case of alpha 1 antitrypsin deficiency leading to panacinar emphysema in the lungs. The histological
description of option A is most consistent with that.
Answer. a
a. HMB 45
b. MART1
c. SOX 11
d. SOX 10
Solution. C
Answer. c
b. Juvenile polyp
c. PeutzJegher polyp
d. Ulcerative colitis
Solution. A
Familial adenomatous polyposis is an inherited condition with neoplastic polyps, whereas JPS and PJP are classified under non neoplastic hamartomatous
polyps. Ulcerative colitis and Crohns disease comprise the spectrum of inflammatory bowel disease and therefore also carry a risk of colorectal cancer
(equal incidence).
Answer. a
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200. A child with delayed growth and history of malabsorption presents with pruritic, grouped vesicular rashes on the extensor surface of elbows and
knees. Immunofluorescence study shows the following. Which of the following findings can be expected if a biopsy from the small intestine is taken?
a. Normal histology
b. Crypt hyperplasia
Solution. B
The picture above shows immunofluorescence in tips of dermal papillae only. The clinical picture is most consistent with that of dermatitis herpetiformis.
An intestinal association of this condition is celiac disease (gluten sensitive enteropathy) which is characterised by loss of villus architecture but crypt
hyperplasia on biopsy evaluation.
Answer. b
201. Based on the dose response curve, which one of the following statement is true
Solution. (a) Drug A is more potent and more efficacy than drug C
Sol:
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Answer. a
202. Which one of the following receptor is mediated through inhibitory adenylcyclase pathway
a. M2
b. M1
c. Nm
d. Alpha 1
Solution. (a) M2
Sol:
M2 M4 Gi pathway
M1.M3, M5 Gq pathway
Alpha 2 Gi pathway
Alpha1- Gq pathway
Answer. a
a. Dexamethasone
b. Tocilizumab
c. Reislzumba
d. Anakinra
Sol:
Tocilizumab-IL 6 blocker
Steroids-IL, IL 6 blocker
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Answer. b
Sol:
o Teratogenicity -Thalidomide
Answer. b
Sol:
- Nabumetone is the only nonacid NSAID in current use; it is given as a ketone prodrug, Its half-life of more than 24 hours permits once-daily
dosing, Renal impairment results in a doubling of its half-life and a 30% increase in the area under the curve, has been associated with pseudoporphyria
and photosensitivity in some patients
Answer. b
a. Tardive dyskinesia
b. Narcolepsy
d. Mania
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Solution. (a) Tardive dyskinesia
Sol:
VALBENAZINE-
Valbenazine has not been effectively studied in pregnancy, and it is recommended that women who are pregnant or breastfeeding avoid use of
valbenazine
Answer. a
a. Clorgiline
b. Omeprazole
c. Digoxin
d. Reserpine
Sol:
Hit and run drugs: MAO inhibitors, PPIs, Guanethidine, Reserpine, Aspirin
Answer. c
a. Telmisartan
b. Valsartan
c. Losartan
d. Azilsartan
Sol:
Telmisartan is an angiotensin II receptor blocker that shows high affinity for the angiotensin II receptor type 1 (AT1), with a binding affinity 3000
times greater for AT1 than AT2.
In addition to blocking the RAS, telmisartan acts as a selective modulator of peroxisome proliferator-activated receptor gamma(PPAR-), a central
regulator of insulin and glucose metabolism. It is believed that telmisartans dual mode of action may provide protective benefits against the vascular
and renal damage caused by diabetes and cardiovascular disease (CVD).
Telmisartan's activity at the peroxisome proliferator-activated receptor delta (PPAR-) receptor has prompted speculation around its potential as a
sport doping agent as an alternative to GW 501516.
Answer. a
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a. Topotecan
b. Etoposide
c. L asparaginase
d. Pemetrexed
Sol:
Natural products
v. Antitumor antibiotics: Anthracyclines (daunorubicin, doxorubicin, epirubicin, idarubicin,mitoxantrone), bleomycin, dactinomycin, mitomycin-C
Answer. d
210.
a. Lu-Dotatate
b. Ivacaftor
c. Apafant
d. Anagrelide
Sol:
Apafant-Acute pancreatitis
Anagrelide-Essential thrombocytosis
Answer. a
a. Vorinostat
b. Aldeslukin
c. Panobinostat
d. Mepolizumab
Sol:
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Panobinostat- useful in multiple myeloma
Answer. a
a. Brentuximab
b. Gemtuzumab
c. Rituximab
d. Alemtuzumab
Sol:
Answer. a
a. Chlormphenical
b. Vancomycin
c. Penicillin
d. Cycloserine
Sol:
Answer. b
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Sol:
Acute Hepatitis
Patients with acute hepatitis rarely need to be treated for tuberculosis on an urgent basis. Since ATT can be delayed, it should be deferred until acute
hepatitis has resolved.
Once there is evidence of acute hepatitis in a patient receiving ATT, it is essential to immediately stop all potentially hepatotoxic drugs such as INH,
RIF, and PZA till complete clinical and biochemical resolution of hepatotoxicity. In the interim period, at least three non-hepatotoxic drugs viz. EMB,
streptomycin and quinolones such as ofloxacin, levofloxacin, etc. can be used after checking renal function and visual acuity
Most ATD can be safely restarted in a phased manner after complete resolution of transaminitis.
Hepatitis B virus (HBV) infection has been reported to be a significant risk factor for hepatotoxicity related to ATT
Isoniazid monotherapy is safe in patients with HBV infectionwhile multidrug ATT is associated with significant incidence of hepatotoxicity.
Multidrug therapy for tuberculosis is also associated with fulminant disease, increased mortality and later onset of hepatotoxic effects in these patients
Answer. c
a. Diarrhoea in HIV
b. Constipation in HIV
c. Neuropathy in HIV
d. Lymphoma in HIV
Sol:
Crofelemer-
Crofelemer (USAN, trade name Mytesi) is a botanical drug for the treatment of diarrhoea associated with anti-HIV drugs such as nucleoside
analog reverse transcriptase inhibitors and protease inhibitors.
Other possible uses include diarrhoea in children, acute infectious diarrhoea, and diarrhoea in patients with irritable bowel syndrome
Answer. a
Solution.
Sol:
Doses of metronidazole:
Answer. a
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a. Ondensetran
b. Nabilone
c. Aprepitant
d. Domperidone
Sol:
Aprepitant- NK 1 antagonist, useful for controlling delayed phase vomiting following anti cancer therapy
Answer. b
a. Roundworm
b. Hookworm
c. Tapeworm
d. Pinworm
Sol:
Albendazole is the drug of choice for the treatment of all nematode infestations including cutaneous larva migrans (creeping eruption), visceral
larva migrans
(toxocariasis) and neurocysticercosis except enterobius (mebendazole), wuchereria and brugia (DEC), onchocerca and strongyloides (ivermectin)
and dracunculus (Metronidazole).
Answer. c
a. Apraclonidine
b. Latanaprost
c. Dipivefrine
d. Betaxalol
Sol:
Answer. b
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220. Nasopharyngitis is the common side effect of
a. Linagliptin
b. Exenatide
c. Pramlintide
d. Acarbose
Sol:
Exenatide-GLP-1 analouge, ADR- gastero intestinal problem like nausea, vomiting and diarrhoea is common, rarely Necrotising pancreatitis
Answer. a
221.
Cardiac index is
Solution. C
Cardiac index is defined as cardiac output per square meter of body surface area and it averages 3.2L/min/sq meter.
Answer. c
222. All of the following cause heterometric regulation of cardiac output except
Solution. D
When cardiac output is regulated by changes in cardiac muscle fiber length, this is referred to as heterometric regulation. Conversely, changes in
contractility independent of length is called homometric regulation of cardiac output.
Answer. d
223. During exercise, a man consumes 1.8 L of oxygen per minute. His arterial O2 content is 190mL/ L and his O2 content of his mixed venous blood is
130mL/ L. His cardiac output is approximately
a. 10.0 L/min
b. 20.0 L/min
c. 30.0 L/min
d. 40.0 L/min
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Solution. C
To calculate flow or cardiac output (L/min) by the Ficks principle, divide the oxygen consumption in mL/min by the arterio-venous oxygen difference in
mL/L.
Answer. c
224. The work done by the left ventricle is significantly higher than the right ventricle even at rest, because
Solution. D
Since the resistance and therefore, the afterload is more for the left ventricle, work done by the left ventricle is substantially higher by the left ventricle.
Answer. d
a. inspiratory capacity
Solution. D
Answer. d
d.
Solution. D
During voluntary hyperventilation arterial Pco2 may fall as low as 15 mm Hg, alveolar Po2 increases to 120-140 mm Hg and cerebral blood flow reduces
by 30% or more because of the direct vasoconstrictor effect of hypocapnia on cerebral blood vessels. The cerebral ischemia causes light headedness,
dizziness, and paresthesias. Voluntary hyperventilation causes a CO2 washout resulting in a respiratory alkalosis.
Answer. d
227. Lactic acid given intravenously increases rate and depth of ventilation due its action on
a. medullary chemoreceptors
b. carotid bodies
c. central chemoreceptors
d. pulmonary chemoreceptors
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Solution. b
H+ stimulates the peripheral chemoreceptors to increase the rate and depth of ventilation. Lactic acid given intravenously will not have any effect on the
central or medullary chemoreceptors because it cannot cross the blood brain barrier
Answer. b
228.
a. PCT
b. TAL
c. DCT
d. CD
Solution. A
Maximum calcium (65%) is reabsorbed in the PCT. 25-30% of the filtered calcium is reabsorbed in the thick ascending limb. Calcium reabsorption in the
DCT (4-9%) is under the control of parathormone. Less than 1% of the filtered calcium is excreted in the urine.
Answer. a
a. oxyntic cells
b. parietal cells
c. chief cells
d. ECL cells
Solution. c
Oxyntic or parietal cells secrete HCl and intrinsic factor. Chief cells or peptic cells secrete pepsinogens and gastric lipase. ECL or enterochromaffin like
cells secrete histamine.
Answer. c
a. salivary glands
b. stomach
c. bile
d. pancreatic
Solution. B
Daily secretion of saliva is 800-1200mL. Gastric secretion is 2000-2500mL per day. Bile is approximately 500mL per day. Pancreatic secretion is 1500mL
per day.
Answer. b
a. Basket cells
b. Granule cells
c. Stellate cells
d. Golgi cells
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Solution. B
The neurotransmitter released by purkinje, basket, stellate and golgi cells is GABA whereas granule cells release glutamate.
Answer. b
232. All of the following are true about short chain fatty acids except
a. SCFAs are produced in colon by the action of colonic bacteria on complex carbohydrates, resistant starches and dietary fiber
Solution. D
SCFAs are produced in colon by the action of colonic bacteria on complex carbohydrates, resistant starches and dietary fiber and are absorbed in the
colon. 60% of total is acetate, 25% propionate, and 15% butyrate. Absorbed SCFAs are metabolized and make a significant contribution to the total caloric
intake. They exert a trophic effect on the colonic epithelial cells. SCFAs are absorbed by specific transporters present in colonic epithelial cells.
Answer. d
233. Which of the following movements does not occur in the colon?
a. peristalsis
b. segmentation contractions
Solution. D
Migrating motor complexes begin as a ring of contraction the body of stomach and terminate in the distal ileum.
Answer. d
234.
a. Reticulospinal tract
c. Rubrospinal tract
d. Vestibulospinal tract
Solution. d
Lateral corticospinal and rubrospinal tracts innervate the A alpha neurons to the flexors. Vestibulospinal tract innervate the A alpha to the extensors.
Answer. d
235. The circuit shown below has an inflow pressure of 120 mm Hg and an outflow pressure of 40 mm Hg. Resistance in each of the four vessels is 2 mm
Hg/mL/min. What is the total peripheral resistance of the circuit?
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a. 8 mm Hg/mL/min
b. 4 mm Hg/mL/min
c. 2 mm Hg/mL/min
d. 0.5 mm Hg/mL/min
When vessels are arranged in parallel, the total resistance is the sum total of the reciprocal of the resistance of the individual vessel.
Answer. d
236. A smoker states that he has been smoking for 6 years. In the first year he was taking up to 5 sticks per day only. In the next 3 years he increased it
to half pack per day (which was an odd number). In the 5th year, his habits worsened to 1 pack per day. In the last year he stated that his daily
sticks consumption is 2 packs per day. Select the correct statement for mean, median and mode of number of sticks are
a. 16,10,15
b. 16,10,10
c. 24,15,15
d. 16,16,15
Sol:
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Answer. c
237. Throat swab was done on a child & stool sample was also collected after the child had developed weakness in limbs. Child had no history of any
recent vaccination. Sewer sample were also positive for the virus. No wild strain was found in the community. Strain is:
a. Type 1
b. Type 2
c. Type 3
Sol:
Answer. b
238. A study was conducted to assess relationship between height and osteoporosis. In this two participants were chosen with the following details. This
is:
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a. Matched
b. Overmatched
c. Unmatched
d. Randomized
Sol:
Process of selecting controls so that they are similar to cases with regard to certain variables
Dont match for the variable in interest as wont be able to get statistical results
Eliminates confounding
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Answer. b
a. CXR
b. Smear examination
c. Both
d. CBNAAT
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Ref:Read the text below
Sol:
- As per the new revised guidelines of RNTCP any patient with HIV positive status; the test to be performed is CBNAAT
Answer. d
a. Case control
b. Cohort
c. Ecological
d. RCT
Sol:
Answer. c
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c. Mixed
d. Recurrent
Sol:
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Answer. a
a. 8 years
b. 10 years
c. 12 years
d. 6 years
Sol:
Answer. b
243. This diagram is the pictorial representation of which type of study design?
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a. RCT
b. Cross sectional
c. Ecological
d. Any of these
Sol:
Answer. a
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Sol:
Answer. a
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a. 3
b. 6
c. 15
d. 1.1
Solution. (b) 6
Sol:
This is a ROC/ Receiver Operator Curve which is used to select the cut offs
X- axis: 1 Specificity/ FP
Y- axis: Sensitivity/ TP
Types:
Excellent
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Answer. b
246. A person died in emergency. The anaesthetist was resuscitating the patient but in middle his mask fell off and had contact with patients mucosal
secretion as patient had coughed out gastric contents. The anaesthetist died after 10 days. No unnatural reasons were found. On autopsy intra
cytoplasmic bodies were found. The most probable infectious agent is:
a. Rabies
b. Botulism
c. Anthrax
d. Cause Unknown
Sol:
Answer. a
247. The intraocular pressure(IOP) was measured in a population of 400 people above age of 65. The mean IOP was 25 & SD was 10. What is the range
that would contain IOP of 95% of population:
a. 23-27
b. 21-29
c. 24-26
d. 22-28
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Solution. (c) 24-26
Sol:
Answer. c
a. Visual inspection of cervix is good enough in patient > 65 years old & regular PAP screening is not needed
c. If PAP smear did not show any abnormality test can be repeated in 3 years
d. Screening to be done in age group of 25 and 40 years as it the most needed time
Solution. (d) Screening to be done in age group of 25 and 40 years as it the most needed time
Sol:
Answer. d
249. In a centre number of nodes dissected during 20 modified radical mastectomy were plotted in form of curve & there are 3 markings on
curve below. Based on the distribution, which of following is correct?
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Sol:
Answer. a
c. 1 III; 2 V; 3 II; 4 I; 5 IV
d. 1 I; 2 III; 3 II; 4 V; 5 - IV
Sol:
Answer. a
Sol:
Reduvid bug (Triatominae/ Kissing/ Assassin/ Cone nose bug): Sleeping sickness (American trypanosomiasis (Chagas Disease)
Answer. d
252. Which of the following is false about the best indicators for disease burden?
Sol:
Answer. c
253. Which is not correct about the nodal heads for disaster management?
b. Level CHC
d. Ministry - Home
Sol:
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Answer. b
a. Rota
b. JE
c. Yellow fever
d. IPV
Sol:
All vaccines which are not reconstituted can be reused for up to a maximum of 4 WEEKS/ 28 days if
The expiry date has not passed; The vaccines are stored under appropriate cold chain conditions
Answer. d
a. Psychomotor
b. Cognitive
c. Affective
Sol:
Answer. a
256. A 35 year old women suffering from recurrent major depression becomes very distressed when her supervisor asks her to revise a projects she has
been working on for weeks. I dont do anything right. I must be the most incompetent person in the firm. I will lose my job for sure she state, sobbing,
to her therapist. According to the cognitive model, her depression is a consequence of which of the following Problems?
b. Hopelessness
c. Worthlessness
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d. Maladaptive negative beliefs
Sol:
The lady here is having cognitive distortion (also known as maladaptive assumptions or beliefs) that she has overgeneralised her problem when she
was asked to revise the project.
She did an arbitrary inference that I will lose my job for sure.
Answer. d
257. Which of the following is not true about KLEINE LEVIN SYNDROME?
b. Voracious eating
Sol:
Self limiting
Social withdrawal
Apathy
Irritability
Confusion
Voracious eating
Delusions/ hallucinations
Incoherent speech
Answer. d
258. Which of the following is not true about waveform seen in EEG below?
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Sol:
Sleep spindles and k complexesare seen in stage 2 nrem, with no rapid eye movements and reduced EMG levels.
Answer. c
259. An 18-year-old man is seen by a psychiatrist in the emergency room. During the history, the patient is asked to describe his mood. He answers the
following, My mood is flextitating, I am up and down. The patient is exhibiting which of the following thought disorders?
a. Clang association
b. Thought blocking
c. Tangentiality
d. Neologism
Sol:
A neologism is either the use of a completely made up word or phrase, or the use of an existing word or phrase in an idiosyncratic manner.
Clang associationsare thoughts which come out in a rhyming pattern, whether or not the verbalized sentence means anything logically.
Thought blocking is a sudden stoppage or blocking in the patients pattern of thought, so much so that speech is disrupted as well.
Tangentiality refersto a pattern of thought in which the patient answers a question with something that is related to the question, but does not answer it
directly. For example:
Answer. d
260. A psychiatric resident is called to consult on the case of a 75-year-old woman who had undergone a hip replacement 2 days before. On
examination,the resident notes that the patient states the date as 1956, and she thinks she is at her sons house. These impairments best illustrate which
aspect of the mental status examination?
a. Concentration
b. Memory
c. Thought process
d. Orientation
Solution.
(d) Orientation
Sol:
Orientation refers to the state of awareness of the individual as to time and place, and to the awareness of the identity of oneself and others
in the environment.
This is the reason patients cognitive states are often referred to as oriented 3, meaning oriented to person, place, and time.
Answer. d
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c. Supportive Psychotherapy
d. Crisis intervention
Solution.
Sol:
Answer. a
262. Most Common Location of imagined defect in patients with Body Dysmorphic Disorder?
a. Hair
b. Nose
c. Skin
d. Eyes
Sol:
Answer. a
263. A 23-year old man impulsively steals a pack of gum at a convenience store. He has never stolen anything previously, and almost immediately upon
exiting the store with the gum, he begins to feel extremely guilty.Which of the following concepts introduced by Freud is most likely responsible for this
mans emotional response to his theft?
a. Id
b. Ego
c. Superego
d. Preconscious function
Sol:
In his structural theory of the mind, Freud divided the psychic apparatus into three agencies: the id,which contains the instinctual drives; the ego,
whose function is to find an equilibrium between gratification of the instinctual drives and the rules of society (and the demands of the superego); and the
superego, the agency that contains the internalized parental and societal rules and dictates to the ego what is not to be done.
superegos prohibitions.
Preconscious and conscious functions are dimensions of the ego. Logical and abstract thinking as well as verbal expression come from these functions.
Answer. c
264. A young man is often the object of his friends jokes because he drops to the floor whenever he is having a good laugh. Which of the following
isthis man most likely suffering from?
a. Cataplexy
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b. Narcolepsy
c. Drop seizures
d. Histrionic personality
Sol:
Cataplexy refersto a sudden loss of muscle tone (ranging in severity from weakness in the knee to a total loss of tone) triggered by strong emotions,
which takes place during full wakefulness.
Cataplexy is thought to be because of an abnormal intrusion of REM sleep phenomena in periods of wakefulness.
It is usually treated with medications that reduce REM sleep, such as antidepressants.
Cataplexy maybe a symptom of narcolepsy, another dyssomnia characterized by the irresistible urge to fall asleep regardless of the situation.
Answer. b
265. A 46-year-old man is being monitored in a sleep study laboratory.After he has been asleep for 90 minutes, his EEG shows low-voltage,
random fast activity with sawtooth waves. When awakened during this period,the patient reports that he was dreaming. Which of the following
sleep stages was this patient in when awakened?
a. Alpha waves
b. Theta waves
c. Delta waves
Sol:
The EEG shows characteristic low-voltage waves that are random, fast, and saw toothed.S
Active eye movements are attributed to the individuals watching his or her dreams.
A lack of muscle tone during REM sleep prevents the individual from acting out his or her dreams.
REM sleep is also characterized by increased heart rate and blood pressure and penile or clitoral nocturnal erections.
Answer. d
a. MRI
b. USG
c. Mammography
d. CT
Sol:
Mammography will have limitations in sensitivity at her age because of a glandular breast which will be dense.
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MRI is recommended for screening for DCIS in high risk females and evaluation of breast implants. MRI also for differentiating operative scar from
recurrence.
Answer. b
Sol:
CXR erect is the classic xraywhich is considered the best Xray for detecting pneumoperitoneum and is considered better than abdominal erect.
However, in this question, all three choices mention CXR erect in different positions. AP & PA view have almost same sensitivity while a CXR erect
lateral projection has maximum sensitivity.
It is not often clinically done, but this is the answer. Also note CT Abdomen is most sensitive radiological investigation for pneumoperitoneum.
Answer. c
a. Mannitol
b. Water
c. Barium
d. Iodinated contrast
Sol:
MR enterography is a new non-invasive technique for diagnosis of small bowel disorders, like crohns disease.
Patients drink about 1-1.5 L of a 2.5% mannitol solution at regular intervals over a period of approximately 40 minutes prior to the study.
This solution acts as a hyperosmolar agent which draw fluid into the bowel and (biphasic) appears as low signal intensity on T1-weighted images
and high signal intensity on T2-weighted images
Answer. a
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b. 5 is LA, 4 is RA, 2 is RVOT, 1 Aortic root, 3 SVC
Sol:
Key to image
1 = root of aorta
2 = pulmonary outflow
3 = superior vena cava
4 = right atrium
5 = left atrium
6 = left pulmonary vein
7 = right pulmonary vein
8 = descending aorta
Answer. b
a. Coarctation of Aorta
c. TGA
d. Ebsteins anomaly
Sol:
Note the carinal widening, and bulge of the left atrial appendage. Also notice the double atrial density evident on the right side. These are findings
consistent with LA enlargement seen in RHD due to mitral valvular disease.
See the findings in this annotated image: In yellow the boundaries of the enlarged LA are shown.
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Ebsteins anomaly would show box shaped heart, with pulmonary oligaemia & predominately right atrial enlargement.
TGA (uncorrected) shows an egg on side/string appearance with narrow vascular pedicle.
Answer. b
a. CT
b. MRI
c. USG
d. PET
Sol:
FAST(focussed assessment with sonography in trauma) is the 1st step n evaluating a patient with blunt abdominal trauma.
Answer. a
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d. CT showing Thymus
Sol:
- This is a CT scan of the thorax, note the white appearance of bones and note the triangular structure in anterior mediastinum,just anterior to great
vessels: thymus.
Answer. d
b. Hyperparathyroidism
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d. Vertebral hemangioma
Sol:
Discussions
Choice C is not aneurysmal bone cyst. There is a lytic lesion in epiphysis of an immature skeleton, which is likely to be chondrobalstoma also called
as codmans tumour. Histological characterized by chicken wire calcification.
Choice Dis classic CT scan showing polka dot sign of the vertebral hemangioma
Choice Ais GCT of the lower end of radius in mature skeleton with multilocular/expansile appearance and subarticular location. ABC on the other
hand is seen in immature skeleton in subphyseal location
Choice B is subperiosteal resorption of the 2/3 digit on radial side, typical of hyperparathryoidism
Answer. c
c. Is rarely seen.
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Ref:Read the text below
Sol:
The area of hemoperitoneum adjacent to a source of bleeding is most likely to clot first and may thus help localize the source of bleeding.
The clotted component is more dense than the unclotted blood, not less dense.
Answer. a
275. An asymmetric breast density is seen on MLO view,but not on CC view. so next appropriate approach would be
a. Exaggerated CC view
b. Cleavage view
d. Rolled cc view
Sol:
The real lesion is unlikely to change its appearance, regardless of the angle of projection. A straight lateral view for an asymmetry seen only on a
mediolateral oblique (MLO) view and a rolled view for an asymmetry seen only on a craniocaudal (CC) view should be obtained.
If the asymmetryis maintained even after the angle of projection is changed, additional views in other projections should be obtained.
Answer. c
276. Sepsis increases metabolic needs by approximately what percentage above the normal value?
a. 25%
b. 50%
c. 75%
d. 100%
Sol:
Sepsis increases the metabolic needs to approximately 150-160% of resting energy expenditure, or 50% above normal.
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Answer. b
a. Carbohydrate
b. Protein
c. Fat
d. Vitamins
Sol:
In pulmonary failure formulas, fat content is usually increased to 50% of the total calories, with a corresponding reduction in carbohydrate
content.
The goal is to reduce carbon dioxide production and alleviate ventilation burden for failing lungs.
Answer. c
278. A 70 kg man with a laceration to the femoral artery loses approximately 850 cc of blood. He presents to the emergency with a PR of 101/min.
Which class of hemorrhage would this represent?
a. Class 1
b. Class 2
c. Class 3
d. Class 4
Sol:
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Answer. b
Sol:
Answer. c
280. In a patient with symptomatic varicose veins where the GSV has reflux and a diameter of 9mm, the preferred surgical treatment is:
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a. Sclerotherapy
c. Vein valvuloplasty
Sol:
RFA (radiofrequency ablation)is the best method to manage symptomatic varicose vein patients.
EVLT (endovenous laser therapy) is equally effective as RFA in the management of these patients
Sclerotherapyis used for patients with veins less than 3 mm in diameter and this technique is associated with a lot of complications
Open surgery (Trendenlenburg procedure) flush ligation of SFJ was done earlier but since the developmentof RFA/EVLT, this is not used.
Answer. b
281. Which of the following is not one of the five principles of surgical correction of GERD?
b. The operation should restore the pressure of the LES to 10 times the gastric pressure
d. The fundoplication should not increase the resistance above what the peristalsis of the esophagus can overcome
Solution. (b) The operation should restore the pressure of the LES to 10 times the gastric pressure
Sol:
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Answer. b
282. In an attempt to teach medical students about a barium swallow, a volunteer undergoes this test and is incidentally discovered with the finding
shown in the image. How should this patient be managed?
a. Observation
b. Dilation
Sol:
This image shows a schatzkis ring, which is a thin submucosal ring in the lower esophagus close to the squamo-columnar junction.
Asymptomatic patientsdont require any treatment whereas symptomatic patients should be managed with dilation.
Answer. a
283.
Which of the following catheter materials is most suitable for long-term use?
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a. Latex
b. Silicone
c. Rubber
d. Polyurethane
Sol:
Answer. b
284. What is the probable diagnosis of the patient with spinal cast presenting with bilious vomiting?
b. Duodenal obstruction
c. Peritonitis
d. Acute pancreatitis
Sol:
SMA arises from anterior aspect of aortaand crosses in front of the third portion of the duodenum to enter the root of mesentery.
Disease particularly affect young asthenic individual being more common in female.
Symptoms include profound nausea,vomiting, abdominal distension weight loss and post parandial abdominal pain.
Treatment Conservative
Answer. b
285. Which of the following preservative is used while packing catgut suture?
a. Isopropyl alcohol
b. Colloidal iodine
c. Glutaraldehyde
d. Hydrogen peroxide
Sol:
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Catgut suture
- Catgut suture causes inflammatory cellular reaction with release of protease. It also carries the risk of prion transmission.
- On soaking in chromic acid (chromic catgut) promote early dissolution in body fluids.
Answer. a
a. Adenoma
c. Atrophic gastritis
d. Verrucous gastritis
Sol:
Answer. c
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a. Hemorrhoid surgery
Sol:
The image shows a circular stapler, which is used for Hemorrhoid surgery, LAR following rectal cancer surgery & Esophago-jejunostomy
following total gastrectomy
Answer. b
288. Which one of the following statements regarding breast cancer during pregnancy is not true?
b. Breast conservation surgery can be done if the patient is diagnosed in the third trimester
Solution.
Sol:
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Usually BCS is avoided during pregnancy because radiotherapy cannot be given, but if the patient is diagnosed in the third trimester, BCS can be
done and RT can be given after delivery.
Hormonal therapy and RT are contraindicated in all trimesters. 2nd trimester is the safest trimester to give chemotherapy in breast cancer
Answer. c
289.
a. S. anterior flap
b. L. dorsii flap
d. Trapezius flap
Sol:
This image clearly highlights the marking of an L. dorsii flap, which is an axial flap based on the thoracodorsal pedicle.
This flap is used for the reconstruction of the chest wall and the breast.
Answer. b
a. Surgeons knot
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b. Grannys knot
c. Reef knot
d. Aberdeens knot
Sol:
Answer. a
a. Ulnar
b. Radial
c. Facial
d. Median
Sol:
In clinical practice ulnar nerve is the most common site for nerve stimulation monitoring.
Median; posterior tibial; common peroneal and facial nerve can also be used:
- To determine the exact site of injury at the time of surgery (as in brachial plexus repair)
Answer. a
292.
In the immediate postopera ve period the common cause of respiratory insuciency could be because of the following, except:
c. Mild hypovolemia
d. Myocardial infarction
Sol:
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Mild hypovolemia is well compensatedby body and is usually asymptomatic
Infact respiratory insufficient isseen only in serve hypovolemic shock, when there would be acidosis secondary to impaired tissue perfusion.
Answer. c
293. Which one of the following is an indication for IVC filter in a patient with DVT?
c. 55 year old male with recent history of intra-cranial hge with DVT
Solution. (c) 55 year old male with recent history of intra-cranial hge with DVT
Sol:
Answer. c
294. Which one of the following changes have been incorporated in the 8th AJCC classification for breast cancer?
c. LCIS has been removed as an in-situ lesion from the latest staging and is now considered a benign condition
Solution.
(c) LCIS has been removed as an in-situ lesion from the latest staging and is now considered a benign condition
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Ref: Read the text below
Sol:
According to the 8th AJCC Breast cancer classification, LCIS is no longer considered as an in-situ lesion. It has been labeled as a benign disease
with an increased risk of breast cancer.
Involvement of the pectoralis major muscle is not considered as chest wall involvement
Skin involvement is only when peaudorange, ulceration or satellite nodules are present
Answer. c
a. Tubercular lymphadenitis
c. Plasmacytoma
Sol:
FNAC is the first investigationdone in thyroid, parotid, breast and lymph node enlargement.
Answer. d
a. Bronchogenic carcinoma
b. Carcinoma parotid
c. Dysgerminoma
d. Osteogenic sarcoma
Sol:
Answer. c
297. Which one of the following statements is not true regarding Fowlers position?
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Sol:
Answer. a
298. The root cause of majority of wrong site surgeries result from:
a. Communication errors
b. Emergency surgery
d. Multiple surgeons
Solution.
Sol:
All the reasons listed can lead to wrong site surgery but the most important cause is communication errors and to prevent this a WHO surgical safety
checklist is used.
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The image below highlights the components of the WHO surgical safety checklist
Answer. a
a. Partial gastrectomy
b. Illeal transposition
c. Gastic bypass
d. Illeopancreatic diversion
Sol:
SURGICAL THERAPY
According to NIH guidelines for bariatric surgery, Patients must have a BMI greater than 40 kg/m2 without associated comorbid medical
problem. They must have also failed dietary therapy.
Not used now because of poor long term weight loss, a high rate of late stenosis of the gastric outlet, and a tendency for patients to adopt a high-
calorie liquid diet, thereby leading to regain of weight.
In this procedure bands are applied on the proximal part of stomach and work on the principle of restriction of oral intake by limiting the volume of
the proximal part of the stomach. Their advantage over the traditional vertical banded gastroplasty is adjustability.
The pars flaccid technique has become the approach of choice for placing the adjustable band
Complications include band slippage (common) and erosion of band (rare but serious).
BILIOPANCREATIC DIVERSION
The intestinal tract is reconstructed to allow only a short so-called common channel of the distal 50-cm of terminal ileum for absorption of fat and
protein.
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DUODENAL SWITCH/DS
Answer. b
300. In order to expose the celiac axis, left renal vein, superior mesenteric artery and abdominal aorta in a case of trauma.Choose the most appropriate
procedure?
Sol:
The suprarenal aorta, celiac axis, proximal superior mesenteric , and left renal arteries can all be exposed by left medial visceral rotation.
Answer. a
Test Answer
1. (c) 2. (b) 3. (b) 4. (c) 5. (a) 6. (d) 7. (a) 8. (d) 9. (c) 10. (d)
11. (c) 12. (d) 13. (c) 14. (d) 15. (a) 16. (d) 17. (c) 18. (a) 19. (c) 20. (a)
21. (c) 22. (b) 23. (c) 24. (c) 25. (b) 26. (a) 27. (c) 28. (d) 29. (c) 30. (a)
31. (a) 32. (d) 33. (b) 34. (a) 35. (c) 36. (a) 37. (a) 38. (c) 39. (a) 40. (c)
41. (b) 42. (a) 43. (c) 44. (d) 45. (a) 46. (a) 47. (d) 48. (d) 49. (d) 50. (b)
51. (a) 52. (b) 53. (d) 54. (b) 55. (d) 56. (d) 57. (a) 58. (a) 59. (d) 60. (a)
61. (b) 62. (a) 63. (a) 64. (c) 65. (a) 66. (b) 67. (a) 68. (a) 69. (c) 70. (d)
71. (a) 72. (c) 73. (d) 74. (b) 75. (a) 76. (d) 77. (b) 78. (b) 79. (d) 80. (c)
81. (a) 82. (b) 83. (a) 84. (a) 85. (d) 86. (b) 87. (d) 88. (b) 89. (b) 90. (d)
91. (c) 92. (c) 93. (c) 94. (d) 95. (d) 96. (d) 97. (d) 98. (c) 99. (a) 100. (b)
101. (c) 102. (c) 103. (c) 104. (c) 105. (a) 106. (c) 107. (d) 108. (c) 109. (c) 110. (d)
111. (c) 112. (c) 113. (d) 114. (c) 115. (a) 116. (b) 117. (d) 118. (b) 119. (d) 120. (d)
121. (d) 122. (d) 123. (a) 124. (c) 125. (c) 126. (a) 127. (b) 128. (c) 129. (d) 130. (c)
131. (c) 132. (b) 133. (a) 134. (b) 135. (c) 136. (d) 137. (a) 138. (b) 139. (d) 140. (c)
141. (c) 142. (b) 143. (c) 144. (d) 145. (c) 146. (d) 147. (a) 148. (a) 149. (b) 150. (a)
151. (a) 152. (b) 153. (d) 154. (d) 155. (a) 156. (a) 157. (a) 158. (d) 159. (a) 160. (b)
161. (d) 162. (b) 163. (a) 164. (c) 165. (c) 166. (d) 167. (a) 168. (a) 169. (c) 170. (a)
171. (d) 172. (a) 173. (b) 174. (a) 175. (a) 176. (c) 177. (a) 178. (c) 179. (b) 180. (c)
181. (c) 182. (b) 183. (b) 184. (d) 185. (b) 186. (a) 187. (a) 188. (a) 189. (c) 190. (c)
191. (c) 192. (c) 193. (b) 194. (d) 195. (a) 196. (d) 197. (a) 198. (c) 199. (a) 200. (b)
201. (a) 202. (a) 203. (b) 204. (b) 205. (b) 206. (a) 207. (c) 208. (a) 209. (d) 210. (a)
211. (a) 212. (a) 213. (b) 214. (c) 215. (a) 216. (a) 217. (b) 218. (c) 219. (b) 220. (a)
221. (c) 222. (d) 223. (c) 224. (d) 225. (d) 226. (d) 227. (b) 228. (a) 229. (c) 230. (b)
231. (b) 232. (d) 233. (d) 234. (d) 235. (d) 236. (c) 237. (b) 238. (b) 239. (d) 240. (c)
241. (a) 242. (b) 243. (a) 244. (a) 245. (b) 246. (a) 247. (c) 248. (d) 249. (a) 250. (a)
251. (d) 252. (c) 253. (b) 254. (d) 255. (a) 256. (d) 257. (d) 258. (c) 259. (d) 260. (d)
261. (a) 262. (a) 263. (c) 264. (b) 265. (d) 266. (b) 267. (c) 268. (a) 269. (b) 270. (b)
271. (a) 272. (d) 273. (c) 274. (a) 275. (c) 276. (b) 277. (c) 278. (b) 279. (c) 280. (b)
281. (b) 282. (a) 283. (b) 284. (b) 285. (a) 286. (c) 287. (b) 288. (c) 289. (b) 290. (a)
291. (a) 292. (c) 293. (c) 294. (c) 295. (d) 296. (c) 297. (a) 298. (a) 299. (b) 300. (a)
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