MH

PG CET 2011
A COMPILATION OF QUESTIONS AND EXPLANATORY ANSWERS

BY: YASHANT ASWANI RANK 1 MH PG CET 2011

foreword

The objective of this is to help students grasp the content in a very easy manner and so I have incorporated a lot of tables & flow charts --- the way I used to learn things. Plus it has been written taking references from the latest editions of books like Harrisons 18th ed. , Grays anatomy 40 th ed. , Williams Obs 23rd etc. to assure the latest medical information .I would wish a very good luck to all the students.In case of any doubt you can write to me on : yashant_aswani@rediffmail.com

Dedicated to my parents Mrs Laxmi aswani & Mr JK Aswani & my brother Nishant Aswani.

For Advani maam & Yogesh to smile

Special thanks: Dr Padma Badhe Dr Lohith Ambadipudi Dr Yogesh Thube Dr Ulhas Chakraborty Dr Chandrakant Satpute Dr Prashant Patil Dr Ricky Somai Dr Abhishek Jain

Acknowledgements: Dr Pallavi Jha Dr Shashank Raut Dr Chetan Gadekar Dr Ramesh Patil Dr Nikhil Saxena Dr Ankit Bhalani Dr Ankit Solanki

ANATOMY

1.Nucleus ambiguous gives rise to motor fibres A)Glossopharyngeal B)Vagus C)Cranio accessory D)All of the above

of following nerve(s):

2.Corpora Arenacea is characteristically found in A)Spinal neuron B)Amygdaloid body C)Pineal gland D)Posterior pituitary gland

3.Anorectal ring is formed by all except? A)Puborectalis B)Superficial external sphincter C)Deep external sphincter D)Internal anal sphincter

4.Following are the nerves of posterior cord of the Brachial Plexus except: A)Thoracodorsal B)Musculocutaneous

C Radial nerve D)Upper Subscapular

5.Knee joint cavity communicates with the following bursa: A)Subcutaneous Infrapatellar B) Subcutaneous Prepatellar C)Suprapatellar D)Deep Infrapatellar

6.Following vein drains into IVC Directly? A)Left Renal Vein B) )Left Adrenal Vein C) )Left Gonadal Vein D) ) )Left Inferior Phrenic Vein

7.Brunners glands are seen in: A)Duodenum B)Jejunum C)Stomach D) Ileum

8.Muscle insertion on anterior surface of Greater Trochanter of femur is: A)Gluteus maximus B) Gluteus minimus

C) Pyriformis D) Gluteus medius 9.All of the following statemants about paneth cell are true except: A)Rich in RER B)Rich in zinc C)Contains lysozyme

D)Foamy appearance

10.Killians dehiscence is present between: A)Middle & Inferior constrictor B)Superior & Middle constrictor C)Superior & Inferior constrictor D)Thyropharyngeus & Cricopharyngeus

11.The anterior margins of Epiploic foramen is a free peritoneal fold that contains: A)Portal vein,hepatic artery & bile duct B)caudate lobe C)IVC D)1st part of duodenum

12.The three germ layer embryo is A)Blastula B)Neurula C)Gastrula

called

D)Morula

13.The following are derivatives of Paramesonephric duct except: A)Uterus B)Ovary C)fallopian tube D)Upper part of vagina

14.Myelin sheath of neurons in CNS is A)Oligodendrocytes B)Schwann cells C)Microglia D)Astrocytes

synthesized by:

PHYSIOLOGY 15.Capacitation is the process of conditioning within: A)Vas deferns B)Epididymis C)Seminiferous tubules D)Female genital tract of sperms before fertilisation that occurs

16.During ventricular phase of depolarisation, which part is depolarised in the end: A)Papillary muscle B)Posterior basal part of LV

C)Outer surface of heart near the apex D)Interventricular septum

17.All of the following are the actions of hormone Insulin except? A)Neoglucogenesis B)Lipogenesis C)Amino acid transport into cell D)Inhibition of hormone sensitive lipase

18.Which of the following receptors hertz? A)Pacinian corpuscles B)Ruffinis ending C)Merkels disc D)Meissners corpuscle

responds rapidly to vibration sense

of 30 to 800

19.The voltage in mV(of membrane potential)when voltage gated Na channels are activated: A) -50 to -70 B) -70 to -90 C) -90 to -100 d) -100 to -130

20.The Equilibrium potential calculated by Nernst equation at 37 degree C for Chloride is A) Ecl = + 62.5 log [ Cl o ] / [ Cl I ] B) Ecl = - 61.5 log [ Cl I ] / [ Cl o ] C) Ecl = + 61.5 log [ Cl I ] / [ Cl o ]

D) Ecl = - 62.5 log [ Cl o ] / [ Cl I ]

21.Which of the following factor causes a shift to the right in oxygen hemoglobin dissociation curve? A) Increase in fetal haemoglobin B)Increase in pH C)Decrease in CO2 D)Increase in CO2

22.Which of the following is/are true for Oxygen debt mechanism functioning during vigorous muscle contraction: A)Excess accumulation of lactate and its rapid diffusion in blood B)Energy is predominantly extracted by anaerobic mechanisms C)Phosphoryl creatine is the source of ATP D)All

23.Which of the following is true as regards to action of somatostatin,insulin and glucagon? A)Glucagon blocks insulin and somatostatin B)Insulin blocks glucagon and somatostatin C)Somatostatin stimulates insulin D)Somatostatin blocks release of both insulin and glucagon

24.Folliculostatin usually binds and inhibits which of the following hormone? A)Estrogen B)FSH C)Progesterone

D)LH

25.Thromasthenin is: A)Thrombogenic protein B)contractile protein C)Plasminogen activator D)Anticoagulant

26.The transport maximum is defined as: A)Maximum tubular secretion B) Maximum tubular reabsorption C) Maximum tubular secretion and reabsorption D)All

27.Which of the following is related to appetite and satiety? A)Leptin B)Ghrelin C)Neuropeptide D)All

28.The absorption of which of the following is dependent on Na dependent co-transporter mechanism in the gut? A)Glucose B)Galactose C)Peptide D)all

29.Factor present in the final common terminal pathway of complement system is: A)C3 B)C4 C)C5 D)Protein B

30.the slow wave sleep predominating in the first third of night sleep is a feature of which phase? A)REM B)NREM-1 C)NREM-2 D)NREM -3&4

31(a).Glucocorticoids suppress the production of: A)Lymphocytes B)Platelets C)Eosinophils D)RBCs

31(b). Glucocorticoids suppress the production of: A)Lymphocytes B)Platelets C)Neutr ophils D)RBCs

32.In isometric exercise all are increased except? A)Heart rate B)Cardiac output C)Mean arterial pressure D)Systemic vascular resistance

33.Half life of monocytes is: A) 1-3 days B) 1-3 weeks C) 1-3 months D) 1-3years

BIOCHEMISTRY

34.The type of mutation that leads to the replacement of valine for glutamate in Sickle cell disease is: A)Nonsense B)Point C)Silent D)Missense

35.Which of the following amino acid participates in urea cycle as well as formation of nitric oxide:\?

A)Glycine B)Arginine C)Lysine D)Trytophan

36.Which of the following lipoproteins has the highest content of phospholipids? A)Chylomicrons B)VLDL c)LDL d)HDL

37.Proof reading is a function of A)DNA polymerase 1 B) DNA polymerase 2 C)restriction endonuclease D)Exonuclease

38.Glucose 6-phosphate has all possible fates within the cell except? A)Glycolysis B)HMP shunt C)Glycogenesis D)Neoglucogenesis

39.Which of the following complexes is not involved in the generation of proton gradient? A)Cytochrome oxidase

B) Cytochrome reductase C)Succinate CoQ reductase D)NADH CoQ reductase

40.Deficiency of the following vitamin would lead to excretion of xantheurenic acid in urine: A)Folate B)Pyridoxine C)Thiamine D)Ascorbic acid

41Parathormone exerts its bone resoptive action on its receptors present on all except A)Osteoblast B)Osteocyte C)Osteoclast D) Osteocyte membrane

42.Which is untrue about HGPRTase deficiency? A)Its deiciency produces Lesch Nyhan syndrome in males B)The enzyme is involved in salvage pathway of nucleotide metabolism C)It predominantly affects hepatocytes D)PRPP is the substrate

43.The 4 pyrrole rings in haemoglobin structure are joined together by : A)Hydrogen bonds B)Methylene bridges C)Alpha linkage

D)Disulfide linkage

44.Enzyme deficient in Alkaptonuria is A)Cystathionine synthase B)Tyrosinase C)homogentisic acid oxidase D)Phenyl alanine hydroxylase

45.Following properties favour water as an ideal bio solvent except? A)Hydrogen bonding capacity helps dissolve organic molecules B)Water is a polar solvent C)Capacity for covalent bonding D)high dipole moment causes dissolution of salts

46.Which of the following has fastest electrophoretic motility? A)Chylomicrons B)VLDL c)LDL d)HDL

PHARMACOLOGY

47.All of the following are selective beta blockers except? A)Pindolol B)Bisoprolol C)Atenolol

D)Nebivolol

48.Drug of choice for legionella infection is: A)Azithromycin B)Ceftriaxone C)Vancomycin D)Imipenem

49.Which of the following is GLP-1 agonist? A)Sitagliptin B)Exenatide C)Pramlintide D)Acarbose

50.Anti platelet action of aspirin lasts for A)28 days B)7 days C)14 days D)21 days

51.Dobutamine is agonist on the following receptors A)D1 B)Alpha & beta C)Beta D)All

52.Selective alpha -2 blocker is A)terazosin B)Tamsulosin C)Yohimbine D)Prazosin

53.The drug associated with Coronary steal : A)Nicorandil B)dipyridamole C)Ranolazine D)Diltiazem

54.Peliosis hepatis is caused by all except: A)Anabolic steroids B)OC pills C)Danazol D)analgesics

55.Ganciclovir is more effective than acyclovir against: A)Herpes B)Hepatitis C)CMV D)Influenza

56.Treatmant of choice for craniofacial mucormycosis is:

A)Liposomal amphotericim B B)Voriconazole C)Posaconazole D)Itraconazole

57.Following are uses of phentolamine : A)Antidote to nerve agents B) In Adrenergic crises C)For high altitude pulmonary edma D)All

58.Colchicine is : A)Analgesic B)Anti inflammatory C)Uricosuric D)None

59.The microsomal enzymes CYP2B &CYP3A are induced by all except A)Primidone B)valproate C)Phenobarbitone D)Phenytoin

60.Which drug acts by inhibiting DNA dependent RNA polymerase? A)Isoniazid B)Streptomycin

C)Ethambutol D)Rifamycin

61.Which of the following is least likely to cause increase in bradykinin concentration ? A)Benazipril B)perindopril C)Irbesartan D)All

62.Entacapone acts by inhibiting : A)COMT B)MAO-A C)MAO-B D)Decarboxylase

63.Erythromycin acts by interfering with _______in protein synthesis of bacteria. A)Transduction B)transcription C)Translation D)Translocation

64.Naloxone is an antagonist for which receptor(s)? A)Mu

B)Kappa C)Delta D)all

65.Hepatic necrosis is caused by: A)Carbon tetrachloride B)Yellow phosphorus C)Amanita phalloides D)all

66)Apparent volume of distribution for a drug is 5 litres per kg .In which of the following compartments will the drug be seen predominantly? A)Intravascular compartment B)Total body water C)Intra cellular fluid D)Extra cellular fluid

67)which of the following cannabinoid receptor blocker is used as an anti-obesity drug? A)Mazindol B)Orlistat C)rimonabant D)none

68.Which of the following is very effective in treatment of acute exacerbation of asthma & status asthmaticus? A)beclomethasone

B)Budesonide C)Fluticasone D)none

69.Following drugs inhibits gastrin production : A)Omeprazole B)Ranitidine C)Pirenzipine D)Misoprostol

PATHOLOGY

70.The following are major free radical scavenging systems except? A)Glutamine B)catalase C)Superoxide dismutase D)Glutathione

71(a).Mallory hyaline is characteristically seen in A)Yellow fever B)hepatitis B infection C)Primary sclerosing cholangitis D)Alcoholic hepatitis

71(b). Mallory hyaline is seen in A)Yellow fever

B)hepatitis B infection C)Primary sclerosing cholangitis D)Alcoholic hepatitis

72.Crescentic glomerulonephritis is seen with all except: A)Thromboangitis obliterans B)Wegeners granulomatosis C)polyarteritis nodosa D)All

73.Histamine is secreted by: A)Platelets B)Mast cells C)Basophils D)All

74.Which of the following is not an acute phase reactant protein: A)CRP B)Fibrinogen C)SAA protein D)Tissue factor

75.Following is /are the receptor for HIV infection A)CCR-5 B)CD-4

C)CCR-5 & CXCR-4 D)All 76.Idiopathic nephrotic syndrome is seen in all except: A)Membranous nephropathy B)Focal segmental glomerulosclerosis C)Membrano proliferative glomerulo nephritis D)Minimal change disease

77.In which of the following linear IgA deposits are seen? A)Henoch Schonlein Purpura B) Focal segmental glomerulosclerosis C) Membranous nephropathy D)Wegners granulomatosis

78.Intrinsic cell wall defect in RBC is a feature of A)Paroxysmal nocturnal hemoglobinuria B)Sickle cell disease C)Heredity spherocytosis D)All

79All are true for a choriocarcinoma except: A)Aggressive malignancy B)Common below 20 years of age C)Raised HCG levels D)Gonadal type is chemosensitive

80.Which type of thyroid neoplasms are associated with calcitonin induced amyloid deposition? A)Medullary B)Anaplastic C)Follicular D)Papillary

81.Ectopic rest of normal tissue is known as: A)Choristoma B)Lymphoma C)Pseudotumor D)Hamartoma

82.Pancreatic carcinoma is associated with raised levels of which of the following? A)CA-19-9 A)CA-125 C)CA-15-3 D)All

83.Following is the most reliable feature to differentiate a benign pheochromocytoma from a malignant one? A)capsular invasion B)Presence of mitoses C)Vascular invasion D)None

84(a).The major transgene to achieve angiogenesis in cardiac muscles is

A)VEGF B)FGF C)HIF-1-alpha D)TGF-beta

84(b).The major transgene to achieve growth of 2 nd heart field is : A)VEGF B)FGF C)HIF-1-alpha D)TGF-beta

85.Role of P-selectin is : A)Margination B)Rolling C)Adhesion D)Transmigration(diapedesis)

86.Most common cause of hyperpitutarism is: A)Prolactinoma B)GH-secreting adenoma C)FSH- secreting adenoma D)ACTH- secreting adenoma

87.Which of the following is the single most important indicator of likelihoodness of progression of Hepatitis B to liver cirrhosis ?

A)Etiology B)Associated serological findings C)Presence of bridging necrosis D)Presence of Mallory Hyaline

MICROBIOLOGY

88.Which of the following test is useful to differentiate micrococci from Staphylococci? A)Catalase test B)Hugh Leifsons test C)Oxidase test D)All

89. Which of the following is not true about Sabin vaccine ? A)3 doses as primary immunization are given. B)Doses given at an interval of 4-6 weeks C)Given I.M. D)Contains all 3 strains of viruses

90.Fish is one of the host for the following except: A)Paragonimus westermanii B)Clonorchis sinensis C)Ophisthorchis viverini

D)Diphyllobothrium latum

91.Loefflers medium is : A)Indicator B)Selective C)Enrichment D)Enriched

92.LGV is caused by: A)Chlamydia trachomatis B)Calymmatobacter granulomatis C)Hemophilus ducreyi D)Treponema pallidum

93.Transfer of a portion of DNA from one bacterium to another by the agency of a bacteriophage is known as: A)Transformation B)Transduction C)Conjugation D)Lysogenic conversion

94.True about bacterial capsule is all except: A)Stains by Grams stain B)Lost by repeated subcultures C)Protects bacteria from phagocytosis

D)It protects against action of lytic enzyme

95.Which is the alive part of Hydatid cyst? A)Ectocyst B)Pericyst cyst C) Endocyst D)None

96.Regression metamorphosis is a feature of : A)Hydatid cyst B)Cysticercoid C)cysticercus cellulosae D) cysticercus bovis

97.The Formol-Ether concentration technique ,the layer that contains parasites is A)Supernatant B)Formol water C)Ether D)Sediment

98.Iso hemagglutinin (anti-A & anti-B) are which type of antibodies? A)IgG B)IgA

C)IgM D)IgD

99.In Hot Air oven , a holding period of 1 hour is prescribed for a temperature of : A)100 degree C B)120 degree C C)140 degree C D)160 degree C

100.Mad cow disease is caused by: A)Bacteria B)Virus C)Fungus D)Prion

101.White Piedra is caused by: A)Piedraia hortae B)Pityriosporum orbiculare C)Malassezia furfur D)Trichosporon beigelii

102.Which is the only species of Shigella that produces an exotoxin? A)S.dysenteriae

B)S.Flexneri C)S.boydii D)S.sonnei

103.Mycobacterium avium is A)Photochromogen B)Scotochromogen C)Non Photochromogen D)Rapid growers

104.Weil-Felix reaction is useful for all except: A)Epidemic typhus B)Trench fever C)Endemic typhus D)Scrub typhus

105.The Fc piece of which immunoglobulin fixes C1? A)IgA B)IgG C)IgM D)IgE

106.Which of the following needs cholesterol and other lipids for growth? A)Mycobacterium TB

B)Hemophilus C)Yersinia D)Mycoplasma

107.Filariform larva is seen in A)Enterobius vermicularis B)Necator americanus C)Ascaris lumbricoides D)Trichuris trichura

108.Cutaneous larva migrans is seen in: A)Ankylostoma braziliense B)Ankylostoma duodenale C)Necator americanus D)None

109.Borrelia recurrentis is caused by: A)Mite B)Louse C)Tick D)Mosquito

110.Which is not a part of HACEK group? A)Hemophilus B)Corynebacterium C)Kingella D)Eikenella

111.In schwann cells .mycobacterium leprae divides in how many days? A)2-3 days B)11-13 days C)22-23 days D)32-33 days

FORENSIC MEDICINE AND TOXICOLOGY

112.The following can occur in death due to 12-14 hours of salt water drowning except: A)Acute fulminant pulmonary edema B)Hypovolemia/hemoconcentration C)Hemolysis with hyperkalemia D)Circulatory collapse

113.In death due to police firing ,inquest is done by: A)Magistrate B)Metropolitan magistrate

C)Doctor D)Assistant commissioner of police

114.Cut off age for juvenile offender is A)16 years B)18 years C)21 years D)15 years

115.The path of which of the following bullet can be followed after shot from the gun? A)Incendiary B)Tracer C)Yawning D)Tandem

116.Final authority on disciplinary action for professional misconduct is: A)MCI B)SMC C)Judicial magistrate D)None

117.Suit of negligence against doctor can be filed within what duration of negligent treatmant? A) 1/2 year B) 1 year

C) 1 years D) 2 years

118.Preservative used commonly for viscera preservation : A)10% formalin B)Saturated NaCl C)Rectified spirit D)Thymol

119Cupper sulfate is used as an antidote for A)Phosphorus poisoning B)Arsenic poisoning C)Mercury poisoning D)Lead poisoning

120.Le Facie Sympathique indicates: A)Antemortem hanging B)Suicidal hanging C)Homicidal hanging CD)Postmortem hanging

PSM 121. The study of physical, social & cultural history of man is known as-

A. B. C. D.

Anthropology Sociology Acculturation Social sciences

122. Which of the following units of measurement should be used in order to compare variation between two variables? A. Standard deviation B. Percentile C. Mean deviation D. Coefficient of variation

123. Under NLEP, leprosy status of Maharashtra state corresponds to which of the following category? A. Category 1 B. Category 2 C. Category 3 D. Category 4

124.(A) Soft tick transmitsA. KFD B. Q Fever C. Relapsing fever D. Indian tick typhus

124.(B) Soft tick transmitsA. KFD

B. Q Fever C. Relapsing fever D. All of the above

125. Which of the following method of assessment of protein quality gives complete assessment of protein quality? A. Biological value B. NPU C. Digestibility co-efficient D. amino acid score

126. The denominator of positive predictive value hasA. True positive + false negative B. True negative + false positive C. True positive + false positive D. True negative + false negative

127. In the calendar method, the first day of fertile period is calculated byA. Shortest cycle -18 B. Shortest cycle +18 C. Shortest cycle +10 D. Shortest cycle -10

128. Assessment & aiding for development of funds for the National Blindness Control Program was done byA. UNICEF

B. World Bank C. DANIDA D. WHO

129. When ortho-toluidine is added to water, which color is produced? A. Blue B. Red C. Yellow D. Green

130. Which of the following is most sensitive index foe recent malaria transmission? A. Infant parasite rate B. Spleen rate C. Average enlarged spleen D. Parasite density index

131. In MDG, the numbers of goals directed towards health are? A. 1 out of 8 B. 2 out of 8 C. 3 out of 8 D. 4 out of 8

132. A patient who has come with a new , clean wound with tetanus immunization 6 yrs back needs to takeA. Observe B. 1 toxoid

C. 1 toxoid + immunoglobulin D. complete course of toxoid

133. According to International standards, still birth is defined as death of fetus weighing ________ or more dying in 1 yr in every 1000 total births. A. 500gms B. 750gms C. 1000gms D. 1250gms

134. If the annual growth rate of population is 1.5-2% what will be the numbers of years for the population to get doubled? A. 35 to 47 years B. 28 to 35 years C. 23 to 28 years D. 47 to 70 years

135. Which of the following studies was conducted to determine that Community Health Education contribute to reduced risk of cardio vascular diseases A. Stanford -3- community study B. North Karelia Project C. MRFIT D. Oslow international study 136. In WHO growth chart, the upper reference curve corresponds toA. 80th percentile of boys B. 80th percentile of girls C. 50th percentile of boys

D. 50th percentile of girls

137. Sullivans index is an indicator ofA. Burden of disease B. Disability rate C. Literacy rate D. Mortality rate

138. According to Bio Medical waste, 1998, the yellow color code is forA. Human anatomical waste B. Chemical waste C. Incineration ash D. Disinfectants & insecticides

139. Which of the following is not a fundamental aspect of disease management? A. Disease response B. Disease mitigation C. Disease awakening D. Disease preparedness

140. PERT & CPM are components ofA. Work sampling B. Network analysis C. Input analysis D. System analysis

141. PQLI does not includeA. Literacy B. Per capita income C. Life expectancy D. Infant mortality

142. Nalgonda technique is used forA. Fluorine B. Chlorine C. Nitrate D. Nitrite

143. The time interval between reception of infection & maximum infectivity of the host isA. Generation time B. Incubation period C. Latent period D. Serial interval

OPHTHALMOLOGY 144. Drug of first choice for primary open angle glaucoma : a. Latanlprost b. Dorzolamide c. Brimonidine d. Timolol

145. Anti glaucoma drug that is long acting and used once daily: a. Latanoprost b. D Dorzolamide c. Brimonidine d. Timolol

146. Latent squint is also known as : a. Heterophoria b. Heterotropia c. Exophoria d. Esophoria

147. Sea fans configuration of retina is seen in : a. Retinopathy of prematurity b. SLE c. CRAO d. Sickle cell disease

148. If a neonate is suffering from bilateral dense lenticular opacities since birth , the ideal time to operate so as to avoid stimulation deprivation amblyopia : a. 6 weeks b. 6 months c. 12 weeks d. 12 months

149. Keratic precipitates and cells in the anterior chamber of eye are suggestive of ? a. Conjunctivitis b. Keratitis c. Scleritis d. Iridocyclitis

150. The radius of curvature of anterior surface of cornea is : a. 6.8 mm b. 7.8 mm c. 5.8 mm d. 4.8 mm

151. The visible spectrum of light is : a. 200 280 nm b. 280 320 nm c. 320 400 nm d. 400 700 nm

152. Angular conjunctivitis is caused usually by : a. C. diphtheriae b. Moraxella axenfield c. C. trachomatis d. Staphylococcus aureus

153. On SAFE strategy false is : a. Screening b. Antibiotics c. Facial hygiene d. Environmental modification

154. Laser used in LASIK is : a. Excimer b. Nd YAG c. Krypton red d. Argon green

155. Rosette shaped cataract is sen in : a. Trauma b. Diabetes c. Complicated cataract d. Wilson disease

156. Blue sclera is seen in : a. Osteogenesis imperfecta b. Osteopetrosis c. Achondroplasia d. Cleido cranial dysostosis

ENT 157. All of the following are extrinsic laryngeal membranes/ligaments except,

a. hyoepiglottic b. cricothyroid c. cricotracheal d. thyrohyoid

158. For which of the following frequencies , the normal transmission has the greatest sensitivity, a. 3000Hz b. 800-1600Hz c. 500-3000Hz d. 500-2000Hz

159. Which of the following is the only intrinsic muscle of larynx that lies in the laryngeal framework ? a. cricothyroid b. posterior cricoarytenoid c. lateral cricoarytenoid d. aryepiglotticus

160. Mucocoele most commonly affects which of the following paranasal sinus? a. frontal b. ethmoid c. sphenoid d. maxillary

161. Lucs abscess is found involving

a. posterior root of zygoma b. external auditory canal c. digastric triangle of neck d. angle of jaw

162. Which of the following is associated with metaplasia a. atrophic rhinitis b. rhinitis sicca c. rhinoscleroma d. rhinitis caseosa

163. Following is false as regards to acute retropharyngeal abscess a. extends into paranasal space b. torticollis is not uncommon c. present to the one side of midline d. caries of the cervical spine is the common cause

MEDICINE

164. Chediak Higashi syndrome is associated with all except: a. delayed microbial killing b. defective degranulation c. neutrophilia d. giant granules are seen

165. AFP is present in all except a. seminoma b. yolk sac tumor c. embronal carcinoma d. immature teratoma

166. Most common type of diabetes associated neuropathy a. mononeuropathy b. distal symmetric polyneuropathy c. autonomic neuropathy d. polyradiculopathy

167. Which of the following retroviral drugs cause nephrolithiasis ? a. zidovudine b. tenofovir c. efavirenz d. indinavir

168. Which of the following histopathological subtypes of emphysema is associated with alpha-1 antitrypsin deficiency a. centriacinar b. panacinar c. distal acinar d. irregular variant

169. Following drugs cause pyridoxine deficiency

a. hydralazine b. isoniazid c. penicillamine d. All

170. Libman Sachs endocarditis is seen in a. bacterial endocarditis b. SLE c. non bacterial thrombotic endocarditis d. rheumatic heart disease

171. Cork Screw appearance of esophagus is seen in a. monilial esophagitis b. achalasia c. diffuse esophageal spasm d. carcinoma esophagus

172. Which of the following drug should be given to a pregnant lady as chemoprophylaxis while she is travelling in chloroquine resistant malaria endemic zone a. proguanil/atovaquine b. mefloquine c. primaquine d. doxycycline

173. For the following malignancies, staging is not only an important prognostic factor but also helps in guiding therapy

a. follicular lymphoma b. Hodgkins lymphoma c. Burkitts lymphoma d. multiple myeloma

174.HRCT is investigation of choice for a.Mediastinal masses b.Interstitial Lung Disease c.Bronchogenic carcinoma d.Traumatic Chest lesions

175.Which of the following does not play role in production , maintenance & activation of lymphocytes? a. IL 1 b. IL 2 c. IL 4 d. IL 12

176. Which of the following antibody is associated with Hepatitis C ? a.Anti LKM 1 b. Anti LKM 1&2 c. Anti LKM 2 d. Anti LKM 3

177. Which of the following is associated with niacin deficiency a. Riboflavin deficiency

b.INH therapy c.Pyridoxine d.All

178.Inheritance pattern of ABO blood group system is : a.Autosomal dominant b.Pseudo dominant c. Autosomal recessive d.Co dominant

179.Apoptosis is inhibited by: a. p 53 b. N myc c. RAS d. BCL 2

180. Which of the following is untrue for Cholorrheic enteropathy? a.Response to low fat diet is good b.Bile acid pool is normal c.Fecal loss of fat is insignificant d.Responds well to cholestyramine

181.Heinz bodies are seen in : a.Thalassemia b.Hereditary spherocytosis

c.G 6-PD deficiency d.PNH

182.Following is /are the ECG criteria for LVH: a.RaVL + SV 3 > 20 mm b. RaVL + SV 3 > 28 mm c.SV1 + RV 6 > 35 mm d.All

183. Which of the following can be given a single intravenous bolus over a period of 10 seconds? a. t PA b. TNK c. r PA d. All

184.Causes of bilateral facial palsy is / are : a. GBS b.Sarcoidosis c.Lymes disease d.All

185.Fully humanized monoclonal antibody used in Rheumatoid arthritis is : a.Adalimumab b.Etanercept

c.Infliximab d.Anakinra

186.The most common organism isolated from ABPA is : a.Aspergillus nigra b. Aspergillus nidularis c. Aspergillus fumigatus d. Aspergillus flavus

187.Thermoactinomyces is not a cause for: a.Mushroom workers disease b.Farmers lung c.Millers lung disease d.Bagassosis

188. Which of the following is an autosomal dominant disorder? a.Hemochromatosis b.Wilsons disease c.MEN 2 d.All

189.Most common inherited cause of bleeding disorder is : a.Von Willebrand disease

b.Bernard Soulier syndrome c.Glanzmann thromasthenia d.All

190. Which of the following types of RTA is associated with hyperkalemia? a.RTA 1 b.RTA 1 & 2 c.RTA 2 d.RTA 4

191.Henoch schonlein purpura is characterised by all except : a.Palpable purpura b.Arthralgia c.Renal failure d.Thrombocytopenia

192.Cataplexy is a feature of: a.OSAHS b.Idiopathic hypersomnolence c.Narcolepsy d.All

193.in which of the following ,prominent Y descent is not seen ? a.Restrictive cardiomyopathy b.Constrictive pericarditis c.Cardiac tamponade d.RVMI

194.Prazosin is effective for treatment of : a.Naja naja b.Viper snake c.Mesobuthus tamulus d.All

195.Characteristic EEG pattern in absence seizure is a.3 HZ spike waves b.Hypsarrhythmia c.Generalised polyspikes d. 1 2 Hz spike waves

196.Drug of choice for MAC prophylaxis is : a.Azithromycin b.Ceftriaxone c.Imipenem d.Vancomycin

197.Neutropenic FUO is defined as neutrophil count less than ) per ml ): a.200 ml b.350 ml c.500 ml d.750 ml d. Post mastectomy irradiated limb

SURGERY

198. Most common location of spleenunculi is : a. Tail of pancreas b. Mesocolon c. Hilum of spleen d. Spleenic ligaments

199. Most common benign tumor of spleen is : a. Lymphoma b. Lymphangioma c. Hemangioma d. Angiosarcoma

200. Most common cause of chylothorax in children is : a. Congenital b. Post surgery c. Malignancy

d. Trauma

201. An adrenal mas is removed when the size starts growing beyond : a. 1.5 cm b. 4 cm c. 7.5 cm d. 10 cm

202. Treatment of choice for stage 1 non seminoma: a. Orchidectomy & RPLND b. Orchidectomy & radiotherapy c. Orchidectomy & radiotherapy d. Chemotherapy & radiotherapy

203. All of the following are indications for thoracotomy except: a. Initial blood loss > 1500 ml b. Cardiac tamponade c. Continuing blood loss > 100 ml / hour d. Persistent air leak

204. Ormands disease is a. Idiopathic retroperitoneal fibrosis b. Idiopathic mediastinal fibrosis c. Idiopathic thyroiditis d. Idiopathic mesenteritis

205. Most common site for Lymphangiosarcoma is : a. thoracic duct b. Retroperitoneum c. Uterus d. Post mastectomy irradiated limb

206. All of the following are criteria for admission to a burns unit except: a. Any burn in a unmarried woman b. Inhalational injury caused due to burns c. Burns > 15 % of total body surface d. Chemical burns / acid burns

207. Morbid obesity is defined as BMI greater than ( in kg / m2 ): a. 35 b. 30 c. 40 d. 45

208. Charles Philip procedure is for a. Urethral stricture b. Solitary rectal ulcer c. Recurrent intestinal obstruction d. Small bowel atresia

209. Most common site for Angiodysplasia is : a. Ascending colon b. Tranverse colon c. Descending colon d. Sigmoid colon 210. Most common site for Posterior Urethral Valve is : a. Proximal to veromontanum b. At the veromontanum c. Distal to veromontanum d. None

211. Which of the following is correct regarding Peyrronies disease ? a. Fixed deformity of penis b. Bowing deformity of erect penis c. Fibrosis of corpora spogiosa d. None

212. Which of the following conditions when identified on a plain X ray and necessitates cholecystectomy ? a. Cholesterolosis b. Porcelain gall bladder c. Cholelithiasis d. Emphysematous cholecystitis

213. Which of the following is the earliest manifestation of renal tuberculosis? a. Increased urinary frequency

b. Painless hematuria c. Renal angle tenderness d. Sterile pyuria

214. Most common site of ulcer in Solitary Rectal Ulcer Syndrome (SRUS )? a. Posterior wall b. Right lateral wall c. Left lateral wall d. Anterior wall

215. Carcinoma prostate is common in : a. Central zone b. Transition zone c. Peri urethral zone d. Peripheral zone

216. Deleromes operation is done for : a. Solitary rectal ulcer syndrome b. Rectal prolapse c. Rectal stricture d. Rectal carcinoma

217. The normal Lower Esophageal Sphincter pressure is in mm Hg ) : a. 2 10 b. 10 25 c. 22 30

d. 5 - 15

218. Spigelian hernia occurs a. Through the obturator canal b. At the level of arcuate line c. Above / below umbilicus through linea alba d. Through the posterior parietal peritoneum

219. In Ulcerative colitis , diagnosis of toxic megacolon is confirmed if the diameter of colon on X ray is more than : a. 4.5 cm b. 5.5 cm c. 6 cm d. 7 cm

220. Which of the following has worst prognosis? a. Cystadenolymphoma b. Muco epidermoid carcinoma c. Adenoid cystic carcinoma d. Acinic cell carcinoma

221. Following polyp does not have malignant potential : a. Juvenile polyp b. Hamartomatous polyp in Peutz Jeghers syndrome c. Juvenile Polyposis syndrome d. Famalial Adenomatosis Polyposis syndrome

OBSTETRICS & GYNECOLOGY

222(A). The most common type of degeneration seen in uterine fibroid is : a.Cystic degeneration b.Red degeneration c. Calcific degeneration d. Hyaline degeneration

222(B). The most common type of degeneration seen in uterine fibroid during pregnancy is : a.Cystic degeneration b.Red degeneration c. Calcific degeneration d. Hyaline degeneration

223. Indications for colposcopy include all except: a. Women with abnormal Pap smear b. Clinically suspicious cervical lesion with history of contact bleeding c. For conservative treatment of Cervical Intraepithelial Neoplasia d. Obvious visible growth

224. Which of the following diameters is engaged in face to pubis delivery? a. Occipito frontal

b. Suboccipito bregmatic c. Submento vertical d. Submento bregmatic

225.As per ACOG criteria to diagnosis GDM using GTT ; plasma glucose at 2 hours post oral glucose consumption should be more than ( mg / dl): a. 180 b. 140 c. 95 d. 155

226. Diagnosis of ectopic pregnancy can be made with hCG level more than________ at 4 weeks of amenorrhea? a. 1000 m IU / ml b. 1500 m IU / ml c. 2000 m IU / ml d. 2500 m IU / ml

227. Using Mifepristone , therapeutic abortion can be induced until__________ weeks of gestation? a. 6 b. 7 c. 8 d. 9

228. Breast self examination by females should be done at what time in relation to the monthly cycle: a. Pre- menstrually b. During menses c. Following menses d. During ovulatory period

229.Maximum circumference of fetal head is : a. 32.5 cm b. 34.5 cm c. 30.5 cm d. 33.5 cm

230. If fetal presenting part is at ischial spine , it is said to be at which station? a. 2 b. 1 c. 0 d. + 1

231. Fetal tachycardia is defined as heart rate more than ( beats per minute): a. 140 b. 150 c. 160 d. 170

232. During repair of cervical tear, the first stitch is placed: a. At the angle b. Above the angle c. Below the angle d. Anywhere

233. Which is the longest diameter among the following? a. Bitemporal b. Biparietal c. Occipito mental d. Occipito frontal

234. Strawberry vagina is seen in : a. Gardenellosis b. Trichmoniasis c. Candidiasis d. HSV infection

235. Most common cause of acute renal failure during pregnancy is: a. Abruptio placentae b. HELLP syndrome c. Pre eclampsia / eclampsia d. Abortion

236. The following is / are complication of intra uterine fetal death : a. Hypofibrinogenemia

b. Sterility c. Cervical tear d. All

237.Most common type of conjoint twin is : a. Thoracopagus b. Craniopagus c. Ischiopagus d. Abdominopagus

238. The dose of radiation at point B in treatment of cervical carcinoma is : a. 5000 rads b. 2000 rads c. 3000 rads d. 8000 rads

239. If a lady presents with complaints of vomiting and PV bleed with fundal height more than period of gestation , is likely suffering from : a. Hydatidiform mole b. Poly hydramnios c. Abruptio placenta d. Threatened abortion

240. The type of abortion in which Os is open and abortus is present in uterus is: a. Threatened abortion

b. Incomplete abortion c. Missed abortion d. Inevitable abortion

241.Criteria for Twin to Twin transfusion syndrome are all except ? a. Fetal weight discrepancy more than / equal to 25 % b. Hemoglobin concentration difference equal to/ more than 5 gm % c. Oligohydramnios & anemia in donor twin d. Oligohydramnios & anemia in recipient twin

242. Following change is first to occur on administration of Iron therapy? a. Decreased irritability b. Reticulocytosis c. Increased serum iron d. Replenished iron stores

243. Which is the most sensitive criteria for fetal well being in 2 nd trimester of pregnancy? a. Head circumference b. Abdominal circumference c. Femur length d. Bi parietal diameter

244.Surgery for entrapped head of breech is : a. Kelly operation b. Mc Donald operation

c. Kerr s operation d. Duhrssens operation . PEDIATRICS

245.In a 1 year old child hypogltcemia should be treated with which of the following? a. 100 ml /kg , 25% dextrose b. 4 ml / kg ,25 % dextrose c. 2 ml / kg , 25 % dextrose d. 2ml / kg , 10 % dextrose

246. Which of the following is ideal for maintenance of body temperature of a newborn during transportation? a. Transport incubator b. Thermocol box c. Kangaroo Mother Care d. Hot water bottle

247. In which of the following Mucopolysaccharidoses is cloudy cornea not seen? a. Maroteaux Lamy syndrome b. Hurler syndrome c. Hunters syndrome d. Morquio syndrome

248. Apple peel bowel with loss of dorsal mesentery is a feature of which type of ileal atresia?

a. Type 3 b. Type 2 c. Type 4 d. Type 1

249.When are the chances of HIV transmission from a mother to her baby maximum ? a. Ante natal period b. Intra partum ( Cesarean section ) c. Intra partum ( Vaginal delivery ) d. Breast feeding

250. What is the amount of citrate present in WHO ORS 2002 formula? a. 1.5 gm b. 2.5 gm c. 2.9 gm d. 3.9 gm

251. The amount of WHO ORS required in first 4 hours in a 1 year old child with some dehydration ( weight of the child is not known ) is : a. 200 400 ml b. 400 600 ml c. 600 800 ml d. 800 1200 ml

252. All of the following are true for Regurgitation except ? a. There is no nausea b. Effortless regurgitation of meals post feeding c. Can lead to failure to thrive d. Seen in 3 5 year old children.

253. A 2 year old child was brought to PHC with a history of cough and fever for 4 days with inability to drink for last several hours .The respiratory rate is 45 / minute. The child will be classified as : a. Very severe disease b. Severe pneumonia c. Pneumonia d. No pneumonia

254. Lactose content of breast milk ( per 100 ml ) is : a. 3.5 g b. 4.5 g c. 6 g d. 7 g

ORTHOPAEDICS

255. Sequestrum is best defined as A) A piece of dead bone surrounded by infected granulation tissue. B) A piece of dense sclerotic bone surrounding infected granulation tissue.

C) A piece of dead bone surrounding infected granulation tissue. D) A piece of dead bone.

256. Most common ligament injured in ankle sprain A) anterior talofibular B) posterior talofibular C) deltoid D) spring

257. What is the percentage mortality in first rib fracture? A) 5% B) 10% C) 20% D) 36%

258. Hill sachs lesion is seen in A) posterior shoulder dislocation B) recurrent shoulder dislocation C) inferior shoulder dislocation D) anterior shoulder dislocation

259. In congenital dislocation of knee, what is the attitude in which knee joint is found? A) flexion B) genu varus C) genu valgus D) hyperextension

260. Avascular necrosis of femoral head is seen most commonly with A) intracapsular fracture neck femur B) extracapsular fracture neck femur C) dislocation of hip D) fracture femur shaft

261. All of the following about Giant Cell Tumor are false except A) seen in <15 years of age B) usually present as lytic lesion with sclerotic rim C) epiphyseal in location D) nature is always benign

262. Deformity most common in primary osteoarthritis of knee A) genu valgus B) genu recurvatum C) genu varus D) none

263. Tension band wiring is done for all except A) fracture patella B) fracture olecranon C) fracture medial malleolus D) Colles fracture

264. Winging of scapula is seen in injury of A) bells nerve B) thoracodorsal nerve C) median nerve D) radial nerve

DERMATOLOGY 265. Max Joseph space is seen in A) Pityriasis rosea B) Lichen planus C) Psoriasis D) Darriers disease

266. Koebners phenomenon is not seen in A) Molluscum contagiosum B) Scleromyxedema C) Erythema multiforme D) Darriers disease

267. Which of the following vesiculobullous disorder exhibit intraepidermal split? A) Bullous pemphigoid B) Pemphigus vulgaris C) Dermatitis herpetiformis D) All 268. Dennie Morgan folds are seen in A) Dermatitits herpetiformis

B) Hailey-Hailey disease C) Atopic dermatitits D) Erythema multiforme

269. Pedal botryomycosis is caused by A) Actinomycosis somaliensis B) Staphylococcus aureus C) Nocardia asteroids D) Madura madurella

270. A sexually active male presents with an ulcer on glans that is painless and bleeds on touch. He is suffering from A) chancre B) donovanosis C) chancroid D) lymphogranuloma venereum

271. Auspitz sign is a feature of A) Pemphigus vulgaris B) Psoriasis C) Lichen planus D) Pityriasis alba

272. Condyloma acuminata is caused by A) HPV B) HSV

C) HIV D) Parvo

ANAESTHESIA

273. Which of the following is the most effective treatment for post dural puncture headache? A) drip of Hartmans solution in epidural space B) NSAIDs C) epidural blood patch D) intravenous fluids

274. Maximum plasma protein binding is seen in which of the following local anaesthetics A) procaine B) bupivacaine C) mepivacaine D) tetracaine

275. Following are contraindicated in renal failure except A) enflurane B) pethidine C) pancuronium D) midazolam

276. Which of the following may result in sudden increase in ET CO2 A) hypoventilation B) malignant hyperthermia

C) hyperthyroidism D) all

277. Which of the following is the use of capnography ? A. Determining vaporizer malfunction B. Determining circuit hypoxia C. Detecting concentration of O2 in anaesthetic circuit D. Determining appropriate placement of endotracheal tube.

278. Which of the following is the longest acting aneasthetic ? A. Lignocaine B. Dibucaine C. Chlorprocaine D. Prilocaine

279. Following is known to potentiate actions of succinyl choline. A. Sevoflurane B. Nitrous oxide C. Halothane D. Isoflurane

280. The colour of NO ( nitric oxide ) cylinder is A. Black B. Blue C. Black with white shoulder

D. Blue with white shoulder

281. Obliteration of right heart border on chest X-ray, with base of the opacity towards heart & apex directed laterally suggest pathology of A. Apical segment of the right lower lobe B. Right lower lobe medial segment C. Right middle lobe D. Apical segment of right upper lobe.

282. Which of the following is not emitted by radio active isotope? A. X-ray B. Alpha particle C. Beta particle D. Gamma rays

283. Which among the following is the most stable radio-isotope ? A. O-18 B. I-125 C. P-32 D. C-14.

284. String of beads appearance is seen in A. CHPS B. Sigmoid volvulus C. Large bowel obstruction D. small bowel obstruction.

285. Codmans triangle is a feature of A. Osteosarcoma B. Osteochondroma C. Osteoid osteoma D. Chondrosarcoma.

286. Which of the following is radiosensitiser ? A. CO2 B. N2 C. O2 D. H2

287. X-ray of which of the following would be the most appropriate for determining for bone age at 1113 yrs? A. Shoulder B. Medial end of clavicle C. Wrist D. Knee 288. Which of the following is the most potent derivative of Cannabis ? A. Charas B. Ganja C. Bhang D. Majun.

289. Sexual perversion in which seal gratification is obtained or increased by pain is

A. Sadism B. Masochism C. Fetichism D. Bestiality.

290. Shrilankan lady which was saved in tsunami presents with complaints of recalling the events during the disaster, remembering the apathy & sufferings of the sufferer, she is most likely suffering from A. PTSD B. MDP C. OCD D. Specific phobia.

291. Avoiding awareness of pain of reality ( from conscious awareness ) involuntarily is which type of defense mechanism. A. Dissociation B. Denial C. Displacement D. Distortion.

292. Manchausen syndrome by proxy is defined as A. Illness caused by care-giver B. Toxin mediated psychiatric illness C. Drug abusal D. All.

293. Early morning awakening & reduced latency of REM sleep is suggestive of

A. Delirium B. Depression C. Schizophrenia D. Anxiety.

294. The minimum MMSE score that suggests cognitive impairment A. 23 B. 24 C. 20 D. 30

295. A seven year old child has destructive behaviour, difficulty in organizing things, not playing with peers, interrupts others in school and easily gets distracted. The likely diagnosis is A. Learning disorder B. Autistic disorder C. Attention deficit hyperactivity disorder D. Conduct disorder

296. In an alcoholic man, Blackouts are seen in A. Alcohol abstinence B. Alcohol intoxication C. Alcohol withdrawl D. Hepatic encephalopathy.

297. One of the following is a clinical sign of mania ? A. Neologism

B. Perseveration C. Echolalia D. Flight of ideas

298. Therapeutic exposure is a form of therapy. A. Psychoanalytical B. Cognitive C. Supportive D. Behavioral

299. Catastrophic reaction is a feature of A.Dementia B. Schizophrenia C. Delirium D. Anxiety.

300. A 20 yr old female presents with complaints of reduced sleep with disorganized behaviour since 9 mnths , she feels there is a camera fixed behind her head which always follows her. What is the likely diagnosis ? A. Psychotic depression B. Paranoid Schizophrenia C. Delusional disorder D. Paranoid Personality disorder.

ANATOMY

1. Ans D ( ALL) :Grays 40th/283;BDC 3/4th/324

NUCLEUS AMBIGUUS (situated deep in medullary reticular formation)

ROSTRAL FIBRES

CAUDAL FIBRES

Give Origin To Glossopharyngeal (SVE)

Give Origin To Vagus (SVE/GVE) Cranial accessory(SVE)

Where:SVE:special visceral efferent ;GVE:general visceral efferent

RELATED QUESTION Nucleus accumbens is related to basal ganglia (2002) Nucleus globosus is present in cerebellum

2. Ans C (PINEAL GLAND ) : Grays 40th/324

CORPORA AMYLACEA Lipoprotein + lipofuschin deposits In lysosomes of ageing neurons,esp. spinal neurons

CORPORA ARENACEA Concentric calcareous deposits Found in pineal gland

3. Ans B (SUPERFICIAL EXTERNAL SPHINCTER): Grays 40th/1159;bdc 2/4th/383

The Ano-rectal ring is formed by A.) puborectalis + B.) internal anal sphincter + C.) deep part of external anal sphincter.

MUSCLES FORMING ANAL SPHINCTER 1. External anal sphincter a.)Subcutaneous external sphincter b.)Superficial external sphincter c.)Deep external sphincter 2. Internal anal sphincter 3. ---------

MUSCLES FORMING ANORECTAL RING ----------Yes Yes Puborectalis

TRICK: ANO RECTAL RING rectalis pubis

Anal sphincters Internal Deep external (ASIDE)

4. Ans B (MUSCULOCUTANEOUS NERVE) : Grays 40th/781

Cords of brachial plexus

MEDIAL CORD

LATERAL CORD

POSTERIOR CORD

1.Medial pectoral nerve 2.Medial cutaneous nerve of arm 3. Medial cutaneous nerve of forearm 4.Medial branch of median nerve 5.Ulnar

1.Lateral pectoral nerve 2.Lateral branch of median 3.musculocutaneous nerve

U.=upper subscapular L.=lower subscapular T.=thoracodorsal R.=radial A.=axillary

5. Ans C (SUPRAPATELLAR ): Grays 40th/1402;BDC 2/4th/147

BURSAE ON ANTERIOR ASPECT OF KNEE JOINT:

BURSAE 1. Subcutaneous pre patellar 2. Subcutaneous infra patellar 3. Deep infra patellar 4.Supra patellar

COMMUNICATION WITH KNEE JOINT No No No Yes

Other bursae that communicates with knee joint cavity: a.) Semimembranosus bursa b.) Bursa between lateral head of gastocnemius & knee joint capsule.

RELATED QUESTION: Housemaid knee affects pre patellar bursa(2002)

6.Ans A (LEFT RENAL VEIN ): BDC 2/4th/297,316,307 DRAINAGE OF a.)Renal vein b.)Gonadal vein c.)Adrenal vein d.)Inferior phrenic vein ON RIGHT SIDE Into IVC Into IVC Into IVC Into IVC ON LEFT SIDE Into IVC Into left renal vein Into left renal vein Into left renal vein

7. Ans A (DUODENUM ) :Grays 40th / 1135,1210

SMALL INTESTINE a.)Duodenum b.)Jejunum

MAJOR CHARACTERISTICS FUNCTION Brunners glands Alkaline secretion Crypts of Leiberkhun (also present in other parts of small intestine) Peyers patches Refer ans 3 of 2010

c.)Ileum

Lymphoid aggregates

8. Ans B (GLUTEUS MINIMUS ) : Grays 40th/1369,1370 ; BDC 2/4th/19

MUSCLE INSERTION ON GREATER TROCHANTER SURFACE MUSCLE 1.Anterior surface Gluteus minimus (lateral part ) 2.Lateral surface Gluteus medius 3.Medial surface 4.Apex 5.Trochanteric fossa Obturator internus Superior-inferior gamelli Pyriformis Obturator externus

TRICK MINI =minimus ANT =anteriorly ME =medius LA =laterally

A P F O E

=apex =PYRIFORMIS =fossa =obturator = externus

RELATED QUESTION: Muscle attached to ischial tuberosity infero-medially is biceps femoris(2002) Gluteus maximus is chiefly inserted into ilio-tibial tract (2003)

9. Ans D (FOAMY APPEARANCE ): Histology &Cell Biology by Kierszenbaum(2002)/434

PANETH CELL Granulated secretory epithelial cells Found at the base of crypt Are exocrine glands Contains rough endoplasmic reticulum Rich in zinc

GRANULES OF PANETH CELLS CONTAIN Lysozyme TNF-alpha Defensins Cryptidins

10. Ans D (THYROPHARYNGEUS & CRICOPHARYNGEUS):BDC 3/4th/223 ; Dhingra 5th/263

Killian dehiscence is present between Thyropharyngeus & Cricopharyngeus. Formed as a result of neuro-muscular incoordination between the PROPULSIVE Thyropharyngeus & SPHINCTERIC Cricopharyngeus. Protruding esophageal mucosa through this forms Zenkers diverticulum.

THYROPHARYNGEUS (oblique fibres of inferior constrictor)

KILLIANS DEHISCENCE

CRICOPHARYNGEUS (transverse fibres of inferior constrictor)

Nerve:pharyngeal plexus

(Gateway of tears)

Nerve:recurrent laryngeal

Action:propulsive

Action:sphincteric

11.

Ans A (PORTAL VEIN, HEPATIC ARTERY& BILE DUCT ):BDC 2/4th/231-232

MARGINS OF EPIPLOIC FORAMEN OF WINSLOW SUPERIOR a.)Caudate lobe of liver

POSTERIOR a.) IVC b.) Right suprarenal gland c.) T12 vertebra FORAMEN OF WINSLOW

ANTERIOR (right free margin of lesser omentum) a.)Portal vein b.)Hepatic artery c.)bile duct

INFERIOR a.) 1ST part of duodenum b.) horizontal part of hepatic artery It is the connection between greater & lesser sac.

12. Ans C (GASTRULA ) : langmans 9th/65

Gastrulation is the process that establishes 3 germ layers.

PROCESS OF GASTRULATION

BEGINS WITH Formation of Primitive streak (on the surface of epiblast)

ENDS WITH Formation of 3 germ layers (week 3 of embryogenesis

PROCESS:

Epiblast ingression at caudal end of embryo

Primitive streak/furrow appears(at caudal end)

Ingressed epiblast cells from endoderm & mesoderm

Later epiblast forms ectoderm

Gastrulation (3 layers formed)

13. Ans B (OVARY ) : langmans 9th/360

Please refer question 1 of 2010

RELATED QUESTION : Paramesonephric duct in males form prostatic utricle.

14. Ans A (OLIGODENDROCYTES ):Snells neuroanatomy 6th/51-57

NEUROGLIA 1. Astrocytes

2.Oligodendrocytes 3.Microglia 4.Ependyma a.) Ependymocyte b.) Tanycyte c.)Choroid epithelium

FUNCTION Provide supporting framework Are electric insulators Take up excess K+ ions Form blood-brain-barrier Store glycogen Fills in sites of lost parenchyma(replacement gliosis) Myelination in CNS Phagocytic

Circulation of CSF Transport of substances from CSF to hypophyseal portal system Production of CSF

Oligodendrocytes form myelin sheath in CNS neurons. Schwann cells form myelin sheath in peripheral neurons.

PHYSIOLOGY

15. Ans D (FEMALE GENITAL TRACK) : Guyton 12 th/976,977

CAPACITATION Process of sperm maturation /activation (post ejaculation)

Occurs in female genital track.

SPERMS IN FEMALE GENITAL TRACK

CAPACITATION

ACROSOME REACTION Sperm(after capacitation) binds Zona pellucida

Lasts 1 -10 hours Neutralization of inhibitory substances Weakening of sperm membrane Whipping motility of tail

Acrosome release enzymes

Zona penetrated Swinging motility of head. fertilisation

16. Ans B (POSTERO-BASAL LEFT VENTRICLE): Gannong 23rd/492

ORDER OF SPREAD OF ELECTRIC ACTIVITY IN VENTRICLES( repolarisation)

IMPULSE STARTS: Lft side of inter ventricular septum

Moves to

Right across the mid-portion of the septum

Activates

Antero septal region /apex

Endocardium to epicardium

LAST TO BE DEPOLARISED ARE

Posterobasal Portion of Left ventricle

Pulmonary conus

Upper portion of septum

17. Ans A (NEO GLUCOGENESIS ): Guyton 12 th/941-944

EFFECTS OF INSULIN

CARBOHYDRATE METABOLISM

FAT METABOLISM

PROTEIN METABOLISM

Facilitates glucose uptake

Facilitates glucose transport Into the fat cells for Lipogenesis

Facilitates transport of amino Acids into the cells

Facilitates glucose storage Inhibits hormone sensitive lipase Facilitates translation of m-RNA.

Inhibits neoglucogenesis

Facilitates transcription .

18. Ans A ( PACINIAN CORPUSCLE ): Guyton 12th/561-562 ;Gannong 23rd/121-127 Pacinian corpuscle:Detects vibration from 30-800 hertz because they respond extremely rapidly to minute & rapid deformations of tissues.They transmit signals via A beta fibres. DETECTION OF VIBRATION FUNCTION Rapidly adapting Vibration of 30-800 hertz can be detected Less rapidly adapting Vibrations from2-80 hertz can be detected LOCATION Beneath skin In deep fascial structure Non-hair bearing areas

PACINIAN CORPUSCLE

MEISSNERS CORPUSCLE

OTHER RECEPTORS:

RECEPTORS 1.Ruffini

2.Hair end organ

LOCATION Joint capsule Deeper skin Deep tissues Hair bearing parts

FUNCTION Pressure

3.Merkels/Iggo dome discs 4.Free nerve endings

Underside of skin epithelium Everywhere

Movement of object on body Detects initial contact with body Localises touch Detects texture Detects touch Detects pressure

RELATED QUESTION: Slowly adapting mechanoreceptors sensitive to perpendicular indentation are Merkels discs(2006).

19. Ans A (-50to -70 ):guyton 12th/61-62

The action potential at which the Na channels open (the threshold),is around -50 to -70 mV.

Na channel: outer activation gate cell membrane inner inactivation gate

THE ACTION POTENTIAL SEQUENCE: EVENT RESTING STATE 1.)MEMBRANE -90 POTENTIAL 2.)Na CHANNEL ACTIVATION Close GATE 3.)Na CHANNEL INACTIVATION Open GATE 4.)DIAGRAM

DEPOLARISATION/ UPSTROKE -90 to +35

REPOLARISATION/ DOWNSTROKE +35 to -90

Open

Open

Open

Close

Outer activation gate

Inner inactivation gate

5.)K CHANNEL GATE

close

close

open

20. Ans C ( E cl = + 61.5 log [ Cl i ] / [ Cl o]:Gannong 23rd/7

Nernst equation calculates the potential (equilibrium potential) at which the influx of an ion into the cell equals its efflux out of the cell)

NERNST EQUATION FOR Cl (at 37 C ) E cl = + 61.5 log [ Cl i ] / [ Cl o ]

NERNST EQUATION FOR K + (at 37 C ) E k = + 61.5 log [ K o ] / [ K i ]

E cl = - 61.5 log [ Cl o ] / [ Cl i ]

E k = - 61.5 log [ K i ] / [ K o ]

Where : i= concentration of ion inside o= concentration of ion outside Note:Equations are different for Cl & K because Cl is chiefly in ECF and K is chiefly in ICF.

TRICK: MiKi is superior: where Mi = minus sign Ki = K ion intracellularly Superior = denotes that[Ki] is in numerator

21. Ans D ( INCREASE IN CO2 ) : Gannong 23rd

SHIFT

TO

R I G H T

Releases

gas (O2)

at tissues

Whatever happens at tissue level will cause a shift to right of the oxy-hemoglobin curve 1. Increase in CO2 Because of metabolism CO2 is generated at tissue level.So increase in CO2 will cause a rightward shift. 2. Increase in H+/decrease in pH CO2 dissolves in water to give carbonic acid which gives H+ ions.So increase in H+ causes right shift 3. Increase in temperature Metabolic activities generate heat energy at tissue level.So increase in temperature causes Right shift.

RELATED QUESTION: Hemoglobin has highest affinity for CO.(2001)

22. Ans D (all) :Gannong 23rd/103 ;guyton 12th/861,1034

CONCEPT OF O2 DEBT: When muscles exercise vigourously for shorter duration,energy is released predominantly via anaerobic pathway.During rest excess O2 is consumed to remove the wastes generated as a result of anaerobic cycles.(So payment of debt of O2 taken at the time of need exercise)

LITTLE EXERCISE

VIGOROUS EXERCISE

VESSLES DIALATE

PHOSPHORYL CREATINE + GLYCOLYSIS (anaerobic pathway)

situation of O2 debt

MORE O2 REACHES MUSCLES

ATP + LACTATE

AEROBIC PATHWAY (KREBS CYCLE)

Extra O2

DUMPING OF METABOLIC WASTES ATP GENERATED

23. Ans D (SOMATOSTATIN BLOCKS INSULIN & : Gannong 23rd/3,30,331,447,448 GLUCAGON)

SOMATOSTATIN

Increased by: Arginine Leucine Acid CCK

Inhibits

INSULIN

GLUCAGON

CCK

PANCREATIC POLYPEPTIDE

GASTRIC MOTILITY

Somatostatin In Excess

somatostatin in excess

somatostatin in excess

DIABETES MELLITUS

GALL STONES

DYSPEPSIA

Somatostatin also inhibits: Growth hormone Gastrin VIP GIP Secretin

24. Ans B ( FSH )

Like somatostatin means Somatotroph( i.e. growth hormone ) inhibitor (statin ) ; in a much similar way folliculo statin means Folliculo (FSH ) inhibitor (statin ).

SOMATO STATIN

FOLLICULO STATIN

GH

inhibitor

FSH

inhibitor

25. Ans B (CONTRACTILE PROTEIN ) :Guyton 12th/451454

Platelets contribute directly to clot retraction byy activating platelet thromasthenin ,actin and myosin molecule ,which are all contractile in nature --------thereby bringing the opposing ends of vessel in close proximity.

BLOOD Damage to blood vessel CLOTTING: Platelet fibrin clot

The cut ends of the vessel filled with the clot

Contractile protein of platelet cytoplasm Actin Myosin thrombasthenin

Apposition of vessel walls

Hemostasis

26. Ans B (TUBULAR RESORPTION ):Gannong 23rd/709 -711

Tm i.e. transport maximum is the maximum rate at which glucose or any other substance can be resorbed by the tubular epithelium.

Filtered load of glucose in renal tubules

Reasorbed until carrier molecules saturate (Tm glucose = 375 mg/min)

So glucose would not come in urine until filtered load exceeds 375 mg/min

But glucose appears at 250 mg/min as Tm of all nephrons is not same

375 mg/min Overall transport maximum for kidneys All nephrons have reached their maximal capacity to reabsorb.

250 mg /min Treshold value for glucose Some nephrons have reached maximum capacity to reabsorb ,so glucose appears in urine

RELATED QUESTION; : Lowest renal clearnance is of glucose (2003)

27. Ans D (ALL): Guyton 12th/1847 ARCATE NUCLEI IN ARCUATE NUCLEI IN HYPOTHALAMUS

Arcuate nuclei of hypothalamus has POMC neurons (that decrease food intake ) & neurons that increase the food intake--orexigenic neurons. Substances like leptin, peptide YY , etc. activate POMC neurons while orexigenic neurons are stimulated by ghrelin / NPY,AGRP.

POMC NEURONS

OREXIGENIC NEURONS

DECREASE IN FOOD INTAKE INCREASE IN FOOD INTAKE 1. 2. 3. 4. 5. 6. 7. Leptin peptide YY CART CCK Insulin serotonin MSH 1. 2. 3. 4. 5. 6. 7. 8. NPY AGRP MCH AGRP Ghrelin cortisol endorphin orexins

28. Ans D (ALL) :Harper 27th/483-485

ABSORPTION OF MONOSACCHRIDES GLUCOSE Na dependent active transport (SGLT-1) Carrier mediated diffusion (GLUT-5) GALACTOSE Na dependent active transport (SGLT-1) Carrier mediated diffusion (GLUT-5) FRUCTOSE -----

Active transport Passive transport

Carrier mediated diffusion (GLUT-5)

ABSORPTION OF AMINO ACIDS & PEPTIDES AMINO ACIDS DI / TRIPEPTIDES LARGE PEPTIDES Na dependent active Enter brush border to get Transcellular path transport hydrolysed to amino acids Paracellular path

RELATED QUESTION: Glucose at intestinal level is absorbed by secondary active transport. GLUT-4 is insulin dependent glucose transporter (2003) Insulin controls entry of glucose into myocytes (cardiac/skeletal) & adipocytes (2003) In extensive small intestinal mucosal inflammation protein digestion & absorption is not affected (2008)

29. Ans C ( C 5 ) :Robbins 8th/64,65 ; Harrisons 18th/1010,2667

CLASSSIC PATH Antigen-antibody complex

ALTERNATE PATH Bacterial endotoxins

LECTIN PATH MBL + bacterial carbohydrates

Convergence onto C 3

C3 activation

Terminal common pathway C5,C6,C7,C8

Poly C9

C5-9 /MAC

Where : MBL = mannose binding lectin MAC = membrane attack complex

All 3 pathways converge onto C3 for its activation. The 1st factor of terminal common pathway is C5.

30. Ans C (NREM-2) : Guyton 12th/721,722; KDT 6th/388,389

NREM/SLOW WAVE /ORTHODOX SLEEP (70-80 % of sleep) Stage 1: Dozing First & lightest stage of sleep Predominantly theta waves 3 6 % of sleep Stage 2: Unequivocal characetrised by sleep spindles & k complexes 40 50 % of sleep Stage3: Deep sleep transition First appearance of delta waves 5 8 % of slep Stage4: cerebral sleep Predominant delta activity 10 -20 % of sleep It is called dreamless sleep but dreams do occur . Dreams are not registered in memory. No increase in autonomic activity Regular respiration Fall in BP & heart rate Sleep disorders seen : 1.sleep walking(somnambulism) 2.Sleep talking(somniloquy) 3.night terror(pavor nocturnes) 4.Teeth grinding(bruxism) 5.bed wetting(nocturnal enuresis)

REM /PARADOXICAL SLEEP (30-40 % of sleep) Light phase of sleep but arousal is difficult Mixed frequency ,low amplitude waves on EEG Active sleep Also known as desynchronisation sleep Dreaming is seen. Dreams are associated with bodily activity Recall of dreams possible Increase in autonomic activity Penile erection is seen Bursts of eye movement are seen Muscle tone decreases Respiration is irregular BP & heart rate are variable Sleep disorders seen : 1.Nightmares 2.Narcolepsy 3.Nocturnal penile tumescense

RELATED QUESTION: Stimulation of lower Pontine Raphe nucleus induces sleep.(2008)

31(a).Ans A = C (LYMPHOCYTES = EOSINOPHILS ) :Guyton 12th/931 ; Gannong 23rd/350 KDT 5th/257

EFFECT OF GLUCOCORTICOIDS ON BLOOD CELLS

RBC

WBC

PLATELETS

Eosinophil

Basophil

Neutrophil

Lymphocyte

CONCEPT: Gluco-corticoids

1.)reduce immunity ( by decreasing lymphocytes ) ; 2.)are anti-inflammatory (by decreasing basophils which release histamine & eosinophils which cause allergic reactions )

31(b). Ans A (LYMPHOCYTE )

32. Ans D ( SYSTEMIC VASCULAR RESISTANCE) :www.pubmedcentral.nih.gov/ pagerender.fcgi/article301529

BLOOD FLOW = (cardiac output)

Pressure difference Resistance to blood flow

{ Cardiac output = Heart rate X stroke volume }

ISOMETRIC EXERCISE All parameters of the above given equation INCREASE except Resistance & Stroke volume Increases Increases UNCHANGED Increases Increases UNCHANGED

ISOTONIC EXERCISE All parameters of the above equation INCREASE except BP & Rresistance Increases Increases Increases Increases UNCHANGED / DECREASES DECREASES

Cardiac Output Heart Rate Stroke Volume Systolic BP Diastolic BP Resistance

TRICK: ISOMETRIC

Resistance Invariable (i.e. resistance is constant)

33. Ans A ( 1 3 DAYS ): Gannong 23 rd/65

HALF LIFE OF MONOCYTE - MACROPHAGE IN BLOOD (it is monocyte) It is 3 days IN TISSUES (it becomes macrophage) It is 3 months

34. Ans D (Missense mutation):Harpers 28th/335

POINT MUTATION ( Replacement or changes in single base) SILENT YES YES NO (since mutation is silent) Hb VARIANTS: 1.milwaukee 2.bristol 3.sydney MISSENSE YES YES YES (i.e. the property of protein is lost) 1.sickle cell 2.Hb M(boston) NONSENSE YES YES Termination of protein synthesis i.e. nonsense

1.CHANGE OF CODON 2.CHANGE OF AMINO ACID 3.EFFECT

4.EXAMPLES

CONCEPT: 1. In silent mutation ,mutation does not manifests itself i.e. remains silent. 2. In nonsense mutation,mutation causes premature end of protein synthesis. 3. In missense mutation,mutation causes clinically apparent disorder.

35. Ans B (Arginine): Harpers 27th/195

Endothelial cell L-ARGININE + NADPH+O2

smooth muscle cell GTP

NO SYNTHASE

GUANYLYL CYCLASE C-GMP

CITRULLINE+NADP+NO RELAXATION

NO is also called ENDOTHELIAL DERIVED RELAXING FACTOR.

36. Ans D (HDL): Harpers 27th/218

1.PROTEIN 2.LIPIDS a.)PHOSPHOLIPIDS

CHYLOMICRON minimum maximum minimum

VLDL < > < < >

LDL < > < maximum >

HDL maximum minimum maximum > minimum

b.)CHOLESTEROL minimum c.)TRIGLYCERIDES maximum

TRICK: 1. ALL POLAR SUBSTANCES ARE MAXIMUM IN HDL EXCEPT CHOLESTEROL. 2. All non polar substances are maximum in chylomicrons.

RELATED QUESTIONS: 1. Lipids are transported from intestine via chylomicron.(2003) 2. LDL is most atherogenic lipoprotein(2003) 3. LDL is associated with apo protein B-100.(2006)

37. Ans B (DNA POL-2): Harpers 27th/336

POLYMERASE A.) 1 B.) 2 C.) 3

FUNCTION Gap filling and synthesis of lagging strand DNA proofreading & repair Processive Leading strand synthesis

38. Ans (NONE): Harpers 27th/152

NEO-GLUCOGENESIS G L Y C O G E N E S I S G L Y C O G E N O L Y S I S

GLUCOSE 6- PHOSPHATE Other than Being used in HMP SHUNT Is also Used in:

GLYCOLYSIS

39. Ans C ( succinate CO Q reductase):Lehninger 4th/696

Complex-2 / Succinate-CoQ Reductase

FADH2 to FAD

Complex-1/ NADPH-CoQ Reductase

Co-Q

Complex-3/ Cytochrome Reductase

CYT C

Complex-4/ Cytochrome Oxidase

O2

(CYT b-c1) NADH to NAD proton gradient generated proton gradient generated

(CYT a-a3) proton gradient generated

The complex 2 of electron transport chain is not involved in generation of proton gradient across the inner mitochondrial membrane.

RELATED QUESTION: 1.Oxidation reduction system with maximum positive redox potential is:(O2/H2O) > (H+/H) > (NAD/NADH) > ( LIPOATE ). (2008)

40. Ans B (pyridoxine): Harpers 27th/263-265

Xantheuranate in urine is a marker of pyridoxine deficiency as pyridoxine mediated degradation of 3-OH kynurenine (a metabolite formed during trytophan metabolism) does not occur.

TRYTOPHAN METABOLISM 3-OH KYNURENINE 3-OH KYNURENINE

B-6 In plenty

B-6 deficiency XANTHEURANATE

DEGRADATION

PASSED IN URINE

RELATED QUESTION: 1. Niacin is produced from tryptophan.(2007) 2. 60 mg trytophan gives 1 mg niacin (2005)

41. Ans C (osteoclast) :KDT 6th/328

Parathyroid hormone receptor is absent from osteoclast. GUTTON 12TH/964: The cell membranes of both the osteocyte & osteoblasts have receptors for binding PTH. Osteocytic Membrane System:connection between osteocytes & osteoblasts throughout the bone(except adjacent to osteoclasts)via long filmy processes.

PARATHORMONE COMBINES WITH

OSTEOCYTIC MEMBRANE (osteocytes + osteoblasts) SECRETE RANK-LIGAND

BONE FORMATION

COMBINES WITH OSTEOCLAST (with RANK receptors)

BONE RESORPTION

42. Ans C (It predominantly affects hepatocytes): Lehninger 4 th/875

LESCH NYHAN SYNDROME ETIOLOGY 1.genetic lack of HGPRTase 2.X-linked recessive 3.seen in males LESCH NYHAN SYNDROME CLINICAL 1.self-mutilating tendency 2.mentally retarded 3.manifests by 2 years

PATHOGENESIS PRPP ,as a result of blocked salvage pathway due to absent HGPRTase is diverted to the other pathway i.e. the de-novo synthesis,leading to hyperuricemia and gout.

PRPP (substrate)

production of nucleotides by de-novo synthesis

combines with free bases in salvage pathway

hyperproduction of purines

pathway blocked

hyperuricemia & gout SALVAGE PATHWAY IS CHIEFLY OPERATIONAL IN BRAIN AND THIS MAY ACCOUNT FOR BRAIN DAMAGE.

1. Lesch Nyhan syndrome results due to complete lack of HGPRTase. 2. Kelley Siegelmann syndrome results due to partial lack of HGPRTase.

43. Ans B (methylene bridges): Harpers26th/270

HEMOGLOBIN =

HEME +

GLOBIN

Fe2+

4pyrrole rings

BOND BETWEEN 1. Pyrrole rings

BOND TYPE Methylene

2. Fe2+ & other groups

Coordinate

A.) In hemoglobin ,the methylene bridges join the 4 pyrrole rings to form a tetra pyrrole ring(protoporphyrin type 9) B.) The centre of protoporphyrin ring has Fe 2+ which combines via coordinate bonds.

RELATED QUESTIONS: 1. Iron in Heme is linked to globin via amino acid histidine(2009) 2. Porphyrin in Heme is protoporphyrin 9 (2006)

44. Ans C (homogentisate oxidase): Harpers 26th/255

PHENYLALANINE METABOLISM

HOMOGENTISIC ACID OXIDASE (a metabolite in phenylalanine metabolism)

Homogentisic acid oxidase Absent in Alkaptonuria

Homogentisic Acid oxidase

BENZOQUINONE

DEGRADED

DEPOSITS IN CONNECTIVE TISSUES a.) arthritis b.) pigmentation (ochronosis) c.) dark urine (when sample kept for sometime)

DISEASE 1. Phenyl alanine 2. Albinism 3. Homocystinuria

DEFICIENT ENZYME Phenylalanine hydroxylase Tyrosinase Cystathionine synthase

45. Ans C (Capacity for covalent bonding): Harpers 27th/5

Water as a biological solvent (is a polar molecule)

dissolves

Organic biomolecules as a result of Hydrogen bond

Salts as a result of strong dipole moment & high dielectric constant

46. Ans D(HDL): Harpers 27th/218-222

On an electrophoretic run ,chylomicron remains at the origin i.e. the cathode while the HDL particles run fastest and reach the anode.

CATHODE(the origin)

CHYLOMICRON

SLOWEST

LDL

VLDL

ANODE( the end point)

HDL

FASTEST

PHARMACOLOGY 47. Ans A (pindolol) :KDT 6th/136,137

BETA-BLOCKERS 1.) NON-SELECTIVE A.) Without intrinsic sympathomimetic Activity Propranolol Sotalol Timolol B.) With sympathomimetic Activity pindolol C.) With additional alpha blocking Property Labetalol Carvedilol BETA -1 SELECTIVE Metoprolol Atenolol Acebutolol Betaxolol Bisoprolol Esmolol Celiprolol Nebivolol

48. Ans A( AZITHROMYCIN ):kdt 6TH/730,731

AZITHROMYCIN as a 1st choice drug: 1. 2. 3. 4. 5. Legionnaries pneumonia Chlamydia trachomatis Donovanosis Chancroid PPNG urethritis

Where PPNG means Penicillinase producing Neisseria gonorrhoeae.

49.Ans B (exenatide ) :KDT 6th/273

NEWER APPROACHES IN DM-2:

ORAL GLUCOSE IN GUT

AGONIST (exenatide)

RELEASE OF GLP-1 (incretin) metabolised by DPP-4

INHIBITOR (sitagliptin)

ENHANCEMENT OF POSTPRANDIAL INSULIN RELEASE WHERE:

A.) B.) C.)

GLUCAGON APPETITE GASTRIC EMPTYING

GLP-1 = glucagon like peptide 1 DPP-4 = dipeptidyl peptidase 4

RELATED QUESTIONS: Alpha glucosidase inhibitor is maglitol(2005)

50. Ans B (7 days) :KDT6th/609

ACTION OF LOW DOSE ASPIRIN LASTS FOR 5-7 DAYS:

Aspirin inhibits thromboxane synthase (in platelets)

No nuclei in platelets to resynthesize the enzyme

Because platelets are replaced every 57th day

Therefore action of low dose aspirin lasts 5-7 days 51. Ans B (alfa & beta ):KDT 6th/126

DOBUTAMINE ACTS ON

Alpha adrenergic receptors

Beta adrenergic receptors

a.) At clinically employed doses ,dobutamine acts as a relatively selective beta -1 agonist. b.) Althiugh a dopamine derivative ,yet does not act on D-1/D2 receptors.

52. Ans C (yohimbine):KDT6th/132-135

SELECTIVE ALPHA BLOCKERS ALPHA -1A/1B/1D Prazosin Terazosin Doxazosin ALPHA 1A/1D Tamsulosin Timazosin ALPHA 1 Alfuzosin Indoramine Urapidil ALPHA 2 Yohimbine Rawolscine

RELATED QUESTION: a. Anti-hypertensive drug that is glucose neutral(does not affect the glucose metabolism) is prazosin.

53. Ans B ( DIPYRIDAMOLE ):kdt 6TH/535

THERAPEUTIC FAILURE OF DIPYRIDAMOLE:CORONARY STEAL

A.) Dipyridamole is not used as an anti-anginal drug inspite of it being a dilator. B.) It prevents reuptake /degradation of adenosine thereby causing dilation of resistance vessels C.) Dipyridamole dilates vessels of all areas (ischemic as well as non-ischemic----ischemic vessels are already dilated;normal zone vessels are also dilated) D.) This causes shunting of blood from ischemic to non-ischemic zone resulting in therapeutic failure.

Ischemia

Atherosclerotic vessels dilated because of auto-regulation

Healthy vessles undilated

Dipyridamole

dipyridamole

No effect

Dilation occurs

Shunting of blood from ischemic to non-ischemic zone

54. Ans D (Analgesics) :Robbins 8th/872

SINUSOIDAL DILATION OF LIVER

PRIMARY

SECONDARY

Primary deformity. Eg. Peliosis hepatis

When efflux of blood is impeded,sinusoids dilate.

ETIOLOGY OF PELIOSIS HEPATIS: DISEASE DRUGS Cancer Anabolic steroids AIDS TB Oral contraceptives Bartonellosis Post transplant danazol immunodeficiency

55. Ans C (CMV):KDT6th/770

a.) Ganciclovir is more active than acyclovir against CMV. b.) Anti-viral drugs for CMV: ganciclovir foscarnet

56.

Ans A (Liposomal amphotericin B)KDT6th/759

Amphotericin B is 1st choice drug for all systemic mycoses except : a.) Paracoccidiodomyces b.) Chromomycosis

BLASTOMYCOSIS COCCIDIODOMYCES ASPERGILLOSIS SPOROMYCOSIS AMPHOTERICIN As 1st choice for

MUCORMYCOSIS CANDIDIASIS HISTOPLASMOSIS CRYPTOCOCCOSIS

RELATED QUESTION: Dose of amphotericin B for non AIDS cryptoccocal meningitis is 0.6 to 0.7 mg/kg /day for 10 weeks. Tuberculate spores are found in Histoplasma.(2010) Reynolds Braude phenomenon is shown by Candida albicans.(2001)

57. Ans D (ALL):Harrisons 18th/2058,2059,1785

USES OF PHENTOLAMINE: A.) In high altitude pulmonary edema B.) As an antidote for nerve agents C.) In adrenergic crises.

58. Ans (None) :KDT6th/206

COLCHICINE A.) Neither analgesic nor anti-inflammatory B.) Suppreses gouty inflammation C.) It is not uricosuric. MECHANISM OF ACTION:

Urate crystals in Joint cavity

Phagocytosis by PMNs

Release of P-glycoprotein

(inhibited by colchicine)

More & more PMNs accumulate

Lysosomal enzyme Mediated destruction

Decreased local pH causes more urate crystals to deposit

ADR: a.) b.) c.) d.) e.) f.) g.)

bloody diarrhea abdominal cramps renal damage aplastic anemia agranulocytosis CNS depression respiratory failure

59. Ans B(valproate):KDT6th/27

DRUG Phenobarbitone

Rifampicin Isoniazid alcohol

CYTOCHROME CYP-3A CYP-2B-1 CYP-2D-6 CYP-3A CYP-2D-6 CYP-2E-1

Phenobarbitone is an enzyme inducer: a.) Phenobarbitone affects metabolism of a lot of drugs on account of it being an enzyme inducer b.) It enhances degradation of phenytoin & carbamazepine.

Primidone can also induce cytochrome enzymes: a.) Primidone,a deoxy-barbiturate is converted to phenobarbitone. (so it is an enzyme inducer) b.)this conversion occurs in liver

Phenytoin inducesmicrosomal enzymes: a.) It increases degradation of steroids(failurwe of OC pills) b.) Phenytoin induces metabolism of phenobarbitone,doxycycline,theophylline,digoxin.

60. Ans D (rifampicin):KDT6th/741 MECHANISM OF ACTION OF RIFAMPICIN: Rifampicin inhibits DNA dependent RNA synthesis. Mycobacterial DNA

Inhibited by rifampicin

Mycobacterial RNA

Mycobacterial proteins

A FEW OTHER DRUGS: DRUG 1.Isoniazid/pyrazinamide 2.Ethambutol 3.chloramphenicol 4.Erythromycin 5.Tetracyclin 6.Aminoglycoside MECHANISM OF ACTION Inhibition of mycolic acid synthesis (defective cell wall synthesis) Inhibits mycolic acid incorporation into cell wall. Inhibits arabinosyl transferase Inhibits peptide bond formation(inhibits peptidyl transferase) Inhibits translocation Inhibit attachment of aminoacyl t-RNA to m-RNA ribosome complex Freeze initiation Disaggregate ribosomes Causes misreading of codons

61. Ans D (all):KDT6th/4888

BRADYKININ

Inhibited by ACE inhibitors

DEGRADATION

A.) DEGRADATION OF BRADYKININ IS NOT AFFECTED BY ANGIOTENSIN RECEPTOR BLOCKER/ANTAGONISTS. B.) ACE inhibitors block this degradation pathway.

C.) The un-degraded bradykinin.in excess causes brassy cough ---a well known ADR of ACE inhibitor.

62. Ans A(COMT) :KDT6th/417

ANTI-PARKINSONIAN DRUGS L-DOPA IN BRAIN L-DOPA IN PERIPHERY

Degraded COMT inhibited by tolcapone L-dopa DCASE Dopamine COMT Degradation MAO-B (inhibited by Selegiline) Degradation COMT

Degraded

L-dopa inhibited by carbidopa Dopamine

(Where DCASE means DECARBOXYLASE.)

a.) L-dopa is freely permeable across BBB b.) It is decarboxylated in periphery by decabboxylase which is inhibited by carbidopa c.) Within CNS ,dopamine degradation is inhibited by MAO-B & COMT enzymes d.) Dopamine so formed causes dopaminergic drive in dopamine depleted patients of parkinsonism.

63. Ans D (translocation):KDT6th/727

MECHANISM OF ACTION OF ERYTHROMYCIN: Erythromycin binds 50 s subunit of ribosomes and hinder translocation of elongated peptide chain from A to P site. The ribosome ,thus ,does not move along m RNA to expose the next codon

Peptide at A site

TRANSLOCATION

inhibited by erythromycin

Peptide at P site

So A site is free for the next aminoacyl t-RNA

Translocation is inhibited

64.Ans D (all) :Kadzung11th/533

DRUGS ACTING ON MU RECEPTORS PARTIAL ANTAGONISTS AGONISTS Morphine Pentazocine Pentazocine Methadone Butarphenol Naloxone Codeine Buprenorphine Naltrexone AGONISTS

DRUGS ACTING ON KAPPA RECEPTORS AGONISTS ANTAGONISTS Morphine Naloxone Nalorphine Naltrexone Pentazocine buprenorphine

DRUGS ACTING ON DELTA RECEPTORS AGONISTS ANTAGONISTS Morphine Naloxone Naltrexone

65.Ans D (all) :Harrisons18th/2558-2560

PATTERN OF HEPATIC NECROSIS CENTRILOBULAR NECROSIS Carbon tetrachloride Trichloro ethylene acetaminophen

PERIPORTAL NECROSIS Yellow phosphorus

MASSIVE NECROSIS Amanita phylloides

66. ans C (ICF):KDT6th/18

Lets briefly review 2 important concepts:

BODY WATER (roughly equals)

VOLUME OF DISTRIBUTION OF A DRUG DEPENDS ON: a.) lipid solubility b.) plasma protein binding c.) tissue protein binding

INTRA EXTRA CELLULAR CELLULAR 68. Ans D (none) FLUID FLUID

INTRA VASCULAR

CHARACTERISTIC OF A DRUG 1.)lipid insoluble(do not enter cells) 2.)plasma protein bound (cannot easily leave intravascular compartment) 3.)Tissue protein bound(tissue sequestration)(volume of distribution is more than total body water)

PREDOMINANT DISTRIBUTION ECF intravascularly

VOLUME OF DISTRIBUTION 0.25L/kg (approx) 0.1 L/kg

EXAMPLES Aminoglycosides Warfarin Diclofenac Phenylbutazone Digoxin Propranolol morphine

ICF

3.5 to 6 L/kg

67.Ans C (rimonabant):KDT6th/131

CANNABINOID RECEPTORS

Activated by: Feeding Pain Emotion Lipid metabolism

CB-1

CB-2

Found in brain cells

found in immune cells

Antagonist:Rimonabant a.)anti obesity drug b.) anti smoking drug c.) ADR:depression nausea anxiety

68.Ans D (none)

please refer question 89 in 2010.

69.Ans D (misoprostol) :KDT6th/628

CYTOPROTECTIVE ROLE OF PROSTAGLANDIN ANALOGUE IN PEPTIC ULCER DISEASE Increases Mucus Increases Mucosal blood flow decreases Gastrin

decreases Acid

1.)REDUCTION OF GASTRIC ACID SECRETION a.) Proton pump inhibitors Omeprazole,lancoprazole etc b.) H2 blockers Ranitidine,famotidine etc c.) Prostaglandin analogues Misoprostol etc d.) Anticholinergics Pirenzepine,propantheline etc

2.)ULCERO-PROTECTIVE AGENTS sucralfate,CBS 3.)NEUTRALISATION OF GASTRIC ACID NaHCO3,Mg(OH)2,Al(OH)3 4.)ANTI H.PYLORI DRUGS Amoxicillin,clarithromycin,tetracyclin Metronidazole,tinidazole

70. Ans A [GLUTAMINE] Robbins 8th/21 FREE RADICAL SCAVANGING SYSTEM Toxin: superoxide ion O2
.

Enzyme: superoxide dismutase SOD

. Converts O2 To H2O2 (hydrogen peroxide)

H2O2

Enzyme: catalase Reaction: decomposes H2O2 to water Found in peroxisomes

Enzyme: Glutathione peroxidase Reaction: decomposes H2O2 to water using reduced glutathione (GSH)

Superoxide free radical formed during metabolism is converted to hydrogen peroxide by SOD and subsequently decomposed by catalase/glutathione peroxidase.

71 (A). Ans D [alcoholic hepatitis] Robbins 8th/858 MALLORY HYALINE Intrahepatocyte accumulation of proteins Cytokeratin 8, 18 Appear as eosinophilic clumps. Found in: Alcoholic steatohepatitis Non-alcoholic fatty liver disease (NAFLD) Wilsons disease Ubiquitin

Alpha-1 antitrypsin deficiency Hepatocellular tumors Primary biliary cirrhosis (PBC) Chronic cholestatic syndromes

71 (B). Ans D = C Because PSC is a chronic cholestatic disease.

72. Ans B [Wegeners granulomatosis] Robbins 8th/920 Crescents in glomerulus -proliferation of parietal cells in glomerulus -migration of macrophages/monocytes within glomerulus Rapidly progressive/ Crescentic glomerulonephritis: Type I (anti GBM antibody) -renal limited -Goodpasture syndrome

Type II (immune complex)

-idiopathic -post infectious -lupus nephritis -HSP/IgA nephropathy

Type III (pauci immune)

-idiopathic -ANCA associated -wegeners granulomatosis

-microscopic polyangitis

73. Ans D [all] Robbins 57, 58, 199 Histamine Sources: mast cell granules(in connective tissue adjacent to blood vessels) Basophils Platelets Actions: smooth muscle contraction Increased vascular permeability Increased mucus secretion(nasal, bronchial, gastric) Primary mediators of anaphylaxis histamine and serotonin while secondary are prostaglandin and TNF (2006) Eotaxin recruits and directs migration of eosinophil (2006)

74. Ans D [tissue factor] Robbins 8th/74,75 Three of the best known acute phase plasma proteins are CRP (C-reactive protein), fibrinogen and SAA (serum amyloid associated protein). Their concentration increases during inflammation. Upregulation Action CRP IL-6 Opsonin Fibrinogen IL-6 Binds RBC(raises ESR) hypercoagulability SAA IL6, IL1, TNF -opsonin -diverts HDL to macrophages for energy secondary amyloidosis

Prolonged -atherosclerosis production of -MI proteins Hepcidin: -Iron regulating peptide

-Is also increased in acute phase response -Reduces iron availability to red cells, if chronically increased -Chronic elevation causes anemia of chronic disease

75. Ans B [CD4] Robbins 8th/239 HIV infection

Receptor CD4 Binds with Gp120 of HIV

Co-receptor CCR5, CXCR4 binds with Gp120 that has combined with CD4

HIV infects cells by using the CD4 molecule as receptor and various other chemokine receptors (CCR5, CXCR4) as co-receptors. 76. Ans D ( MINIMAL CHANGE DISEASE ) : Robbins 8th /922,926,928

NEPHROTIC SYNDROME MEMBRANOUS NEPHROPATHY 85 % cases are idiopathic

FOCAL SEGMENTAL GLOMERULOSCLEROSIS Idiopathic FSGS is known as primary FSGS

MEMBRANO PROLIFERATIVE GLOMERULONEPHRITIS Idiopathic variety has 2 subtypes: a.) MPGN 1 b.) MPGN - 2

RELATED QUESTION: Most common cause of Nephrotic syndrome in children is Minimal change disease.(2002)

77. Ans A ( HENOCH SCHONLEIN PURPURA ): Robbins 8th / 918,934

ANTIBODY DEPOSITION IN GLOMERULAR PATHOLOGY

Ig A Bergers nephropathy HSP Ig G (rest of glomerulopathies) Post infectious glomerulopathies Goodpasteurs syndrome Membraanous glomerulopathy MPGN 1 & 2 Ig A nephropathy Ig M FSGS Ig A nephropathy

No antibody deposits: Minimal change disease Chronic glomerulonephritis( sometimes)

78. Ans A=C [PNH=HS] Robbins 8th/640 HEMOLYTIC ANEMIA Intrinsic causes Extrinsic causes Defects limited to RBC membrane and External factor leading to hemolysis intracellular contents Inherited: Antibody mediated Membrane disorders- HS, HE -Rh disease -transfusion reaction -autoimmune disorders Enzyme deficienciesG6PD deficiency, Hexokinase deficiency Mechanical trauma -microangiopathy -cardiac traumatic hemolysis Hemoglobin abnormalities Infections of RBC Thalassemia, Sickle cell anemia -Malaria -Babesia Acquired: Toxins Deficiency of phosphatidylinositol linked glycoproteins(in membrane) PNH

79. Ans D ( GONADAL TYPE IS CHEMOSENSITIVE ):Robbins 8th /1060 CHORIOCARCINOMA Seen in first 3 decades of life Seen as unilateral tumor GERM CELL ORIGIN

PREGNANCY RELATED (gestational)

Malignancy of trophoblast cells of previously normal / abnormal pregnancy Rapidly invasive No villi seen Frequent mitoses seen High hCG titres Most common site of metastasis is lung Responds very well to chemotherapy

Origin : placental Exists in combination with other germ cell tumors Aggressive High hCG titres seen Resistant to chemotherapy Often fatal

80. Ans A ( MEDULLARY ): Robbins 8th/771 THYROID NEOPLASMS

PAPILLARY Most common Mutation of RET oncogene Ground glass nuclei Pseudo inclusions Psammoma bodies Excellent prognosis FOLLICULAR Difference between follicular carcinoma & adenoma is vascular / capsular invasion in the former MEDULLARY Arise from parafollicular C cells Amyloid deposits of calcitonin Familial/sporadic/syndromic

ANAPLASTIC Poorly differentiated Uniformly lethal cancer

RELATED QUESTION: Among thyroid tumors psammoma bodies are present in papillary thyroid carcinoma(2009)

81. Ans A ( CHORISTOMA ):Robbins 8th/262,816

Choristoma Hamartoma

Well developed & normally organized heterotopic rest of cells Disorganized but benign appearing masses composed of cells indigenous to a particular site. OR Tumor like growths composed of mature tissues that are normally present at the site in which they develop

82. Ans A ( CA_19_9 ): Robbins 8th/327 a. Mucin / glycoprotein CA 19 -9 CA 125 CA 15 -3 b. Oncofetal antigens AFP CEA Pancreas , colon Ovary Breast Liver cell cancer Non seminomatous germ cell tumor Colon,pancreas Lung,heart stomach Trophoblastic tumors Non seminomatous germ cell tumor Medullary carcinoma thyroid Pheochromocytoma Prostate cancer Neuroblastoma Small cell carcinoma lung Multiple myeloma

c. Hormones hCG Calcitonin Catecholamines d. Isoenzymes Prostatic acid hydrolase Neuron specific enolase e. Specific proteins Immunoglobulins

83. Ans D ( NONE ): Robbins 8th/1161 PHEOCHROMOCYTOMA

BENIGN

MALIGNANT

ABSENCE OF METASTASES

PRESENCE OF METASTASES

There is no histologic feature that predicts clinical behaviour in Pheochromocytoma Features common to both benign & malignant forms are :

a. Number of mitoses b. Confluent necrosis c. Spindle cell morphology d. Presence of giant cells

e. Capsular invasion f. Vascular invasion g. Cellular pleomorphism h. Nuclear pleomorphism

RELATED QUESTION: PHEOCHROMOCYTOMA ARISES FROM CHROMAFFIN CELLS OF ADRENAL MEDULLA(2002) Pheochromocytoma of malignant potential exclusively secretes dopamine (2002)

84(a). Ans A ( VEGF ): Harrisons 17th/423

GENE THERAPY IN MYOCARDIAL INFARCTION / ANGINA

ACHIEVES ANGIOGENESIS

INCREASED FLOW TO ISCHEMIC ZONES

VARIOUS TRANSGENES EMPLOYED ARE: 1. 2. 3. VEGF (major ) FGF HIF-1 alpha

84(b). Ans B ( FGF ): Robbins 8th/537,538 DEVELOPMENT OF HEART Cardiac precursors (from lateral mesoderm)

Move to midline in 2 migratory waves: 1st Heart field/ 1st Crescent of cells Genes involved are: TBX 5 Hand 1 Forms future left ventricle 2nd Heart field/ 2nd Crescent of cells Genes involved are: FGF 10 Hand 2 Forms rest of the heart

EVENTS Day 15 : 1st & 2nd heart fields are established Day 20 : Crescents develop in beating tube Day 28 : Tube loops to right & begins ti form chambers Formation of endocardial cushions Formation of septations & aortic arches ( from neural crest cells ) Day 50 : 4 chambered heart

85. Ans B ( ROLLING ): Robbins 8th/44 LEUCOCYTE ADHESION TO ENDOTHELIUM MARGINATION Redistribution of WBCs to assume a more peripheral position along the vessel wall endothelial surface

ROLLING Transient attachment of leucocytes to the endothelium to the endothelium involving detach and bind again & again.

Mediated by Selectins 1. Leucocytes : L Selectin 2. Endothelium : E Selectin P _ Selectin 3. Platelets : P _ Selectin

FIRM ADHESION Mediated by Integrins. a. ICAM 1 : Adhesion Arrest Transmigration b. VCAM 1 : Adhesion

86. Ans A ( PROLACTINOMA) : Robbins 8th/1100,1103,1104

Most common cause of hyperpituitarism: Anterior lobe adenoma

Most common type of pituitary adenoma: 1st Prolactinoma 2nd Growth hormone adenoma

87. Ans A ( ETIOLOGY ) :

In all instances of chronic hepatitis, etiology is the single most important indicator of likelihood to progress to cirrhosis.

Age at the time of infection is the best determinant of chronicity

Robbins 7th/898

Robbins 8th/850

FROM NOW ON if a question is asked regarding the BEST / SINGLE MOST important indicator to predict likelihood to CHRONICITY / CIRRHOSIS , answer would be age at the time of infection.

88. Ans B = C ( HL TEST = OXIDASE ) :Ananthnarayan 8th/202

STAPHYLOCOCCUS MORPHOLOGY OXIDASE HUGH LEIFSONS TEST O2 REQUIREMENT PATHOGENIC ON Bunch of grapes Fermentative

MICROCOCCUS Tetrads + Oxidative Strict aerobe Mammalian skin

Aerobe Facultative anaerobe Multiple organs including skin

RELATED QUESTION: Pseudomonas aeroginosa is an obligate aerobe (2001) Toxic shock syndrome is caused by Staphylococcus (2001) UTI in sexually women is most commonly caused by S. saprophyticus(2001) 89. Ans C ( given i. v.) : Ananthnarayan 8th/486,487 ; Park 20th / 180

SABIN / LIVE 1. STRAINS 2. PRIMARY IMMUNISATION 3. BOOSTER 4. ROUTE 5. IMMUNITY (SERUM) All 3 3 doses Yes ( 1) oral IgM IgG IgA IgA IgA yes yes Both local & systemic immunity

SALK / KILLED All 3 4 doses Yes ( multiple) I.M. IgM IgG IgA ---- Useful in pregnancy Can be used in immunodeficient

6. IMMUNITY ( NASAL) 7. IMMUNITY (INTESTINAL) 8. CONTRIBUTION TO HERD IMMUNITY) 9. USEFUL DURING EPIDEMICS 10.ADVANTAGES

90. Ans A (PARAGONIMUS ) : Harrisons 18th/1752

TRANSMISSION OF TREMATODE INFECTION : EXAMPLE ROUTE OF TRANSMISSION 1. All Schistosoma Skin penetration 2. All Fasciola / Fasciolopsis 3. Paragonimus 4. Clonorchis Opisthorchis Heterophtes Fern ( aquatic plants) Cray fish / crab

Fish

Cray fish is not a fish ; its a crustacean ( arthropod ) Diphyllobothrium latum is caused due to consumption of raw fish (called fish tapeworm ) 91. Ans D (ENRICHED ) : Ananthnarayan 7th/37

An enriched media is enriched with blood ( BLOOD AGAR ) ; glucose ( LOEFFLERsMEDIUM ) ; egg ( DORSET s MEDIA ) etc. Loefflers has dextrose ( glucose ) added to it ( enriched media ).

INDICATOR Indicate bacterial growth by a change in color of media.

ENRICHMENT Required pathogen thrives well ; others do not . Liquid media.

SELECTIVE Reqiured pathogen thrives well ; others do not . Solid

92. Ans A ( CHLAMYDIA TRACHOMATIS ): Harrisons 18yth/154 ORGANISM 1.) Treponema pallidum 2.) Calymmatobacter granulomatis DISEASES Condyloma lata Syphilis chancre Donovanosis (Granuloma inguinale ) Chancroid Trachoma Inclusion conjunctivitis Lymphogranuloma venereum Condyloma acuminate

3.) Hemophilus ducreyi 4.) Chlamydia trachomatis (A , B , C ) 5.) Chlamydia trachomatis (D to K ) 6.) Chlamydia trachomatis (L1 ,L2 ,L3 ) 7.) HPV

RELATED QUESTION: Wart is a cutaneous neoplasm caused by HPV (2008)

93. Ans B ( TRANSDUCTION) : Ananthnarayan 7th/55 ,56

TRANSFORMATION

TRANSDUCTION

Transfer of genetic material through the agency of free DNA

Transfer of DNA ( episomes or plasmids )through the agency of bacteriophage CONJUGATION

LYSOGENIC CONVERSION

Bacteriophage DNA becomes integrated with host DNA ( known as prophage)

Male/donor bacteria transfers genetic material into female /recipient bacteria by making physical contact

94. Ans A ( STAINS BY GRAMS STAIN ):Ananthnarayan 8th/14

VISCID MATERIAL AROUND BACTERIAL CELL WALL

ORGANISED SHARPLY Capsule eg.pneumococcus

UNDEMARCATED Slime layer: Polysaccharide : pneumococcus Protein : B. anthracis

Functions / features of capsule: Stained by Indian ink preparation /usage of mordants Capsule is antigenic Quellung reaction : capsule antigen + capsule antibody Protects bacteria from lytic enzymes Contribute to virulence Inhibits phagocytosis Repeated subculture causes loss of capsule

95. Ans C ( ENDO CYST ) :LB 25th/56 LAYERS OF HYDATID CYST OUTERMOST Pericyst Compressed hort tissue & fibroblastic reaction Non infective Acellular laminated layer Alive layer

MIDDLE

Ectocyst Endocyst ( germinal membrane)

INNERMOST

RELATED QUESTION: Multi loculated hydatid cysts are caused by E. multilocularis(2001)

96. Ans A ( HYDATID CYST ) :Medical Parasitology 1st/117 Regression :Reverting back to a previous (low ) developed state from a higher / more developed state.

LIFE CYCLE OF ECHINOCOCCUS: ADULT WORM IN DOG GUT

Hydatid cyst in definitive host

Regression Metamorphosis

releases eggs

EGGS IN DOG FECES

EATEN BY DOG (sheep flesh with protoscolices)

DOG FECES CONSUMED BY CATTLE / SHEEP

PROTOSCOLICES DEVELOP FROM THE LARVAE

EGGS DEVELOP IN LARVAE WITHIN HYDATID CYST IN SHEEP

CONCEPT: Normally hydatid cyst is formed in intermediate host ( shhep) ; adult form in definitive host ( dog) But in Regression metamorphosis hydatid cyst forms from protoscolices ( in the definitive host ) that actually were destined to form adult worm.

RELATED QUESTION: Casonis test is positive in Echinococcus (2003)

97. Ans D ( SEDIMENT ) : FORMOL ETHER CONCENTRATION TECHNIQUE 1 gm of faeces + 7 ml formol saline 10 minutes Strain through wire gauze

Add 3 ml of ether centrifuge 2000rpm for 2min Put sediment on slide

Egg / cysts can be seen

98. Ans C ( Ig M ) : Ananthnarayan 7th/ 89 The isohemagglutinins (anti A ,anti B ) are usually IgM.

EXPLANATION: BLOOD GROUP A B AB O

ANTIBODY Anti b Anti a --Anti a & anti b

TYPE Ig M Ig M ---IgM

CLINICAL Since Ig M cannot cross placenta ;less trouble to the developing fetus in utero.

Anti Rh antibody is IgG type that can cross placenta, so harmful to fetus .

RELATED QUESTION: Earliest Ig to appear in fetus is If M(2001) Predominant Ig in body secretions is Ig A (2001) Transplacental transfer of antibodies from immunized mother to her newborn is acquired passive immunity(2003) Prozone phenomenon is due to antibody excess(2008) Jernes hypothesis of immune regulation is based on sequential anti idiotype antiboby formation (2009) 99. Ans D (160 DEGREE C ) : Ananthnarayan 8TH/25

HOT AIR OVEN

HOLDING TIME 160 degree C

MATERIALS Glass Forceps Scissors Swabs Liquid paraffin Dressing powder Fats/oils

TIME 1 hour

TEST OF EFFICIENCY Non toxigenic Clostridium tetani spores

RELATED QUESTION : Endoscopes should be sterilized with glutaraldehyde(2007)

100.Ans D ( PRION ) : Robbins 8th/880

Prions are infectious proteins that cause CNS degeneration. Only infectious pathogens that lack nucleic acid Composed largely of PrPsc proteins (which markedly differs from its precursor PrPc ) Prions reproduce by binding to normal cellular isoform of prion protein & converting it into prion form. PRION IN ANIMALS Scrapie in sheep/goats Bovine spongiform encephalopathy(Mad cow disease) Transmissible mink encephalopathy Chronic wasting disease

PRION IN HUMANS Creutzfeldt Jacob disease Familial Fatal Insomnia Gerstmann Straussler Scheinker disease Kuru

RELATED QUESTION: Prions do not evoke an inflammatory response(2005) Prusiner got the Noble Prize in 1997 for prion proteins(2006) Prion disease can be sporadic /familial /inherited (2009)

101.Ans D ( TRICHOSPORON BEIGELLI ): Ananthnarayan 7th/570

PIEDRA ( colonization of hair shafts forming irregular nodules)

NODULE WHITE COLOR Trichosporon beigelli

NODULE BLACK COLOR Piedra hortae

These nodules are aggretates of mycelia + anthroconidia Infection may affect hair of scalp , body , & genitalia.

102. Ans A ( S. DYSENTERIAE ) : Ananthnarayan 7th/286

S. DYSENTERIAE Produces exotoxin 1. Produces endotoxin 2. 3. Does not ferment mannitol

SHIGELLA S. FLEXNERI S. BOYDII ----------------yes ferments yes ferments

S. SONNEI ----Yes ferments

Pathogenecity of diphtheria is due to exotoxin(2002) Meningococcal rash is due to endotoxin(2002) Shigella dysentery due to exotoxin is seen with S. dysenteriae.(2002)

103. Ans C (NON PHOTOCHROMOGEN ): Ananthnarayan 8TH/351 ATYPICAL MYCOBACTERIA

PHOTOCHROMOGEN M. kansasii M. marinum M. simiae

SCOTOCHROMOGEN M. scrofulaceum M. gordonae M. szulgai

NONPHOTOCHROMOGEN M. intracellulare M. avium M. ulcerans

RAPID GROWERS M. fortuitium M. chelonae M. vaccae

104. Ans B ( TRENCH FEVER ): Ananthnarayan 7th/ 418

WEIL-FELIX REACTION

DISEASE A.)EPIDEMIC TYPHUS B.)ENDEMIC TYPHUS C.)RMSF D.)SCRUB TYPHUS

AGGLUTINATION PATTERN OX 19 OX 2 OX K +++ + +++ ++ +/++ +++

105. Ans C > B ( Ig M > Ig G ): Ananthnarayan 7th/112 ; Harrisons 18th /1010,2667 ; Robbins 8th /6

Please refer question 29 of 2011. THE FIRST STEP OF CLASSICAL PATHWAY

1 2

4 5 +

Inactive C 1 molecule

Immunoglobin

Active C 1 with Ig ( activates subsequent pathway)

Inactive C1 must combine with antibody to get activated . C1 has 6 binding sites ; of which atleast 2 should be occupied. 1 molecule if Ig M OR 2 molecules of Ig G activate C 1 . So Ig M appears to be more appropriate answer

106.Ans D ( MYCOPLASMA ) : Ananthnarayan 7th/397

Unique among prokaryotes is the requirement of most Mycoplasma for cholesterol & related sterols.

ANANTHANARAYAN

BACTERIA 1.Mycoplasma 2.Mycobacterium T.B 3. Yersinia pestis 4.Treponema

LIPID USED AS Cholesterol Mycolic acid Oil/ghee over broth Lipid

FEATURE For surface membrane For cell wall Gives stalactite growth pattern For outer membrane layer

RELATED QUESTION: Primary atypical pneumonia is caused by Mycoplasma(2003)

107.Ans B ( NECATOR AMERICANUS) : Harrisons 18th/1740,1742

Filariform larva is seen in Hookworm (Ankylostoma duodenale & Necator americanus) And Strongyloides .

INFECTIVE FORM ROUTE OF INFECTION PULMONARY PHASE DIAGNOSIS

ASCARI S Egg Oral + Egg in stool

HOOKWORM STRONGYLOIDES TRICHURIS ENTEROBIUS Filariform larva Percutaneous + Egg in fresh feces Larvae in old feces Filariform larva Percutaneous Autoinfection + Larva in duodenum /stool Egg Oral Egg in stool Egg Oral Egg from perianal area

108. Ans A (A. BRAZILIENSE ) : Harrisons 18th/

CUTANEOUS LARVA MIGRANS

A. braziliense larva

Penetrates human skin

Start of migration along dermoepidermal junction

Tortuous , erythematous tracks with vesicles/bullae

Larva die spontaneously

RELATED QUESTION: Strongyloids is ovoviviparous (2008) Route of transmission of strongyloides is NOT fecoal rather Percutaneous / autoinfection(2001)

Larval form of Taenia solium is cysticercus cellulosae(2003) Parasite that causes duodenal stricture is Strongyloides(2006) Bile stained eggs are seen in Taenia ,Trichuris , fertilized eggs of ascaris(2007) Day time blood sample is collected for Loa Loa microfilaria (2005) Rhabditiform larva of Strongyloides is passed in feces that can transform into infectious Filariform larva either directly or after a free living phase of development .(2010)

109.Ans B ( LOUSE ): Park 20th/672

BORRELIA CAUSES RELAPSING FEVER

LOUSE BORNE B. recurrentis

TICK BORNE (rest all Borrelia) B. hermsii B. duttoni B. hispanica B. turicatae

110. Ans B (CORYNEBACTERIUM ): Robbins 8th/567

HACEK group endocarditis:

H A C E K

Hemopilus Actinobacillus Cardiobacterium Eikenella Kingella

111. Ans B ( 11 13 days ) :Hastings dermatology 2nd/55 ; Ananthnarayan 8th/368

In schwann cells, M. leprae divide in 11 -13 days. ORGANISM 1. Mycobacterium leprae 2. Tubercle bacilli 3. Colliform bacillus GENERATION TIME 11- 13 days 14 hours 20 minutes

112. Ans C (hemolysis with hyperkalemia): Reddys 29th/326,327

PARAMETER FLUID DYNAMICS

FRESH WATER DROWNING

SALT WATER DROWNING

Alveolus H2O H2O

Blood Vessel

hemodilution

hemoconcentration

Fresh water is hypotonic to plasma ,so water quickly enters from alveoli to plasma leading to hemodilution

salt water being hypertonic draws water from plasma into alveoli leading to hemoconcentration and pulmonary edema..

RBC Swell and burst MORPHOLOGY IONS Hyperkalemia(as RBCs burst) Hyponatremia( hemodilution) Hypochloremia ( hemodilution) CAUSE OF DEATH Ventricular fibrillation

Crenation Hypermagnesemia( hemoconcentration) Hyperchloremia( hemoconcentration)

Cardiac asystole Cardiac stand still

RELATED QUESTION: Paltauf hemorrhages are seen in death due to drowing.(2003)

113. Ans A (magistrate): Reddys 29th/5

Inquest (inquiry into the cause of death)

POLICE INQUEST 1.)most common 2.)investigating officer is not below the category of (senior)head constable and usually is a subinspector.

MAGISTRATE INQUEST 1.)conducted by DM/ SDM/ executive magistrate

CORONERS INQUEST 1.)formerly in Mumbai only . 2.)now not practiced

2.)indications: a.)death in police custody 3.)conducted by an b.)death during police firing advocate/ c.)dowry deaths attorney/ d.)death in psychiatric class1 magistrate hospitals (with 5 years of experience)/ e.)exhumation cases metropolitan magistrate.

Medical examiners inquest (in which a medical practitioner is appointed to perform functions of coroner)is not practiced in India.

RELATED QUESTIONS:

1.) EXHUMATION can be ordered by district magistrate.(2008) 2.) Inquest refers to legal inquiry into the cause of death.(2007) 3.) The post mortem report in case of death in police custody should be recorded as video recording.(2005) 4.) Limit for exhumation in India is no time limit (2003)

114.Ans B (18 years) : Reddys 29th/74

JUVENILE JUSTICE AMENDMENT BILL,2006 (care and protection of children)

JUVENILE

BOY <18 YEARS

GIRL <18 YEARS

FOUND GUILTY

DONE 1.) To participate in group counseling 2.) Perform community service 3.) Released on probation of conduct 4.) Pay fine 5.) To be sent to a special home

NOT DONE 1.) life imprisonment 2.) committed to prison 3.) death sentence

RELATED QUESTIONS: 1.) Juvenile court is presided over by class 1 woman magistrate.(2003)

115. Ans B (tracer): Reddys 29th/202

TYPES OF BULLETS:

1.)TRACER 2.)RICOCHET 3.)YAWNING 4.)TANDEM 5.)INCENDIARY 6.)SOUVENIR 7.)DUM DUM 8.)TUMBLING

The base is ignited by flame of the propellent;this provides a visible pyrotechnic display during bullets flight. One which before striking the object aimed at ,strikes some intervening object 1st,andthen after ricocheting & rebounding from this,hits the object. One which travels in irregular fashion instead of traveling nose on & cause a key hole entry wound. Two bullets are ejected one after the other ,when 1 st bullet failed to leave the barrel & is ejected by subsequently fired bullet. Intended to ignite inflammable materials such as phosphorus & gasoline(contains a charge of chemical incendiary object) A bullet left in the body for long time & gets surrounded by dense fibrous tissue. A jacketed bullet with its nose cut off to expose the core & it expands on impact. One that rotates in end on end during its motion.

116. Ans A(MCI): Reddys 29th/22

PROFESSIONAL MISCONDUCT A.) any conduct of doctor that might reasonably be regarded as disgraceful or dishonourable B.) the doctors conduct is judged by men of good repute & competence C.) the RMP ia required to observe certain prescribed rules of the conduct contained in the code of medical ethics,published by MCI & by several SMCs AUTHORITY ON DISCIPLINARY ACTION If anyone is found guilty of any offences mentioned in warning notice issued by MCI,his name can be erased from the medical register.

117. Ans D (2years): Reddys 29th/37

Limitations of law for punishment for negligence: a.) a suit filed against a doctor after 2 years stands dismissed as it is beyond the period of limitation. b.) When breach of duty to provide care as per contract between a patient and a doctor is committed ,legal action can be initiated upto 3 years from the date of alleged negligence.

118. Ans B (saturated NaCl): Reddys 29th /113

POISONING 1. All poisons including carbolic acid but Excluding other acids 2. Poisoning with acids except carbolic acid 3. Urine

PRESERVATIVE Saturated NaCl Rectified spirit Saturated saline Rectified spirit Thymol Conc. HCL Sodium floride + potassium oxalate Sodium nitrate + potassium oxalate Liquid paraffin Sodium floride + sodium citrate

4. Blood for alcohol poisoning 5. Blood for floride poisoning 6. . Blood for CO poisoning 7. Blood for oxalic acid poisoning

RELATED QUESTIONS: A.) best biological fluid for post mortem examination is vitreous humor (2009) B.) The component of vitreous that helps determine time since death is K+(2006)

119. Ans A (phosphorus poisoning) : Reddys 29th /493

TREATMENT OF PHOSPHORUS POISONING (avoid oils/fats as they enhance more phosphorus absorption)

STOMACH a.)lavage with 1:5000 KMnO4 b.)0.2% CuSO4 solution c.)activated charcoal

LIVER a)transfusion of glucose -saline. b)transfusion of nor-adrenaline.

KIDNEY a.)peritoneal dialysis b)hemodialysis

COLON a.)bowel evacuation with MgSO4

RELATED QUESTIONS: 1.) Gastric lavage for phenol poisoning is given using 10 % glycerine(2001)

120. Ans A ( ANTEMORTEM HANGING ): Reddys 29th/306 ; Modis 22nd /275 ; Parikh 6th/360

SIGNS OF ANTEMORTEM HANGING

LE FACIES SYMPATHIQUE Pressure on ipsilateral sympathetics by ligature knot causes ipsilateral eye & pupil to wide open

DRIBBBLING OF SALIVA Cannot occur after death( Modi) Can occur after death ( Parikh)

Please refer question 118 of 2010

PSM 121. Ans A ( ANTHROPOLOGY) :Park 21st/620

1.)ANTHROPOLOGY 2.)SOCIOLOGY 3.)SOCIAL SCIENCES 4.) ACCULTURATION

Study of physical, social & cultural history of man Study of human relationships & human behaviour for better understanding of pattern of human life The scientific examination of human behaviour. Mixing of 2 cultures when person of one culture comes in contact with a person of different culture.

RELATED QUESTION: A.) tendency of some members of a group to identify & interact with selected members only leading to formation of a sub group is called sociometry .(2003) B.) the example of primary social relationship is that of a husband & a wife.(2003)

122. Ans D (COV): BK Mahajan 7th/68

Measures of variability It tells us that a particular value is how much away from the mean value(i.e. variability)

1.) 2.) 3.) 4.)

range mean deviation standard deviation coefficient of variation

COEFFICIENT OF VARIATION: It is dimensionless(i.e. has a value but has no units like kg or metre etc.) It is used to compare variability of 2 distributions with different units of measurements.

RELATED QUESTION: A.) standard deviation equals square root of variance(2003) B.) histogram is used for quantitative continous data.(2003)

123. Ans C ( CATEGORY 3 ): J. Kishore Book on National Health Programs9 th/362-370

Leprosy prevelance in various Indian states: CATEGORY PREVELANCE STATES / UNION TERRITORIES Some districis in Delhi

>5 per 10000 Bihar Chattisgarh Dadra & Nagra haweli Rest all states including MAHARASHTRA

1 & above per 10000

< 1 per 10000

RELATED QUESTION : Lepromin test is read in 4 th week .(2001) Lepromin test is positive in Tuberculoid leprosy & negative in Lepromatous type indicating a failure of CMI.(2010) Only Indian classification has Pure Neuritic type of leprosy (2003)

124(a). Ans C (relapsing fever) : Park 21st/721 please refer question 108 of 2010

124(b). Ans D (all) : Park 21st/721 Ticks transfer Q fever in extra human hosts. 125. Ans B (NPU) : Park 21st/586

NET PROTEIN UTILISATION a.)gives more complete expression of protein quality b.)If NPU is low ,protein requirement is high c.) NPU of Indian diet is 50-80 d.)its a product of digestibility coefficient & biological value.

AMINO ACID SCORE It is a measure of concentration of each essential amino acid in the test protein expressed as a percentage of that amino acid in the reference protein.

Amino acid score of starch is 50-60 while that of animal food is 70 -80.

126. Ans C( TP +FP) : Park 21st/128

SENSITIVITY

SPECIFICITY

TP/(TP + FN) X 100

TN/(TN + FP )

X100

POSITIVE PREDICTIVE VALUE NEGATIVE PREDICTIVE VALUE

TP/(TP + FP)

X100

TN/(TN + FN ) X100

Where: TP =true positive FP =false positive TN =true negative FN =false negative

RELATED QUESTION: True positives are detected by sensitivity (2001)

127. Ans A (shortest cycle 18) : Park 21st/469

OGINO/CALENDAR/RHYTHM METHOD FERTILE PERIOD OF A WOMAN

1ST DAY OF FERTILE PERIOD shortest cycle -18 days

LAST DAY OF FERTILE PERIOD Longest cycle 10 days

RELATED QUESTION: Rhythm method is not classified as a natural family planning method.(2009)

128. Ans C (DANIDA) : Park 21st/403

AGENCY 1.)World Bank 2.)DANIDA 3.)WHO

ASSISTANCE TO Cataract blindness control program NPCB Assistance to Prevention of blindness Support of vision 2020

END OF PROJECT 2002 2003

NOTE: Although assistance toby DANIDA to National Blindness Control Program ended in 2003 ; the question says assistance was provided to the National Program(WHO simply provides assistance for prevention of blindness---be it national or international.) 129Ans C (yellow): Park 21st/662

ORTHO-TOLIDINE + CHLORINE WATER

YELLOW COLOR

Reading within 10 seconds

Reading at 15-20 minutes

DETECTS FREE CHLORINE

DETECTS FREE + COMBINED CHLORINE

130.Ans A (IPR ): Park 21st/237

PRE-ERADICATION ERA MALARIA INDICES:

SPLEEN RATE

AVERAGE ENLARGED SPLEEN It is a useful malariometric index.

PARASITE DENSITY INDEX Tells about degree of parasitemia

INFANT PARASITE RATE

Tells about endemicity of malaria in a community

It is the most sensitive index of recent malaria transmission

RELATED QUESTIONS: A.) mosquito whose larvae lie horizontal to water surface is anopheles (2006) B.) modified plan of operation divides endemic areas on the basis of Annual Parasite Index.(2005) C.) culex is a nuisance mosquito.(2005) D.) Plasmodium species affecting older RBCs is malariae & falciparam (2005) E.) Ring forms (other than plasmodium) are seen in babesia(2005) F.) Highly anthrophilic & transmitting malaria parasite even at low density is A. fluvitalis(2003)

131. Ans C (3 on 8): Park 21st/830

MILLENNIUM DEVELOPMENT GOALS,2000 a.) Base year of calculation of targets is 1990. b.) Target year is 2015 c.) Has 8 goals;18 targets;48 indicators d.) 3/8 goals, 8/18 targets ; 18/48 indicators ade directed towards health GOALS 1.) Eradicate extreme hunger & poverty 2.) Universal primary education 3.) Dispel gender disparity 4.) Reduce child mortality TARGET: reduce child mortality by 2/3 rd of 1990 INDICATOR: IMR & % of under 5 Children vaccinated for Measles 5.) Improving maternal health TARGET: reduce MMR by 3/4th Of 1990 INDICATOR:MMR & % attended Deliveries 6.) Combat HIV-AIDS,malaria & other diseases 7.) Ensure environmental sustainability 8.) Global partnership for development

RELATED QUESTION: The target year for achievement of Millennium development goals is 2015 .(2010)

132. Ans B ( 1 toxoid): Park 21st/287

PREVENTION OF TETANUS BOOSTER WITHIN <5 YEARS 5 10 YEARS >10 TEARS ? NEW,CLEAN WOUNDS -1 toxoid 1 toxoid Complete course of toxoid OTHER WOUNDS -1 toxoid 1 toxoid Complete course of toxoid + Ig

Where: Ig = human tetanus immunoglobulin.

133. Ans C (1000g) : Park 21st/519

Still Birth Rate Death of a fetus weighing 100g (this is equivalent to 28 weeeks of gestation) or more occurring during one year in every 1000 total births.

134. Ans A (35 47 years) : Park 21st/445

RATING 1.)STATIONARY 2.)SLOW GROWTH 3.)MODERATE 4.)RAPID

ANNUAL GROWTH RATE No growth < 0.5 0.5 to 1.0 1.0 to 1.5

NO. OF YEARS REQUIRED FOR THE POPULATION TO DOUBLE IN SIZE ->139 70 to 139 47 to 70

5.)VERY RAPID 6.)EXPLOSIVE 7.) EXPLOSIVE 8.) EXPLOSIVE 9.) EXPLOSIVE

1.5 to 2.0 2.0 to 2.5 2.5 to 3.0 3.0 to 3.5 3.5 to 4.0

35 to 47 28 to 35 23 to 28 20 to 23 18 to 20

135. Ans A ( STANDFORT 3 COMMUNITY STUDY):Park 21st/343

Intervention trials 1.) STANDFORT 3 COMMUNITY STUDY 2.)NORTH KERELIAN PROJECT 3.) MRFIT

4.)OSLOW INTERVENTION STUDY 5.)LIPID RESEARCH CLINIC STUDY 136. Ans C

Strategy to prevent CHD Community health education Mass community action against risk factors & advice on their avoidance Cessation of smoking Controlling BP Altering diet to reduce hypercholesterolemia Cessation of smoking Lowering serum lipids Lowering serum cholesterol

(50th centile for boys) : Park 19th/435

WHO GROWTH CHART CURVES

Upper reference curve represents 50 th centile for boys.

Lower reference curve represents 3rd centile for girls

137. Ans B (disability rate): Park 21st/25,26 INDEX 1.)Sullivans index DESCRIPTION a.)Expectation of life free of disability b.) [LIFE EXPECTANCY - DURATION OF DISABILITY] A.)life expectancy at birth but includes an adjustment for time spent in poor health

2.)HALE(health adjusted life expectancy)

3.)DALY(disability adjusted life years)

B.)Years in full health that a newborn can be expected to live based on current rates of illhealth & mortality a.)it is a measure of burden of disease b.)measure of effectiveness of intervention c.)years of life lost to premature death d.)years of life lived with disability

RELATED QUESTION: 1.) Birth & death registration should be in 21 & 21 days (2001) 2.) DALY is a measure of effectiveness of an intervention(2009)

138. Ans A(human anatomical waste): Park 21st/734,735 CATEGORIES OF BIO-MEDICAL WASTE:

1.) 2.) 3.) 4.) 5.) 6.) 7.) 8.) 9.) 10.)

Human anatomical waste Animal waste Microbiology/biotechnology waste Waste sharps Discarded/cytotoxic medicines Solid waste(blood/fluid contaminated) Solid waste Liquid waste Incineration ash Disinfectants/insecticides

COLOR OF CONTAINER Yellow bag Red bag Blue/white container black

CATEGORY 1,2,3,6 3,6,7 4,7 5,9,10

TRICK: HUMAN (cat 1)

ANIMAL (cat 2)

LABORATORIES (cat 3)

SHARP (cat 4)

PILLS (cat 5)

SOLID WASTE (cat 6 ,7)

EFFLUENT (cat 8) 139.Ans C (disaster awakenings): Park 20 /700

th

FUNDAMENTALS OF DISASTER MANAGEMENT

DISASTER RESPONSE

DISASTER MITIGATION

DISASTER PREPAREDNESS

140. Ans B(network analysis) :Park 20th/775

NETWORK ANALYSIS Graphic plan of all events & activities to be completed in order to reach an end objective

PERT

CRITICAL PATH METHOD

Involves making an arrow diagram.

Critical path = longest path of The network

Gives information about a.)logical sequence of events b.)time consumed in each activity c.)critical activities

If any activity along critical path gets ,delayed the whole project gets delayed

141.Ans B (Per capita income) : Park 21st/16 please refer question 128 of 2010 PHYSICAL QUALITY OF LIFE INDEX (PQLI) b.) Infant mortality c.) Life expectancy at age 1 d.) Income PQLI value ranges from 0 to 100

HUMAN DEVELOPMENT INDEX (HDI ) a.)Longevity ( life expectancy at birth ) b.)Knowledge ( adult literacy rate & mean years of schooling ) c.)Income HDI Value ranges from 0 to 1 For India = 0.612 (2007) World rank of India for HDI = 128

142. Ans A (Flourine) : Park 21st/558 Please refer question 133 of 2010

Nalgonda technique is for defloridation of water. Developer : NEER institute ,Nagpur Utilizes lime & alum It involves various processes : Flocculation

Sedimentation

Filteration

RELATED QUESTION: Fluoride in drinking water should be less than 1.5 mg /L , recommended is 0.8 mg /L & optimal is 1 2mg/L (2007) Softening of water is recommended when the hardness exceeds 150 mg /L .

143. Ans A (generation time): Park 21st/95 Please refer question 139 of 2010

GENERATION TIME SERIAL INTERVAL

MEDIAN INCUBATION PERIOD SCREENING TIME

Interval of time between receipt of infection by host & maximal infectivity of that host Gap in time between the onset of primary case & the secondary case The time interval between invasion by an infectious agent & appearance of first sign / symptom in 50 % of the cases Time interval between first possible diagnosis & final critical diagnosis.

144. ans : A. ( Latanoprost ) Khurana 4th / 222, Neil friedman / 203.

CHOICE OF DRUG IN POAG

Topical B blocker

Latanoprost

Dorzolamide

Brimonidine

1st choice ( in poor )

1st choice ( in affording) & Adjunct

2nd choice 2nd choice Adjunct

Neither 1st choice nor 2nd choice in POAG 1. Pilocarpine 2. Epinephrine 3. Dipivefrine NOTE : Latanoprost is superior to once daily Timolol gel for intraocular pressure reduction.( Beckers & schaffers book on Glaucoma ;8th/361) Related question : Chronic simple glaucoma is a type of POAG. (2009) Phacolytic glaucoma is a 2ndary OAG, occurs in hypermature cataract & is due to lens proteins. (2008). Polychromatic luster (2008)/Bread crumb appearance is seen in complicated cataract. Treatment of Congenital glaucoma (Buphthalmos ) is Goniotomy

145) ans:A (Latanoprost) :KDT 6th /144,Khurana 4th /223 drug Timolol Levobunolol Betaxlol Cartiolol Latanoprost Pilocarpine Dorzolamide Epinephrine/Dipivefrine Brimonidine Frequency per day Khurana KDT 1-2 1 1-2 1 2 1-2 1 1 3-4 3-4 2-3 3 1-2 2 2 3

146) ans :A (Heterophoria) :Kanski 6th /735,736

Squint

Heterophoria /Latent Squint Tendency of eyes to deviate when fusion is blocked

Heterotrophia /Manifest Squint Manifest deviation in which visual axes do not intersect at fixation point

Related question: Diplopia seen in paralytic squint.(2002) For Measurement of angle of deviation in squint Hirschberg test , Prism bar reflex test & test with Synaptophore are done.(2009) Squint caused due to excess convergence with sustained accommodation is seen in hypermetropia.(2006) 147) ans:D(Sickle cell retinopathy ):/ Kanski 6th 603 Sea fans configuration
1. 2. 3. .seen in sickle cell retinopathy. Seen in stage 3 Sprouting of new vessels from peripheral A-V anastomosis leads to sea- fans.

Related question: Bulls eye maculopathy is caused by Chloroquine (2006). 148) ans : A (6 weeks) :Kanski 6th /365,366.

Treatment of congenital cataract

Unilateral

Bilateral

Dense

Partial

Dense
Operate within 4 to 6 weeks

Partial

Operate within days of birth

Observe

Observe

Dense Opacity : 1 Occludes pupil 2 Retinal vessels visualized only by indirect ophthalmoscopy. 3 Central opacity more than 3mm. Partial Opacity : 1 Retinal vessels visualized both by direct & indirect ophthalmoscopy. 2 Central opacity less than 3mm. Related question : Maximum visual Disturbance is seen with nebula .(2009) Intraocular lens made up of PMMA, Silicon ,Hydrophilic acrylic.(2003) Recovery in cataract is fastest following Phako . (2002)

149) ans: D Iridocyclitis : Khurana 5th /271 Signs of Anterior uveitis A Lid edema B C Circumcorneal congestion Corneal Signs:
1. 2. 3. Edema Keratic Precipitates Post corneal opacity Aqueous cells Aqueous flare Hypopyon Hyphema Changes in depth /Angle of Anterior Chamber Iris Nodules(Koeppe/Busaca) Post Synechiae( Segmental /annular(Iris bomb )/Total) Neovascularisation of Iris (rubeosis iridis) Narrow pupil Festooned pupil Ectropion pupillae Occlusio pupillae Sluggish pupillary reaction

Anterior Chamber Signs:

1. 2. 3. 4. 5.

Iris Signs:
1. 2. 3.

Pupillary Signs:
1. 2. 3. 4. 5.

Changes in lens:
1. 2. 3. Pigment dispersal Exudates Complicated Cataract (Bread crumb polychromatic) Exudates Inflammatory cells

Changes in vitreous:
1. 2.

Keratic precipitates : Protein + cells. Arranged on back of cornea.

 A}Mutton-fat 1. Macrophage epitheloid cells 2. fluffy, lordaceous, waxy. e.g. Granulomatous iridocyclitis B}Small & medium + 1.

Types of Keratic precipitates are C}Red type RBC + Inflammatory cells. D}Old Irregular , crenated , Pigmented . e.g. Healed uveitis

Lymphocytes

present. 2. Small,

dirty e.g. Hemorrhagic Non uveitis

white, discrete. e.g. -granulomatuos iridocyclitis

150. ans : B ( 7.8 mm ) Khurana 4th / 89.

CORNEAL DIMENSIONS
ANTERIOR SURFACE 1.] Horizontal diameter : 11.7 mm 2.] Vertical diameter : 11 mm CORNEAL THICKNESS 1.] Center : 0.52 mm 2.] Periphery : 0.70 mm Related question : Gonococcus ( 2006 ) , C.diphtheriae & Fungi can penetrate intact cornea. 151. ans: D ( 400-700nm) Khurana 4th / 19 Light in visible portion of electromagnetic spectrum lies between 400 nm (violet) to 700 nm (red) POSTERIOR SURFACE 1.] Horizontal diameter : 11.5 mm 2.] Vertical diameter : 11.5 mm RADIUS OF CURVATURE 1.] Anterior : 7.8 mm 2.]Posterior : 6.5 mm

Related questions : 1. UV light for treatment of skin diseases : 200-400 nm.(2001) 2. Maximum sensitivity for rods & cones is 498 & 555 nm respectively.(2007) 3. Appreciation of colour is a function of cones.(2003)

152. ans: B ( Moraxella axenfield ) Khurana 4th / 61 Angular conjunctivitis is caused by Moraxella axenfield.

Type of conjunctivitis 1. Adult inclusion 2.Acute membranous 3.Acute hemorrhagic 4.Epidemic keratoconjunctivitis 5.Pharyngoconjunctival fever 153.ans: A.( Screening ) Parsons 19th / 595.

Organism C. trachomatis D K C. diphtheriae , virulent S. hemolyticus Picorna virus Adeno 8,19 Adeno 3.7

SAFE strategy has been developed by WHO to combat Trachomatous blindness. SAFE strategy

S Surgery Entropion Trichiasis

A Antibiotics Tetracycline eye ointment

F Face washing Facial cleanliness

E Environment Improvement/ modification

154.ans: A ( Excimer ) Parsons 19th / 297

LASERS IN OPHTHALMOLOGY Laser 1.) Excimer 2.)Nd-YAG Application LASIK PRK Posterior capsulotomy in after cataract Iridotomy

3.)Diode laser & Krypton red 4.)Argon greed

Retinal photocoagulation Trabeculoplasty Retinal photocoagulation Iridoplasty

Related questions : 155.ans: A ( Trauma ) refer question no. 155 of ( 2010 ) 156.ans: A ( Osteogenesis imperfecta ) Robbins 18th / 1351 Blue sclera Thinning of sclera Brown uvea becomes visible Then it appears blue [ due to optical tyndall effect ] Blue sclera is seen in Staphyloma Episodes of scleritis High intraocular pressure Osteogenesis imperfecta Congenital melanosis oculi Elschnig pearl in papillary aperture is a sign of After cataract. (2009) It is removed by Nd-YAG Laser posterior capsulotomy. (2006)

157.ans: B ( Cricothyroid ligament ) Grays 39th & Disorders of larynx 2nd / 41.

Ligaments & membranes of Larynx A. EXTRINSIC

These connect laryngeal cartilage & epiglottis to neighbouring structures. E.g. 1. Thyrohyoid membrane : connects thyroid to hyoid. 2. Hyoepiglottic ligament : connects hyoid to epiglottis.

3. Cricotracheal ligament : connects cricoid to 1st tracheal ring

B. INTRINSIC
These connect laryngeal cartilage & epiglottis with each other. E.g. 1. Quadrangular membrane Aryepiglottic ligament, Vestibular ligament 2. Triangular membrane Vocal ligament, Cricotyroid ligament 3. Thyroepiglottic ligament 158. ans : C ( 500- 3000 Hz ) Dhingra 5th/ 18. Natural resonance of external & internal ear : External auditory canal Tympanic membrane Middle ear Ossicular chain 3000 Hz 800-1600 Hz 800 Hz 500-2000 Hz

So, sound frequency of as low as 500 hz & as high as 3000 hz have greatest sensitivity of transmission & they are the frequencies of day to day conversation.

159.ans : A ( Cricothyroid ) The only intrinsic muscle lying outside laryngeal network is Cricothyroid. Previously asked question : The only abductor of vocal cord is Posterior cricoarytenoid.( 2010 ) 160.ans : A ( Frontal sinus ) Dhingra 5th / 211.

Pathology
1.) Sinusitis / Cancer 2.) Osteoma / Mucocoele 3.) Fungal ball

Order of sinus involvement

M > E > F > S F > E > M > S M > S > E > F

4.) Orbital complication Related question :

E >

F > M > S

M : Maxillary sinus E : Ethmoid sinus F : Frontal sinus S : Sphenoid sinus

Paranasal osteoma most commonly develop in Frontal sinus. ( 2009 )

161.ans : B ( Abscess involving external auditory canal ) Dhingra 5th / 87. ABSCESS 1.] Wilds SITE Postauricular (mastoid) MC TRICK P : Posterior A : Auricular W : Wilds

2.] Zygomatic

3.] Bezolds

4.] Lucs 5.] Citellis

Front & above pinna. (Posterior Root of Zygomatic arch ) 1.Tip of mastoid 2. Angle of jaw 3. Post. Triangle of neck 4.Parapharyngeal space. Between antrum & external auditory meatus 1. over occiput 2. in digastric triangle of neck

Be : Bezold Ti : Tip of mastoid

O : over occiput C : Citelli D : Digastric triangle

162A. ans : B ( Rhinitis sicca ) Dhingra 5th / 171.

RHINITIS SICCA
CAUSATIVE SURROUNDING Hot Dusty Dry e.g. bakers goldsmith PATHOLOGY Crust formation in anterior third of nose. Removal of crusts cause bleeding & ulcers / septal perforation. HISTOPATHOLOGY Squamous metaplasia of ciliated columnar epithelium TREATMENT 1. bland ointment 2. antibiotic / steroid ointment 3. nasal douches

162B. None 163. D ( Caries of spine is a common cause ) Dhingra 5th / 280. RETROPHARYNGEAL SPACE 1. 2. 3. 4. 5. Space between buccopharyngeal fascia & prevertebral fascia. Divided into two compartments. ( space of Gillete ) Extends from skull base to tracheal bifurcation. communicates with parapharyngeal space. contains retropharyngeal lymph nodes.

ACUTE RETROPHARYNGEAL ABSCESS Common in less than 3 yrs of age group. ETIOLOGY : 1. Suppurative lymphadenopathy, 2. Penetrating injury of posterior pharyngeal wall / cervical esophagus Clinical : 1. dysphagia 2. dyspnea 3. stridor 4. croupy cough 5. torticollis 6. bulge in posterior pharyngeal wall ( one sided ) Treatment : 1. Incision & Drainage , 2. Antibiotic course.

164. C ( Neutrophilia) Robbins 8th/ 55 Ans. CHEDIAK HIGASHI SYNDROME Characterized by defective fusion of lysosome with phagosome. Autosomal recessive Pathogenesis: There is defective fusion of phagosome with lysosome leading to defective degranulation of lysosomal contents which are seen on electron microscopy as dense granules. Findings: 1.Neutropenia 2.Albinism ( Due to defective melanocytes) 3.Bleeding tendency

165. Ans A (seminoma) :Harrisons 18th/806,Robbins 8th/988

TUMOUR MARKERS IN GERM CELL TUMOURS

1. 2. 3. 4. TUMOUR seminoma yolk sac tumor immature teratoma mixed germ cell tumor AFP hCG (15% times)

+ +/ +/ +

+/ + +

5. 6.

choriocarcinoma embryonal carcinoma

166. Ans B (DSPN): Harrisons 18th/2984

Most common form of diabetic neuropathy is Distal Symmetric Polyneuropathy.

DIABETIC NEUROPATHIES 1. Distal symmetric

polyneuropathy

FEATURES a.)most common type b.)distal sensory loss is seen . c.)neuropathic pain + d.)dysesthesia,paresthesia,hyperesthesia e.)sensory deficit persists

2.Polyradiculopathy

3.Mononeuropathy

4.Autonomic neuropathy

a.)pain along the distribution of a particular nerve root. b.)motor manifestations seen.c.)self limiting d.)resolve in 12 months a.)isolated cranial or peripheral nerve involvement b.)pain & motor distribution along a single nerve distribution c.)most commonly affects 3rd cranial nerve a.)resting tachycardia b.)gastroperesis c.)hyperhidrosis d.)anhidrosis (hands) (feet) e.)sudden death f.)orthostatic hypotension g.)hypoglycemic h.)bladder unawareness abnormalities

167. Ans D (indinavir) : Harrisons 18th/1570-1574

INDINAVIR nephrolithiasis indirect hyperbilirubinemia hyperglycemia

EFAVIRENZ

TENOFOVIR renal osteomalacia fanconi like syndrome hypophosphatemia ZIDOVUDINE granulocytopenia anemia myopathy lactic acidosis nail pigmentation

rash dysphoria drowsiness depression dreams(abnormal)

Nephrolithiasis causing ART: 1. indinavir 2. amprenavir 3. fos amprenavir

168. Ans B (panacinar) : Robbins 8th/684 Emphysema Affects centriacinar Central /proximal acinus Seen in Site smokers upper lobe chronic bronchitis apical segments Concept Upper lobe is well aerated so cigarette rises up in the lung Lower lung better perfused, so more elastase to destroy the lung

panacinar

whole of the acinus

alpha -1 anti trypsin defiency from the blood

lower zone anterior margins lung bases

169. Ans D (all): Harrisons 18th/599

DRUGS CAUSING VIT B-6 DEFIENCY Isoniazid Penicillamine Cycloserine L-dopa Hydralazine Phenelzine

RELATED QUESTION: Vitamin that is sensitive to light is riboflavin.

170. Ans B (SLE ):Robbins 8th/569

LIBMANN SAC ENDOCARDITIS/ ENDOCARDITIS OF SLE

GENERAL Affects mitral & tricuspid valve Single/multiple warty lesion

SITES Upper surface of AV valves Under surface of AV valves Valvular endocardium On the chords Mural endocardium

HISTO PATHOLOGY Hematoxylin bodies Fibrinoid necrosis Homogenous remnants of nuclei

171. C (DIFFUSE ESOPHAGEAL SPASM ): Harrisons 18th/2432 ESOPHAGEAL DISORDER 1.diffuse esophageal spasm 2.monilial esophagitis 3.leiomyoma 4.achalasia RADIOGRAPHIC APPEARANCE Cork screw appearance Nut cracker esophagus Irregular plaque-like filling defects Smooth filling defect It is present at right angles to esophageal wall. Dilated esophageal body Air-fluid level Closed esophageal sphincter(birds beak)

RELATED QUESTION: Rat tail appearance is sen in carcinoma esophagus.

172. Ans B (MEFLOQUIN ): Harrisons 18th/1703 CHEMOPROPHYLAXIS OF MALARIA IN PREGNANCY

CHLOROQUIN SENSITIVE Chloroquin

CHLOROQUIN RESISTANT Mefloquin Proguanil

RELATED QUESTION: ACCCOLE forms are seen in peripheral blood smear of P. falciparam(2001)

173. Ans B (HODGKINS): Robbins 8th/600

UTILITY OF STAGING IN LYMPHOMA

NON-HODGKINS LYMPHOMA Prognosis

HODGKINS LYMPHOMA Guides therapy Prognosis

RELATED QUESTION: Solid second malignancy in hodgkins lymphoma may be due to radiation therapy.(2008) Most common lymphoma in AIDS is large cell immunoblastic lymphoma(2006)

174.Ans B (INTERSTITIAL LUNG DISEASE ): Harrisons 18th/2095

Indications of HRCT:

A. Lung pathologies B. Petrous Temporal Bone

1.Interstitial lung disease 2.Bronchiectasis 1.Cholesteatoma 2.Petrositis 3.Mastoiditis 4.ossicular chain disruption

175.Ans A (IL-1) :Robbins 8th/73,195

IL-1 Fever Expression of endothelium adhesion molecules Secreted by activated macrophage

IL-2 Stimulates proliferatio n of lymphocyt es Secreted by CD4+ cells

Il-4 Stimulates B-cells to differentiate into IgE secreting cells Secreted by Th-2 cells

IL-12 Stimulates T lymphocytes Secreted By Activated macrophages

IL 12 function

T cell IL-12 Actrivated T cell Activated macrophage

INF-gamma Macrophage

IL 4 function

Th 2 cell ( IL 4 ) B- cell Ig E secreting plasma cell

IL 2 function

Activated Th 1 cell autocrine stimulation IL-2

Paracrine stimulation of other Th1 cells

176. Ans A (ANTI-LKM-1): Harrisons 18th/2567

LKM stands for liver-kidney-microsomes.

ANTI LKM ANTIBODY 1

ASSOCIATED CONDITIONS Chronic Hepatitis C Autoimmune Hepatitis 2

2 3

Drug Induced Hepatitis Chronic Hepatitis D Autoimmune Hepatitis 2 (infrequently)

177. Ans D (all): Harrisons 18th/598

CAUSES OF NIACIN DEFICIENCY Alcoholics Hartnup disease Corn eating(predominantly) Deficiency of Fe Deficiency of B-2 Deficiency of B-6

178. Ans D (Co-dominant): Harrisons 18th/1951

a.)

b.) c.)

Genes determine A & B phenotype of blood group . They are expressed in a Mendelian Co-dominant manner They are located on chromosome 9p.

179.Ans D (BCL-2) :Robbins 8th/22

BCL stands for B-cell lymphoma ,so obviously it causes limitless growth & not apoptosis. GENE 1. N-myc 2. p 53 SPECIAL FEATURE Seen in neuroblastoma Seen in most of the carcinomas Acts at G1/S and G2/M checkpoints of the cell cycle Known as molecular policeman of genome Seen in colon carcinoma Seen in pancreatic adenocarcinoma Seen in thyroid cancer Seen in AML

3.

RAS

RELATED QUESTION: Specific feature of apoptosis is (activation of caspase) > ( inter nucleosomal cleavage ) (2006)

180.Ans A (RESPONSE TO LOW FAT DIET IS GOOD): Harrisons 18th/2462,2463

CONCEPT of ENTERO HEPATIC CIRCULATION

Liver

Bile acids

R E S O R P T I O N

Ileum,colon

LIMITED ILEAL DISEASE

EXTENSIVE ILEAL DISEASE

BILE ACID DIARRHOEA (cholorrheic anteropathy) 1.BILE ACID ABSORPTION (lesser ileal length) 2. FECAL BILE ACIDS ( lesser reabsorption) 3. FECAL LOSS COMPENSATION BY LIVER 4. BILE ACID POOL 5. STEATORRHOEA 6. RESPONSE TO CHOLESTYRAMINE 7. RESPONSE TO LOW FAT DIET

FATTY ACID DIARRHOEA

YES (because of limited disease) NORMAL +/+ _

NO

> 20 gm +

181. Ans C (G-6 PD DEFIENCY): Robbins 8th/645

As spleic macrophages pluck out Heinz bodies (denatured hemoglobin),Bite cells are produced in G-6PD deficiency.

DISORDER G-6PD deficiency Thalassemia

Heredity spherocytosis

BLOOD SMEAR Bite cells Heinz bodies Punctate basophilia Target cells Elliptocytes Microcytes Spherocytes

RELATED QUESTION: Sickle cell trait does not cause leg ulcers(2002) (Leg ulcer are seen in Sickle cell disease ).Trait shows anemia & normal osmotic fragility of cells. Hemoglobin level required to be maintained by Bete-thalassemia patients for body growth & normal activities is 10-12 gm % Phototherapy following jaundice in newborns gives rise to Bronze baby syndrome(2005) Hair on end appearance is seen in thalassemia(2001) Genes responsible for thalassemia are located on chromosome 11 (2006) 182. Ans D (all): Harrisons 18th/1835

ECG CRITERIA FOR LVH

SV 1 + RV 6 >35mm

RaVL + SV 3 > 20 mm (females)

RaVL + SV 3 > 28 mm (males)

RELATED QUESTION : During ECG the lead 2 negative terminal is connected to right upper limb(2008) Patients with ASD with secondum defect have right bundle branch block. In hexa-axial reference system continous lines are generated from standard leads(2003)

183. Ans

B ( TNK) : Harrisons 18th/2027

FIBRINOLYTIC IN MI 1. TISSUE PLASMINOGEN ACTIVATOR (t-PA) 2 STRPTOKINASE 3. TENECTEPLASE (TNK) 4. RETEPLASE (rPA)

BOLUS DOSE ( In 30 min) X (in 10 sec) (double bolus)

INFUSION DOSE

RELATED QUESTION: TPA is most effective if given within 1-3 hours of ischemic injury(2003)

184.Ans D (all) : Harrisons 18th/3362,3363

CAUSES OF BILATERAL FACIAL PALSY Lymes disease GBS Sarcoid Moebius syndrome Leukemia Syphilis Pontine glioma Basilar skull fracture

Leprosy can sometimes cause bilateral facial palsy.

RELATED QUESTION Bells palsy involves 7th (facial) nerve (2002)

185. Ans A (ADALIMUMAB ): Harrisons 18th/2777

NAME 1. Infliximab 2. Etanercept 3. Adalimumab

SPECIAL Chimeric human-mouse monoclonal antibody TNF-alpha IgG fusion protein Fully human derived monoclonal body

CONCEPT:

Name of antibody has 4 parts: PREFIX inf ada Prefix is different for each antibody TARGET li lim Li/lim is used to denote rheumatoid arthritis ORIGIN xi U Xi denotes chimeric U denotes human SUFFIX mab mab M= monoclonal Ab=antibody

Therefore xi in Infliximab tells it is a chimeric antibody

RELATED QUESTION: Drug used in rheumatoid arthritis that acts by inhibition of T cell production is leflunomide (2008) Bamboo spine is seen in ankylosing spondylitis(2005)

186: Ans: C. Aspergillus fumigatus. Harrisons 18th 2120. Aspergillus fumigatus is the most common cause of ABPA. Main diagnostic criteria for ABPA: Immediate wheal flare to A. Fumigates. Bronchial asthma Peripheral eosinophilia Elevated IgE Central bronchiectasis Serum precipitins to A. fumigatus Other diagnostic features: Elevated IgE (IgG) specific for A. fumigatus Culture of the organism from sputum History of brownish plugs in the sputum.

187: Ans C (millers lung disease) Harrisons 18th 2117 Millers lung disease is caused by Sitophilus granarius infesting wheat flour. Thermophilic actinomycetes cause i. ii. iii. iv. v. RQ: Thermomyces is used for sterilisation standardisation (2002) Bagassosis Farmers lung Ventilation pneumonitis (Air conditioner lung) Mushroom workers lung Potato riddlers lung

188. Ans C. MEN 2

MEN 1 / 2: autosomal dominant Wilsons: Autosomal recessive Hemochromatosis: Autosomal recessive

189: Ans A. Von Willebrand disease Harrisons 18th / 971 Most common inherited bleeding disorder: Von Willebrand disease. Most common inherited cause of hypercoagulability: Factor 5 leiden mutation, prothrombin mutation RQ: Factor 5 leiden is resistant to inactivation by activated protein C. (2009) Gp IIb/IIIa deficiency causes Glanzman thrombasthenia (2009) Clotting factor deficiency that is asymptomatic: Factor XII

190. Ans D. RTA 4 Type I RTA Type II RTA

Unable to acidify urine, pH <5.5 Stone formation Urine Ca++ raised, citrate decreased Rickets/osteomalacia Hypokalemia

Impaired bicarbonate excretion, pH>5.5 and bicarbonate excretion >15% Fanconi syndrome All increased: Phosphate, urate, Ca++, amino acids, glucose Rickets/osteomalacia Hypokalemia

Normal anion gap

Normal anion gap

Type 4 RTA presents with hyperkalemia.

191. Ans D (thrombocytopenia) Henoch Schonlein Purpura: A small vessel vasculitic disease Characterised by :palpable purpura, arthralgia, GI involvement, glomerulonephritis. Incidence: more in children, male:female = 5:1 Pathology: immine complex deposition, with IgA deposited in renal mesangium. Clinical: i. ii. iii. iv. palpable purpura, mostly over buttocks,legs. poly arthralgia, with no arthritis GI involvement (Nausea, vomiting, diarrhoea, constipation, PR bleed) Glomerulonephritis

Lab findings: Leukocytosis, Elevated IgA, with normal platelets Diagnosis: Based on clinical picture. Biopsy of renal tissue showing IgA in mesangium is rarely needed. Treatment: Steroids. For Renal disease, Plasmaexchange. Prognosis is excellent.

192. Ans C ( NARCOLEPSY ): Harrisons 18th/2186

1.) AGE 2.) CATAPLEXY 3.) NIGHT SLEEP Duration Awakenings Snoring Morning drunkeness 4.) DAYTIME NAPS Frequency Time of day Duration

Adult No

Young Yes

Young No

Normal Occasional + occasional

Normal Frequent Occasional Occasional

Long Rare Occasional Common

Few Afternoon/evening < 1 hour

Many Few Afternoon/evening Morning < 1 hour > 1 hour

193. Ans C (CARDIAC TAMPONADE ): Harrisons 18th/1975

1. Tamponade 2. Constrictive pericarditis 3. Restrictive cardiomyopathy 4. RVMI

Prominent Y descent No Yes Yes (rare) Yes (rare)

JUGULAR VENOUS PULSE

a wave c wave

Due to distension produced by right atrial systole Bulge of tricuspid valve into right atrium during ventricular isovolemic systole. Atrial relaxation & downward displacement of tricuspid valve Accentuated in Reduced in Constrictive pericarditis Right ventricle dilation Tamponade Restrictive cardiomyopathy

Ax Descent

v wave

Due to increasing blood volume in right atrium when tricuspid is closed & ventricle is contracting By opening of tricuspid valve & inflow of bloor into right ventricle Accentuated in Tricuspid regurgitation Constrictive pericarditis Reduced in Tricuspid stenosis Atrial myxoma

vy descent

ya ascent

Due to continuous diastolic inflow of blood from great veins into right atrium

RELATED QUESTION: Kussmauls sign is seen in Constrictive pericarditis.(2003) Characteristic of RVMI is hepatomegaly with raised JVP. Acute pericarditis has effusive & fibrinous variants(2001).

194. Ans C ( MESOBUTHUS TAMULUS ): Harrisons 18th/3580-3581

Bites of Mesobuthus , Leiurus Androctonus & Tityus are associated with massive catecholamine release leading to adrenergic crisis ---may benefit from prazosin administration. Treatment of Scorpion Bite: LOCAL DISCOMFORT Analgesics HYPERTENSION / PULMONARY EDEMA Nifedipine Nitropruside Hydralazine Prazosin BRADYCARDIA Atropine NEUROMUSCULAR MANIFESTATIONS Midazolam

195. Ans A ( 3 HZ SPIKR-WAVE ): Harrisons 18th /2253,2650,3252,3428

EEG PATTERN 1. Triphasic 2. Bilateral periodic bursts of high voltage tri / polyphasic bursts < 200 milli sec occurring every 1-2 sec 3. Periodic stereotype sharp slow complexes in temporal lobe at regular 2 3sec 4. Normal alpha waves

DISEASES Hepatic encephalopathy hyponatremia CJD

HSV encephalitis

5. Periodic high voltage sharp slow waves every 3 -8 sec followed by periods of

Hysteria Locked-in syndrome Catatonia SSPE

attenuated background 6. Generalised , symmetric 3 spike wave that begins & end abruptly.(superimposed on normal background) 7. Generalised slow spike wave less than or equal to 2.5 per sec 8. Isoelectric 9. Focal inter ictal epileptiform discharges 10. Symmetric slowing

Typical absence seizure

Atypical absence seizure Brain death Focal seizure Diffuse cerebral dysfunction ( delirium )

RELATED QUESTION: Most common type of seizure in childhood is GTC (2003) Risks for febrile seizures include 2 4 years of age , positive family history & uncontrolled High grade fever (2003) Neonatal seizures are most commonly associated with deficiency of pyridoxine. Juvenile myoclonic epilepsy has onset between 8 -18 years , 90 % seizures are tonic-clonic & response to valproate is excellent.(2007)

196. Ans A ( AZITHROMYCIN ): Harrisons 18th/1544

DRUG OF FIRST CHOICE IN MAC INFECTION: INDICATION CD 4 + count < 50 / micro L Prior documented disseminated disease ( may stop prophylaxis if CD 4 + is > 100 / micro L for 3 or more months ) 1 ST CHOICE Azithromycin OR Clarithromycin Clarithromycin + Ethambutol + Rifabutin

RELATED QUESTION: Under passive T.B. surveillance ,a cough of 2 or more weeks is an indication for sputum microscopy (2005)

197. Ans C ( < 500 MICRO L ): Harrisons 17th/131

FUO

CLASSIC FUO

NOSO COMIAL FUO Yes(in hospitalized patients) > 3 weeks

HIV FUO

NEUTRO PENIC FUO Yes

TEMPERATURE Yes > 38.3 C ( 101 F) DURATION OF > 3 week FEVER

Yes

Yes

> 3 week

NO. OF DAYS SPENT IN DIAGNOSIS YET NO DIAGNOSIS REACHED

7 days of inpatient investigation

3 OPD visits OR 3 day hospital stay OR 7 days of intelligent & invasive ambulatory investigations

>3 days)IPD patients) OR > 4 week ( OPD ) patients 3 days of 3 days of investigation investigation ( with 2 days ( with 2 days of incubation of incubation of cultures) of cultures

> 3 week

3 days of investigatio n ( with 2 days of incubation of cultures

Neutropenia < 500 micro L RELATED QUESTION: FUO is body temperature of 101 F (2009)

198. Ans C ( SPLEEN HILUM ) : LB 25th/1103

SPLEENUNCULI (single / multiple accessory spleen)

MOST COMMON SITE: Spleen hilum

OTHER SITES: Tail of pancreas Mesocolon Spleenic ligaments

199. Ans C ( HEMANGIOMA ) : LB 25th/1108

Most common benign tumor of spleen: Hemangioma

Most common cause of neoplastic enlargement of spleen is lymphoma

200. Ans B ( POST SURGERY ): Paediatric respiratory reviews (2009)19

CHYLOTHORAX

ETIOLOGY IN CHILDREN Cardiothoracic surgery (most common ) Thrombosis of subclevian veins Malformed pulmonary / thoracic lymphatics

ETIOLOGY IN ADULT Thoracic / neck trauma (most common) Malignancy at thoracic aperture

CLINICAL Dyspnea Pleural effusion DIAGNOSTIC TESTS Triglycerides in effusion > 1.2 mg% Milky effusion Presence of chylomicrons Presence of lymphocytes TREATMENT OPTIONS Chest tube with octreotide Pleuroperitoneal shunt / ligation of leaking duct.

201. Ans B ( 4 CM ): LB 25th/808,809

INCIDENTALOMA Clinically unapparent mass detected incidentally by imaging techniques Detected in 4 % of patients on imaging

INCIDENCE 78 % Non-functioning adenoma 12 % Functional adenoma

Most common functioning adenoma: Cushngs adenoma

TREATMENT OF NON-FUNCTIONAL ADENOMA

> 4 cm in size Increases in size over time

< 4 cm in size static in size

Surgery

Follow up at 6 , 12 ,24 Months by a.)Imaging b.)Hormonal assay

202. Ans A ( ORCHIDECTOMY AND RPLND ):Harrisons 18th/808,809

TREATMENT OF NON-SEMINOMA AFTER ORCHIDECTOMY STAGE 1 No clinical evidence of disease No radiological evidence of disease AFP / hCG levels normal or declining

RPLND A.)Lynphatic /vascular invasion B.)Tumor spread beyond testis

Observe ---

 STAGE 2

Limited ,ipsilateral lymphadenopathy ( retro-peritoneal ) Nodes 3 cm or less in largest diameter a. 2 cm or less in size b. AFP /hCG normal c. Less than 6 nodes a. 2 -3 in size b. AFP /hCG levels high c. More than 6 nodes

Bilateral RPLND

Bilateral RPLND + 2 cycles of chemotherapy

STAGE 2c 3

Combination chemotherapy Cisplatin + Etoposide + Bleomycin

EASIER VERSION: STAGE 1 2 TREATMENT RPLND or observe Bilateral RPLND +/ 2 cycles of chemotherapy Chemotherapy

2C & 3

203. Ans C ( CONTINUING BLOOD LOSS..) : LB 25th/345

Chest injury with Hemothorax

Assess Hemodynamic status

UNSTABLE

STABLE

Thoracotomy

Tube Thoracostomy

Observe if :

Thoracotomy if:

Stable

>1500ml initial blood in the draining tube > 200 ml blood / hour for 3 hours cardiac tamponade /arrest tracheo-bronchial injury esophageal perforation vasculature injury persistent air leak retained foreign body > 1.5 cm in diameter

204. Ans A ( IDIOPATHIC RETROPERITONEAL FIBROSIS ) :LB 25th/644

ORMANDS DISEASE Progressive retroperitoneal fibrosis involving one / both ureters Etiology is unknown Symptoms: a.) Unremitting backache b.)Renal failure USG : hydronephrosis Excretory urogram : ureters displaced towards midline Treatment :

a.)Temporary Ureteric stents Percutaneous nephrostomies Dialysis

b.)Permanent Ureterolysis with wrapping of omentum around ureters.

205. Ans D (POST MASTECTOMY IRRADIATED LIMB ): LB 25th/845

LYMPH ANGIOSARCOMA (Stewart Treves Syndrome ) Etiology : chronic lymphedema ( esp. post lymph node dissection ) Presentation : multiple subcutaneous nodules Site :upper limb Prognosis : poor Treatment : forequarter amputation

206. Ans A ( ANY BURN IN AN UNMARRIED WOMAN ): LB 25th/380

CRITERIA FOR ACUTE ADMISSION TO A BURNS UNIT

Suspected airway / inhalational injury. Any burn likely to require fluid resuscitation / surgery. Any burns to hands / face / feet / perineum. Patients whose psychiatric / social background makes it inadvisable to send them home. Any suspicion of non-accidental injury. Any burns in patients of extremes of age. High tension electric burns. Concentrated hydro fluoric acid burns.

207. Ans D ( 45 ) : LB 25th/1077 CRITERIA FOR MORBID OBESITY A.) Body Mass Index > 45 kg /m2 B.) Weight for Height > or equals 100% over ideal

208. Ans C ( RECURRENT INTESTINAL OBSTRUCTION ) : LB 25th/1198 Treatment of Recurrent Intestinal Obstruction caused by Adhesions Charles Philip transmesentric plication. Nobles plication. Repeat adhesiolysis(enterolysis). Intestinal intubation.

209. Ans A ( ASCENDING COLON ): Robbins 8th/793 ANGIODYSPLASIA Occurs in 6 th decade Most often in caecum & right colon PATHOLOGY Malformed mucosal / submucosal blood vessels Ecstatic nests of tortuous veins ,venules & capillaries It is separated from the gut lumen by vascular wall & a layer of attenuated epithelial cells ASSOCIATIONS Age (increasing) Aortic stenosis Meckels diverticulum CLINICAL Presence of hemorrhage

210. Ans C ( DISTAL TO VEROMONTANUM ): LB 25th/1362 POSTERIOR URETHRAL VALVE Folds of urothelium causing urethral obstruction Flap valves : urine flow is obstructed but urethral catheter can pass Found in boys POSITION Distal to veromontanum (more common) Proximal to veromontanum ( less common ) DIAGNOSIS Antenatally : USG Postnatally : UTI (urinary track infection ) May present even in adulthood / adolescence.

CLINICAL Bladder hypertrophy Bladder diverticula UTI / VUR (vescico-ureteral reflux) Renal failure

TREATMENT Relieve back pressure on kidneys followed by transurethral resection of valves.

211.Ans B (BOWING DEFORMITY OF ERECT PENIS ) : LB 25th/1373

PEYRONNIES DISEASE

Deformity of erect penis

Eect penis bends towards the side of fibrous plaque

There is fibrosis of tunica of corpora cavernosa.

Plaques may calcify. Association seen with Dupuytren s contracture

Treatment : Nesbitts operation.

RELATED QUESTION Peyronmies disease affects penis (2005)

212.Ans B (PORCELAIN GALL BLADDER ) :LB 25th/1112-1113

A plain X ray may show calcification of the gall bladder (Porcelain gall bladder ) It is an indication for cholecystectomy. CHOLELITHIASIS 10 % of stones are radioopaque Mercedes benz /Seagull sign ( tri radiate gas in the centre of the stone ) Calcification of the gall bladder wall Radiolucent gas in the gall bladder wall Cholecystectomy ,if indicated

PORCELAIN GALL BLADDER EMPHYSEMATOUS CHOLECYSTITIS

Cholecystectomy ( as 25 % patients develop carcinoma Cholecystectomy

213.Ans A ( INCREASED URINARY FREQUENCY ): LB 25th/1306-1307

RENAL TUBERCULOSIS SPECTRUM OF DISEASE Hematogenous infection

Tubercles in pyramid

Coalesce to form ulcer

Abscess formation fibrosis of : a.) renal pelvis b.) neck of calyces Pyonephrosis

Peri-nephric abscess

Putty kidney ( caseous contents ) CLINICAL Incidence : Males > females Right > left kidney Frequency ( EARLIEST SYMPTOM ) Sterile pyuria Hematuria Pain

Cement kidney ( calcification )

INVESTIGATION Cystoscopy : GOLF hole orifice of the ureter IVP : Indistinct renal papillae Calyceal stenosis Hydronephrosis TREATMENT Medical : AKT Surgical : 6 12 weeks after AKT 214.Ans D ( ANERIOR WALL ): LB 25th/1227

SOLITARY RECTAL ULCER SYNDROME (SRUS )

Internal intussception

SRUS Increased rectal pressure Anterior rectal wall prolapse

Occurs on anterior rectal wall Heals with formation of inflammatory polyp Benign but difficult to treat PR bleed & mucus discharge present Treatment : abdominal rectopexy / intrarectal stapling

215.Ans D ( PERIPHERAL ZONE ) : Robbins 8th/992 LOBES OF PROSTATE Peripheral Carcinoma

Transitional Benign Hyperplasia of prostate

Central

Note : If lobes are mentioned instead of zones , BPH occurs in median lobe hyperplasia.

216. Ans B (RECTAL PROLAPSE ): LB 25TH/1225

TREATMENT OF FULL THICKNESS RECTAL PROLAPSE A.)Perineal approach: Patient is elderly & very frail 1.Deleromes operation anal mucosa is sutured to unprolapsed rectal mucosa AND MUSCLE IS PLICATED. A coloanal anastomosis is created it has become obsolete as it causes chronic perineal sepsis & anal stenosis

2.Altemiers procedure 3.Thiersch operation

B.)Abdominal approach: Patient is in otherwise good health 1.Wells operation 2.Ripsteins operation the rectum is fixed to sacrum the rectosigmoid junction is fixed to sacrum

As abdominal approach risks damage to pelvic autonomic nerves,resulting in possible sexual dysfunction, the PERINEAL approach is also usually preferred in young men.

217. Ans B (10-25 ): LB 25TH/1010 The normal lower esophageal sphincter is 3 4 cm long & has a pressure of 10 25 mm Hg.

218. Ans B (AT THE LEVEL OF ARCUATE LINE) : LB 25TH/983

SPIGELIAN HERNIA Its a variety of inter-parietal hernia Occurs at the level of arcuate lines(lateral to rectus muscle) Incidence in males is equal to that in females Diagnosis:USG / CT It may undergo strangulation

RELATED QUESTION: Richters hernia involves a part of circumference of the intestine (2001) A femoral hernia has more chances to undergo strangulation than inguinal hernia(2010) ( Although inguinal hernia is 10 times more common than femoral hernia)

219. Ans C (6 CM ) : LB 25TH/1164

The diagnosis of toxic megacolon is confirmed by a dilatation of colon > 6 cm on plain X-ray film BAILEY & LOVE,25th/1164

Toxic megacolon is confirmed by loss of haustrations & a dilation of transverse /right colon > 6 cm

HARRISONS,18th/

RELATED QUESTION: Earliest sign of ulcerative colitis on barium enema is granularity of mucosa (2005)

220. Ans C (ADENOID CYSTIC) :Robbins 8th/758-760 TUMOR 5 YEAR SURVIVAL 1. Adenoid cystic 60 -70 %

2.Acinic cell

90%

3.Mucoepidermoid(low grade)

90%

4.Mucoepidermoid(high & intermediate grade)

50%

5.Cystadenolymphoma

Benign

RELATED QUESTION: Acinic cell tumor is a tumor of parotid.(2002) Most common parotid gland is pleomorphic adenoma.(2007) Treatment of choice for pleomorphic adenoma is excision of tumor[superficial parotidectomy](2007)

221. Ans B (HAMARTOMATOUS POLYP IN PEUTZ JEGHERS SYNDROME):Robbins 8th/814-816

TYPE 1.Inflammatory

SITE Rectum

MALIGNANCY no

HISTOLOGY CLINICAL Lamina PR propria bleed/mucus fibromuscular Prolapse of hyperplasia rectum

2.Hamartomatous A.)juvenile rectum jejunum Polyp may be dysplastic Juvenile polyposis syndrome has adenocarcinoma Polyps are nonneoplastic GI adenocarcinoma no Dilated glands with mucin PR bleed Prolapse of rectum

B.)peutz jeghers

Skin pigmentation

3.Hyperplastic

Left colon

Goblet cell accumulation

OBSTETRICS AND GYNECOLOGY 222(a). Ans D (HYALINE DEGENERATION ): Duttas gynecology 5th/265

DEGENERATIONS IN FIBROID Most common type = hyaline degeneration Most common type in pregnancy = red degeneration

TYPE 1. Hyaline

2.Cystic 3.Fatty 4.Calcific

MORE COMMON IN APPEARANCE Fibroids with high Loss of whorled connective tissue pattern content Occurs in the central most part of fibroid Common in Liquefaction is interstitial fibroid seen Fat globules in muscles Common in CaCO3 subserous fibroid (Ca)3(PO4)2 deposition is seen (womb stone)

SEEN IN

Menopausal phase Menopausal phase Menopausal phase

5.Red

It appears raw beef like There is necrobiosis

2nd trimester of pregnancy Puerperium

RELATED QUESTION: Most common presentation of anterior wall fibroid is urinary retention(2006)

222(b). Ans B (RED DEGENERATION)

223. Ans D (OBVIOUS VISIBLE GROWTH ): Duttas gynecology 5th/112-113

INDICATIONS OF COLPOSCOPY

Women with abnormal smear

Conservative treatment of CIN

Guiding biopsies

Women with clinically suspicious cervical lesion with history of contact bleeding.

224. Ans A (OCCIPITO-FRONTAL ):Duttas obstetrics 7th/370

FACE TO PUBIS DELIVERY

ENGAGING DIAMETER :OCCIPITO- FRONTAL (11.5 cm)

DELAYED ENGAGEMENT

PERINEAL Leads to STRETCHING

MOULDING

MAY LEAD TO OBSTRUCTED LABOR

PERINEAL TEAR

TENTORIAL TEAR

225. Ans D (155) :Williams 23rd/1108 ; Duttas Obstetrics 7th/282

CRITERIA FOR DIAGNOSIS OF GDM

Time elapsed After oral glucose ( 75 or 100 g) A. Fasting B. 1 hour C. 2 hours D. 3 hours

glucose (mg/dl) in plasma

95 180 155 140

ACOG prefers 100 g glucose value at 3 hour in OGTT WHO prefers 75 g glucose value at 2 hour in OGTT Carried by 100 g /75 g of oral glucose Fasting of 8 -14 hours 2 or more values to be positive for GDM 3 days of unrestricted diet 3 days of unrestricted activity

RELATED QUESTION: Most common anomaly in a baby of a diabetic mother is cardiac anomalies(2006) Search for GDM is carried out at 24-28 weeks of gestation.(2003)

226. Ans B (1500): Duttas Obstetrics 7th/182

DIAGNOSIS OF ECTOPIC PREGNANCY GESTATION a.) 4 5 weeks b.) 5 6 weeks hCG 1500 IU/L 6000IU/L USG TVS TAS

Where TVS: trans vaginal scan TAS : trans abdominal scan

RELATED QUESTION: Medical management of ectopic pregnancy is indicated if gestational sac is less than than 4 cm , hCG levels are lower than 2000 IU /L & patient is unstable(2007) Surgical management of ectopic pregnancy involves Conservative approaches ( Salpingostomy , Salpingotomy & Fimbrial expression of ectopic pregnancy ) and Radical approach ( Salpingectomy) (2010)

227. Ans D ( 9 ) : Duttas Gynecology 5th/511

MIFEPRISTONE

MECHANISM Blocks progesterone receptors

USES Therapeutic abortion(effective upto 7 weeks) Post coital contraception Cervical ripening Shrinkage of fibroids Termination of ectopic pregnancy

CONTRAINDICATIONS Adrenal insufficiency Age > 35 years Heavy smoker Corticosteroid therapy

Release of prostaglandins

ADVERSE REACTIONS Nausea headache

Increased PV bleed

Pregnancy is terminated

228. Ans C (FOLLOWING MENSES ): Duttas Gynecology 5th/538

BREAST SELF EXAMINATION

START WHEN By the of 20 years PROCEDURE

FREQUENCY Monthly following menses (as breasts become less tender & less engorged

Inspection in front of a mirror Palpation with opposite hand (sitting/supi ne position) Palpate axillary & supraclavic ular areas Compress nipples for any discharge

229. Ans B ( 34.5 CM ) : Williams 23rd/82

CIRCUMFERENCE OF FETAL HEAD

DIAMETER 1. Greatest 2. Smallest

ALONG THE PLANE Occipito-frontal Suboccipito-bregmatic

SIZE 34.5 cm 32 cm

230. Ans C ( 0 ): Williams 23rd/392 ; Dutta obstetrics 7th/133 STATION Level of presenting fetal part ( in birth canal ) in relationship to ischial spines.

ACOG CLASSIFICATION STATION INTERPRETATION a.) - 5 to - 1 - 5 cm to 1 cm above ischial spine b.) 0 At ischial spine c.) + 1 to + 5 + 1 cm to + 5 cm below ischial spine

231. Ans C ( 160 ) : Williams 23rd/412 ; Dutta Obstetrics 7th/609

Bradycardia tachycardia

HEART RATE < 110 /min > 160 / min

232. Ans B ( ABOVE THE ANGLE ) : Williams 23rd/783 ; Dutta Obstetrics 7th/424

Because the hemorrhage usually comes from the upper angle of the wound, the first suture is placed proximal to angle.

Bleeder point 1 st stitch above the angle

Stitches

Cut ends of cervical tear

Above the angle stitch takes care of active bleed

233. Ans C (OCCIPITO MENTAL ) : Williams 23rd/81

DIAMETERS 1. Bitemporal 2.biparietal 3.Suboccipito bregmatic 4.Occipito frontal 5.Occipito mental

SIZE (cm) 8 9.5 9.5 11.5 12.5

234. Ans B (Trichomoniasis ):Novaks 14th /542

FEATURES DISCHARGE ODOR pH MICROSCOPY

GARDENELLOSIS White Fishy > 4.5 Increased Clue cells Decreased lactobacillus Whiff test +

TRICHOMONIASIS Green ,frothy Foul >5 Motile trichomonas

CANDIDIASIS Curdy < 4.5 More acidic pH Budding yeast/mycelia

OTHERS

Strawberry vagina

In immunocomprised patients

TRICK: Mona likes strawberries: Trichomonas causes Strawberry vaginitis.

CANDIDA :ACIDpH

RELATED QUESTION : Clue cells are seen in Gardenellosis (2005) 235.Ans C (PRE ECLAMPSIA ) : Williams 23rd/1045,1046

Renal failure is most often associated with severe pre-eclampsia eclampsia.

ACUTE RENAL FAILURE IN PREGNANCY ETIOLOGY 1.Severe pre eclampsia- eclampsia 2. HELLP syndrome 3.Obstetrical hemorrhage (placental abruption) 4.Abortion related 5.Septicemia 6.Acute fatty liver of pregnancy MANAGEMENT Medication dose adjustment Hemofiltration/dialysis

RELATED QUESTION: MgSO4 is not cardiotoxic (2002) In MgSO4 therapy patellar reflex disappears at 10 meq /L ( respiratory paralysis at 12 meq /L ). (2008 ) MgSO4 is used to treat pre-eclampsia because it has additional anti-hypertensive action.(2001)

236. Ans A (HYPOFIBRINOGENEMIA )Duttas Obstetrics 7th/324

COMPLICATIONS OF INTRA-UTERINE DEATH 1. Blood coagulation disorders a.) Hypofibrinogenemia b.) DIC 2. Infections (esp. by Clostridium welchii) 3.Uterine inertia 4.Retained placenta 5.Post partum hemorrhage 6.Psychological upset

237. Ans A ( THORACOPAGUS ) : Duttas Obstetrics 7th/200

Most common type of conjoint twin is : THORACOPAGUS GENESIS OF MONOZYGOTE TWINS:

a. b. c. d.

TIMING OF DIVISION IN EMBRYONIC MASS < 4 DAYS 4 8 DAYS > 8 DAYS > 2 WEEKS

TYPE OF TWIN

DIAMNIOTIC DICHORIONIC DIAMNIOTIC MONOCHORIONIC MONOAMNIOTIC MONOCHORIONIC SIAMESE / CONJOINT TWINS

238. Ans B ( 2000 ):

POINT A POINT B

Crossing of ureter Lateral pelvic wall

SHAWS 8000 rads 4500 rads

DUTTA 8000 rads 2000 rads

Point A = 2 cm above fornix & 2 cm lateral to uterine axis Point B = 2 cm above fornix & 5 cm lateral to uterine axis & 3 cm lateral to point A

Point of crossing of ureter Point of Obturator gland / lateral pelvic wall.

Uterine axis

Tube

2 cm A 2 cm

3 cm B

fornix

vagina

MANCHESTER POINT A & B IN CARCINOMA CERVIX

STAGING OF CARCINOMA CERVIX

STAGE 0

Carcinoma in Situ

STAGE 1 1 a = Micro invasive Depth of stromal invasion equal to less than 5 mm Lateral spread equal to less than 7 mm 1 a 1 = < 3 mm X < 7 mm 1 a 2 = 3 5 mm X < 7 mm

1 b = Clinically visible but confined to cervix or microscopic but > 1 a . 1 b 1 = equal to / less than 4 cm 1 b 2 = > 4 cm

STAGE 2 Disease beyond cervix but not to pelvic wall or lower 1/ 3rd of vagina.

2b not to pelvic wall 2a not to lower 1/3 rd of vagina

STAGE 3 Disease to pelvic wall or lower 1/ 3 rd of vagina.

Tumor T U M O R

3b involving pelvic wall

3a involving lower 1 /3 rd of vaginal wall

STAGE 4

1. Metastasis 2. Invasion of bladder 3. Invasion of rectum

RELATED QUESTION: Manchester point A & B are used for radiotherapy for cervical carcinoma(2003) Conventional daily dose regimen in external beam radiotherapy is 180- 200 c GY (2003) Carcinoma cervix is caused by HPV (2005) Stage of carcinoma cervix with involvement of parametrium; upper 2/3rds of vagina & no free space on per rectal examination is STAGE 3A Stage of carcinoma cervix when microscopic length involvement is > 3mm but < 5 mm with invasion no wider than 7 mm is STAGE 1A.

239. Ans A (H. MOLE ) :Duttas Obstetrics 7th/190-198 HYDATIDIFORM MOLE Abnormal condition of ovum with partly degenerative ,partly hyperplastic changes in young chorionic villi. Benign neoplasia of chorion with malignant potential INCIDENCE Highest in Philippines ( 1: 80) In India 1: 400 ETIOLOGY Teenage pregnancy > 35 years of age racial factors PATHOLOGY Villi are seen with absent blood vessels Marked proliferation of syncitio & cytotrophoblast Hydropic degeneration of stromal tissue CLINICAL FEATURES Vaginal bleed (most common symptom) :WHITE CURRENT IN RED CURRENT Passage of grape like vesicles Vomiting Size of uterus is more than the gestational age Abdominal pain Thyrotoxicosis History of quickening absent INVESTIGATIONS USG :Snow storm appearance in uterus Theca lutein cysts in ovary Rapidly increasing Beta hCG titre. TREATMENT Suction evacuation

RELATED QUESTION: 70 % of patients with hydatidiform mole have fundal height more than expected(2005).

240. Ans D ( INEVITABLE ABORTION ) : Duttas Obstetrics 7th/158-164

TYPES OF ABORTION FEATURES 1. PV bleed THREATENED INEVITABLE INCOMPLETE COMPLETE Yes yes yes no MISSED Persistent brown discharge Firm;closed No Dead & retained in uterus

2. Os 3. Pain 4. Conceptus

Closed Yes In utero

Dilated; conceptus felt yes In utero

patulous yes Partly expelled

closed no Fully expelled

TYPES OF ABORTION

Conceptus In utero Os diameter

Conceptus In utero

Conceptus partly expelled

Conceptus fully expelled

Threatened Abortion

Inevitable abortion

Incomplete abortion

Complete abortion

RELATED QUESTION: Treatment for missed abortion at 14 16 weeks is misoprostol(2007).This is the most safe & most effective method.

241. Ans D (OLIGOHYDRAMNIOS & ANEMIA IN RECEPIENT ): please refer question 227 in 2010 242. Ans A ( DECREASED IRRITABILITY ): Duttas obstetrics 7th/265 Response is evidenced by a sense of welll being / decreased irritability. RELATED QUESTION: Fetal demand for iron is evident after 25 weeks of gestation (2007) Amount of Iron required for fetus in pregnancy tenure is 0.3 g (200). 243. Ans B ( AC ): Duttas Obstetrics 6th/646

In 2 nd trimester USG : Abdominal circumference is the single most sensitive parameter for assessment of fetal growth.

244. Ans D ( DUHRSSEN OPERATION ): please refer question 222 of 2010. 245. Ans D ( 2ml/kg 10 % DEXTROSE ) :Ghai 7th/155

HYPOGLYCEMIA IN NEONATES

BLOOD GLUCOSE CONCENTRATION < 40 mg / dl

PLASMA GLUCOSE CONCENTRATION < 45 mg / dl

a.) TREATMENT OF ASYMTOMATIC HYPOGLYCEMIA: INITIAL BLOOD SUGAR

> 20 mg / dl

< 20 mg / dl

PER ORALLY FEED FORTIED FEED

I. V. INFUSION OF GLUCOSE

After hour

BLOOD GLUCOSE > 40 mg/dl

BLOOD GLUCOSE < 40 mg/dl

6 Hourly monitoring for 48 hours

b.) TREATMENT OF SYMPTOMATIC HYPOGLYCEMIA:

BOLUS : 2mg /kg of 10 % dextrose

INFUSION: 6 mg /kg/ min of glucose

Check every 30 45 minutes

Blood glucose > 50 mg /dl after 24 hours

Hypoglycemia persistent

Repeated samples of of blood show blood glucose > 50 mg /dl

Incease infusion rate maximum to 12 mg/kg/min

Taper infusion rate

Switch to oral feeds

246. Ans C (KMC ) : Ghai 7th/122,123 KMC is best to provide thermal protection to baby esp. while transportation.Hot water bottle can cause accidental burns to baby.

KANGAROO MOTHER CARE Given to preterm / LBW infants Suggested by Edgar Ray POSITION OF BABY Skin to skin contact Baby held in vertical position Baby between breasts & under mothers clothing TYPES OF KMC There are 2 types of KMC:

CONTINOUS 24 hours a day Mother is in semi reclining position

INTERMITTENT 1 2 hours atleast in a single sitting.

BABYS DRESS Front open sleeveless shirt Cap Socks Nappy STOPPAGE OF KMC Weight attained 2500 g Gestation of 37 week Baby starts wriggling out/fusses/cries. BENEFITS Thermal protection Stimulates breast milk production Encourages exclusive breast feeding Helps in bonding

247. Ans

B (HURLER ) : Nelsons 18th/622 MUCOPOLYSACCHARIDOSES 1 HURLER SCHIE HURLER SCHIE HUNTERS (a hunter needs a clear vision) SANFILLIPO (types A,B,C,D) MORQUIO MAROTEAUX LAMY CORNEAL MORPHOLOGY CLOUDING

CLEAR 3 4 6 CLEAR FINE OPACITIES CLOUDING

FEATURES OF HURLERS: H = hepatosplenomegaly U = ugly faces R = recessive(Autosomal) L = L-iduronidase deficiency E = eyes(cornea) clear R = retardation (mental) S = short,stubby fingers

RELATED QUESTION: Enzyme deficient in Maroteaux lamy syndrome is Arylsulfatase B (2002)

248. Ans A ( 3 ):Nelsons 18th/1560

CLASSIFICATION OF JEJUNO-ILEAL ATRESIA

GRADE

PROXIMAL LOOP OF SMALL BOWEL

DISTAL LOOP OF SMALL BOWEL

The proximal loop continues into distal The cause of reduced calibre is intra luminal diaphragm Ends as a blind loop Ends as a blind loop Ends as a blind loop Ends as a blind loop Ends as a blind loop Ends as a blind loop Loss of dorsal mesentry APPLE PEEL: Distal loop( the ileum) Coils around ileo colic Artery

CONTINUITY OF PROXIMALDISTAL LOOPS yes

2 3a 3b

Yes ( via a solid cord) No no

Multiple segments of bowel atresia are present

249. Ans C (vaginal delivery): Ghai 7th//203 The highest percentage of HIV infected children acquire the virus intrapartum. RISK FACTORS FOR VERTICAL TRANSMISSION: Preterm delivery < 34 weeks Low maternal antenatal CD4 count Use of illicit drugs during pregnancy > 4 hours duration of rupture of membranes Birth weight < 2500g.

250.Ans C (2.9g) : Ghai 7th /263

Citrate is present in concentration of 10 m mol/L (2.9g )in WHO low-osmolarity ORS.

INGREDIENT LOW OSMOLARITY ORS (m mol/L) Na 75 K 20 Cl 65 Citrate 10 Glucose 75

WHO-OLD ORS (m mol/L) 90 20 80 10 111

INGREDIENT LOW OSMOLARITY ORS (g/L) NaCl 2.6 KCl 1.5 Citrate 2.9 Glucose 13.5

WHO-OLD ORS ( g/L) 3.5 1.5 2.9 20

251.Ans C (600-800) : Ghai 7th/265

TREATMENT OF PATIENTS WITH SOME DEHYDRATION (diarrhoea treatment plan B )

REHYDRATION THERAPY (correction of fluid_electrolyte deficit

MAINTENANCE THERAPY (replacement of ongoing losses)

PROVISION OF NORMAL DAILY REQUIREMENTS

REHYDRATION THERAPY (in first 4 hours) 75 ml/kg ORS AGE < 4 mon ORS(ml) 200-400 or 4-11mon 400-600 12-23 mon 600-800 2-4 years 800-1200 5-14 years 1200-2200 >15years >2200

252 (a). Ans D( seen normally in 3-5 years of age ): Nelsons 18th/1521 REGURGITATION Normal gastro-intestinal event Occurs in 1st year of life Etiology: a result of gastro-esophageal reflux Volume of emesis:15-30 ml Vomit can be effortless/forceful Resolves in 80% children by 6 mo of age Resolves in 90% children by 12 mo of age Persistence beyond 1 year of age is pathological Complications:aspiration/esophagitis/failure to thrive

EVENT

PHYSIOLOGICAL REGURGITATION

PATHOLOGICAL REGURGITATION

1 YEAR

252(b). Ans D( seen normally in 3-5 years of age ): Nelsons 18th/113

RUMINATION IS A PSYCHOLOGIC-VEGETATIVE-EATING DISORDER.

RUMINATION DISORDER a.) Repeated regurgitation without nausea/GI illnesss b.) Leads to weight loss/failure to thrive c.) Seen in males d.) Seen in 3-14 mon of age

PSYCHOLOGIC Infants with disturbed parentchild relationship. Seen in infancy TREATMENT a.) behaviour therapt b.) family therapy c.) positive reinforcement of eating d.) negative reinforcement of rumination

SELF STIMULATING Parent-child relationship is fine. Seen at any age Chidren are mentally retarded

253. Ans A=B (very severe disease =severe pneumonia):Ghai 7th/743

SIGNS 1.Any general danger sign: a.) vomiting b.) convulsion c.) lethargy/unconscious ness d.) unable to feed 2.Chest indrawing 3.Stridor 1.Fast breathing: <2 mon :60 or more/min 2mo-12mo :50 or more/min 12mo-5year:40or more/min

CLASSIFIED AS

Severe pneumonia Or Very severe disease

pneumonia

1. No signs of pneumonia Or Very severe disease

254. Ans D (7g):Ghai 6th/ 97

COMPOSITION OF BREAST MILK(per 100 ml) MACRO NUTRIENTS Lactose 7g A Fat 3.5g C Protein 1.1g 5.2 mg Ca P 35 mg 15 mg Zn 120 micro g 60micro gm K 1.4 mEq MAJOR IONS TRACE ELEMENTS

VITAMINS

Na

0.9 mEq Fe 30-50 micro g

RELATED QUESTIONS:

1.) 100 ml of breast milk provides 67 Kcal of energy 2.) exclusive breast feeding is done uptill 6 mon of age(2005) 3.) protein content of breast milk is 7 to 20 g per L (2005)

ORTHOPEDICS 255. Ans A ( PIECE OF DEAD BONE SURROUNDED BY INFECTED) Robbins 8th/1222

When the newly deposited bone forms a sleeve of living tissue around the segment of devitalized bone,it is known as involucrum. The dead piece of bone is known as sequestrum.(It is surrounded by infective granulation tissue)

INVOLUCRUM Outer bone SEQUESTRUM Inner bone ( Mnemonic: SIN )

Newer bone Native bone

Viable bone Necrotic bone

256. Ans A (Anterior talo fibular): Maheshwari 3rd/140

Anerior talo-fibular ligament is most commonly sprained. MEDIAL COLLATERAL/DELTOID LIGAMENT Superiorly attached to apex & margins of medial malleolus Consists of 2 sets of fibres:

Superficial 1. Tibionavicular 2. tibiocalcaneal 3. Posterior tibio-talar LATERAL COLLATERAL LIGAMENT 1. Anterior talo-fibular 2. posterior talo-fibular 3. Calcaneo-fibular

Deep Anterior tibio-talar

RELATED QUESTION: Ligament supporting the head of talus is Spring ligament (2008)

257. Ans D (36%): Emedicine.medscape.com/article825981 FIRST RIB FRACTURE

SITE OF FRACTURE

Groove where subclevian artery passes

MORTALITY

36%

INCIDENCE

rarest of all other rib fractures

MECHANISM

severe trauma leading to violent contraction of scalene muscles

ASSOCIATED INJURIES

Lung/ascending aorta/subclevian artery/brachial plexus

COMPLICATIONS

Norner syndrome/thoracic outlet syndrome/aortic Aneurysm/tracheoesophageal fistula

258. Ans D (anterior shoulder dislocation):maheshwari 3rd/74

SHOULDER DISLOCATION Most common ANTERIOR Most common SUBCORACOID BANKARTS LESION Stripping of glenoid labrum & [eriosteum so that humeral head lies in front of scapula HILLS SACH LESION Depression on postero-lateral part of humeral head due to anterior glenoid rim

RELATED QUESTION: Most common anterior dislocation is subcoracoid(2007)

259. Ans D (hyperextension):John Ebnezar

CONGENITAL DISLOCATION OF KNEE

INTRISIC CAUSES a.) ehlers danlos syndrome b.) AMC c.) Larsen syndrome

EXTRINSIC CAUSES a.) abnormal fetal position (breech) b.) quadriceps fibrosis

ATTITUDE OF LIMBS: A.) forward displacement of proximal tibia over femoral condyles . B.) hyperextension at knee.

TREATMENT: <2 DAYS Reduction & casting

LATE PRESENTATION RECALCITRANT CASES Casting in Bryants cast/prone Open reduction position for 1-2 week) followed by closed reduction

260. Ans A (Intracapsular neck #):JBJS 2006

FRACTURE/DISLOCATION Intracapsular fracture of femur head a.) undisplaced b.) displaced Dislocation a.) posterior b.) anterior

% AVN OF FEMUR HEAD 16% 27-30% 10-26% 3-9%

RELATED QUESTIONS: a.) typer of avascular non-union of fracture are torsion wedge,comminuted and defect nonunion.(2006)

261. Ans C (Epiphyseal): Maheshwari 3rd/216

OSTEOCLASTOMA A.)1/3rd benign B.) 1/3rd locally malignant C.) 1/3rd frankly malignant PATHOLOGY

Undifferentiated spindle cells Multinucleate giant cell Vascular stroma CLINICAL Age is 20-40 years Epiphyseal Most commonly around knee RADIOLOGY Lytic lesion(sclerotic margins are rare) Abutting epiphysis/subchondral Soap bubble appearance TREATMENT Excision with reconstruction Curretage PROGNOSIS Recurrence is a serious problem After every recurrence ,tumor becomes more aggressive

262. Ans C (genu varus): Osteoarthritis affects 1st the medial compartment of knee joint causing genu varus.

263. Ans D (Colles #): Maheshwari 3rd/24

TENSION BAND WIRING (TBW)

A fracture opens up

Distraction forces

Distraction forces converted to Compression forces

Healing of fracture

TENSION BAND WIRE # of patella/olecranon/medial malleolus

TENSION BAND PLATE # of humerus /tibia

TENSION BAND FIXATION # of tibia

264. Ans A (Bells nerve): Grays 812

RELATED QUESTIONS: a.) b.) c.) d.) e.) f.) g.) h.) Pointing index finger is seen in median nerve nerve palsy(2009) Wrist drop is caused by damage to radial nerve(2005) Saturday night palsy is caused by damage to radial nerve(2005) Nerve involved in fracture of surgical neck of humerus is axillary(2002) Nerve involved in fracture shaft humerus is radial(2003) Claw hand is caused by ulnar nerve palsy(2002) Erbs palsy occurs at C5-C6(2002) Klumpkes palsy occurs at C8-T1.(2002)

DERMATOLOGY

265. Ans B (lichen planus):Roxburg 17th/44-46

LICHEN PLANUS CUTANEOUS LESIONS MUCOSAL LESIONS a.) purple,plaina.) Commonly topped,pruritic,poly involves buccal gonal papule mucosa b.) wickhams b.) A white lace like striae(white lace pattern is like pattern) seen/white c.) predilection for macule wrist,shin,genitalia( c.) May complain of face not commonly intolerance to involved) spicy food d.) koebners d.) Genital mucosal phenomenon+ lesions are e.) scalp involvement annular. causes scarring alopecia. NAIL LESIONS a.) pterygium formation (proximal nail fold prolongs onto nail bed) b.) destruction of nail plate c.) onychorrhexia:thi nning,tenting,dista l splittingroughnes s with longitudinal ridging d.) anychia:absence of nail

HISTOLOGY OF LICHEN PLANUS 1.) Aggregation of lymphocytes at dermo-epidermal(DE) junction 2.) Squamatisation of basal cells 3.) Saw-toothing of DE junction 4.) Civatte/colloid bodies 5.) Max Joseph space 6.) Hyperkeratosis 7.) Hypergranulosis

RELATED QUESTION: Gottron papules are lichenoid(2007)

266.Ans B (Scleromyxedema) KOEBNERS PHENOMENON

Development of lesions following trauma over previously uninvolved skin of patients suffering from a particular cutaneous disease.

TRUE 1.) psoriasis 2.) lichen planus 3.) vitiligo PSEUDO 1.) warts 2.) molluscum 3.) pyoderma gangrenosum OCCASIONAL 1.) dariers disease 2.) kyrles disease 3.) Kaposi sarcoma 4.) Erythema multiforme 5.) Pellagra QUESTIONABLE 1.) DLE 2.) Bullous pemphigoid 3.) Morphea 4.) Pityriasis rubra pilaris REVERSE 1.) psoriasis

267.Ans B (Pemphigus vulgaris):Rbbins 8th/1192-1196

Pemphigus vulgaris SITE OF BLISTER AUTO-ANTIBODIES TYPE OF AUTOANTIBODY Suprabasal (acantholytic) Intra epidermal (fish-net appearance) IgG

Bullous pemphigoid Subepidermal (non-acantholytic) Along DEJ IgG

Dermatitis herpetiformis subepidermal Tips of dermal papilla IgA (granular deposits)

Where:DEJ = dermo-epidermal junction

TRICK: 1.) pemphiGus /pemphiGoid has IgG. 2.) dermAtitis has IgA

RELATED QUESTION: Acanthocytosis is seen in abetalipoproteinemia(2002)

268.Ans C (atopic dermatitis):Harrisons 18th/395 CUTANEOUS STIGMA OF ATOPIC DERMATITIS a.) Dennie morgan fold (extra fold of skin beneath the lower eyelid) b.) Increased incidence of cutaneous infections(esp. with staphylococcus) c.) Increased palmer markings d.) Perioal pallor

269. B (staphylococcus aureus) : Harrisons 18th/1325,1329

BOTRYOMYCOSIS

a.)chronic ,suppurative bacterial infection b.)affects soft tissue/visceral tissue c.)characteristic is clumps of bacteria (resembles granules of actinomycosis) d.)causative organism is S . aureus

270.Ans B (donovanosis) : Harrisons 18th/1320,1381,1425 DONOVANOSIS 1.) caused by calymatobacterium donovanosis 2.) causes bleeding,painless,indurated ulcer 3.) pseudo-bubo is seen 4.) pseudo-elephantiasis is seen 5.) microscopy:safety pin appearance(Donovan bodies) 6.) drug of choice:doxycyclin azitromycin(pregnancy) LGV 1.) Caused by C, trachomatis L1/L2/L3 2.) Causes painless,single ,non-bleeding ulcer 3.) Bubo(matted lymph nodes)is seen 4.) Esthiomine is seen 5.) Frie test + 6.) Groove sign+ 7.) Drug of choice:doxycycline CHANCRE 1.)caused by T,pallidum 2.)causes single,painless,indurated ulcer 3.)rubbery painless lymph nodes are seen 4.)diagnosis by dark field microscopy,VDRL,FTA-ABS 5.)drug of choice:penicillin G CHANCROID 1.)caused by Hemophilus ducreyi 2.)causes multiple ,painful, bleeding ,nonindurated ulcer 3.)microscopy shows gram ve coccobacilli & school of fish pattern 4.)drug of choice:ceftriaxone

RELATED QUESTION: A.)groove sign is seen in LGV.(2006)

271.Ans B (psoriasis ) : Robbins 8th/1191 HISTOPATHOLOGY OF PSORIASIS Neutrophil infiltrates in Munros micro abscess parakeratotic stratum corneum 1 2 Spongiform pustule of Kogoj 3 Acanthsis 4 Auspitz sign 5 Thinning of stratum granulosum Neutrophil infiltrates in spongiotic superficial epidermis Marked epidermal thickening Multiple bleeding points when scale is lifted from the psoriatic plaque

Please refer question 74 of 2010

RELATED QUESTION: a.) Streptococcal infection may lesd to guttate psoriasis.(2008) b.) Arthritis mutilans is associated with psoriasis.

272.Ans A (HPV )

273. Ans C (epi-dural blood patch):Lee 12th /685

POST DURAL PUNCTURE HEADACHE ETIOLOGY FEATURES a.)Breach of dura in : a.)Onset in 12-72 hours lumbar puncture b.)Lasts for weeks myelography c.)Pain is Bilateral frontal spinal anesthesia , retro-orbital,occipital & wet epidural tap extending into neck b.)There is reduction of ICP d.)Hallmark is aggravation of due to CSF leakage post pain with change in body dural puncture. position

SITTING STANDING

MANAGEMENT A.)Supine position Analgesia , I.V. Fluids B.)Epidural blood patch With 10-20 ml venous Blood is most effectiv C.)Drip of Hartmanns Solution in epidural Space D.)Vasopressor of choice :EPHEDRINE

LYING DOWN ABDOMINALCOMPRESSION

274. Ans B (bupivacaine )clinical anaesthesia 5th /458 PLASMA PROTEIN BINDING IN LOCAL ANAESTHETICS: B > R = E = T >M >L Where, B=bupivacaine; R=ropivacaine; E=etidocaine; T=tetracaine;M=mepivacaine; L=lidocaine.

RELATED QUESTION: a.) Maximum safe dose of plain lignocaine is 300 mg (2003)

275.

Ans D (midazolam ) :KDT6th/459

DRUG 1. Pancuronium 2. Pethidine 3. Enflurane 4. Midazolam

METABOLISM/CLEARANCE Clearance reduced in hepatic & renal failure In renal failure ,accumulation of nor-pethidine occurs that has excitatory effects Renal excretion is found Hepatic clearance is found

RELATED QUESTION: A.) a few drugs that are safe in porphyria are propofol,midazolam and alfentanyl. 276. Ans D (all) :Pauls 5th /24-1

INCREASES IN ET CO2

DECREASES IN ET CO2

Malignant hyperthermia Hyperthyroidism Hypoventilation Shivering Sepsis Rebreathing

hypothermia hypothyroidism hyperventilation hypoperfusion pulmonary embolism

277. Ans D (determining appropriate placement of : Capnography by JS Gravenstein endotracheal tube)

CAPNOGRAPHY

Method of monitoring partial pressure of O2 in expired gas. Concept: a)dead space air(i.e. air in conducting airway )does not contain CO2. b)CO2 absorbs infra-red rays & gets detected in capnography.

3 Pp CO2 2 1 time 4

Expiratory Inspiratory

PHASES 1: Exhalation 2: Expiratory stroke 3: Expiratory plateau 4: Inhalation

CO2 Minimum Increasing Maximum decreasing

CONCEPT Dead space air comes out first Dead space air + alveolar CO2 Alveolar CO2 Fresh air comes in

USES OF CAPNOGRAPHY: a.)verification of ET tube in position. b.)adequacy of cardio-pulmonary resuscitation c.)evaluation of asthma treatment d.)avoiding secondary injury in head injury patients e.)assessment of return of spontaneous respiration.

RELATED QUESTION: Dead space air is the first to be expired (2001) 278. Ans B (dibucaine) : KDT 5TH/320

LONG DURATION Dibucaine Tetracaine Bupivacaine ropivacaine (in that order) trick: delhi to Bombay rail)

LOCAL ANESTHETICS INTERMEDIATE DURATION Prilocaine lignocaine

SHORT DURATION Procaine Chlorprocaine

Longest acting:dibucaine Shortest acting:chlorprocaine

RELATED QUESTION: B.) Longest acting acting muscle relaxant is doxacurium

279. Ans D (isoflurane) :Morgans 3rd/186

a.) b.) c.) d.)

SUCCINYL CHOLINE non-competitive muscle relaxant depolarizing type of relaxant shortest acting(due to pseudo cholinesterase) causes biphasic blocks: PHASE 2 BLOCK potentiated by 1.enflurane

PHASE 1 BLOCK potentiated by 1. isoflurane 2. Mg2+ 3. Li+ 4. anti cholinestrase ADVERSE REACTIONS: a. post operative myalgia b. malignant hyperthermia c. hyperkalemia RELATED QUESTION:

a.) Adverse effects of scoline are greater in spinal cord trauma patients.(2007) b.) Scoline causes muscle fasciculations(2005) c.) Apnea is seen in presence of abnormal plasma cholinesterase following scoline administration.

280. Ans B (blue) please refer question of 2010

281.Ans C (Right middle lobe):Suttons 7th/14 SILHOUETTES SIGN If aerated alveolar spaces (radiolucent) are replaced by fluid/soft tissue (radio opaque),there is no difference of radiodensity between heart (radio-opaque)and the fluid/soft tissue.

STRUCTURE OF HEART 1. Right heart border 2. Left heart border 3. Aortic knuckle 4. Hemidiaphragm

PATHOLOGIC LOBE OF LUNG Right middle lobe Lingular lobe Apicoposterior segment of left upper lobe Basal segments of lower lobe

282.Ans A (X-rays)

1.

RAYS X-rays Alpha particle Beta particle Gamma rays

ORIGIN Extra -nuclear

SOURCE Fast moving electrons bombarded on anode Radio active isotopes

Intra -nuclear

283. Ans A(O-18)

1. 2. 3. 4.

ISOTOPE O-18 C-14 P-32 I-125

STABILITY yes no no no

EMITS 1 electron 1 electron-antineutrino Beta emission Low energy photons

HALF -LIFE 5730 years 14 days 59 days

284. Ans D (small bowel obstruction):Grainger 5th/981

STRING OF BEADS SIGN

SMALL BOWEL OBSTRUCTED AND DILATED

SMALL BOWEL ALMOST COMPLETELY FLUID-FILLED

BUBBLES OF GAS TRAPPED BETWEEN VALVULAE CONNIVENTES (STRINGS OF BEADS)

SIGN 1.String sign 2. String sign of Kantor 3.String of beads appearance

CONDITION Congenital hypertrophic pyloric stenosis Crohns disease Fibromuscular dysplasia

RELATED QUESTION: Small bowel obstruction presents with triad of vomiting,abdominal distention and string of beads sign on X-ray(2009)

285. Ans A (Osteosarcoma):robbins 8th/1226,1228 ;Maheshwari 3rd/218 X-RAY FINDINGS IN OSTEOSARCOMA 1. Codmans triangle:triangular area of new subperiosteal bone formation 2. Sunray appearance:new bone laid along blood vessels within tumor growing centrifugally 3. Periosteal reaction:irregular and intense 4. Irregular metaphyseal destruction 5. Erosion of cortex

OSTEOSARCOMA ON X-RAY 1. Sunray/sunburst periosteal reaction 2. Codmans triangle OSTEOID OSTEOMA ON X-RAY 1. Nidus radiolucency with central mineralization 2. Tremendous bone formation around the nidus CHONDROSARCOMA ON X-RAY 1. Endosteal scalloping 2. 2.Calcified matrix appears as foci of flocculent densities.

RELATED QUESTIONS 1. The tumor with which osteosarcoma is most commonly associated is retinoblastoma(2001) 2. 2.Young boy complains of pain in leg,worst at night and relieved by salicylates is suffering from osteoid osteoma.(2005)

286. Ans C (O2): Rozers radiotherapy 3rd/161 RADIOSENSITISERS 1. hyperbaric O2 2. Hydroxyurea 3. Cisplatin 4. Doxorubicin 5. Metronidazole 6. Buthinione

RADIOPROTECTORS 1. Amifostine 2. IL-1 3. GM-CSF 4. Pentoxiphylline

287. Ans C [Wrist] Shoulder - <1year Hand & wrist 11-13yrs Elbow 12-14yrs

PSYCHIATRY 288. Ans A(Charas):Neeraj Ahuja 6th/48

CANNABIS PREPARATION 1.Hash oil 2.Hashish/charas 3.Ganja 4.Bhang

THC CONTENT/POTENCY Maximum(15-40%) 8-14% 2% Minimum(1%)

DERIVED FROM Lipid soluble plant extract Resinous extract from flowering tops and leaves Dried female inflorescence Dried leaves

Majoon is a sweet prepared from bhang. RELATED QUESTION: Cannabis causes amotivation syndrome , run amok & flash backs ( 2009) Earliest sign of cocaine toxicity is bitter taste ( 2006) Cocaine does not cause pin point pupil( 2009)

289. Ans B (Masochism):Reddys 29th/373-375

SEXUAL PERVERSION 1.Sadism 2.Masochism 3.Fetichism 4.Bestiality (NOT A SEXUAL PERVERSION)

MODE OF SEXUAL PLEASURE Sexual pleasure on infliction of pain to the sexual partner Sexual gratification on receiving painful stimulus from sexual partner Gratification by contact and sight of central parts of female body or even clothing or any other object. Sexual intercourse by a human being with a lower animal

RELATED QUESTION: Bestiality is not a sexual perversion,rather it is unnatural offence(2007)

290. Ans A(PTSD):Kaplan & Saddocks9th/623

REACTION TO AN EXCEPTIONAL STRESS (rape,earthquake,accident,death)

A) POST TRAUMATIC STRESS DISORDER 1. Recollections of stressful images/thoughts(flash backs) 2. Re-experiencing of stressful events 3. Hyperarousal 4. Anxiety 5. Avoidance of situations that arouse recollections of stressful events

B)

ACUTE STRESS DISORDER (symptoms till 1 month) 1. Immediate onset with clear temporal relation 2. Symptoms resolve within few hours if stress is removed.

291.Ans B(Denial) :Kaplan & Saddocks 10th/201-204 Please refer question 294 of 2010

DEFENCE MECHANISM

DEFINITION 1. Involuntary exclusion of unpleasant realities from conscious awareness. 2. Involves negating sensory data 3. Patient behaves as if he is unaware of something he may be expected to know.

NORMAL EXAMPLE PATHOLOGIC EXAMPLE

Denial

Grief

Psychosis

RELATED QUESTION: 1. Humor is a mature defence mechanism(2009) 2. Blaming others for ones own mistakes is projection type of defence mechanism.(2003) 3. Defence mechanism shown by addicts is denial(2001)

292.Ans A(Illness caused by care giver): Kaplan & Saddocks 10th/923

MANCHUSEN SYNDROME BY PROXY Care giver (mother )fabricates /produces illness in the child by: a. Fabrication b. Severe physical harm c. Even Killing the child To Achieve

Care and attention from the health providers through the sick child

CHARACTERISTICS OF THE AFORESAID MOTHER: 1. Behaves as model parent 2. Highly knowledgeable about medical field 3. Non psychotic 4. Cognitively unimpaired

293.Ans B(Depression): Kaplan & Saddocks 10th/531

MAJOR DEPRESSION (It affects biological rhythms) a. Decreases REM sleep latency b. Increases REM sleep time c. Decreases delta wave sleep d. Early morning awakenings

RELATED QUESTIONS: 1. Disruption of biological rhythm is seen in depression(2009) 2. Daily depressed mood for minimum 2 weeks is necessary for classifying it as major depression. 3. Most common side effect of SSRI in long term is sexual dysfunction.(most common side effect is nausea)(2009)

294.Ans C(20) : Harrisons 18th/3235,3236 Please refer question 300 of 2010 MINI MENTAL STATE EXAMINATION (MMSE) 30 POINT TEST OF COGNITIVE FUNCTION HELPS TO CONFIRM Presence of cognitive impairment Progression of dementia IT INCLUDES TESTS ON Level of consciousness Orientation Speech Language Memory Fund of information Insight & judgement Abstract thoughts Calculation ability INTERPRETATION OF SCORE Total score = 30 Possible cognitive impairment = below 25 Definitive cognitive impairment = below 20

RELATED QUESTION: The total score in MMSE is 30.(2010)

295.Ans C(ADHD): Kaplan & Saddocks 10th /1208

DIAGNOSTIC CRITERIA FOR ADHD A. either (1) or (2) (1) >6 symptoms of INATTENTION for atleast 6 months : a. b. c. d. e. f. g. h. i. Often makes careless mistakes Often has difficulty sustaining attention Often does not listen Often fails to follow instructions/finish tasks Often has difficulty organizing activities Often avoids tasks requiring sustained attention Often loses things Often is distracted Often is forgetful

(2) >6 criteria of HYPERACTIVITYIMPULSIVITY for atleast 6 months:

HYPERACTIVITY a. Often fidgets b. Often leaves seat c. Often moves excessively d. Often has difficulty playing/engaging in leisure activities e. Is often on the go f. Often talks excessively

IMPULSIVITY g. Often blurts out answers h. Often has difficulty awaiting turn i. Often interrupts/intrudes on others. B. symptoms present before 7 years of age

C. D.

symptoms present in 2 or more settings clinically significant impairment in social ,academic or occupational functioning.

296.

Ans B (Alcohol intoxication): Kaplan & Saddocks 10th/397

With blood alcohol concentration between 200-300 mg/dl ,slurred

speech is more intense and memory

impairment such as blackout and anterograde amnesia becomes common.

BLOOD ALCOHOL CONCENTRATION(mg/dl)

SYMPTOMS

TRICK

Disinhibited 50-100 Judgement is affected Nystagmus

D J

was 100-150 Confused Dementia but Drunk 150-300 Incoordination Disorientation 300-400 Stupor D I D sing confused

RELATED QUESTIONS:

1. Alcohol can cause erectile dysfunction(2005) 2. A person is called drunk if alcohol levels are 150-300 mg/dl(2007) 3. Alcohol intoxication is a form of alcohol dependence(2003) 4. At 150-300 mg/dl concentration of blood alcohol body incoordination occurs(2001) 297. Ans D (Flight of ideas ): Kaplan & Saddocks 10th/
252

Flight of ideas

Rapid speech with sudden shifts in ideas without loosing logical connections Perseveration Persistent repetition of words/phrases beyond point of relevance Neologism Are fabricated words whose derivatives cannot be understood easily Echolalia Repetition or echo or mimicking of phrases or words heard

1.mania

1.schizophrenia 2.autism 1.schizophrenia 1.schizophrenia 2.autism 3.tourettes syndrome 4.stupor & catatonic syndrome

298.Ans D(Behavioral): Kaplan & Saddocks 10th/954

BEHAVIOUR THERAPY It is based on theories of learning & aims at changing maladaptive behaviour and substituting it with adaptive behaviour.

TYPE OF BEHAVIOUR THERAPY 1.Exposure & response prevention 2.Aversion therapy 3.Flooding 4.Operant conditioning for increasing a behaviour 5.Operant conditioning for decreasing a behaviour

BASED ON Reciprocal inhibition Pairing of pleasant stimulus with an unpleasant response Direct exposure to phobia but escape not possible 1.positive reinforcement 2.negative reinforcement 3.modelling 1.time out 2.punishment 3.satiation

USED IN 1.phobia 2.OCD 1.drug abuse 2.sexual deviations 1.phobia 1.for augmenting an adaptive behaviour 1.for demoting a maladaptive behaviour

299. Ans A (Dementia):Neeraj Ahuja 5th/24 CATASTROPHIC REACTION

On confrontation with an assignment beyond residual intellectual capacity of patient. Found in dementia.

The patient may go into a Sudden rage.

300. Ans B (Paranoid schizophrenia): Kaplan & Saddocks 10th/476

DISEASE

CORRECT REASON ANSWER 1.Delusional disorder no In DD the patient is not (DD) disorganized.He is able to maintain his daily routine. 2.Psychotic no Features of depression like depression anhedonia ,weight loss,anergia,crying etc. are absent. 3.Paranoid yes There is delusion(camera fixed and schizophrenia following ) &disorganized behaviour(schizophrenia) 4.Paranoid personality no 1.Personality develops in adolescence 2.Absence of delusions

RELATED QUESTION: Globally prevelance of Schizophrenia is 0. 85 % (2008 ) ( Life time prevelance of Schizophrenia is 1 1.5 % )2006) Bleuler s 4 A s of Schizophrenia are Ambivalence , Autism , Affect disturbance & association disturbance.(2010)