Download PGI PG PGI 2014 May Solved Question Paper

Download PGIMER (Post Graduate Institute of Medical Education & Research, Chandigarh) PGI 2014 May Solved Question Paper

1.Allaretrueaboutulnarnerveexcept:
a)RootvalueC8TI
b)Passthroughcubitaltunnel
c)Supplyflexordigitorumsuperficialis
d)Supplyflexorcarpiulnaris
e)Passesbehindmedialepicondyle
CorrectAnswer-C
Ans.c.Supplyflexordigitorumsuperficialis
Nervecourse:
RootvalueofulnarnerveisC7,C86T1.
Ulnarnerve(C8,T1)arisesfromthemedialcordofthebrachial
plexus&descendsintheintervalb/wtheaxillaryartery&vein
Atelbow,ulnarnervepassesbehindthemedialepicondyle
Thecubitaltunnelisachannelwhichallowstheulnarnervetotravel
overtheelbow
Variousbranchesofulnarnerveare:?
Inarm:Nobranch.
Inforearm:Therearefollowingbranches:?
Muscular:Inproximalpartofforearmitsuppliesflexorcarpiulnaris
andmedialhalfofflexordigitorumprofundus.
Cutaneous:Therearetwocutaneousbranchesinforearm:-
Superficialterminalbranch:Itsuppliespalmarisbrevisandskinof
palmarsurfaceofmedial11/2fingers.
Palmarcutaneousbranch:Suppliesskinoverthehypothenar
eminence.
Dorsal(posterior)cutaneousbranch:Suppliesskinovermedial1/3
ofdorsumofhandanddorsalsurfaceofmedial11/2fingers.

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Inhand:Ulnarnerveentersthepalmbypassingsuperficialtoflexor
retinaculumanddividesintotwoterminalbranches:?
Deepterminalbranch:Itsuppliesadductorpollicis,allinterossei,
medialtwo(3rd&4th)lumbricalsandallhypothenarmusclesexcept
palmarisbrevis(i.e.abductordigitiminimi,flexordigitiminimi,
opponensdigitiminimi).

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2.Branchofinternaliliacarteryis/are:
a)Inferiorvesicalartery
b)Inferiorepigastricartery
c)Iliolumbarartery
d)Internalpudendalartery
e)Obturatorartery
CorrectAnswer-A:C:D:E
Ans.a.Inferiorvesicalartery;c.Iliolumbarartery;d.Internal
pudendalartery;e.Obturatorartery
Branchesofanteriordivisionofinternaliliacarteryare:
Superiorvesical
Middlerectal
Inferiorvesical(inmales),
Internalpudendal,
Vaginal(infemales),
Uterine(infemales)
Obturator
Inferiorgluteal.
Branchesofposteriordivisionare:
Iliolumbar
Lateralsacral
Superiorgluteal.

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3.Compressionofcervicalribcancauses:
a)Thenarhypertrophy
b)Neurovascularsymptom
c)Reynaud'sphenomenon
d)C8Tlparaesthesia
e)All
CorrectAnswer-B:C:D
Ans.b.Neurovascularsymptom;c.Reynaud'sphenomenon;d.
C8Tlparesthesia
Thelowertrunkofthebrachialplexus(C8,Tl),togetherwiththe
subclavianarterymaybeangulatedoveracervicalrib(thoracic
outletsyndrome).
Thereisaslowinsidiousonsetofwastingofthesmallmusclesof
thehand,whichoftenstartsonthelateralsidewithinvolvementof
thethenareminence&firstdorsalinterosseous.
Thereispain&paraesthesiainthemedialaspectoftheforearm
extendingtothelitdefinger

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4.Trueaboutattachmentofsuprapleural
membrane:
a)AttachedtoClavicle
b)Attachedtolstrib&itscostalcartilage
c)Attachedto2ndrib&itscostalcartilage
d)Attachedtojunctionofmanubrium&bodyofsternum
e)Attachedtotipofthetransverseprocessofthe7thcervical
vertebrae
CorrectAnswer-B:E
Ans.b.Attachedtolstrib&itscostalcartilage;e.Attachedto
tipofthetransverseprocessofthe7thcervicalvertebrae
SuprapleuralMembrane:
Itistentshapedfibroussheetattachedlaterallytothemedialborder
ofthelstrib&costalcartilage.
Mediallyitattachedtothefasciainvestingthestructurespassing
fromthethoraxintotheneck.
Itisattachedatitsapextothetipofthetransverseprocessofthe
7thcervicalvertebrae

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5.Whichofthefollowingsinusesopeninto
middlemeatus:
a)Frontalsinus
b)Anteriorethmoidalsinus
c)Posteriorethmoidalsinus
d)Maxillarysinus
e)Sphenoidsinus
CorrectAnswer-A:B:D
Ans.a.Frontalsinus;b.Anteriorethmoidalsinus;d.Maxillary
sinus
Partoflateralnasal Openings
wall
Inferior
Nasolacrimalduct
Frontalsinus,Maxillarysinus,Anterior
Middle
ethmoidalsinus
Superior
Posteriorethmoidalsinus
Sphenoethmoidal
Sphenoidsinus
recess

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6.TrueaboutanatomyofEustachiantube:
a)Aeratemiddleear
b)Openduringswallowing
c)Lager&widerinadultthanchildren
d)Morehorizontalininfant&children
e)Openinoropharynx
CorrectAnswer-A:B:D
Ans.a.Aeratemiddleear;b.Openduringswallowing;d.More
horizontalininfant&children
TheEustachiantube/auditorytubeintheadultis36mmin
length.(Range32-38mm)Fromitstympanicend,itruns
downwardforwardandmediallyjoininganangleof45?with
horizontal.
Ininfants,thetubeisshorter,widerandismorehorizontal.
Thetympanicendoftheeustachiantubeisbonyandissituatedin
theanteriorwallofmiddleear.
Thepharyngealendofthetubeisslitlikeandissituatedinthe
lateralwallofthenasopharynx,1-1.25cmbehindtheposteriorend
ofinferiorturbinate.
NormallyEustachiantube(ET)isclosedandopensintermittently
duringyawning,swallowingandsneezingthroughactivecontraction
ofTensorvilipalatinimuscle.
Normaltubalfunction:
Abilityoftubetoequilibratepositive&negativepressurestoambient
pressure.
Donebothinpatientswithperforatedorintacttympanicmembrane.

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7.Trueaboutpalatinetonsil:
a)Cryptsislinedbysquamousepithelium
b)SuppliedbyIXCN
c)Tonguedepressorisusedforexamination
d)Arterialsupplyisbytonsillarascendingbranchofgrater
palatineartery
e)Presentinoropharynx
CorrectAnswer-A:B:C:E
Ans.(A)Cryptsislinedbysquamousepithelium;(B)Supplied
byIXCN;(C)Tonguedepressorisusedforexamination;(E)
Presentinoropharynx
Palatinetonsil
ThePalatinetonsilsaretwoprominentmassessituatedoneon
eithersidebetweentheglossopalatineandpharyngopalatine
arches.
Eachtonsilconsistsfundamentallyofanaggregationoflymphoid
tissueunderlyingthemucousmembranebetweenthepalatine
arches.
Inthechildthetonsilsarerelatively(andfrequentlyabsolutely)
largerthanintheadult
Thefolliclesofthetonsilarelinedbyacontinuationofthemucous
membraneofthepharynx,coveredwithstratifiedsquamous
epithelium
Arteriessupplyingthetonsilarethe:
Dorsalislinguaefromthelingual
Theascendingpalatineandtonsillarfromtheexternalmaxillary
Theascendingpharyngealfromtheexternalcarotid

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Thedescendingpalatinebranchoftheinternalmaxillary
Atwigfromthesmallmeningeal.
Theveinsendinthetonsillarplexus,onthelateralsideofthetonsil
Thenervesarederivedfromthesphenopalatineganglion,andfrom
theglossopharyngeal.

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8.Featuresofstellateganglionlesions
include:
a)Miosis
b)Vasodilationinipsilateralarm
c)Mydriasisincontralateraleye
d)Mydriasisinipsilateraleye
e)Visualloss
CorrectAnswer-A:B
Ans.a.Miosis;b.Vasodilationinipsilateralarm
HorneroccurduetoinjuryofTlsympathetictrunk.Thereisptosis,
miosis,anhydrosis(vasodilation&lackofthermalsweating),
enophthalmos(sunkenglobe),lossofcilio-spinalreflex,narrow
palpebralfissureofaffectedside

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9.Trueaboutparietalperitoneum:
a)Suppliedbylower5thoracic&1stlumbar
b)Suppliedbylower4thoracic&upper3lumbar
c)Painissomaticinnature
d)Stretchingofparietalperitoneumcausepain
e)None
CorrectAnswer-A:C
Ans.a.Suppliedbylower5thoracic&1stlumbar;c.Painis
somaticinnature
ParietalPeritoneum:
Itissensitivetopain,temperature,touch&pressure
Theparietalperitoneumliningtheanteriorabdominalwallissupplied
bythelower6thoracic&1stlumbarnervesthatis,thesamenerves
thatinnervatetheoverlyingmuscles&skin.
Thecentralpartofdiaphragmaticperitoneumissuppliedbythe
phrenicnerve;peripherally,diaphragmaticperitoneumissuppliedby
lowersixthoracicnerves.
Theparietalperitoneuminthepelvisismainlysuppliedbythe
obturatornerve,abranchofthelumbarplexus

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10.Trueregardingsaphenousvein:
a)Longsaphenousvein-formedascontinuationofmedialsideof
deepvenousarch
b)Longsaphenousvein-situatedposteriortomedialmalleolus
c)Longsaphenousvein-closelyrelatedtosaphenousnerve
d)Shortsaphenousvein-openintogreatsaphenousvein
e)Shortsaphenousvein-associatedwithsuralnerve
CorrectAnswer-A:C:D:E
Ans.a.Longsaphenousvein-formedascontinuationofmedial
sideofdeepvenousarch;c.Longsaphenousvein-closely
relatedtosaphenousnerve;d.Shortsaphenousvein-openinto
greatsaphenousvein;e.Shortsaphenousvein-associated
withsuralnerve
LongSaphenousVein
Formedbytheunionofthemedialendofdorsalvenousarchwith
themedialmarginalvein
Passesupwardsinfrontofthemedialmalleolus,crossesthelower
one-thirdofthemedialsurfaceoftibiaobliquely&runsalongits
medialbordertoreachthebackoftheknees
ThesaphenousnerverunsinfrontofthegreatsaphenousVein
Small/ShortSaphenousVein:
Formedonthedorsumoffootbytheunionofthelateralendof
dorsalvenousarchwiththelateralmarginalvein
Entersthebackofthelegbypassingbehindthelateralmalleolus
Connectedwiththegreatsaphenousvein&withthedeepveins&is
accompaniedbythesuralnerve

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11.TrueaboutHering-Breuerreflex:
a)Signalinitiatedthroughmechanoreceptorreceptorsoflung
b)SignalinitiatedthroughChemoreceptoroflung
c)SignalinitiatedthroughCarotid&aorticbody
d)Transmitsignalsthroughthevagusnerve
e)None
CorrectAnswer-A:D
Ans,(A)Signalinitiatedthroughmechanoreceptorreceptorsof
lung(D)Transmitsignalsthroughthevagusnerve
[Ref:Ganong25th/662,24th/664;Guyton12th/372;A.K.lain5th/461,
463,465]
Hering-BreuerinflationReflex-LunginflationSignalsLimit
Inspiration:
Hering-Breuerinflationreflexisanincreaseinthedurationof
expirationproducedbysteadylunginflation,andtheHering-Breuer
deflationreflexisadecreaseinthedurationofexpirationproduced
bymarkeddeflationofthelung.
Inhumanbeings,theHering-Breuerreflexprobablyisnotactivated
untilthetidalvolumeincreasestomorethanthreetimesnormal
(greaterthanabout1.5litersperbreath).
LungInflationSignalsLimitInspiration-TheHerireuerInflation
Reflex:
Stretchreceptorstomechanoreceptorclass.
Stretchreceptors,locatedinthemuscularportionsofthewallsofthe
bronchiandbronchiolesthroughoutthelungs,transmitsignals
throughthevagiintothedorsalrespiratorygroupofneuronswhen
thelungsbecomeoverstretched.

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12.Trueaboutbloodsupplyofkidney:
a)Flowis600ml/mineachkidney
b)Itreceivesmorebloodsupplyperunitmassthanthebrain
c)Renalmedullahavemoresupplythanrenalcortex
d)Itisunderdirectsympatheticcontrol
e)None
CorrectAnswer-A:B:D
Ans.(A)Flowis600ml/mineachkidney(B)Itreceivesmore
bloodsupplyperunitmassthanthebrain(D)Itisunderdirect
sympatheticcontrol
[Ref:Ganong25th/602,674,24th/676-77;Guyton12th/466-67]
Essentiallyallthebloodvesselsofthekidneys,includingtheafferent
andefferentarterioles,arerichlyinnervatedbysympatheticnerve
fibers.
Bloodflowtothetwokidneysisnormallyabout22percentofthe
cardiacoutput,or1100mlmin
Theouterpartofthekidney,therenalcortex,receivemostofthe
kidney'sbloodflow.
Bloodflowinrenalmedullaaccountsforonly1to2%ofthetotal
renalflow
Onaper-gram-weightbasis,thekidneysnormallyconsumeoxygen
attwicetherateofthebrainbuthavealmostseventimestheblood
flowofthebrain.
Inarestingadult,thekidneysreceive1.2-1.3Lofbloodperminute,
orjustunder25%ofthecardiacoutput

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13.AllaretrueaboutBrunner'sglandexcept:
a)Itliesinduodenumonly
b)Itliesinduodenum&ileum
c)Itsecretesbicarbonaterichfluid
d)ItsecretionsneutralizesacidicpHofstomach
e)Secretesmucusrichfluid
CorrectAnswer-B
Ans.B.Itliesinduodenum&ileum
[RefGuyton12th/400;A.K.lain5th/202-03]
Brunner'sGland:
Sub-mucousglands&aretortuous,long&penetratethemuscularis
mucosa
Drainsintothecryptsoflieberkuhn.
Numerousinfirstpartofduodenum(duodenalcaporbulb)meager
belowthecommonopeningofbile&pancreaticducts.
Ingestionoffattyfoodorsecretininjectionproduceslargevolumeof
thickalkalinemucoussecretionwhichprobablyhelpstoprotectthe
duodenalmucosafromthegastricacid.
Intheduodenumthereareinadditionthesmall,coiledacinotubular
duodenalglands(Brunner'sglands
Functions:
Protectstheduodenalwallfromdigestionbythehighlyacidicgastric
juiceemptyingfromthestomach.
Mucuscontainsalargeexcessofbicarbonateions,whichaddtothe
bicarbonateionsfrompancreaticsecretionandliverbilein
neutralizingthehydrochloricacidenteringtheduodenumfromthe
stomach"

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14.Bloodbrainbarrierisabsentin?
a)Adenohypophysis
b)Neurohypophysis
c)Hypothalamus
d)Thalamus
e)None
CorrectAnswer-B
Ans.is'b'i.e.,Neurohypophysis
Bloodbrainbarriersexistbothatthechoroidplexusandatthetissue
capillarymembranesinessentiallyallareasofthebrainparenchyma
exceptinsomeareosofthehypothalamus,pinealgland,adarca
posttema,wheresubstancesdiffusewithgreatereaseintothetissue
spaces.
FourareasthatareoutsideofBBBare(l)theposteriorpituitary
(neurohypophysis)andtheadjacentventralpartofthemedian
eminenceofthehypothalamus,(2)theareapostrema,(3)the
organumvasculosumofthelaminaterminalis(OVLT,supraoptic
crest),and(4)thesubfornicalorgan(SFO).
Referredtocollectivelyasthecircumventricularorgans

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15.Oxygenbindingtohemoglobincause
allostericactivation.Thisallosteric
propertyofHbresultsin:
a)Maintainingironinferrousstate(Fe2+)
b)Increaseoxygensupplytotissue
c)Increasesoxygenbinding
d)Increases2,3-DPGinblood
e)None
CorrectAnswer-B:C
Ans.(B)Increaseoxygensupplytotissue(C)Increasesoxygen
binding
[RefHarper30th/54-55,29th/S0-51;Ganong2STH/639-4I,
24th/64I-44;Guyton12th/353-56;A.KIain5the/p.57]
Theironinhaemlsinfenousstate(Fe2+)form.
EachFe2+combineloosely&reversiblywithonemoleculeof
oxygen.
Combinationofhaemwithoxygeniscalledoxygenation&not
oxidation,becauseaftercombinationwithorygen,ironinhaemstay
inFe2+state
OxygenationofHemoglobinTriggersConformationalChanges
intheApoprotein:
Hemoglobinsbindfourmoleculesof02pertetramer,oneperheme.
AmoleculeofO2bindstoahemoglobintetramermorereadilyif
otherO2moleculesarealreadybound.
Termedcooperativebinding,thisphenomenonpermitshemoglobin
tomaximizeboththequantityofO2loadedatthePO2ofthelungs

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andthequantityofO2releasedatthePO2oftheperipheraltissues.
TheAllostericPropertiesofHemoglobinsResultfroMTheir
QuaternaryStructures.
Thepropertiesofindividualhemoglobinsareconsequencesoftheir
quaternaryaswellasoftheirsecondaryandtertiarystructures.
Thequaternarystructureofhemoglobinconfersstrikingadditional
properties,absentfrommonomericmyoglobin,whichadaptsittoits
uniquebiologicalroles.

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16.Secretionofinsulinisincreasedby:
a)Fattyacid
b)Aminoacid
c)Adrenaline
d)Acetylcholine
e)Somatostatin
CorrectAnswer-A:B:D
Ans.(A)Fattyacid(B)Aminoacid(D)Acetylcholine
[RefGanong25TH/439,24th/441;Guyton12th/615]
IncreaseinsulinSecretion:
Increasedbloodglucose
increasedbloodfreefattyacids
Increasedbloodaminoacids
Gastrointestinalhormones(gastrin,cholecystokinin,secretin,gastric
inhibitorypeptide)
Glucagon,growthhormone,cortisol
Parasympatheticstimulation;acetylcholine
Beta-adrenergicstimulation
Insulinresistance;obesity
Sulfonylureadrugs(glyburide,tolbutamide)

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17.Nervevelocityisincreasedby:
a)Myelination
b)Smalleraxondiameter
c)Decreasedtemperature
d)Increaseinintracellularcalcium
e)Increaseinextracelluarsodium
CorrectAnswer-A
Ans.A.Myelination
[RefGanong25TH/94,24th/91;Guyton12th/72-7j;A.K'lain5th/147]
Greaterthediameterofagivennervefibre,thegreaterisitsspeed
(becausealargefiberofferslessresistancetohighcurrent.
Inmyelinatedfibres,thespeedofconductionisapproximately6
timesthefiberdiameter.
Thediameterofmyelinatedfibersrangefrom1-20micro/m,therifore
conductionvelocityvariesfrom6-120mts/sec

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18.Trueaboutcarbohydratemetabolism:
a)Itsupplies4kcalspergram
b)Itincreasesinsulinsecretion
c)Storedinliver
d)Instarvationglycogeninliverisexhaustedonlyafter24-48hr
e)Itprovide80%calorieneedofbody
CorrectAnswer-A:B:C:E
Ans.A,Itsupplies4kcalspergramB,Itincreasesinsulin
secretionC,Storedinliver&E,Itprovide80%calorieneedof
body
[Ref:Harper30th/176;Park23rd/613;LippincottBiochemistry
6th/329:Ganong25TH/24,24th/441;A.KIain5th/622-29]
Carbohydratemetabolism:
After12to18hoursoffasting,liverglycogenisalmosttotally
depleted.
Theliverservesasreceiving,manufacturing,storing&distributing
centreforglucose.
Liverglycogenisnearlyexhaustedafter10-18houroffasting.
Provides4k/calspergrams(protein-4;fat-9;dietaryfibre-2)
Themainsourceofenergyindietsiscarbohydratesare
carbohydratesderivedlargelyfromcereals.
Thesecerealsconstituteabout80%ofourdiet&provides50-80%
ofdailyenergyintake.

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19.Calcitriolinchildrenisformedin:
a)Glomerulus
b)Bowmanncapsule
c)PCT
d)DCT
e)Collectingduct
CorrectAnswer-C
Ans.(C)PCT
[Ref:Ganong25th/377-78,24th/461Nelson19th/204;A.K.lain
Sth/730:OPGhai8th/112]
Calcitriolisproducedinthecellsoftheproximaltubuleofthe
nephroninthekidneysbytheactionof25-hydroxyvitaminD31-
alpha-hydroxylase,amitochondrialoxygenaseandanenzyme
whichcatalyzesthehydroxylationof25-hydroxycholecalciferol
(calcifediol).
TheactIVItyoftheenzymeisstimulatedbypTH.
ThereactionisanimportantcontrolpointinCa2+homeostasis.

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20.Whichofthefollowingis/arePainscale:
a)McGillPainQuestionnaire
b)Visualanaloguescale
c)ColouredAnalogueScale
d)Alloftheabove
e)Noneoftheabove
CorrectAnswer-D
Ans.A,McGillPainQuestionnaireB,Visualanaloguescale&
C,ColouredAnalogueScale
ListofPainMeasurementScales:
Wong-BakerFACESPainRatingScale
Visualanalogscale(VAS)
McGillPainQuestionnaire(MPQ)
NeckPainandDisabilityScale-NPAD
Lequesnealgofunctionalindex.
BehavioralPainScale(BPS)
BriefPainInventory(BPI)
ClinicalGlobalImpression(CGI)
Critical-CarePainObservationTool(CPOT)
COMFORTscale
FacesPainScale-Revised(FPS-R)

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21.Terminalproduct(s)ofphenylalanineis:
a)Fumarate
b)AcetylCoA
c)Oxaloacetate
d)Acetoacetate
e)None
CorrectAnswer-A:B:D
Ans:a.Fumarate,b.AcetylCoA&d.Acetoacetate
[RefHarper30th/285,304,29th/269,290;Lippincott6th/263,262;
Satyanarayan3rd/345-47;Vasudevan5th/202-03]
"Thepredominantmetabolismofphenylalanineoccursthrough
tyrosine.Duringthecourseofdegradation,phenylalanine&tyrosine
areconvertedtometabolite,fumarate&acetoacetate,whichcan
serveasprecursorsforthesynthesisofglucose(fumarate-Itisan
intermediateofthecitricacidcycle&canalsoserveasprecursorfor
gluconeogenesis)&fat(acetoacetate-Itisaketonebodyfromwhich
fatcanbesynthesized)".
Phenylalaninehydroxylaseisanenzymethatcatalyzesthe
hydroxylationofthearomaticside-chainofphenylalanineto
generatetyrosine.
Phenylalanineisfirstconvertedtotyrosine.Subsequentreactions
arethoseoftyrosine"(Harper30th/304,29th/288)"Hydroxylationof
phenylalanineproducetyrosine.Metabolismofphenylalanine&
tyrosinemerge,leadingultimatelytotheformationoffumarateer
acetoacetate.phenylalanine&tyrosineare,therefore,both
glucogenicorketogenic.

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22.NADPHisproducedby:
a)Pyruvatedehydrogense
b)Isocitratedehydrogense
c)a-ketoglutarylDehydrogense
d)SuccinateDehydrogense
e)Malatedehydrogense
CorrectAnswer-A:B:C:E
Ans:a.Pyruvate...,b.Isocitrate....c.a-ketoglutaryl...,&e.
Malate...,
[RefHarper30th/169,29th/177;Lippincott6th/109-13,155;Shinde
7th/321]
MethodofATP
Pathway Reactioncatalyzedby
ATP
formation
1.Pyruvate
1.Respiratorychain
5
dehydrogenase
oxidationof2NADH
2.Isocitrate
2.Respiratorychain
5
dehydrogenase
oxidationof2NADH
3.a-Ketoglutarate
3.Respiratorychain
Citric
5
dehydrogenase
oxidationof2NADH
acid
4.Substratelevel
cycle
4.Succinatethiokinase
2
phosphorylation
5.Succinate
5.Respiratorychain
3
dehydrogenase
oxidationof2ADH2
6.Malate
6.Respiratorychain
5
dehydrogenase
oxidationof2NADH

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23.Opticallyinactiveaminoacidis/are:
a)Threonine
b)Thyronine
c)Valine
d)Glycine
e)Serine
CorrectAnswer-D
Ans:d.Glycine[RefVasudevan5th/20;Shinde7th/78]
Aminoacidshavinganasymmetriccarbonatomexhibitoptical
activity.Asymmetryariseswhen4differentgroupsareattachedto
thesamecarbonatom
Glycineisthesimplestaminoacids&hasnoasymmetriccarbon
atom&thereforeshowsnoopticalactivity.Allothersareoptically
active
Themirrorimageformsproducedwithreferencetothealphacarbon
atom,arecalledD&Lisomers
Isoleucineerthreoninehave2opticallyactivecentres&therefore
eachhas4diastereoisomers

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24.Informing3Dstructureofprotein
followingcomponentshelp:
a)Hydrogenbonds
b)Aminoacidsequence
c)Interactionbetweenaminoacidsidechains
d)Chaperon
e)allofthese
CorrectAnswer-E
Ans:(E)allofthese[RefHarper30th/39-41,29th/36-40;
Vasudevan5th/27;Lippincott6th/18-19,22;Shinde7th/86-88]
The3-dimensionalarrangementofproteinstructureisreferredtoas
tertiarystructure.Thistypeofarrangementensuresstabilityofthe
molecule.Besidesthehydrogenbonds,disulfidebonds,ionic
interactions(electrostaticbonds)&hydrophobicinteractionsalso
contributetothetertiarystructureofprotein.
Theunique3dimensionalstructureofthenativeconformationis
determinedbyitsprimarystructure,thatis,itsaminoacidsequence,
Interactionsb/wtheaminoacidsidechainsguidethefoldingofthe
polypeptidechaintoformsecondary,tertiary&(sometimes)
quaternarystructures,whichcooperateinstabilizingthenative
conformationoftheprotein.
Inaddition,aspecializedgroupofproteinnamedchaperonesis
requiredfortheproperfoldingofmanyspeciesofproteins.

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25.Testusedforproteinis/are:
a)Westernblot
b)Southernblot
c)ELISA
d)CHIPessay
e)Dotblotting
CorrectAnswer-A:C:D
Ans:a.Westernblot,c.ELISAd.CHIPessay
[RefHarper30th/457,29th/439;Lippincott6th/484,473,485;
Satyanarayan3rd/589]
Westernblot-Measuresproteinamount
ELISA-detectsproteins(antigenorantibodies)

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26.FullformofLCATis:
a)Lecithincholesterolacyltransferase
b)Lecithincholineacyltransferase
c)Lecithincholesterolalkyltransferase
d)Lecithincholinealcoholtransferase
e)LecithinCoAtransferase
CorrectAnswer-A
Ans:a.Lecithincholesterol...[RefHarper30th/272,29th/242,
256;Lippincott6th/234-36]
PlasmaLCATIsResponsibleforVirtuallyAllPlasmaCholesteryl
EsterinHumans(Harper29th/256).LCATactivityisassociatedwith
HDLcontainingapoA-I.AscholesterolinHDLbecomesesterified,it
createsaconcentrationgradientanddrawsincholesterolfrom
tissuesandfromotherlipoproteins,thusenablingHDLtofunctionin
reversecholesteroltransport.
Thisprotein,associatedwithHDL,isfoundinplasmaofhumansand
manyotherspecies.Itfacilitatestransferofcholesterylesterfrom
HDLtoVLDL,IDL,andLDLinexchangefortriacylglycerol,relieving
productinhibitionofLCATactivityinHDL.

---

27.Whichvitamindeficiencycausedementia:
a)VitaminA
b)VitaminC
c)VitaminB12
d)VitaminB1
e)Nicotinicacid
CorrectAnswer-C:D:E
Ans:c.Vitamin...,d.Vitamin...&e.Nicotinic...[RefLippincott
6th/379-80;Harrison19th/463]
Niacinornicotinicaciddeficiencycausespellagra.Thesymptomof
pellagraprogressthroughthethreeDs:dermatitis,diarrhea
&dementia"
Niacinpellagra:pigmentedrashofsun-exposedareas,brightred
tongue,diarrhea,apathy,memoryloss,disorientation
FolateMegaloblasticanemia,atrophicglossitis,depression,T
homocysteine
VitaminMegaloblasticanemia,lossofvibratoryandposition
B12sense,abnormalgait,dementia,impotence,lossofbladder
andbowelcontrol,Thomocysteine,Methylmalonicacid
VitaminCScurvy:petechiae,ecchymosis,coiledhairs,inflamed
andbleedinggums,jointeffusion,poorwoundhealing,fatigue
VitaminAXerophthalmia,nightblindness,Bitot'sspots,follicular
hyperkeratosis,impairedembryonicdevelopment,immune
dysfunction

---

28.Whichofthefollowingorgancannotuse
ketonebody:
a)Brain
b)RBC
c)Muscle
d)Heart
e)Liver
CorrectAnswer-A:E
Ans:a.Brain,e.Liver[RefHarper30th/150,211-12,29th/161,
211-12;Lippincott6th/196;Vasudevan5th/1451.
Ketonebodiescanbeusedbyextrahepatictissuesuchasskeletal&
cardiacmuscle,intestinalmucosa&renalcortex.Eventhebraincan
useketonebodiestohelpmeetitsenergyneedsifthebloodlevels
risesufficiently.
Theketonebodiesareformedintheliver;buttheyareutilizedby
extrahepatictissues.Theheartmuscle&renalcortexpreferthe
ketonebodiestoglucoseasfuel.Tissuelikeskeletalmuscle&brain
canalsoutilizetheketonebodiesasalternatesourcesofenergy,if
glucoseisnotavailable.

---

29.

---

Allofthefollowingarepartofinnate
immunityexcept:
a)Complement
b)NKcells
c)Macrophages
d)Tcells
e)None
CorrectAnswer-D
Ans.(d)TcellsRefHarrison17/e;p2021,2031,18/e,p2651.2668
ComponentsoftheAdaptiveImmuneSystem
Thymus-derived(T)lymphocytes-Tcellprecursorsin
thethymus;naivematureTlymphocytesbeforeantigen
exposure;memoryTlymphocytesafterantigencontact;
Cellular
helperTlymphocytesforBandTcellresponses;
cytotoxicTlymphocytesthatkillpathogen-infectedtarget
cells.
Bone-marrow-derived(B)lymphocytes-Bcellprecursors
inbonemarrow;naiveBcellspriortoantigenrecognition;
Humoral
memoryBcellsafterantigencontact;plasmacellsthat
secretespecificantibody.
Solubleproteinsthatdirectfocusandregulate
Cytokines specificTversusBlymphocyteimmuneresponses.
MajorComponentsoftheInnateImmuneSystem
Pattern
Ctypelectins,leucine-richproteins,scavenger
recognition
receptors,pentraxins,lipidtransferases;

---

receptors(PRR) integrins
a-Defensins,8-defensins,cathelin,protegrin,
Antimicrobial
granulysin,histatin,secretory
peptides
leukoproteaseinhibitor,andprobiotics
Macrophages,dendriticcells,NKcells,NK-T
Cells
cells,neutrophils,eosinophils,mastcells,
basophils,andepithelialcells.
ClassicandaltAutocrine,paracrineernative
Complement
complementpathway,andproteinsthat
components
bindcomplementcomponents
Autocrine,paracrine,endocrinecytokinesthat
mediatehostdefenceandinflammation,aswellas
Cytokines
recruit,direct,andregulateadaptive
immuneresponses

---

30.Whichofthefollowingdiseaseoccursdue
toDNAmoleculerepairdefect:
a)Krabe'sdisease
b)Angelmannsyndrome
c)Xerodermapigmentosum
d)Marfansyndrome
e)Ataxiatelangiectasia
CorrectAnswer-C:E
Ans:c.Xeroderma...,e.Ataxia...[RefHarper30th/390,29th/374,
28th/330-333;Lippincott6th/410-13;Harrison18th/496,
17th/395]
Angelmannsyndromeresultsfromgeneticdisorderthatresultsfrom
defectingenethatencodesubiquitin";"Marfansyndrome:Itis
causedbymutationingeneforfibrillin";"Krabbedisease:dueto13
?galactosidaseenzymedeficiency.
XerodermaPigmentosum(XP):Anautosomalrecessivegenetic
disease;morethan10genesareinvolved;Theclinical
syndromeincludesmarkedsensitivitytosunlight(ultraviolet)with
subsequentformationofmultipleskincancersandpremature
death,Theriskofdevelopingskincancerisincreased1000-to
2000-fold.

---

31.cDNAisusedingeneamplificationin
bacteriainsteadofgenomicDNA
because:
a)Easytoreplicatebecauseofsmallsize
b)cDNAlacksintronwhereasthisispresentingenomicDNA
c)Promotorarenotfoundinbacteria
d)Completegenomecannoteasilyreplicatedinbacteria
e)None
CorrectAnswer-A:B:D
Ans:a.Easy...,b.cDNA...&d.Complete[RefHarper30th/455-
56,29th/438-39;Lippincott6th/469-70;Vasudevan5th/449]
BecausecDNAhasnointervening,itcanbeclonedintoan
expressionvectorforthesynthesisofeukaryoticproteinsby
bacteria";"cDNAlacksintrons&thecontrolregionsofthegene,
whereasthesearepresentingenomicDNA"(Lippincott6th/469)
"Bacterialpromotersarerelativelysimple.
cDNAlibrariescontainthoseDNAsequencesthatonlyappearas
processedmessengerRNAmolecules&thesedifferfromonecell
typetoanother.AcDNAlibrarycomprisescomplementaryDNA
copiesofthepopulationofmRNAsinatissue.
cDNAprobesareusedtodetectDNAfragmentsonSouthernblot
transfersandtodetectandquantitateRNAonNorthernblot
transfers

---

32.FunctionofmiRNAis/are:
a)Genesilencing
b)Geneactivation
c)Transcriptioninhibition
d)Translationrepression
e)BreakingofmessengerRNA
CorrectAnswer-A:D:E
Ans:a.Gene...,d.Translation...&e.Breaking...[RefHarper
30th/368,29th/351-52;Lippincott6th/459;Vasudevan5th/436]
RNAinterferenceisamechanismofgenesilencingthrough
decreasedexpressionofmRNA,eitherbyrepressionoftranslation
orbyincreaseddegradation.
miRNAbindtomatchingpiecesofmessengerRNA,turnitintoa
doublestrand&keepitfromdoingitsjob.Theprocesseffectively
blockstheproductionofcorrespondingprotein.
miRNAsaretypically21-25nucleotidesinlengthandaregenerated
bynucleolyticprocessingoftheproductsofdistinct
genes/transcriptionunits.miRNAprecursorsaresinglestrandedbut
haveextensiveintramolecularsecondarystructure.

---

33.WhichofthefollowingisCD15&CD30
positive:
a)LymphocytepredominanceHodgkin'slymphoma
b)Mantlecelllymphoma
c)Burkit'slymphoma
d)MixedcellularityHodgkin'slymphoma
e)DiffuselargeBcelllymphoma
CorrectAnswer-D
Answer-D.MixedcellularityHodgkin'slymphoma
CD15-
Granulocytes;alsoexpressedbyReed-Sternbergcellsandvariants
inclassicalHodgkinlymphoma
CD30-
ActivatedBcells,Tcells,andmonocytes;alsoexpressedbyReed-
SternbergcellsandvariantsinclassicalHodgkinlymphoma.

---

34.Bcellantigensare:
a)CD1
b)CD2
c)CD3
d)CD19
e)CD20
CorrectAnswer-D:E
Answer-(D)CD19(E)CD20
CD1-CorticalthymocytesandLangerhanshistiocytes
CD3-Thymocytes,peripheralTcells
CD19-Marrowpre-BcellsandmatureBcellsbutnotplasmacells
CD20-Marrowpre-BcellsafterCD19andmatureBcellsbutnot
plasmacells

---

35.Trueaboutprotooncogene:
a)Onlyfoundinvirus
b)Onlyfoundinmalignantcell
c)Normallyinvolvedincellcycleproliferation
d)Canbeconvertedtooncogene
e)Onmutationitcausescancer
CorrectAnswer-C:D:E
Answer-(C)Normallyinvolvedincellcycleproliferation(D)Can
beconvertedtooncogene(E)Onmutationitcausescancer
Genesthatpromoteautonomouscellgrowthincancercellsare
calledoncogenes,andtheirnormalcellularcounterpartsarecalled
protooncogenes.
Proteinsencodedbyprotooncogenesmayfunctionasgrowthfactor
malignantsandreceptors,signaltransducers,transcriptionfactors,
andcell-cyclecomponents.

---

36.Thrombosisispredisposedby:
a)ProteinSdeficiency
b)Complementdeficiency
c)Antiphospholipidantibodysyndrome
d)Homocysteinuria
e)All
CorrectAnswer-A:C:D
Answer-(A)ProteinSdeficiency(C)Antiphospholipidantibody
syndrome(D)Homocysteinuria
Hypercoagulablestates-
Primary(Genetic)-
ProteinCdeficiency
ProteinSdeficiency
Homozygoushomocystinuria
Secondary(acquired)-
MI
Atrialfibrillation
Prostheticcardiacvalves
DIC
Thrombocytopenia

---

37.Pancytopeniacanoccurin:
a)CML
b)Kala-azar
c)Typhoid
d)Hairycellleukemia
e)None
CorrectAnswer-B:D
Answer-(B)Kala-azar(D)Hairycellleukemia
Primarybonemarrowdiseases-
Myelodysplasia
Paroxysmalnocturnalhemoglobinuria
Myelofibrosis
BonemarrowlymphomaHairycellleukemia
Sarcoidosis
Tuberculosis
Leishmaniasis

---

38.Non-smallcelllungcarcinomais/are
associated:
a)K-ras
b)EGFR
c)WT1
d)P53
e)All
CorrectAnswer-A:B:D
Answer-(A)K-ras(B)EGFR(D)P53
K-RASmutationsareseenprimarilyinadenocarcinoma.
p53andRBtumorsuppressorgenesarefrequentlymutated-
Squamouscellcarcinomas
EGFR-Adenocarcinoma

---

39.Trueaboutcarotidbodytumor:
a)Slowgrowingtumour
b)Uncapsulated
c)MostlyBilateral
d)Mostlybenign
e)All
CorrectAnswer-A:D
Answer-(A)Slowgrowingtumour(D)Mostlybenign
Raretumouroccurb/w3rd&6thdecadeoflifewithslightfemale
preponderance
Afewarebilateral&someshowfamilialincidence
Grosslytheyaresmall,firm,darktan,encapsulatednodules
Tumoursareusuallybenignwithonlyasmallnumberofcases
producingprovenmetastases.
Thereisoftenalonghistoryofaslowlyenlarging,painlesslumpat
thecarotidbifurcation.

---

40.Whichofthefollowingis/aretrueabout
autosomaldominantpolycystickidney
diseaseexcept:
a)Manypatientsmaybeasymptomatictill3rdor4thdecade
b)Pancreaticcyst
c)Associatedwithhypertension
d)Subarachnoidhaemorrhageismostcommonextrarenal
complication
e)None
CorrectAnswer-D
Answer-D.Subarachnoidhaemorrhageismostcommonextra
renalcomplication
ADPKDischaracterizedbytheprogressivebilateralformationof
renalcrisis.
Inheritance-autosomaldominant
Characterizedbymultipleexpandingcystsofbothkidneys.
Ingrossappearance,thekidneysarebilaterallyenlarged.
Thepainmayresultfromrenalcystinfection,haemorrhage,or
nephrolithiasis.
'Intravenousurographypolycystickidneydisease:Thespiderlegs,
deformityofthecalyces
Focalrenalcystsaretypicallydetectedinaffectedsubjectsbefore
30yearsofage.
Complications-
Hematuria,flankpain,urinarytractinfection,renalstones,
hypertension

---

---

41.Whichofthefollowingisnotafeatureof
reversiblecellinjury?
a)Diminishedgenerationofadenosinetriphosphate(ATP)
b)Formationofamorphousdensitiesinthemitochondrialmatrix
c)Formationofblebsintheplasmamembrane
d)Detachmentofribosomesfromthegranularendoplasmic
reticulum
e)Creationofmyelinfigures
CorrectAnswer-B
Answer-B.Formationofamorphousdensitiesinthe
mitochondrialmatrix
Largeflocculent,amorphousdensitiesinthemitochondrialmatrix
occurasaresultofirreversiblecelldamage.
Membranedamageplaysacentralroleinthepathogenesisof
irreversiblecellinjury.
Itismorphologicallyassociatedwithsevereswellingofthe
mitochondria,damageofplasmamembranesandswellingof
lysosomes.

---

42.Redinfarctoccurin:
a)Intissueswithdualcirculations
b)Occuronlywhenbotharterial&venousobstructionoccurs
simultaneously
c)Organswhicharepreviouslycongested
d)Organswithloosetissue
e)All
CorrectAnswer-A:C:D
Answer-(A)Intissueswithdualcirculations(C)Organswhich
arepreviouslycongested(D)Organswithloosetissue
Redinfarcts(Haemorrhagic):occurwith:
Venousocclusions(egovariantorsion);
Inloosetissues(suchaslungs);
Intissueswithdualcirculation(e.g.Lung&S.intestine)
Intissuesthatwerepreviouslycongestedbecauseofsluggish
venousoutflow.
Whenflowisreestablilshedtoasiteofpreviousarterialocculusion
andnecrosis.

---

43.Trueaboutfibrolamellarcarcinomaof
liver:
a)Betterprognosisthantypicalhepatocellularcarcinoma
b)Associatedwithcirrhosis
c)AFP-positive
d)Occurinyoungeradults
e)Morecommoninfemales
CorrectAnswer-A:D:E
Answer-(A)Betterprognosisthantypicalhepatocellular
carcinoma(D)Occurinyoungeradults(E)orecommonin
females
Itisadistinctivevariantofhepatocellularcarcinoma
Itisseeninyoungadults(20-40yrsofage)
Ithasequalsexincidence
Ithasbetterprognosis
IthasnoassociationwithHBVorcirrhosis
Itisgrosslyencapsulatedmass.
AFPelevationisnotseeninFibrolamellarCa

---

44.Whichofthefollowingis/aretrueabout
Prothrombintime:
a)Assessextrinsicpathways
b)TinLiverdisease
c)LinVit.Kdeficiency
d)Normalvalueis2-4minute
e)None
CorrectAnswer-A:B
Answer-(A)Assessextrinsicpathways(B)TinLiverdisease
Prothrombiatimeassayassessesthefunctionoftheproteinsinthe
extrinsicpathways.
Normalvalue-10to14sec
Evaluationofextrinsic&commonpathway.
Increasedinoralanticoagulationtherapy,DICandliverdisease,
VitaminKdeficiency.

---

45.TrueaboutThromboticthrombocytopenic
purpura:
a)Indirecthyperbilirubemia
b)Spherocytosiswiththrombocytopenia
c)Scistocytosiswiththrombocytopenia
d)Thrombiformation
e)All
CorrectAnswer-A:C:D
Answer-(A)Indirecthyperbilirubemia(C)Scistocytosiswith
thrombocytopenia(D)Thrombiformation
Itischaracterizedbyapentad-
Micromgiopathichemolyticanemia,thrombcytopenia,renalfailure,
neurologicfindings,andfever.
TTPdiagnosisincludeanincreasedlactatedehydrogenaseand
indirectbilirubin,decreasedhaptoglobin,andincreasedreticulocyte
count.
Theperipheralsmearshouldbeexaminedforevidenceof
schistocytes.

---

46.Inwhichofthefollowingdiseases
antineutrophilcytoplasmic
antibodies(ANCA)arenotfound:
a)Polyarteritisnodosa
b)Microscopicpolyangitis
c)Wegenergranulomatosis
d)Bechetsyndrome
e)Churg-Strausssyndrome
CorrectAnswer-A:D
Answer-(A)Polyarteritisnodosa(D)Bechetsyndrome
ANCApositive
Wegner'sgranulomatosis
Microscopicpolyarteritis
Churg'strausssyndrome
Renal-limitedvaculitis
(crescentricglomerulonephritis)

---

47.Anti-nuclearantibodiesarenotfoundin:
a)SLE
b)DiffuseScleroderma
c)Druginducedlupus
d)Limitedsceleroderma
e)Sarcoidosis
CorrectAnswer-E
Answer-(E)Sarcoidosis
Foundin-
Druginducedlupus
Sjogren'ssyndrome
Scleroderma
Polymyositis
Dermatomyositis
Arthritis

---

48.at30yrofage,bloodformingbone
marrowarefoundin
a)Sternum
b)Sacrum
c)Pelvis
d)Upperendtibia
e)Upperendhumerus
CorrectAnswer-A:B:C:D:E
Answer-(A)Sternum(B)Sacrum(C)Pelvis(D)Upperendtibia
(E)Upperendhumerus
Byage18onlythevertebrae,ribs,sternum,skull,pelvis,and
proximalepiphysealregionsofthehumerusandfemur.

---

49.Pericardialeffusionis/areseeninall
except:
a)Uraemia
b)SLE
c)Rheumaticfever
d)Myxedema
e)Hyperthyroidism
CorrectAnswer-E
Answer-(E)Hyperthyroidism
Infectious
Viral
Bacterial
Fungal
Parasite
Rickettsia
Postinjury
Trauma
Surgery
Myocardialinfarction
Radiation
Metabolicdiseases
Uremia
Medications
Systemicdiseases
Rheumatoidarthritis
Systemiclupuserythematosus

---

Sarcoidosis
Scleroderma
Dermatomyositis
AmyloidosisTumors
Aorticdissection

---

50.Epidermalgrowthfactoris/areformedby:
a)Platelet
b)Fibroblast
c)Mastcell
d)Endothelialcell
e)Keratinocyte
CorrectAnswer-A:E
Answer-(A)Platelet(E)Keratinocyte
Inhealingwoundsoftheskin,EGFisproducedbykeratinocytes,
macrophages,andotherinflammatorycellsthatmigrateintothe
area.

---

51.Cyclindependentkinase-2(CDK-2)acts
via:
a)CyclinA
b)CyclinB
c)CyclinC
d)CyclinD
e)CyclinE
CorrectAnswer-A:E
Answer-(A)CyclinA(E)CyclinE
FormsacomplexwithcyclinEinlateG1,whichisinvolvedinthe
G1/Stransition.
FormsacomplexwithcyclinAattheSphasethatfacilitatesthe
G2/Mtransition.

---

52.WhichofthefollowingpairofGreceptor
iscorrectlymatchedwithitsaction:
a)Gi-Activationofcalciumchannel
b)Gq-Tcytoplasmiccalcium
c)Gs-Openingofcalciumchannel
d)Go-Openingofpotassiumchannel
e)Gt-Activationofpotassiumchannel
CorrectAnswer-B:C:D
Ans.B,Gq-TcytoplasmiccalciumC,Gs-Openingofcalcium
channel&D,Go-Openingofpotassiumchannel
[RefKDT7th/a5-49;Katzung31]
GsopenCa2+channelsinmyocardium6skeletalmuscle,whileGi
&GoopenK+channelinheart&smoothmuscleasweIIasinhibit
neuronalCa2+channel
GReceptor:
Gs:Adenylylcyclaseactivation,Ca2+channelopening
Gi:Adenylylcyclaseinhibition,K+channelopening
Go:Ca2+channelinhibition.
Gq:PhospholipaseCactivation

---

53.Mineralocorticoidreceptorsantagonist(s)
is/are:
a)Spironolactone
b)Triamterene
c)Epleroenone
d)Amiloride
e)Acetazolamide
CorrectAnswer-A:C
Ans.(A)Spironolactone&(C)Epleroenone
[RefKDT.Tth/578;Katzung12th/261-62]
PotassiumSparingDiuretics
Aldosteroneantagonists:Spironolactone,eplerenone
InhibitorsofrenalepithelialNa+channel:Triamterene,Amiloride
MOA:
Actbydirectpharmacologicantagonismofmineralocorticoid
receptors(spironolactone,eplerenone)orbyinhibitionofNatinflux
throughionchannelsintheluminalmembrane(amiloride,
triamterene).

---

54.Allofthefollowingareactionsof
muscarinicantogonists,except:
a)Decreasegastricsecretions
b)Decreaserespiratorysecretions
c)Contractradialmusclesofiris
d)FascilitatesAVconduction
e)None
CorrectAnswer-C
Ansis'c'i.e.Contractradialmusclesofiris
Radialmusclesareinnervatedbysympatheticsystemsnotby
parasympathetic(muscarinic)system
Irismusclesthatcontrolthesizeofpupil
Therearetwotypesofmusclesiniristhatcontrolthesizeof
pupil:
1. Theirissphincterorconstrictorpupillae(circularmuscles):These
musclesareinnervatedbytheparasympatheticsystemandcause
constrictionofpupil(miosis).
2. Theirisdilatorordilatorpupillae(radialmuscles):Thesemuscles
areinnervatedbysympathetic(a,adrenergic)systemandcause
dilatationofpupil(mydriasis)
So,pupilsizemaybealteredbyfollowingmechanismsbydifferent
ANSdrugs:
A.Mydriasis(dilatationofpupil)
Sympathomimeticdrugs(a,agonists):Bycontractionofradial
muscles(dilator).
Antimuscarinicdrugs:Byblockingtheactionofcircularmuscles

---

(pupillarysphincter).
B.Miosis(constrictionofpupil)
1. Parasympathomimetic(muscarinic)drgus:Bystimulatingthe
contractionofcircularmuscles(pupillarysphincter).
2. Sympatholyticdrugs(a,antagonists):Byblockingtheactionofradial
muscles(irisdilator)Aboutotheroptions
Muscarinicantagonists(antimuscarinicdrugs)decreasebothgastric
andrespiratory(bronchial)secretionsoAntimuscarinicdrugs
facilitateAVconduction(seepreviousexplanations).

---

55.UnwantedinteractionsofMAOinhibitors
occurwith:
a)Levodopa
b)Hydrochlorothiazide
c)Reserpine
d)Pethidine
e)None
CorrectAnswer-A:C:D
Ans.A,LevodopaC,Reserpine&D,Pethidine
NonSelectiveMAOInhibitors:Interactions:
Cheesereaction-
Varietiesofcheese,beer,wine,pickledmeat&fish,yeastextract
containlargequantitiesoftyramine,dopaetc.
InMAOinhibitedpatientscausehypertensivecrisis&
cerebrovascularaccidents.
Cold&coughremedies-Ephedrine.
Reserpine,guanethidine,tricyclicantidepressants
Levodopa:
Excitement&hypertension.
Antiparkinsoniananticholinergics:
Hallucinations&symptomssimilartothoseofatropinepoisoning
Barbiturates,alcohol,opioids,antihistamines:
Actionsofthesedrugisintensified&prolonged.Respirationmay
fail..
Pethidine:
Highfever,sweating,excitation,delirium,convulsions&severe

---

respiratorydepression.
Note:
HydrochlorothiazidedruginteractionsnotincludeMAO-Inhibitors

---

56.Whichofthefollowingis/aretrueabout
Sulfonylureaexcept:
a)Increaseinsulinsecretion
b)Causehypoglycemia
c)Causeweightloss
d)Disulfiram-likereactionafteralcoholintake
e)Safeinpregnancy
CorrectAnswer-C:E
Ans.C,Causeweightloss&E,Safeinpregnancy
[RefKDT7th/270-73;Katzung12th/754-5]
Sulfonylureas:
Provokeabriskreleaseofinsulinfrompancreas.
Hypoglycemiaisthemostcommonproblem.
MajorityofdiabeticsstartedonSUstendtogain1-3kg.
Flushing&disulfiram-likereactionafteralcoholoccurinsome
individualstakingSUs
Safetyduringpregnancyisnotestablished.

---

57.Weightgainisnotseenwith:
a)Clozapine
b)Risperidone
c)Olanzapine
d)SSRI
e)Zotepine
CorrectAnswer-D
Ans.(D)SSRI
[RefKDT7th/aal,442;Katzung12d/512,509]
ClozapineMetaboliccomplications(Major)-Weightgain,
hyperlipidemia&precipitationofdiabetes.
Olanzapinecausesweightgain.
Risperidonecausesweightgain&incidenceofnewonsetdiabetes
islessthanwithclompine
increasedappetite&weightgainisnoteilwithmostTCAs&
trazodone,butnotwithSSRIs,SNRIs&bupropion.
Zotepine:Weightgain,hyperglycemia&dyslipidemiaareLikelyas
withclozapine
Quetiapine:Weightgain&riseinbloodsugarismoderate.
Aripiprazole:Littletendencytoweightgain.

---

58.Whichofthefollowingis/aretrueabout
dobutamine:
a)Selective(32receptoragonist
b)Tventricularfillingpressure
c)Halflifeisabout2min
d)Dopaminereceptoragonist
e)None
CorrectAnswer-C
Ans.(C)Halflifeisabout2min
[R4KDf7th/134;Katzung12th/141-42,218,225;Goodman&
Gilman11th/251]
Dobutamine:
Derivativeofdopamine,butnotaDlotD2receptoragonist.
Hasactiononalpha&betareceptorsalso.
Yet,onlyprominentactionofclinicallyemployeddosesisincreased
forceofcardiaccontraction&outPut,withoutsignificantchangein
heartrate,peripheralresistance&BP.
Consideredtobearelativelyselectivebeta-1agonist.
Half-lifeofabout2minutes&onsetofactionisrapid.
UsedasaninotroPicagentinpumpfailureaccompanying
myocardialinfarction,cardiacsurgery&forshorttermmanagement
ofseverecongestiveheartfailure.

---

59.Apersonhasgiven0.175gmoraldigoxin
withbioavailabilty70%.Theamountof
drugreachinginsystemiccirculationis:
a)0.175
b)0.175x0.7
c)0.175/7
d)0.175+0.7
e)0.175+1/0.7
CorrectAnswer-B
Ans.(B)0.175x0.7
[RdKDT7th/16,515;Katzungt2th/43]
Amountofdrugreachinginsystemiccirculation=drugdosegivenx
bioavailability
=0.175gmx70/100
=0.175gmx0.7

---

60.TrueaboutPlacebo:
a)Itworksonlyinpsychiatricperson
b)Responseisbothobjective&subjective
c)Effectalsoseeninnormalperson
d)Itisaninertsubstance
e)None
CorrectAnswer-B:C:D
Ans.B,Responseisbothobjective&subjectiveC,Effectalso
seeninnormalperson&D,Itisaninertsubstance
[RefKDT7th/67;Katzung12th/72]
Placebo:
Aninertsubstancewhichisgiveninthegarbofamedicine.
Workbypsychodynamicratherthanpharmacodynamicmeans&
oftenproducesresponsesequivalenttotheactivedrug
Placebodoinducesphysiologicalresponses,e.g.,theycanrelease
endorphinsinbrain-causinganalgesia.
Substancescommonlyusedasplaceboarelactosetablets/capsules
&distilledwaterinjection.
Themanifestationofthisphenomenoninthesubjectistheplacebo
response(Latin,'Ishallplease')andmayinvolveobjective
physiologicandbiochemicalchangaaswellaschangesin
subjectivecomplaintsassociatedwiththedisease

---

61.Treatmentofnocardiainfectionincludes:
a)Ampicillin
b)Floroquinolones
c)Azithromycin
d)Cotrimoxazole
e)Amikacin
CorrectAnswer-A:B:D:E
Ans.A,AmpicillinB,FloroquinolonesD,Cotrimoxazole&
E,Amikacin
[RefKDf7th/706,755;Hanisonlgth/1087]
Nocardiosis:
SulfonamidesareofvalueintreatinginfectionsduetoNocardiagrp.
Sulfisoxazoleorsulfadiazinemaybegivenindosagaof6-8gdaily
andiscontinuedforseveralmonthsafteraIImanifestationshave
resolved.
administrationofasulfonamidewith2ndgen.antibiotic(ampicillin,
erythromycin,ardstreptomycin)advised.
CoTrimoxazoleisusedinnocardiosis.

---

62.Trueaboutmorphine:
a)ActasantagonistonIAreceptorwithnoagonistaction
b)Activationinliver
c)Halflife4hr
d)Causemiosis
e)Clearancetimeisaround20hr
CorrectAnswer-B:D:E
Ans.(B)Activationinliver(D)Causemiosis(E)Clearancetime
isaround20hr
[Ref:KDT7th/469-75;Katzung13th/531-44;Goodman&Gilman
p62-66]
Morphine:
Primarilymetabolizedinliverbyglucuronideconjugation.
Morphine-6-glucuronideisanactivemetabolite(morepotentthan
morphineonpopioidrecePtors),whichcontributetoanalgesia.
AnothermetabolitemorPhine-3-glucuronidehasneuroexcitatory
proPerty.
Plasmahalflifemorphineaverages2-3hours
Effectofaparenteraldoselasts4-6hours.
EliminationisalmostcomPletein24hours.
MorphinestimulateEdingerWestphalnucleusof3rdnerveis
stimulatedproducingmiosis.
NomeiosisoccurontopicalaPPlicationofmorPhinetotheeye,
sincethisisacentralaction

---

63.Whichofthefollowingis/aretrueabout
phenytoin-
a)InactivationbyLiverenzyme
b)CausesVitB12deficiency
c)Causesthiaminedeficiency
d)Gumhypertrophyiscommonestside-effect
e)InhibitorofCYP3A4/5
CorrectAnswer-A:D
Ans.(A)InactivationbyLiverenzyme(D)Gumhypertrophyis
commonestside-effect
[Ref:KDT7th/a13-15;Katzung13th/2100-N2;AtoZDrugFacts
2003byDaildS.Tatro;Goodman6Gilman11th/335;Hanison
l9ttt/2554'18th/893,888]
Phenytoin:
MetabolizedinliverbyhydroxylationinvolvingCYP2C9&2C19as
wellasbyglucuronideconjugation.
Megaloblasticanaemia:ltdecreasedfolateabsorption&increaseits
excretion.
ItinterfereswithmetabolicactivationofVitD&withcalcium
absorPtion/metabolism.
Gumhypertrophy:commonest(20%incidence)
PotentinducerofCYP2C8/9,CYP3A4/5&someotherCYPs.
ItcompetitivelyinhibitsCYP2C9/19

---

64.DrugsactiveagainstMRSA:
a)Vancomycin
b)Ceftriaxone
c)Linezolid
d)Piperacillin-tazobactam
e)Meropenam
CorrectAnswer-A:C
Ans.(A)Vancomycin(C)Linezolid
[RefKDT7th/731,757,6th/700,708,732,7i4;G6G11th/1132;
Kntzung13th/779,781;Harrison19th/961-62.18th/2134]
MRSA:
Vancomycinanddaptomycinarenowrecommendedasthedrugof
choiceforthetreatmentofMRSAinfections.
Imipenema,Dalfopristino/Quinpristin,Mupirocin,Teicoplaninaare
alsoeffectiveagainstMRSA
Ceftarolineisa5thgen.cephalosporinwithbactericidalactivity
againstMRSA(includingstrainswithreducedsusceptibilityto
vancomycinanddaptomycin)-Approvedforuseinnosocomial
pneumoniasandforskinandsofttissueinfections.
Otherdrugsare-Linezolid,daptomycin,Quinupristin/dalfopristin.

---

65.Trueaboutdaptomycin:
a)Causesdiarrheaasside-effect
b)Itisaglycopeptideantibiotic
c)Causemyopathy
d)Itcanbeusedorally
e)Excretionthroughkidney
CorrectAnswer-C:D
Ans.(C)Causemyopathy(D)Itcanbeusedorally
[RefKatzung13th/783-85;Goodman&Gilman11th/1197-98:
Harrison19th/961]
Daptomycin:
CycliclipopeptidefermentationproductofStreptomyces
roseosPorus.
Newly-approvedantibacterialagent,thefirstlipopeptideagenttobe
releasedontothemarket.
ItsspectrumofactivityislimitedtoGram-positiveorganisms,
includinganumberofhighlyresistantspecies(MRSA,VISA,VRSA,
VRE)
MOA:
Precisemechanismofactionisnotknown,butifappearstobindto
anddepolarizethecellmembrane,causingPotassiumeffluxand
rapidcelldeath.
Features:
Onlyadministeredintravenously.
Clearedrenally.
Approximately80%oftheadministereddoseisrecoveredinurine.
Cancausemyopathy,andcreatinephosphokinaselevelsshouldbe

---

monitored.

---

66.Trueaboutdoxorubicin:
a)Antineoplasticdrug
b)Alkylatingagent
c)TopoisomeraseIIIinhibitor
d)Anthracyclineantibiotic
e)Cardiotoxic
CorrectAnswer-A:D:E
Ans.(A)Antineoplasticdrug(D)Anthracyclineantibiotic
(E)Cardiotoxic
[RefKDT7th/867;Katzung13th/934-35]
Doxorubicin:
Anthracyclineantibiotichavingantitumoractivity
Itintercalateb/wDNAstrands&blockDNAaswellasRNA
synthesis.
TheyarealsocapableofcausingbreaksinDNAstrandsby
activatingtopoisomerase-2&generatingquininetypefreeradicals.
Cardiotoxicadverseeffect.

---

67.TNF-ainhibitorsare:
a)Bevacizumab
b)Ranibizumab
c)Adalimumab
d)Infliximab
e)Etanercept
CorrectAnswer-A:B:D
Ans.(A)Bevacizumab(B)Ranibizumab(D)Infliximab
TNFalpha-inhibitor:Etanercept,infliximab,certolizumah,
golimumab,&Adalimumab.
MOA:
BindsTNF-alpha,aproinflammatorycytokine.
BlockingTNF-alphafrombindingtoTNFreceptorsoninflammatory
cellsurfacesresultsinsuppressionofdownstreaminflammatory
cytokinessuchasIL-1&IL-6andadhesionmoleculesinvolvedin
leukocyteactivationandmigration.
Anincreasedriskoflymphomaiscommontoeachoftheseagents.

---

68.Whichofthefollowingisacommonside-
effectofCisplatin-
a)Diarrhea
b)Vomiting
c)Pulmonaryfibrosis
d)Alopecia
e)None
CorrectAnswer-B
Ans.is'b'i.e.,Vomiting
Mostcommonside-effectofCisplatinis:Vomiting(highlyemetic
drug).
Themostimportantdosedependenttoxicityisrenalimpairment.
Amifostineislabelledforreductionofcisplatininduced
nephrotoxicity.
Tinnitus,deafness,sensoryneuropathy&hlperuricaemiaareother
problems.
Shocklikestatesometimesoccurduringi.vinfusion.

---

69.WhichofthefollowingCLASPhuman
experiment:
a)MaincenterfortheexperimentwasGeneva
b)MaincenterfortheexperimentwasTokoyo
c)MaincenterfortheexperimentwasinUnitedkingdom
d)Heparinlowdosegiven
e)Drugusedinexperimentsignificantlyreduceseclampsiain
subjects
CorrectAnswer-C
Ans.C.MaincenterfortheexperimentwasinUnitedkingdom
[Ref;http:/www.researchgate.net;
httP://www.ncbi.nlm,nih.gov/pubmed/7905809]
CLASPhumanexperiment:
Correspondenceto:CLASPCo-ordinatingCentre,Harkness
Building,RadcliffeInfirmary,OxfordOX26HE,UK-http://
www,researchgate.net
CLASP
Theimpactofaspirinonproteinuricpreeclampsiaanditsfetal
sequelaeinCLASPwascertainlysmallerthaninsomeprevious
reviews.
Theresultsofavailabletrialsdonotsupportthewidespreadroutine
prophylacticortherapeuticuseofantiplatelettherapyinpregnancy
amongallwomenjudgedtobeatriskofpre-eclampsiaorIUGR.
Overall,theuseofaspirinwasassociatedwithareductionofonly
12%intheincidenceofproteinuriapre-eclampsia,whichwasnot
significant.

---

NorwasthereanysignificanteffectontheincidenceofIUGRorof
stillbirthandneonataldeath.

---

70.Duringseparation,sexualintercourse
betweenhusband&wife:
a)Non-bailableoffence
b)Onlyacrimeifcomplainedbyvictim
c)ItisdefinedunderIPC376C
d)Minimumpunishmentof2year
e)Minimumpunishmentof5year
CorrectAnswer-B:D
Ans:b.Only...,d.Minimum...[RefReddy33rd/412;http:
llindianlawcases.com/Act-Indian.Penal.Code,1860-1835]
Section376B,I.P.C:Whoeverhassexualintercoursewithhisown
wife,whoislivingseparately,whetherunderadecreeofseparation
orotherwise,withoutherconsent,shallbepunishedwith
imprisonmentofeitherdescriptionforatermwhichshallnotbeless
thantwoyearsbutwhichmayextendtosevenyears&shallalsobe
liabletofine.
Section376C,I.P.C:Whoever,beingthesuperintendentor
managerofajail,remandhomeorotherplaceofcustody
establishedbyorunderanylawforthetimebeinginforceorofa
woman'sorchildren'sinstitutiontakesadvantageofhisofficial
positionandinducesorseducesanyfemaleinmateofsuchjail,
remandhome,placeorinstitutiontohavesexualintercoursewith
him,suchsexualintercoursenotamountingtotheoffenceofrape,
shallbepunishedwithimprisonmentofeitherdescriptionforaterm
whichmayextendtofiveyearsandshallalsobeliabletofine.

---

71.Trueabouteuthanasiaareall,
except:
PGI14
a)PassiveeuthanasiaislegalinIndia
b)ActiveeuthanasiaisallowedintheUK
c)PhysicianassistedsuicideislegalinsomeStatesoftheUS
d)ActiveeuthanasiaislegalinNetherlandsandBelgium
e)None
CorrectAnswer-B
Ans.(B)ActiveeuthanasiaisallowedintheUK

---

72.Earlyonsetrigormortisis/areseenin:
a)TB
b)Cholera
c)Asphyxia
d)Arseni
e)Aconite
CorrectAnswer-A:B
Ans:a.TB,b.Cholera
[RefReddy33rd/162;Parikh6th/3.171
Theonsetofrigorisearly&durationisshortindeathsfrom
diseasescausinggreatexhaustion&wastinge.g.,cholera,typhoid,
tuberculosis,canceretc&inviolentdeathasbycut-throat,firearms,
electrocution,lightening&instrychninepoisoning
Inorganophosphatepoisoningrigidityappearsearly,COpoisoning
delaysdisappearance
Theonsetisdelayedindeathsfromasphyxia,severehaemorrhage,
apoplexy,pneumonia&nervousdiseasecausingparalysisof
muscle
IndeathduetopoisoningfromHCN&strychnine,itstartsearly&
persistslonger
Arsenicdelaysputrefaction"-Reddy33rd/541
"RigormortislastslongerthanusualinArsenicpoisoning,Aconiteis
extremelyunstable&isdestroyedbyputrefaction

---

73.Trueaboutorganophosphoruspoisoning:
a)Atropineisbestforearlytreatment&maintenance
b)Pralidoximeisimportantforrestoringneuromuscular
transmission
c)Phenytoinistheprimarydrugusedforseizurecontrol
d)Mydriasispresent
e)Pralidoxime&atropineworkssynergistically
CorrectAnswer-A:B:E
Ans.(A)Atropineisbestforearlytreatment&maintenance
(B)Pralidoximeisimportantforrestoringneuromuscular
transmission(E)Pralidoxime&atropineworkssynergistically
[RefReddy32nd/495-97;G&Gltth/21};KDT7th/111:13th/979-80;
PharmacologybySatoskar24th/297]
OrganophosPhorusPoisoning:
AIIcaseofAnti-ChEpoisoningmustbepromptlygivenatropine2
mgi.Vrepeatedevery10mintilldryness&othersignsof
atropinizationappear.
Continuedtreatmentwithmaintenancedosesmayberequiredfor1-
2weeks
Theuseofoximesinorganophosphatepoisoningissecondaryto
thatofatropine.Moreventheclinicalbenefitofoximesishighly
variable.
Controlofconvulsionswithjudicioususeofdiazepam.
Ocularmanifestationsincludemarkedmiosis'ocularpain'
conjunctivalcongestion,diminishedvision,ciliaryspasm,Andbrow
ache.
Atropineinsufficientdosageeffectivelyantagonizestheactionsat

---

muscarinicreceptorsites,andtoamoderateextentatperipheral
ganglionicandcentralsites

---

74.Pinpointpupilnotseenin:
a)Aconite
b)Opium
c)Alcohol
d)Cannabis
e)Organophosphorus
CorrectAnswer-A:C:D
Ans:a.Aconite,c.Alcohol&d.Cannabis
[RefReddy33rd/6191]
Aconite:Thepupilsalternatelycontract&dilate(hippus),butremain
dilatedinlaterstages.Acutealcoholpoisoning:pupildilated&
reacting"
Opiumpoisoning:Thepupilsarecontractedtopinpointsize&do
notreacttolightbutdilateduringtheagonalasphyxiaphasecaused
byrespiratorydepression&ultimateparalysis.
Phenothiazines,Resting(deepsleep),Opiates,Narcotics,Stroke
(pontinehemorrhage),Lomotil(diphenoxylate),Insecticides,
Mushrooms/Muscarinic(inocybe,clitocybe)

---

75.Whichofthefollowingisnotniacin
positive:
a)Mycobacteriumbovis
b)Mycobacteriumsonei
c)Mycobacteriumchelonae
d)Mycobacteriumtuberculosis
e)Mycobacteriumsimiae
CorrectAnswer-C:D:E
Ans:c.Mycobacterium...,d.Mycobacterium...,e.
Mycobacterium..
[RefAnanthanarayan9th/347-48;MedicalMicrobiologyby
Greenwood16th/201;Harrison19th/1102-05]
Humantuberclebacilliformniacinwhengrownonaneggmedium
Thetestispositivewithhumantype(M.tuberculosis)negativewith
bovinetypeofthebacilli
Itcan,however,bepositiveforM.simiae&afewstrainsof
M.cheloneii

---

76.Feedoraltransmissionoccurin:
a)HepatitisA
b)HepatitisB
c)HepatitisE
d)Rotavirus
e)Herpessimplex
CorrectAnswer-A:C:D
Ans:a.HepatitisA,c.HepatitisE&d.Rota..[Ref
Ananthanarayan9th/561;Harrison19th/2013]
Herpessimplex:Humansaretheonlynaturalhosts&thesourceof
infectionaresaliva,skinlesionsorrespiratory
secretions.Transmissionoccursbyclosecontact&maybevenereal
ingenitalherpes.

---

77.Oroyafeveriscausedby:
a)B.bacilliformis
b)B.henselae
c)B.quintana
d)B.elizabethae
e)B.clarridgeiae
CorrectAnswer-A
Ans:a.B.bacilliformis[RefAnanthanarayan9th/412;Medical
MicrobiologybyGreenwood16th/325-26]
Bartonellosis,orCarrion'sdisease,iscausedbyB.bacilliformis
Bartonellosis,orCarrion'sdisease,iscausedbyB.bacilliformis.The
diseaseischaracterizedbytwodistinctphases:
1. anacutefebrilehematicphase,knownasOroyafever;and
2. aneruptivephasemanifestedbycutaneouslesions,knownas
verrugaperuana

---

78.VectorforO.tsugamiis/are:
a)Chigger
b)L.deliensislarva
c)Xenopsyllacheopis
d)Pediculushumanuscorporis
e)None
CorrectAnswer-A:B
Ans:a.Chigger,b.L.deliensis...(RefAnanthanarayan9th/408;
MedicalMicrobiologybyGreenwood16th/369-72;Harrison
19th/1155,1159]
Scrubtyphusiscausedbyorientiatsutsugamushi(formerlyR.
tsutsugamushiorR.orientalis).Thevectorsaretrombiculidmitesof
genusLeptotrombidium-L.akamushiinJapan&L.deliensisinIndia.
Humansareinfectedwhenarebittenbymitelarvae(chiggers)"
0.tsutsugamushidifferssubstantiallyfromRickettsiaspeciesboth
geneticallyandintermsofcellwallcomposition(i.e.,itlacks
lipopolysaccharide).0.tsutsugamushiismaintainedbytransovarian
transmissionintrombiculidmites.
Illnessvariesfrommildandself-limitingtofatal.Afteranincubation
periodof6-21days,onsetischaracterizedbyfever,headache,
myalgia,cough,andgastrointestinalsymptoms.
Somepatientsrecoverspontaneouslyafterafewdays.Theclassic
casedescriptionincludesanescharwherethechiggerhasfed,
regionallymphadenopathy,andamaculopapularrash--signsthat
areseldomseeninindigenouspatients

---

79.Weilfelixreactioninscrubtyphusis/are
positivefor:
a)OX-19
b)OX-2
c)BothOX-19&OX-2
d)OX-K
e)OX-19,OX-2&OX-K
CorrectAnswer-D
Ans:d.OX-K[RefAnanthanarayan9th/410;Medical
MicrobiologybyGreenwood16th/373]
Thisreactionisanagglutinationtestinwhichseraaretestedfor
agglutininstothe0antigensofcertainnon-motileProteusstrains
OX-19,OX-2&OX-X
Thebasisoftestisthesharingofanalkali-stablecarbohydrate
antigenbysomerickettsiae&bycertainstrainsofproteus,P.
vulgarisOX19&OX2&P.mirabilisOXK.
disease
OX-19
OX-2
OX-K
Epidemic +++
+
_
typhus
Brill-
Usually(?
Zinsser
ve)orweakly
-
disease
(+ve)
Endemic +++
+/-
-
typhus
Tickborne
spotted
++
++
-
fever

---

fever
Scrub
-
-
+++
typhus

---

80.Minimuminfectivedoseofshigellais:
a)1-10
b)10-100
c)103-106
d)Sameasentericfever
e)SameasV.cholera
CorrectAnswer-B
Ans:b.10-100[RefAnanthanarayan9th/287,307,341]
Ithasbeenshownthat106pathogenicvibriosadministeredto
fastingnormalchlorhydricvolunteers,withoutfoodorbuffer,didnot
produceinfection,whilethesamedosealongwithfoodorsodium
bicarbonatecausedclinicalcholerain80-100%ofthem.
Shigellacausebacillarydysentery.Infectionoccursbyingestion.
Theminimuminfectivedoseislow-asfewas10-100bacilliare
capableofinitiatingthedisease,probablybecausetheysurvive
gastricaciditybetterthanotherenterobacteria.

---

81.Acutehemorrhagicconjunctivitisis/are
causedby:
a)CoxsackievirustypeA24
b)Coronavirus
c)Enterovirus-70
d)Herpessimplex
e)Adenovirus
CorrectAnswer-A:C:E
Ans:a.Coxsackie...,c.Enterovirus-70&e.Adeno..[Ref
Ananthanarayan9th/491,493;Greenwood16th/459]
Acutehemorrhagicconjunctivitisiscausedbyenterovirustype70:
Thesymptomsaresuddenswelling,congestion,watering&painin
theeyes.Subconjunctivalhemorrhageisacharacteristicfeature.
CoxsackievirustypeA24alsoproducesthesamedisease
Coronaviruscausesevereacuterespiratorysyndrome,Adenovirus
11alsocausesAcutehemorrhagicconjunctivitis.

---

82.Zonesofoperationtheatreincludesall
except:
a)Septiczone
b)cleanzone
c)Protectivezone
d)Sterilezone
e)Disposalzone
CorrectAnswer-A
Ans:a-septiczone...[Refhttp:
www.peerlesshospital.com/services/ot.html]
ProtectiveZone:Areasincludedinthiszoneare:
Reception
Waitingarea
Trolleybay
Changingroom
CleanZone:Areasincludedinthiszoneare:
Pre-oproom
Recoveryroom
Plasterroom
Staffroom
Store
SterileZone:Areasincludedinthiszoneare:
OperatingSuite
ScrubRoom
AnesthesiaInductionRoom
SetupRoom

---

DisposalZone:Areasincludedinthiszoneare:
DirtyUtility
Disposalcorridor

---

83.Trueaboutacanthamoebainfection:
a)Causeskeratitis
b)Contactlensincreasesriskofkeratitis
c)Causekeratitisincontactlenswearer
d)Alsocausesencephalitis
e)Immunodeficiencyisariskfact
CorrectAnswer-A:B:D:E
Ans:(A)Causeskeratitis(B)Contactlensincreasesriskof
keratitis(D)Alsocausesencephalitis(E)Immunodeficiencyis
ariskfact
[RefPaniker'sParasitology7th/27-28;Khurana6th/112-13;
Harrison19th/1367-68,245e;Greenwood16th/595;Parson
22nd/208]
Acanthamoebakeratitis:Ithasalsobeenseentooccurinnon-
contactlenswearers&mayberelatedtoswimmingorbathingin
contaminatedwater.
Thisisanopportunisticprotozoanpathogenfoundworldwideinthe
environmentinwater&soil,Infectionusuallyoccurinpatientswith
immunodeficiency,diabetes,malignancies,malnutrition,SLEor
alcoholism,Itpresentschieflyas2chronic
conditions-keratitisencephalitis
Acanthamoebakeratitis:majorityofsuchcaseshavebeen
associatedwiththeuseofcontactlens.

---

84.H.parainfluenzaerequiresfactor:
a)V
b)VI
c)VII
d)X
e)XII
CorrectAnswer-A
Ans:(A)V[RefAnanthanarayan9th/328]
FactorV&Xareaccessorygrowthfactorswhichispresentinblood-
(Ananthanarayan9th/327)
Growth
species
requirement
Hemolysisonhorseblood
agar
X V CO2
Hinfluenzae
+ + -
-
Haegyptius
+ + -
-
Hducreyi
+ VARIABLE
VARIABLE
H.parainfluenzae - + -
-
H.haemolyticus
+ + -
+
H.
- + -
+
parahaemolyticus
haphrophilus
+ - +
-
Hparaphrophilus - + +
-

---

85.Meningococcalinfectionispredisposed
bywhichofthefollowingdeficiencyof
complementfactor
a)C1-C3
b)C3-C4
c)C5-C9
d)C1-C4
e)Properdin
CorrectAnswer-C:E
Ans:(C)C5-C9(E)Properdin[Ref:Ananthanarayan9th/229;
Harrison19th/2106-07
Meningococcaldiseaseisfavouredbydeficiencyoftheterminal
complementcomponents(C5-C9
Deficienciesinthealternativepathway(factorsDandproperdin)
areassociatedwiththeoccurrenceofinvasiveNeisseria
infections.
Lastly,deficienciesofanycomplementcomponentinvolvedin
thelyticphase(C5,C6,C7,C8,and,toal*serextent,C9)
predisposeaffectedindividualstosystemicinfectionby
Neisseria.Thisisexplainedbythecriticalroleofcomplementin
thelysisofthethickcellwallpossessedbythisclassof
bacteria.

---

86.Trueabout8thpandemicofcholera:
a)Causedbyserotype0classical
b)Causedbyserotype0Eltor
c)Causedbyserotype0139
d)ItspreadinIndonesiain1961
e)ItspreadinBangladeshin1992-93
CorrectAnswer-C:E
Ans:(C)Causedbyserotype0139&(E)Itspreadin
Bangladeshin1992-93
Aseventofgreatsignificancewasthesuddenemergenceof
non-O-lV.cholera(formelyNAGvibrio)asthecauseof
epidemiccholera(8thpandemic).
Inoctober1992,anewnon-O-|vibriowasisolatedfroma
choleraoutbreakinMadras(Chennai).Similaroutbrealcssoon
followedindffirentpartsofIndia.ByJanuary1993,
SomeconsiderthecholeracausedbytheserotypeOIi9strainto
betheeighthpandemicthatbeganintheIndiansubcontinent
in1992-1993,withspreadtoAsia.Thediseasehasbeenrare
inNorthAmericasincethemid1800s,butanendemicfocus
existsontheGulfCoastofLouisianaandTexas.

---

87.Whichisnotspirochetes:
a)Borrelia
b)Leptospira
c)Fusobacterium
d)Lactobacillus
e)Varicella
CorrectAnswer-C:D:E
Ans:c.Fusobacterium.d.Lactobacillus&e.Varicella
[Ref.Ananthanarayan9th/j71;Hanisonl9th/II32.
"Lactobacillusgenusconsistsofanaerobicgrampositivebacilli"
"Veillonellaareanaerobicgramnegativecocci".
SpirochetesareElongated,motile,flexiblebacteriatwisted
spirallyalongthelongaxisaretermedspirochetes(fromspeira,
meaningcoil&chaite,meaninghair)
Spirochetesbelongtotheorderspirochaetales,comprising2
families-spirochaetaceae&leptospiraceae
Spirochaetaceaecontainsgeneraspirochaeta,cristispira,
treponema&borrelia,leptospiraceaecontainingthegenus
leptospira

---

88.Whichofthefollowingis/aretrue
regardingpopulationgrowthinIndia:
a)During1921-1971:Itbecomemorethandouble
b)In1971,populationwasmorethan500million
c)In1991,populationwasaround1billion
d)Between1971-2011,thedecadalgrowthratewas>20%
e)1921-2011,thedecadalgrowthratewasindoubledigit
CorrectAnswer-A:B:E
Ans:(A)During1921-1971:Itbecomemorethandouble,(B)In
1971,populationwasmorethan500million(E)1921-2011,the
decadalgrowthratewasindoubledigit
[Ref:Park23rd/afl]
Totalpopulation
Decadal
Year
(Million)
growthrate
1901
238.4
?
1911
252.1
0.75
1921
251.3
(-)0.31
1931
279
11
1941
318.7
14.22
1951
361.1
13.31
1961
439.2
21.64
1971
548.2
24.80
1981
683.3
24.66
1991
846.3
23.87
2001
1028.6
21.52
2011
1210.1

---

2011
1210.1
17.64

---

89.TrueaboutPasteurizationofmilkisall
except
a)Doesnotkillthermoduricbacteria
b)Doesnotkillspores
c)Cause>95%decreaseinbacterialcount
d)Killstuberclebacillus
e)None
CorrectAnswer-C
Ans.is'c'i.e.,"Causes>95%decreaseinbacterialcount
Pasteurization
Pasteurizationisdonetodestroythepathogensthatmaybepresent
inmilk,whilecausingminimalchangeinthecomposition.flovour
andnutritivevalue.
Pasteurizationkillsnearly90%ofthebacteriainmilk,includingthe
moreheatresistant-Tuberclebacilli-Qfeverorganisms
Itdoesnotkillthethermoduricbacteria.
Itdoesnotkillbacteriaspores.
Thereare3widelvusedmethodsforpasteurization:
1. Holdermethod:Milkkeptat63-66?Cfur30minutesisrapidly
cooledto5?C.
2. HTSTmethod:'Hightemperatureshorttime'method(Flash
method)
Ileatedto72?Cfor15sec.andthenrapidlycooledto4?C
Thisisnowthemostwidelyusedmethod.
method:
Ultra-hightempraturemethod.

---

Rapidlyheatedintwostagesto125?Cforfewseconds.
Thesecondstageisbeingunderpressure.
Itisthenrapidlycooled.

---

90.Trueaboutanophelesmosquito?
a)Larvaehavesiphontube
b)Larvaearesurfacefeeder
c)Larvaearebottomfeeder
d)Larvaetieatanangletowatersurface
e)None
CorrectAnswer-B
Ans.is'b'i.e.,Larvaearesurfacefeeder
Tribe
Anophelinianopheles
Culciniculex,aedes,
genus
Mansonia
1. Laidsingly
1. Laidinclustersor
Eggs
2. Eggsareboat-shaped
raft,eachraft
containing100-&
containing100-250
providedwithlateral
eggs(exceptaedes)
float
2. Eggsareoval
shaped&not
providedwithlateral
floats
1. Restparalleltowater 1. Suspendedwithhead
surface
downwardsatan
Larvae
2. Nosiphontube
angletowater
3. Palmatehairspresent
surface.
onabdominalsegments
2. Siphontubepresent
3. Nopalmatehairs
Pupae
Siphontubeisbroad Siphontubeis
&short
long&narrow
Adult

---

Adult
1. Whenatrest,inclineda
1.t Whenatrest,the
anangletosurface
bodyexhibitsa
2. Wingsspotted
hunchback
3. Palpilonginboth
2. Wingsunspotted
sexes
3. Palpishortin
female

---

91.Whichofthefollowingis/aresourceof
mortalityrelateddata:
a)Sampleregistrationsystem
b)Deathcertificate
c)Centralbirths&deathsregistrationact
d)Alloftheabove
e)None
CorrectAnswer-D
Ans:d.Alloftheabove[RefPark23rd/840-41]
TheSRSisadual-recordsystem,consistingofcontinuous
enumerationofbirths&deathsbyanenumerator&anindependent
surveyevery6monthsbyaninvestigator-supervisor
Sincetheintroductionofthissystem,morereliableinformationon
birth&deathrates,age-specificfertility&mortalityrates,infant,
under-five&adultmortalityetc.havebecomeavailable.
Theactcameintoforceon1april1970,Theactprovidesfor
compulsoryregistrationofbirths&deathsthroughoutthecountry
Thetimelimitforregisteringtheeventofbirths&thatofdeathsis21
daysuniformlyalloverIndia

---

92.Mean,Medianandmodeallarezero.The
typeofdistributionis?
a)Standardnormal
b)Negativelyskewed
c)Positivelyskewed
d)Jshaped
e)None
CorrectAnswer-A
Ans.is'a'i.e.,Standardnormal

---

93.Whichofthefollowingis/areprobability
sampling:
a)Judgesampling
b)Clustersampling
c)Simplerandomsampling
d)Snowballsampling
e)Stratifiedsampling
CorrectAnswer-B:C:E
Ans:(B)Clustersampling(C)Simplerandom
sampling(E)Stratifiedsampling
[RefMcGraw-HillBasic&ClinicalBiostatistics,4thEdition
Chap4;Park23rd/850;BiostatisticsbyB.K.Mahajan7th/83-91;
BiostatisticsbyKVRao2nd/12-15;Park23rd/850]
Thebestwaytoensurethatthesamplewillleadtoreliableandvalid
inferencesistouseprobabilitysamples,inwhichtheprobabilityof
beingincludedinthesampleisknownforeachsubjectinthe
population.Fourcommonlyusedprobabilitysamplingmethodsin
medicinearesimplerandomsampling,systematicsampling,
stratifiedsampling,andclustersampling,allofwhichuserandom
processes

---

94.Catheterplacedinwhichtypeofcolour
codedbag:
a)Black
b)Blue
c)Yellow
d)Red
e)Transprentwhite
CorrectAnswer-C:E
Ans:(C)Yellow,(E)Transprent:"CategoryNo.7:Solidwaste-
wastesgeneratedfromdisposableitemsotherthanthewaste
sharpssuchastubings,catheters,intravenoussetsetc)
Colour
Typeof
Waste
Treatmentoptionsasper
coding
container
category Schedule1
Cat.1,2,
Yellow
Plasticbag
Incineration/deepburial
3,&6
Disinfected
Cat.
Autoclaving/microwaving/
Red
container/plastic 3,6,&7 Chemicaltreatment
bag
Plasticbag/
Autoclaving/Microwaving/Chemical
Blue/White
Cat.4,
punctureProof
Treatmentand
translucent
Cat.7.
container
Destruction/Shredding
Cat.5,9
Black
Plasticbag
Disposalinsecuredlandfill?
&10

---

95.WHOconditionedguidelinesfortreatment
ofMDRTB2016,includes4coredrugs
andaddondrugs.Addondrugsare?
a)Bedaquiline
b)Linzolide
c)Delamnaid
d)Capreomycin
e)Moxifloxacin
CorrectAnswer-A:C
Answer-A,BedaquilineC,Delamnaid
GroupA=levofloxacin,moxilloxacin.gatifloxacin
GroupB=amikacin,capreomycin,kanamycin,(streptomycin);
GroupC=ethionamide(orprothionamide),cycloserine(or
terizidone),lineznlid,clofazimine;
GroupD2=bedaquiline,delamanid

---

96.Whichofthefollowingistrueregarding
frostbite:
a)Occursattemperatureabovefreezingpoint
b)Reperfusioninjuryismoredangerousthanfrostbite
c)Rewarmingshouldbegradual&spontaneous
d)Occursattemperaturebelowfreezingpoint
e)Intakeofhotfluidspromotesgeneralrewarming
CorrectAnswer-B:C:D:E
Ans:b.Reperfusion...,c.Rewarming...,d.Occurs...&e.
Intake...[RefPark23rd/748:Manipalsurgery4th/941
ReperfusioninjuryManipalsurgery4th/94
Thisdangerouseventfollowsrevascularizationoflimbs,resultingin
acutecompartmentsyndromewithcompartmentalpressure
exceedingcapillarypressure(30mmHg)
Mostofinjuryisbelievedtobedueto02derivedfreeradicals
Diagnosisisclinicalassuggestedbyseverepaininthelimb,
oedemaofleg&muscletenderness
Treatedbyurgentmultiplefasciotomy,decompressionfollowedby
debridementofdeadtissue.
Attemperaturebelowfreezing(dry-coldcondition)frostbiteoccurs;
thetissuefreeze&icecrystalsforminbetweenthecells
Affectedpartshouldbewarmedusingwaterat44?Criticism,
Warmingshouldlastabout20minutesatatime,Intakeofhotfluids
promotesgeneralrewarming

---

97.Whichofthefollowingis/aretrueabout
RevisedNationalTuberculosisControl
Programme(RNTCP)-
a)T.B.ismandatorytonotify
b)SuspiciousTBpatientsarescreenedthrough2sputum
smearexaminations
c)MDR-TBisnotincludedinRNTCP
d)Casefindingisactive
e)CoveredthewholecountrysinceMarch2006
CorrectAnswer-A:B:E
Ans.is'a'i.e.,T.B.ismandatorytonotify;`b'i.e.,SuspiciousTB
patientsarescreenedthrough2sputumsmearexaminations&
'e'i.e.,CoveredthewholecountrysinceMarch2006
[RefPark's24th/ep.427-30;CommunityMedicinebyPiyush
Gupta1"/ep.826-30;Suryakantha4'1*p.921-23;National
HealthProgramsofIndiabyfungalKishore7th/ep.91]
GovernmentofIndiadeclareTBanotifiablediseaseon7thMay
2012withfollowingobjectives:-
TohaveestablishedTBsurveillancesysteminthecountry.
ToextentmechanismofTBtreatmentadherenceandcontact
tracingofpatientstreatedintheprivatesector.
ToensureproperTBdiagnosisandcasemanagementandfurther
acceleratereductionofTBtransmission.
TomitigatetheimpendingdrugresistantTBepidemicinthecountry.

---

98.AccordingtoWHO,recommended
treatmentforuncomplicatedplasmodium
falciparumis/are:
a)Mefloquine
b)Chloroquine
c)Artemether+lumefantrine
d)Artemesinonly
e)Lumefantrineonly
CorrectAnswer-C
Ans:(C)Artemether+lumefantrine[RefPark23rd/263-65;KDT
7th/820;http://whglibdoc.who.int/
publications/2010/9789241547925_eng.pdf]
Recommendationsunchangedfromthefirsteditionofthe
Guidelines(2006);TreatmentofuncomplicatedP.falciparum
malaria
Artemisinin-basedcombinationtherapies(ACTs)arethe
recommendedtreatmentsforuncomplicatedP.falciparummalaria.
ThefollowingACTsarerecommended:
Artemetherpluslumefantrine,artesunateplusamodiaquine,
artesunateplusmefloquine,andartesunateplussulfadoxine-
pyrimethamine.
ThechoiceofACTinacountryorregionwillbebasedonthelevel
ofresistanceofthepartnermedicineinthecombination.
Additionalrecommendationsinthesecondeditionofthe
Guidelines(2010);TreatmentofuncomplicatedP.falciparum
malaria

---

Artemisinin-basedcombinationtherapiesshouldbeusedin
preferencetosulfadoxinepyrimethamine(SP)plusamodiaquine
(AQ)forthetreatmentofuncomplicatedP.falciparummalaria.
Strongrecommendation,moderatequalityevidence.
ACTsshouldincludeatleast3daysoftreatmentwithanartemisinin
derivative.
Strongrecommendation,highqualityevidence.
Dihydroartemisininpluspiperaquine(DHA+PPQ)isanoptionforthe
first-linetreatmentofuncomplicatedP.falciparummalaria
worldwide.

---

99.Whichofthefollowingis/aretrueabout
posteriorepistaxis:
a)Posteriorpackingisdone
b)Oftenduetochronichypertension
c)Persistentcase-ligationofanteriorethmoidalartery
d)Severebleedingincomparisonwithanteriorepistaxis
e)Morecommonlyoccurinelderly
CorrectAnswer-A:B:D:E
Answer-(A)Posteriorpackingisdone(B)Oftenduetochronic
hypertension(D)Severebleedingincomparisonwithanterior
epistaxis(E)Morecommonlyoccurinelderly
Itislesscommon.
Itismostlyseenfromposterosuperiorpartofnasalcavity.
Seenafter40yearsofage
Causedduetohypertensionorarteriosclerosis
Featuresshowbleedingissevere
Treatedbypostnasalpackoftenrequired

---

100.Whichofthefollowingistrue?
a)Internallaryngealnerve:supplycricothyroidmuscle
b)Internallaryngealnerve-sensorysupplybelowvocalcord
c)Internallaryngealnerve-tensevocalcord
d)Externallaryngealnerve-tensevocalcord
e)Internallaryngealnerve-sensorysupplyabovevocalcord
CorrectAnswer-D:E
Answer-(D)Externallaryngealnerve-tensevocal
cord(E)Internallaryngealnerve-sensorysupplyabovevocal
cord
Allthemusclewhichmovethevocalcords(abductors,adductorsor
tensor)aresuppliedbyRecurrentLaryngealnerve.
Abovevocalcords-InternalLaryngealnerveabranchofSuperior
Laryngealnerve
Belowvocalcords-RecurrentLaryngealnerve
Cricothyroidmuscle-ExternalLaryngealnerve

---

101.AllaretrueaboutMeniere'sdisease
except:
a)Triadofrecurrentvertigo,fluctuatingsensorineuralhearingloss,
andtinnitusarefound
b)Treatmentconsistsofuseofthiazide
c)Dropattackoccurs
d)Onsetonlyafter>50year
e)None
CorrectAnswer-D
Answer-(D)Onsetonlyafter>50year
Meniere'sdiseaseisadiseaseoftheinnerear,characterizedbythe
clinicaltriadofrecurrentvertigo,fluctuatingsensorineuralhearing
loss,andtinnitus.
Diseaseisseenintheagegroupof35-60years.
Malesareaffectedmorethanfemales.
Thetinnitusisusuallylow-pitchedandroaring&isaggravated
duringacuteattacks.
AuralfullnessisamanifestationalwayspresentinMeniere'sattack.
Patientswithseverehydropsshouldbetreatedwithdiuretics,salt
restriction.

---

102.Trueaboutpuretoneaudiometry:
a)Thefrequencytestedis2000-9000Hz
b)Doneinsilentroom
c)Airconductionforrightearisrepresentedonaudiogramby
symbol'X'
d)Airconductionforleftearisrepresentedonaudiogramby
symbol'0'
e)All
CorrectAnswer-B
Answer-(B)Doneinsilentroom
Inasoundproofroom,thepatient'sabilitytohearpuretonesinthe
frequencyrangeofabout125to8000Hzismeasured.
Red"O"representsairconductionfortherightearwhileblue"X"
representsairconductionfortheleftear.

---

103.Trueaboutpresbycusis:
a)DegenerationofouterHaircelloforganofCortiinsensorytype
b)Highfrequencyisaffectedfirstinsensorytype
c)Canbetreatedwithhearingaids
d)Usuallyunilateralhearinglossoccurs
e)None
CorrectAnswer-A:B:C
Answer-(A)DegenerationofouterHaircelloforganofCortiin
sensorytype(B)Highfrequencyisaffectedfirstinsensorytype
(C)Canbetreatedwithhearingaids
Presbycusis,orage-relatedhearingloss,isthecumulativeeffectof
agingonhearing.
Itisaprogressiveandirreversiblebilateralsymmetricalage-related
sensorineuralhearinglossresultingfromdegenerationofthe
cochleaorassociatedstructuresoftheinnerearorauditorynerves.
Patientsofpresbycusiscanbehelpedbyahearingaid.

---

104.TobyAyer'stestis/areusedfor:
a)CSFrhinorrhoea
b)Lateralsinusthrombosis
c)Sigmoidsinusthrombosis
d)Tocheckpatencyofeustachiantube
e)None
CorrectAnswer-B:C
Answer-(B)Lateralsinusthrombosis(C)Sigmoidsinus
thrombosis
TheTobey?Ayertestisusedforlateralsinusthrombosisby
monitoringcerebrospinalfluidpressureduringalumbarpuncture.
Tobey-Ayertest&Crowe-Becktestareperformedinlateralsinus
thrombosis(Sigmoidsinusthrombosis)

---

105.Stridoris/arecausedbyallexcept:
a)Vocalcordpalsy
b)Stenosisaftertracheostomy
c)Ludwigangina
d)Retropharyngealabscess
e)None
CorrectAnswer-E
Answer-None
Itisnoisyrespirationproducedbyturbulentairflowthroughthe
narrowedairpassage.
Inspiratorystridor:Oftenproducedinobstructivelesionsof
supraglottisorpharynx
Expiratorystridor:Itisproducedinlesionsofthoracictrachea,
primary&secondarybronchi
Biphasicstridor:Itisseeninlesionsofglottis,subglottis&cervical
trachea

---

106.Trueaboutorbitalrhabdomyosarcoma-
a)Arisefrompleuripotentmesenchymalcell
b)Originfromskeletalmusclecell
c)UsuallyB/1
d)Femalepredisposition
e)Morecommoninchildren
CorrectAnswer-A:E
Answer-(A)Arisefrompleuripotentmesenchymalcell(E)More
commoninchildren
Itisahighlymalignanttumouroftheorbitarisingfromthe
extraocularmuscles.
Usuallyoccurringbelowtheageof15years.
Thetumourcommonlyinvolvesthesuperionasalquadrant.
Male:femaleratioof5:3
PrimaryorbitalRMSoriginatesfromprimitivepleuripotential
mesenchymalcells.

---

107.AllaretrueabouttreatmentofAge
relatedmaculardegenerationexcept:
a)Intravitrealanti-VEGFtherapy
b)Laserabalation
c)Photodynamictherapy(PDT)
d)Transpupillarythermotherapy
e)Prognosisaftertreatmentfornon-exudativevarietyisverygood
CorrectAnswer-E
Answer-E.Prognosisaftertreatmentfornon-exudativevariety
isverygood
Age-relatedmaculardegeneration(ARMD),alsocalledsenile
maculardegeneration,isabilateraldiseaseofpersonsofolder
individuals.
Treatment-
Roleofdietarysupplementsandantioxidantsinpreventionor
treatmentofARMD.
Intravitrealanti-VEGFtherapy(Bevacizumab,Ranibizumab,
Pegaptanib)isthetreatmentchoice.
Photodynamictherapy(PDT)isthe2ndtreatmentofchoice.
TransPupillarythermotherapy(TTT)withadiodelaser
Doublefrequency&YAG532nmphotocoagulation
Surgicaltreatmentintheformofsubmacularsurgery
Pharmacologicmodulationwithantiangiogenicagent.

---

108.Causes(s)ofshallowanteriorchamber
is/are:
a)Anteriorsublaxationoflens
b)PupilblockduetovitreousbulgeafterICCE
c)Anteriordislocationoflensinanteriorchamber
d)Aphakia
e)Myopia
CorrectAnswer-A:B
Answer-(A)Anteriorsublaxationoflens(B)Pupilblockdueto
vitreousbulgeafterICCE
Primarynarrowangleglaucoma
Hypermetropia
Postoperativeshallowanteriorchamber(afterintraocularsurgery
duetowoundleakorciliochoroidaldetachment).
Malignantglaucoma
Anteriorperforations(perforatinginjuriesorperforationofcorneal
ulcer).
Anteriorsubluxationoflens
Intumescent(swollen)lens

---

109.Trueaboutpigmentaryglaucoma:
a)Morecommoninfemales
b)Morecommoninmyopes
c)Slit-liketransilluminationdefectsinthemidperipheryis
pathognomonicfeature
d)Occurduetocloggingupofthetrabecularmeshwork
e)None
CorrectAnswer-C:D
Answer-(C)Slit-liketransilluminationdefectsinthemid
peripheryispathognomonicfeature(D)Occurduetoclogging
upofthetrabecularmeshwork
Itisatypeofsecondaryopen-angleglaucomawhereincloggingup
ofthetrabecularmeshworkoccursbythepigmentparticles.
Theconditiontypicallyoccursinyoungmyopicmales.
C/F
Depositionofpigmentgranulesiniris,posteriorsurfaceofthe
cornea,trabecularmeshwork,ciliaryzonulesandthecrystalline
lens.
Iristransilluminationshowsradialslit-liketransilluminationdefectsin
themidperiphery(pathognomonicfeature).

---

110.Uveitisis/areseenasside-effectof
causedby:
a)Latanoprost
b)Moxifloxacin
c)Cidofovir
d)Rifabutin
e)All
CorrectAnswer-B:C:D
Answer-(B)Moxifloxacin(C)Cidofovir(D)Rifabutin
Rostaglandin-Analoguesbimatoprostandtravoprost
Rifabutin
Cidofovir
Moxifloxacin
DrugInducedUveitis
SystemicDrugs
TopicalDrugs
1. Ritabutin
2. Bisphosphonales
1. Metipranobol
3. Sulphonamides
2. Miolics
4. DielhylcarbanrklZine
3. Proslaglandirts
5. Cidolovir
IntracameralDrugs
1. Gicobvir
2. Aniibidics
3. Lfrakhase

---

Vaccines

---

111.Non-exertionalclassicheatstrokeis/are
predisposedin:
a)Personwithpreviouschronicillness
b)Elderly
c)Young&healthyperson
d)Adolescent
e)All
CorrectAnswer-A:B
Answer-(A)Personwithpreviouschronicillness(B)Elderly
Heatstrokepresentswithahyperthermiaofgreaterthan40.6?C
(105.1?F)incombinationwithconfusionandalackofsweating.
Therearetwoformsofheatstroke-Classic(epidemic)&exertational
PatientswithCHScommonlyhavechronicdiseasesthatpredispose
toheat-relatedillness.
Ifcoolingisdelayed,severehepaticdysfunction,renalfailure,
disseminatedintravascularcoagulation,andfulminantmultisystem
organfailuremayoccur.
Classicheatstrokeisolderpatient.

---

112.Featuresofparkinsonismincludeall
except-
a)Intentiontremors
b)Flaccidity
c)Maskface
d)Rigidity
e)Restingtremors
CorrectAnswer-A:B
Answer-A,B,Intentiontremors,Flaccidity
FourcardinalfeaturesofPDthatcanbegroupedundertheacronym
TRAP-
Tremoratrest,Rigidity,Akinesia(orbradykinesia)andPostural
instability.

---

113.Whichofthefollowingcause(s)motor
neuropathy:
a)GBS
b)Diphtheria
c)Diabetes
d)Fridericataxia
e)All
CorrectAnswer-A:B:D
Answer-(A)GBS(B)Diphtheria(D)Fridericataxia
Parkinson'sdiseaseischaracterizedbyresttremor,rigidity,
bradykinesia,andgaitimpairment,knownasthe"cardinalfeatures"
ofthedisease.
Canincludefreezingofgait,posturalinstability,speechdfficulty,
autonomicdisturbances,sensoryalterations,mooddisorders,sleep
dysfunction,cognitiveimpairment,anddementia.

---

114.Whichofthefollowingis/arefeatureof
Pre-renalARFincomparisontointrinsic
renalfailure:
a)FractionalexcretionofSodium<1
b)Renalfailureindex>1
c)Urineosmolality>500mosmol/kgH20
d)Urinecreatinine/plasmacreatinine>40
e)PlasmaBUN/creatinineratio<20
CorrectAnswer-A:C:D
Answer-(A)FractionalexcretionofSodium<1(C)Urine
osmolality>500mosmol/kgH20(D)Urinecreatinine/plasma
creatinine>40
ComparisonoflabfindingsinAKI(1)
Test
PrerenalAKI
IntrinsicAKI
Urinespecificgravity
>1.020
1.010
Urinesodium,mEq/L
<20
>40
Fractionalexcretionof
<1%(neonates
>2%(neonates
sodium
<2%)
>2.5%)
Fractionalexcretionofurea <35%
>50%
Urineosmolality,mOsm/kg >500
<350
Ureanitrogen-creatinine
>20
10-50
ratio

---

115.Drugcausingpulmonaryfibrosisis/are:
a)Amiodarone
b)Cisplatin
c)Gold
d)Bleomycin
e)All
CorrectAnswer-A:C:D
Answer-(A)Amiodarone(C)Gold(D)Bleomycin
Nitrofurantoin
Bleomycin
Busulfan
CyclophosphamideMethysergide
Phenytoin

---

116.Whichofthefollowingcauses
hyperkalemia:
a)Barttersyndrome
b)RTAI
c)RTAII
d)Tumorlysissyndrome
e)Addison'sdisease
CorrectAnswer-D:E
Answer-(D)Tumorlysissyndrome(E)Addison'sdisease
Inadequateexcretion
A.Advancedrenalinsufficiencv
1. Chronickidneydisease
2. End-stagerenaldisease
3. Acuteoligurickidneyinjury
B.Primaryadrenalinsufficiency
1. Autoimmune:Addison'sdisease,polyglandularendocrinopathy
2. Infectious:HlV,cytomegalovirus,tuberculosis,disseminatedfungal
infection
3. Infiltrative:amyloidosis,malignancy,metastaticcancer
4. Drug-associated:heparin,low-molecular-weightheparin
5. Hereditary:adrenalhypoplasiacongenita,congenitallipoidadrenal
hyperplasia,aldosteronesynthasedeficiency
6. Adrenalhemorrhageorinfarction,includinginantiphospholipid
syndrome

---

117.TreatmentofHyperkalemiaincludes:
a)Insulin
b)CaHCO3
c)Hemodialysis
d)p2agonist
e)50mlof50%dextrosewithinsulin
CorrectAnswer-A:C:D:E
Answer-(A)Insulin(C)Hemodialysis(D)p2agonist(E)50mlof
50%dextrosewithinsulin
Calciumsupplementation(calciumgluconate)
Insulinintravenousinjectionalongwithdextrosetoprevent
hypoglycemia,willleadtoashiftofpotassiumionsintocells,
secondarytoincreasedactivityofthesodium-potassiumATPase.
Bicarbonatetherapy
Salbutamol
SodiumPolystyrenesulfonate
Non-emergencyhyperkalemiatreatment:
Loopdiuretics-ByrenalK+excretion.
Resins[Sodiumpolystyrenesulfate]-BybindingK+
Hemodialysis-ByextracorporealK+removal

---

118.Whichofthefollowingisfeature(s)of
diabeticketoacidosis:
a)Decreasedtriglyceridelevel
b)Increasedfattyacidlevel
c)TLipoprotein
d)Decreasedketonebodies
e)HighAniongapacidosis
CorrectAnswer-B:C:E
Ans:(B)Increasedfattyacidlevel(C)TLipoprotein(E)High
Aniongapacidosis[RefHarper30th/231;Lippincott6th/339,
345;Satyanarayan4th/481,682;Harrison19th/2417-18]
DKAischaracterizedbyhyperglycemia,ketosis,andmetabolic
acidosis(increasedaniongap)alongwithanumberofsecondary
metabolicderangements,Leukocytosis,hypertriglyceridemia,and
hyperlipoproteinemiaarecommonlyfoundaswell
Increasedlacticacidproductionalsocontributestotheacidosis.The
increasedfreefattyacidsincreasetriglycerideandVLDLproduction.
VLDLclearanceisalsoreducedbecausetheactivityofinsulin-
sensitivelipoproteinlipaseinmuscleandfatisdecreased.
Hypertriglyceridemiamaybesevereenoughtocausepancreatitis.
Reducedinsulinlevels,incombinationwithelevationsin
catecholaminesandgrowthhormone,increaselipolysisandthe
releaseoffreefattyacids.Normally,thesefreefattyacidsare
convertedtotriglyceridesorvery-low-densitylipoprotein(VLDL)in
theliver.

---

119.Whichofthefollowingis/arenotfeature
ofanorexianervosa:
a)Strictdieting
b)Hallucination
c)Amenorrhoea
d)Distortionofbodyimage
e)Endocrineabnormalities
CorrectAnswer-B
Answer-B.Hallucination
PSYCHOLOGICALSYMPTOMS:
DistortedBodyImage.
EMOTIONAL:
Moodswings
Increasedcommitmenttowork
BEHAVIORAL-Excessiveexercise,starvation.
PHYSICAL:Extremeweightlossandstuntedgrowth,amenorrhea,
nippledischarge,dehydration,hypothermia,osteoporosis.

---

120.Whichofthefollowingis/aretrueabout
inflammatoryboweldisease:
a)SmokingdecreasesriskofCrohn'sdisease&increasesriskof
ulcerativecolitis
b)PANCA-ulcerativecolitis
c)Linearulcer-Crohn'sdisease
d)Pseudopolyp-Crohn'sdisease
e)Cobblestoning-ulcerativecolitis
CorrectAnswer-B:C
Answer-(B)PANCA-ulcerativecolitis(C)Linearulcer-Crohn's
disease
ULCERATIVE
CROHN'SDISEASE
COLITIS
Wateryorbloody
Chronicdiarrhea
diarrhea
Rectaldischargeof
Abdominalpain
mucus,perforation
Weightloss,pyrexia,
Proctitis
abdominalmass
Acuteintestinal
Colitis
obstruction
Multipleperianal
Proctosigmoditis
fissures,fistula
&abscess
Toxicrnegacolon,
Fatwrappings
severehemorrhage
{creepingrnesentry)

---

ULCERATIVE CROHN'SDISEASE
COLITIS
Gross-
Gross?
Onlythe
Inflammatoryinvolvesfullthicknessofbowelwall
mucosa
thicknessofbowelwallinvolvingserosa
involved
Cobblestoneappearance
Superficial
Deepfissuredulcers
ulceration
Lymphadenopathy
Exudation
Fistulapresent
Pseudopolyps Skipareas
Micro-
Cryptabscess
common
Micro?
Inflammatory Noncaseatinggiantcellgranulomapresent
polyps
Pipestem
colon
ULCERATIVE
CROWN'SDISEASE
COLITIS
Age-2ndto4th&7thto
Age-2ndto4thdecade
9Thdecade
Gender-bothare
Femalesaremore
equallyaffected
affected
Etiology-
Etiology?
Morecommoninnon/
Morecommonin
exsmokers
smokers
Anatomical
Anatomical
distribution?
distribution-
Commonestinileum
Alwaysinvolvesrectum 160%)
&descending
Anallesionsare
colon/sigmoid
common

---

121.Whichofthefollowingcancause
pulmonaryembolism-
a)Pregnancy
b)OCPuses
c)Mitralregurgitation
d)Leftventricularfailure
e)Excessiveunaccustomedexercise
CorrectAnswer-A:B:D
Answer-(A)Pregnancy(B)OCPuses(D)Leftventricularfailure
PatientFactors
Age
Obesity
Varicoseveins/superficialthrombophlibits
Immobility
Pregnancy
PuerPerium
High-doseoestrogentherapyorOCPuse
Diseaseorsurgicalprocedure-
Traumaorsurgery
Malignancy
Heartfailure
Paralysisoflowerlimb
Infection

---

122.Whichofthefollowingcausesacute
pancreatitis:
a)Hypertriglyceridemia
b)Hypercalcemia
c)Steroid
d)Stavudine
e)Gallstone
CorrectAnswer-A:B:C:E
Answer-(A)Hypertriglyceridemia(B)Hypercalcemia(C)Steroid
(E)Gallstone
Gallstones(mostcommon)
Alcoholabuseisthesecondcauseofacutepancreatitis.
Occultdiseaseofthebiliarytreeorpancreaticducts,especially
microlithiasis,sludge.
Hypertriglyceridemia
Pancreasdivisum
Pancreaticcancer
SphincterofOddidysfunction
Cysticfibrosis
Drugs-Steroids,Azathioprine,Valproate,Estrogens,L-
Asparaginase,6-mercaptopurine,Sulfonamides,Tetracycline,Anti-
retroviralagents,Thiazidediuretics
Familialorgenetic
Hyperparathyroidism
Hypercalemia
PostERCP
Mostcommoncausesinchildren:bluntabdominalinjuries,

---

Mostcommoncausesinchildren:bluntabdominalinjuries,
multisystemdisease(hemolyticuremicsyndromeandinflammatory
boweldisease)biliarystonesormicrolithiasis(sludging),anddrug
toxicity

---

123.Paradoxical/reversesplittingofsecond
heartsoundis/areseenin:
a)AS
b)PS
c)Completeleftbundlebranchblock
d)Pulmonaryarterialhypertension
e)All
CorrectAnswer-A:C
Answer-(A)AS(C)Completeleftbundlebranchblock
LeftBundleBranchBlock(LBBB)istypicallyassociatedwith
ReversedorParadoxicalSplittingofS2
ParadoxicalsplittingofsecondheartsoundiscausedbydelayedA2
orearlyP2.LeftBundleBranchBlock(LBBB)isassociatedwith
delayedAorticclosure(delayedA2)duetodelayedelectrical
activationoftheleftventricle.
ASDandRBBBareassociatedwithawidephysiological(non-
paradoxical)splitofsecondheartsoundduetodelayedpulmonic
closure(DelayedP2)whileVSDisassociatedwithawide
physiological(non-paradoxical)splitsecondheartsoundfromearly
aorticclosure(EarlyA2).

---

124.Herpesencephalitisfindingsare:
a)Mostcommonlyinvolvesfrontal&temporallobe
b)Commonlyinvolvesbasalganglia
c)HyperintenselesionintemporallobeonT1-weightedimages
d)HyperintenselesionintemporallobeonT2-weightedimages
e)None
CorrectAnswer-A:D
Answer-(A)Mostcommonlyinvolvesfrontal&temporal
lobe(D)HyperintenselesionintemporallobeonT2-weighted
images
HSVencephalitis-
Examplesoffocalfindingsinclude:
1. areasofincreasedsignalintensityinthefrontotemporal
2. focalareasoflowabsorption,masseffect,andcontrast
enhancementonCT
3. periodicfocaltemporallobespikesonabackgroundofsloworlow-
amplitude("flattened")activityonEEG
80%willhaveabnormalitlesinthetempotallobe.
HyperintenseonT2-images.

---

125.WhichofthefollowingincludedinATPIII
criteriaforMetabolicsyndrome:
a)B.P130/85
b)Triglyceride150mg/dl
c)Fastingglucose100
d)Waistcircumferenceinfemale>80cm
e)None
CorrectAnswer-A:B:C
Answer-A,B.P130/85B,Triglyceride150mg/dlC,Fasting
glucose100
Criteria
Harmonized
NCEP(2001) IDF(2005)
WHO(1998)
(2009)
WC:Z90
DM.IFG.IGT,
Prerequisite
None
cm(men) None
IR
&
280cm
(women)t
No.ofother
and22of:
23of.
and22of: 23of:
criteria
Already
BMI:230&for WC:3102
WC:Z90cm
Obesity
considered
WHR:>0.9
cm(men)&
(men)e.
as
(men)&
388cm
perquisite 3$0cm
>0.85
(women)
criterion
(women)t
(women)
3130/135or Z:130/85
3130/85or
BP(mmHg)
Z140/90
Rx
orRx
Rx

---

BP(mmHg)
Z140/90
Rx
orRx
Rx
<35(men)&
<40(men)
HDL-C(mg/di)
<39(women) <40(men)&
<40(men)&
&
or
<50
<50
<50(women)
(women)
(women)or
orRx
orRx
Rx
TG(mg/d1)
Z150
150orRx
2l50orRx kis()orRx
Fastingglucose
2100or
2110,la
2100orRx
2100orfix
(mg/d1)
No
Urinary
albumin220
ug/minor
Microalbuminuria albumin-
creatinine
ratio>30
mg/g
tRecommendedwaistcircumferencethresholdsfortheabdominal
obesityinpeopleofAsianorigin.

---

126.Whichofthefollowingis/aretrueabout
pneumothorax:
a)Decreasedchestmovement
b)Dullonpercussion
c)Decreasebreathingsound
d)Hyper-resonantnoteonpercussion
e)End-expiratorycrepitation
CorrectAnswer-A:C:D
Answer-A,DecreasedchestmovementC,Decreasebreathing
soundD,Hyper-resonantnoteonpercussion
Inpneumothorax,intra-pleuralpressureequilibrateswiththe
ambientbarometricpressureandthelung'snaturalrecoiltendency
causesittocollapse.
Pneumothoraxtendstocausecollapseofthelungsandadecreased
compliance.
ClosedPneumothorax-
Reducedchestmovement
Hyper-resonantnoteonpercussion
Absentairentry
Mediastinalshifttooppositeside
Cointest
OpenPneumothorax-
Crackpotsoundonpercussion
Amphoricbreathsounds
Displacementofmediastinumwithrespiration
Increasingbreathlessness,cyanosis&tachycardia

---

---

127.Aperson'sX-raychestshowing
homogenousopacityonrightsidewith
shiftingofmediastinumonopposite
side.Mostprobablediagnosisis/are:
a)Collapse
b)Pleuraleffusion
c)Pneumothorax
d)Consolidation
e)Post-pnemectomy
CorrectAnswer-B
Answer-(B)Pleuraleffusion
Pneumonectomychest(Earlysip:within24hr):Partialfillingof
thorax,ipsilateralmediastinalshift&diaphragmaticelevation.
Homogenousopacity
Shiftofmediastinumtotheoppositeside
Concaveupperborder(Ellis'scurve)

---

128.Paraneoplasticsyndromesoflung
carcinomainclude:
a)Hypercalcemia
b)SIADH
c)Hypocalcemia
d)Hypoglycemia
e)Hypernatremia
CorrectAnswer-A:B:C
Answer-A,HypercalcemiaB,SIADHC,Hypocalcemia
Hypercalcemiaofmalignancy
SIADH
Cushing'ssyndrome
Hypoglycemia
Malefeminization
Diarrhoeaorintestinalhypermotility
Osteomalacia
Acromegaly
Hyperthyroidism
Hypertension

---

129.Whichofthefollowinginvestigationis
usefulforZollinger-EllisonSyndrome
(gastrinoma):
a)USG
b)MRI
c)CTscan
d)OctreoScan
e)Endoscopicultrasound
CorrectAnswer-A:B:C:D:E
Answer-A,USGB,MRIC,CTscanD,OctreoScanE,Endoscopic
ultrasound
Investigations-
Serumgastrinelevated
PatientshouldfirstundergoanabdominalCTscan,MRI,or
OctreoScantoexcludemetastaticdisease.
Endoscopicultrasound(EUS)permitsimagingofthepancreaswith
ahighdegreeofresolution
Radiolabelledsomatostatinreceptorscintigraphy.
Gastrinomapatientshavefastinggastrinlevel>150-200pg/ml
BAO>15meq/hinthepresenceofhypergastrinemiais
pathognomonicofZES.
BAO/MAOratio>0.6beinghighlysuggestiveofZES.
Themostsensitiveandspecificgastrinprovocativetestforthe
diagnosisofgastrinomaisthesecretinstudy.(Anincreaseingastrin
of120pgwithin15minofsecretininjectionhasasensitivityand
specificityof>90%forZES.)

---

---

130.Communityacquiredpneumoniais/are
causedby:
a)Staph.aureus
b)Mycoplasmapneumoniae
c)Streptococcuspneumoniae
d)Influenzavirus
e)Neisseriagonorrhoeae
CorrectAnswer-A:B:C:D
Answer-A,Staph.aureusB,Mycoplasma
pneumoniaeC,StreptococcuspneumoniaeD,Influenzavirus
Streptococcuspneumoniae
Haemophilusinfluenzae
Moraxellacatarrhalis
Staphylococcusaureus
Legionellapneumophila
Enterobacteriaceae(Klebsiellapneumoniae)andPseudomonas
sPP.
Mycoplasmapneumoniae
ChlamydiasPP.
InfluenzaA

---

131.Treatmentoffacio-cervical
actinomycosisincludes:
a)Surgeryistreatmentofchoice
b)DrugofchoiceispenicillinG
c)Metronidazole
d)Amoxicillin
e)All
CorrectAnswer-B:D
Answer-B,DrugofchoiceispenicillinGD,Amoxicillin
1stchoice-Penicillinoramoxicillinforsixtotwelvemonths
2ndchoice-Doxicycline
Surgeryifthediseaseisextensive

---

132.NeoplasticlesioninAIDSincludes:
a)Analcarcinoma
b)Non-Hodgkin'slymphoma
c)Esophagealcarcinoma
d)Burkit'slymphoma
e)Cervicalcarcinoma
CorrectAnswer-A:B
Answer-A,AnalcarcinomaB,Non-Hodgkin'slymphoma
Kaposisarcoma(Multifocaltumorofvascularorigin)(HHV-8)
NonHodgkinlymphoma
Primarylymphomaofbrain
Invasivecancerofuterinecervix
Immunoblasticlymphoma(mostcommonlymphoma)
PrimaryEffusionLymphoma(PEL)
Plasmacyticlymphomaoftheoralcavity
Burkitt'slymphoma(EBvirus)

---

133.Whichofthefollowingstatement(s)
is/areregardingAmericanHeart
Association(AHA)Guideline-2015for
cardiopulmonaryresuscitation(CPR)&
Emergencycardiovascularcare(ECC):
a)Chestcompression:ventilationCompressionventilationratio
withoutadvancedairway?rate30:2irrespectiveofrescuer&
ageofpatient
b)Compressionrate-atleast100/min
c)FailuretoachieveanETCO2of10mmHgbywaveform
capnographyafter20minutesofresuscitationhasbeen
associatedwithanextremelypoorchanceofreturnof
spontaneouscirculation(ROSC)
d)Limitinterruptionsinchestcompressionstolessthan10
seconds
e)None
CorrectAnswer-C:D
Answer-C,FailuretoachieveanETCO2of10mmHgby
waveformcapnographyafter20minutesofresuscitationhas
beenassociatedwithanextremelypoorchanceofreturnof
spontaneouscirculation(ROSC)D,Limitinterruptionsinchest
compressionstolessthan10seconds
Compressionrateismodifiedtoarangeofl00to120/min.
Compressionventilationratiowithoutadvancedairway-1or2
rescuers30:2

---

FailuretoachieveanETCO2ofI0mmHgbywaveform
capnographyafter20minutesofresuscitationhasbeenassociated
withanextremelypoorchanceofROSCandsurvival.
Theclarifiedrecommendatio-nforcfrestcompressiondepthfor
adultsisatleast2inches(Scm)butnotgreaterthan2.4inches(6
cm).

---

134.TrueaboutAmoebicliverabscess:
a)Morecommoninrightlobe
b)Patientsusuallypresentwithfever,chills&upperquadrant
abdominalpain
c)Usuallymultiple
d)Abscesscavitycontainsanchovysauce-likefluid
e)Mostcommonlypresentswithjaundice
CorrectAnswer-A:B:D
Answer-A,MorecommoninrightlobeB,Patientsusually
presentwithfever,chills&upperquadrantabdominal
painD,Abscesscavitycontainsanchovysauce-likefluid
Amebicliverabscessisthemostfrequentextraintestinal
manifestationofEntamoebahistolyticainfection.
Therightlobe(posteriorsuperiorquadrant)oftheliverismore
commonlyaffectedthantheleftlobe.
Theabscesscontainsachocolate-coloredfluidthatresembles
anchovypasteandconsistspredominantlyofnecrotichepatocytes.
Anorexia,fevernightsweats,malaise,coughandweightloss.

---

135.Trueaboutulcer:
a)Arterialulcer-painless
b)Venousulcer-penetratesdeepfascia
c)Arterialulcer-punchedout
d)Neuropathiculcer-mayinvolvebone
e)Trophiculcer-Puchedoutedge
CorrectAnswer-C:D:E
Answer-C,Arterialulcer-punchedoutD,Neuropathiculcer-may
involveboneE,Trophiculcer-Puchedoutedge
Puchedoutedge:Itismostlyseeningummatousulcerorinadeep
trophiculcer.
Arterialulcer-Thaeulcertendstobepunchedout
Gummatousulcers,whichoccursintertiarysyphilis,havepunched-
outindolentedge.
Neurogeniculcer-itburrowsdeepinside,mayinvolvebone&also
calledasperforatingulcer.
Venousulcer-Depth-superficial,doesnotpenetratedeepfascia.

---

136.TrueaboutBuergerdisease
a)Affectslargerarteryonly
b)Youngermalesaremorecommonlyaffected
c)Phlebitismigransischaracteristic
d)Coldintolerance
e)Veinsmayinvolved
CorrectAnswer-B:C:E
Answer-B,Youngermalesaremorecommonly
affectedC,PhlebitismigransischaracteristicE,Veinsmay
involved
AlsocalledasThromboangiitisObliterans
Itisainflammatoryocclusivevasculardisorderinvolvingsmalland
mediumsizedarteriesandveinsinupperandlowerextremities.
Itinvolvestibialandradialarteriesandsometimessecondarily
extendingtoveinsandnervesofextremities.
Theclinicalfeaturesofthromboangiitisobliteransincludesatriadof
claudicationoftheaffectedextremity,Raynaud'sphenomenon,and
migratorysuperficialveinthrombophlebitis.

---

137.Allaretrueaboutsquamouscell
carcinomaofskinexcept:
a)Itiscalledmarjolinulcerwhendevelopsinscar
b)Radiotherapymaybeusedintreatment
c)Hematogenousspreadiscommon&occurearly
d)Maydevelopinchroniculcer
e)Lymphaticspreadischiefwayofspreading
CorrectAnswer-C
Answer-(C)Hematogenousspreadiscommon&occurearly
SCCisamalignanttumourofkeratinisingcellsoftheepidermisor
itsappendages.
Alsoarisesfromthestratumbasaleoftheepidermis.
SCCisthesecondmostcommonformofskincancer.
Usuallyaffectstheelderly.
SCCisalsoassociatedwithchronicinflammation.
WhenaSCCappearsinascaritisknownasaMarjolin'ulcer.
AssociatedwithUVlightexposure,chronicinflammationandviral
infection.
"SCCistreatedbywideexcisionorradiotherepy.
Lymphaticspreadisthechiefmethodofspreadeventhoughit
occursrelativelylate.

---

138.Indicationofcircumcisionincludes:
a)Hypospadias
b)Epispadias
c)Phimosis
d)Balanitis
e)Balanoposthitis
CorrectAnswer-C:D:E
Answer-C,PhimosisD,BalanitisE,Balanoposthitis
Indication-religious&phimosis
Medicalindicationsforcircumcisioninboysinclude-
1. recurrentattacksofbalanoposthitis
2. recurrenturinarytractinfections
3. Inadults,inabilitytoretractforintercourse,abnormallytight
frenulum,balanitis

---

139.Inguinalhernialsurgerymaybe
complicatedby:
a)Testicularatrophy
b)Urinaryretention
c)Impotence
d)Constipation
e)Pain
CorrectAnswer-A:B:E
Answer-A,TesticularatrophyB,UrinaryretentionE,Pain
Complicationduringsurgery
Injurytoiliacvessel-themostseriousbutrare
Injurytourinarybladder
Earlypostoperctiveperiod
Pain-Painiscommonduetoincisionintheskin&somedegreeof
retractionofstructuressuchasinguinalligamentdownwards6
conjointtendonupwards
Bleeding
Urinaryretentioniscommon,moresoinmales
Abdominaldistension
Intermediate-between3&7ila*
Seroma
Woundinfection
Late
Inguinodynia
Testicularatrophy

---

140.Trueaboutphysiologicalhernia
a)HerniationofForegut
b)HerniationofForegut+midgut
c)HerniationofMidgut
d)Goesbackaround4weekafterherniation
e)Goesbackaround10weekoffetusage
CorrectAnswer-C:D:E
Answer-C,HerniationofMidgutD,Goesbackaround4week
afterherniationE,Goesbackaround10weekoffetusage
Itisanaturalphenomenonthatoccursinearlypregnancy.
Itusuallyoccursfromaround6-8weeksupuntil13weekin-utero,
afterwhichthebowelretunstotheabdominalcavity.
Atapproximately10-11weekstheabdomenenlargesandthe
intestinesreturntotheabdominalcavity.
At-8weeksgestationalageandisduetoanumberoffactors
includingRapidgrowthofthecranialendofthemidgut(whichwill
formthesmallintestine).

---

141.Burninvolvingonelowerlimbsinadult
correspondencetoarea:
a)4.5%
b)9%
c)13.5%
d)18%
e)27%
CorrectAnswer-D
Answer-(D)18%

---

---

142.Trueaboutthyroidtumor:
a)Follicular-lymphaticmetastasismorecommonthanpapillary
b)Papillary-bloodmetastasismorecommonthanfollicular
c)Hurthle-lymphaticspreadiscommon
d)Hurthle-lessaggressivethanfollicularcarcinoma
e)Follicular-invasionofcapsule&vascularspacesincapsular
region
CorrectAnswer-D:E
Answer-D,Hurthle-lessaggressivethanfollicular
carcinomaE,Follicular-invasionofcapsule&vascularspaces
incapsularregion
Hurthlecellcarcinomaisasubtypeoffollicularcarcinoma.
Thetumorcontainsanabundanceofoxyphiliccells,oroncocytes.
Itappearsinanolderagegroup.
Higherchanceofspreadtolymphnodecomparedtofollicular
carcinoma.
Treatmentissurgical.
FollicularCarcinoma-
Microscopically,thereisinvasionofthecapsuleandofthevascular
spacesinthecapsularregion.
Bloodbornemetastasesaremorecommon.

---

143.Commontumour(s)foundinanterior
mediastinum:
a)Teratoma
b)Cervicalthymoma
c)Lymphoma
d)Schwannoma
e)Thyroidcarcinoma
CorrectAnswer-A:B:C
Answer-A,TeratomaB,CervicalthymomaC,Lymphoma
Thymoma
Teratoma
Parathyroidadenoma
Bronchogeniccyst
Aneurysms
Lymphoma
Lipoma
Spinallesions
Goitre

---

144.TrueaboutCongenitalhypertrophic
pyloricstenosis:
a)Shorteningofpyloriccanalonbariumcontrastimaging
b)Elongationofpyloriccanalonbariumcontrastimaging
c)Narrowingofpyloriccanalonbariumcontrastimaging
d)ThickenedpyloricmuscleonUSG
e)ChildshouldbegivennormalsalinewithKC1
CorrectAnswer-B:C:D:E
Answer-(B)Elongationofpyloriccanalonbariumcontrast
imaging(C)Narrowingofpyloriccanalonbariumcontrast
imaging(D)ThickenedpyloricmuscleonUSG(E)Childshould
begivennormalsalinewithKC1
Imagingconfirmationissoughtbymostcliniciantodifferentiatefrom
gastroesophagealreflex
Precaution:Emptystomachvianasogastrictubebeforestudy&
Removecontrastatend
Elongation&narrowingofpyloriccanal
Stringsign=passingofsmallbariumstreakthroughelongatedpyloric
channel(mostspecificsign)
Double/tripletracksign:crowdingofmucosalfoldsinpyloricchannel

---

145.Bilateralparotidswellingis/areseenin
allexcept:
a)Mump
b)Epstein-Barrvirus
c)Sarcoidosis
d)Brucella
e)Sjogrensyndrome
CorrectAnswer-D
Answer-(D)Brucella
Viralinfections
Mumps
Influenza
Epstein-Barrvirus
CoxsackievirusA
Cytomegalovirus
HIVHCV
Sarcoidosis
Sjogren'ssyndrome
Metabolicdisorders
Diabetesmellitus
Chronicpancreatitis
Hepaticcirrhosis
invalidquestionid

---

147.A65yearoldmalepresentedwithfemur
neckfracture.Hewasmanagedwith
closedreduction+cancellousscrew.6
monthlaterX-raywasdoneinlateral
view.X-rayshowsnon-union&leg
shorting.Now,appropriatemanagement
optionsis/are:
a)Unipolarhemiarthroplasty
b)Bipolarhemiarthroplasty
c)Subtrochantericosteotomy
d)Osteosynthesis
e)Totalhiparthroplasty
CorrectAnswer-A:B:E
Ans.a.Unipolarhemiarthroplasty;b.Bipolarhemiarthroplasty;
e.Totalhiparthroplasty
Ingeneral,operationsforununitedfracturesofthefemoral
neckcanbegroupedintoffvegeneralclasses:
Osteosynthesis,inwhichafractureisrefixedwithnewinternal
fixationdevices;
Subtrochantericosteotomy
Prostheticreplacement(hemiarthroplasty)
Totalhiparthroplasty
Arthrodesis.
Somegeneralguidelinesareasfollows:

---

Inadults<60yearsold,nonunionsinwhichthefemoralheadis
viablecanbetreatedbyangulationosteotomy.Thisprovidesaline
ofweightbearingmoredirectlybeneaththefemoralhead.
Inchildrenandinadults<21yearsold,nonunionsinwhichthe
femoralheadisnotviablecanbetreatedwithanarthrodesis.In
exceptionalcircumstances'ayoungadultmaybetreatedwitha
prosthesis.
Inadults2lto60yearsold,nonunionsinwhichthefemoralheadis
notviablecanbetreatedwithaprosthesis,atotalhiparthroplasty,
oranarthrodesis,dependingonthecircumstancesinthegiven
Patientandontheexperienceandpreferenceofthesurgeon.Rarely
isanarthrodesisindicatedinpatientsolderthan50yearsofageor
inpatientswithasedentaryoccupation.
lnpatients>60years,non-union,regardlessoftheviabilityofthe
femoralhead,usuallyaretreatedwithahemiarthroplastyoratotal
hiparthroplasty'

---

148.Carpaltunnelsyndromeisassociated
withallexcept:
a)Dupuytren'scontracture
b)Myxoedema
c)Idiopathic
d)Rheumatoidarthritis
e)Acromegaly
CorrectAnswer-A
Ans.a.Dupuytren'scontracture
Associatedconditionsthatcanleadstocarpaltunnelsyndrome
are:
1.Idiopathic(mostcommon)
2.Pregnancy
3.Endocrinedisorders
Hypothyroidism
Diabetesmellitus
Myxedema
Acromegaly
Hyperparathyroidism
4.Depositiondisorders
Rheumatoiddisorder
Gout
Rheumaticdisorder
Amyloidosis
Sarcoidosis
Leukemia

---

Chronicrenalfailure

---

149.Whichofthefollowingis/arenot
feature(s)ofrheumatoidarthritis
a)Pannusformationinjoint
b)Osteosclerosisosteoclasticactivityinunderlyingbone
c)Erosionofcartilage
d)Osteophyte
e)Plasmacellinfiltrationofsynovialstroma
CorrectAnswer-D
Ans.d.Osteophyte
Thecharacteristichistologicfeaturesinclude:
Infiltrationofsynovialstromabydenseperivascularinflammatory
cells,consistingofBcellsandCD4+helperT,plasmacellsand
macrophages;
Increasedvascularityowingtovasodilationandangiogenesis,with
superficialhemosiderindeposits;
Aggregationoforganizingfibrincoveringportionsofthesynovium
andfloatinginthejointspaceasricebodies;
Accumulationofneutrophilsinthesynovialfluidandalongthe
surfaceofsynoviumbutusuallynotdeepinthesynovialstroma;
Osteoclasticactivityinunderlyingbone,allowingthesynoviumto
penetrateintotheboneformingjuxta-articularerosions,subchondral
cysts,andosteoporosis;
Pannusformation-Pannusisamassofsynoviumandsynovial
stromaconsistingofinflammatorycellsgranulationtissue,and
fibroblasts,whichgrowsoverthearticularcartilageandcausesits
erosion.

---

---

150.TrueaboutfractureneckTalus:
a)Avascularnecrosisofbodyiscommoncomplication
b)LateralviewX-rayisimportantfordiagnosis
c)Displacedfracturerequirebelowkneeplasteronly
d)Displacedfracturerequireopenreduction&internalfixation
e)All
CorrectAnswer-A:B:D
Ans.a.Avascularnecrosisofbodyiscommoncomplication;b.
LateralviewX-rayisimportantfordiagnosis;d.Displaced
fracturerequireopenreduction&internalfixation
FractureTalus(Neck)
Talusisthemajorweightbearingstructure(thesuperiorarticular
surfacecarriesagreaterloadperunitareathananyotherbonein
body),andithasavulnerablebloodsupplyandisacommonsite
forposttraumaticischemicnecrosis.
Thebodyoftalusissuppliedmainlybyvesselswhichenterthetalar
neckfromthetarsalcanal.Infracturesofthetalarneckthese
vesselsaredivided;ifthefractureisdisplacedtheextraoseous
plexustoomaybedamagedandbodyoftalusbecomesischemic.
Fractureofthetalarneckisproducedbyviolenthyperextensionof
ankle.Bodyoftalusfractureisusuallyacompressioninjurydue
tofallfromheight.
Complications
Avascularnecrosisofbodyismostcontinuumcomplication.The
incidencevarieswiththeseverityofdisplacement:intypeI<10%,
intypeII-40%,intypeIII>90%.
Malunionpredisposetoosteoarthritis.

---

SecondaryOsteoarthritisofankleand/orsubtalarjointoccurs
someyearsafterinjuryinover50%ofpatients.Thereareseveral
causes:articulardamaged/tintialtrauma,malunion,distortionof
articularsurfaceandAVN.
HawkinsClassification
TypeI Undisplaced
TypeII Displacedassociatedwithdislocationofsubtalarjoint
Displacedassociatedwithdislocationatankleaswellas-
TypeIII atsubtalarjoint
TypeIV Type3+Talonavicular-subluxationordislocation
Treatment
BelowkneecastwithfootinplantarflexionX4weeksFurther
plasterchangewillallowthefoottobebroughtupslowlyto
plantigradeClose/openreduction&internalfixation

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151.Trueaboutacuteosteomyelitis?
a)CannotbedetectedonX-raybefore2weeks
b)Bonescandetectafter2weeks
c)Severepain
d)Secondaryosteomyelitisassociatedwithcompoundfractureis
morecommonthanprimaryvariety
e)Limitationofmovements
CorrectAnswer-C:E
Ans.is'c'i.e.,Severepain&`e'i.e.,Limitationofmovements
ACUTEOSTEOMYELITIS:
1. ItPrimary(hematogenous):-Organismsreachthebonethrough
bloodstream.
2. Secondary:-Organismgainentrydirectlythroughwoundsuchasin
compoundfracturesorsurgicaloperation.
Hematogenousosteomyelitisisthecommonestformofosteomyelitis
andmostcommonsourceofboneandjointinfectionis
hematogenous.
Clinicalfeatures:
Metaphysisoflongboneistheearliestandmostcommonsite
involved.
Mostcommoninchildren.
Thebonesmostcommonly:
Proximaltibial
Distalfemur
Proximalhumerus.
Features:
Severepain,fever,malaise,chills&rigors,sweating,andeven

---

shock.
Localtenderness(fingertiptenderness),raisedlocaltemperature,
Localerythemaandlimitationofmovements(typicallythelimbis
heldstill).
Diagnosis:
X-rays
Earliestsign:periostealreaction(periostealnewboneformation)at
themetaphysis,whichtakesabout7-10days.
Bonescan
Increaseduptakebyboneinmetaphysiswithin24hoursofonsetof
symptoms(earliestsign.

---

152.Trueaboutosteoclastoma
a)Mostlymalignant
b)Mostcommonsite-mandible&vertebrae
c)Recurrenceiscommonafterexcision
d)Locatedatepiphysis
e)All
CorrectAnswer-C:D
Ans.c.Recurrenceiscommonafterexcision;d.Locatedat
epiphysis
Giantcelltumor(Osteoclastoma)
GCTisanosteolytictumorarisingfromtheepiphysisandis
commonbetweentheageof20-40years.
ThoughGCTisabenigntumor,itislocallyveryaggressive.
Femalesareaffectedmorethanmales.
Pathologicalfeatures
Thecommonestsitesarelowerendoffemurandupperendoftibia.
Othercommonsitesarelowerendradiusandupperendof
humerus.Itmayalsooccurinthespineandsacrum.
Thetumorisencompassedbyafibrouscapsuleatperiphery.
Thepresenceoftumorgiantcellsisthehallmarkofthistumor.
Clinicalfeatures
Painatthesiteofthetumour.
Graduallyincreasinglocalswelling
Pathologicalfracturesmayoccur.
"Eggshell-crackling"sensationonpalpation.
Radiologicalfeatures
GCTisoneofthecommoncauseofasolitarylyticlesionofthe

---

bone.oTheradiologicalfeaturesare:-
1. Asolitarymaybeloculated,lyticlesion.
2. Eccentriclocation,oftensubchondral.
3. Expansionoftheoverlyingcortex(expansilelesion).
4. 'Soap-bubble'appearance-Thetumorishomogenouslylyticwith
trabeculaeoftheremnantsofbonetraversingit,givingrisetoa
loculatedappearance.
5. Nocalcificationwithinthetumor.
6. Noneorminimalreactivesclerosisaroundthetumor.
7. Cortexmaybethinnedout,orperforatedatplaces.
8. Tumourusuallydoesnotentertheadjacentjoint.

---

153.FracturesiteofMonteggiafractureis
a)Proximalulna
b)Distalendofradius
c)Distalradius
d)Dislocationofradialhead
e)Lowerradio-ulnarjointdislocation
CorrectAnswer-A:D
Ans.a.Proximalulna;d.Dislocationofradialhead
Monteggiafracture-dislocationsareclassifiedbytheBado
system
BadotypeIinjuriesarecharacterizedbyaproximalulnarfracture
withanteriordislocationoftheradialhead.Thisisduetoaforceful
pronationinjuryoftheforearmandisthemostcommontype.
BadotypeIIinjuriesare"reversed"Monteggiafracture-dislocation
injuries.
Here,thereisposteriorangulationoftheulnarfracturesiteand
posteriordislocationoftheradialhead.
BadotypeIIIandIVarerareinjuries.

---

154.TrueregardingDownsyndromeis?
a)Increasedpaternalageisariskfactor
b)Karyotypingisnotneededinallpatients
c)>85%ofaffectedpatientshave1morechromosome21
d)Increasednuchaltranslucency
e)AssociatedwithearlyonsetofAlzheimer'sdisease
CorrectAnswer-B
Answer-B.Karyotypingisnotneededinallpatients
Down'ssyndromeisthemostcommonchromosomaldisorderand
mostcommoncongenitalcauseofmentalretardation(2nd
mostcommongeneticcauseofmentalretardationisFragile-X
sydrome).
Trisomy21-Thereisanextrachromosome21whichisdueto
meioticnondisjunctioninovum.
Themostimportantriskfactorisadvancedmaternalage(>35
Years).
AntenatalScreeningforDownsyndrome
Followingmethodsareused:-
1. TripletestItincludes(i)Unconjugatedestrogen(estriol):decreased;
(ii)Maternalserumalphafetoprotein(MSAFP):decreased;and(iii)
hCG:increased
2. Newmarkers:Theseare(i)IncreasedinhibinAinmaternalblood;
and(ii)DecreasedPAPA(pregnancyassociatedplasmaprotein).
3. USG:Itshows:(i)Increasednuchaltranslucency(increasednuchal
foldthickness);(ii)Ductusvenousflowreversed;and(iii)Nasalbone
hypoplasia.

---

155.Whichofthefollowingischangesduring
pregnancy:
a)Inlasttrimesterbloodvolumeincreaseby50%
b)Cardiacoutputincreaseby20%inlasttrimester
c)HemodynamicchangesinpregnancycancauseCHFfollowing
duringlabourandfollowingdeliveryinpre-existingcardiac
lesions
d)Hypercoagulabilityoccurs
e)None
CorrectAnswer-A:C:D
Ans.(A)Inlasttrimesterbloodvolumeincreaseby50%;(C)
HemodynamicchangesinpregnancycancauseCHFfollowing
duringlabourandfollowingdeliveryinpre-existingcardiac
lesions;(D)Hypercoagulabilityoccurs
HEMATOLOGICALCHANGES:
PARAMETERS
CHANGES
Bloodvolume(mL)
by1500(30?40%)
Plasmavolume(mL)
by1250(40?50%)
RedCellvolume(mL)
by350(20?30%)
TotalHb(g)
by85(18?20%)
SerumIron
TIBC
Hematocrit
Diminished
Erythropoietin
(Neutrophilicleukocytosis-8,000to
WBCcount

---

WBCcount
20,000/mm3)
Plateletcountand
unchanged
volume
VII,VIII,X,plasmafibrinogen:
Coagulationfactors
AntithrombinIII,XI,XIII:
ESR
Plasmafibrinolytic
activity
PlasmaProtein
(Albumin30%;Globulin;A:G)
Concentration
CARDIOVASCULARCHANGES:
Cardiacoutput
by40%(maximumat30thweek)
(L/min)
Strokevolume
by27%
(mL)
Heartrate
by17%
(perminute)
Unaffectedormid-pregnancydropof
Bloodpressure
diastolicpressureby5?10mmHg
Venous
100%
pressure
Colloidoncotic
pressure
by14%
(mmHg)
Systemic
vascular
by21%
resistance
(SVR)
Pulmonary
vascular
by34%
reistance(PVR)
Totalextracellularvolume by16%
Shiftofapicalimpulselaterallyandupwardsinthe
left4'hintercostalspace

---

156.InPregnancy,whichofthefollowing
decreases-
a)SerumALT
b)SerumAlkalinephosphatase
c)SerumAST
d)SerumUrea
e)SerumCreatinine
CorrectAnswer-D:E
Ans.d.SerumUrea;e.SerumCreatinine
IncreasedGFRcausereductionofmaternalplasmalevelsof
creatinine,bloodureanitrogen&uricacid.
Withtheexceptionofraisedalkalinephosphatelevels,otherliver
functiontests(serumlevelsofbilirubin,AST,ALTCPKLDHare
unchanged.

---

157.AllaretrueaboutPCODexcept:
a)Metforminisusedfortreatment
b)Acanthosisnigramaybeassociated
c)Occurinpostmenopausalwomenonly
d)Associatedwithobesity
e)Infertilitymaybepresent
CorrectAnswer-C
Ans.c.Occurinpostmenopausalwomenonly
PCOD:Infertilityisduetoanovulatorycycle
Clinicalfeature:
Youngwoman
Acanthosisnigraduetoinsulinresistance.
Thickpigmentedskinoverthenapeofneck,innerthighandaxilla.
Hirsutism
Infertility
Oligomenorrhoea,amenorrhoea
Centralobesity:BMI>30kg/cm2;Waistline>88cm
Treatment:
MetformintreatstherootcauseofPCOD,rectifiesendocrine&
metabolicfunctions&improvefertilityrate.Itisusedasaninsulin
sensitizer

---

158.Trueaboutcervicalcancerscreeningin
female:
a)Startfrom2lyrofageirrespectiveofsexualactivity
b)Startfrom2lyrof.ageinsexuallyactivewomen
c)After30yr,screeningisdoneevery2-3yearsif3previousPAP
negativesmear
d)In70plusagegroup,ifpreviousPAPsmearisnegative-then
annualsurvey
e)RiskgroupshouldbescreenedthroughHPVDNAtesting
combinedwithcytology
CorrectAnswer-B:C:E
Ans.b.Startfrom2lyrof.ageinsexuallyactivewomen;c.
After30yr,screeningisdoneevery2-3yearsif3previousPAP
negativesmear;e.Riskgroupshouldbescreenedthrough
HPVDNAtestingcombinedwithcytology.
CervicalCancerScreening:
Allsexuallyactivewomenshouldbescreenedstarting,fromtheage
of2lyearsorafter3yearsofvaginalsexwithnoupperagelimits.
Screeningwouldbeyearlytilltheageof30.
Thereafter,itshouldbedoneatanintervalofevery2-3yearsafter3
consecutiveyearlynegativesmears.
TheriskgroupshouldbescreenedwithHPVDNAtestingcombined
withcytology
ThenegativepredictivevalueofonenegativeHPVDNAtest&two
negativecytologytestsarealmost100%.
Whenboththetestsarenegative,thescreeningintervalmaybe

---

increasedto6years.

---

159.TrueaboutstageIbcervixcarcinoma
management:
a)Radiotherapyalone
b)Simplehysterectomyalone
c)Primarychemoradiation
d)Wertheimhysterectomy+pelviclymphadenectomy
e)Simplehysterectomy+adjuvantchemotherapy
CorrectAnswer-C:D
Ans.c.Primarychemoradiation;d.Wertheimhysterectomy+
pelviclymphadenectomy
StagesIBandIIACervicalCancer
Radiationtherapywithchemotherapygivenatthesametime.
Radicalhysterectomyandremovalofpelviclymphnodeswithor
withoutradiationtherapytothepelvis,pluschemotherapy.
Radicaltrachelectomy.
Chemotherapyfollowedbysurgery.
Radiationtherapyalone.

---

160.Whichofthefollowingis/aretrueabout
lockedtwins:
a)Firstfetus-breechpresentation&secondfetuscephalic
presentation
b)Firstfetus-cephalicpresentation&secondfetusbreech
presentation
c)Decapitationofheadcanbedone,ifthefetusisdead
d)CaesareandeliveryisTOC
e)Usuallydeliveredbyvaginalroute
CorrectAnswer-A:C:D
Ans.a.Firstfetus-breechpresentation&secondfetuscephalic
presentation;c.Decapitationofheadcanbedone,ifthefetusis
dead;d.CaesareandeliveryisTOC
LockedTwin:
Thephenomenonoflockedtwinsisrare.
Fortwinstolock,thefirstfetusmustPresentbreech&second
cephalic.
Withdescentofthebreechthroughthebirthcanal,thechinofthe
firstfetuslocksb/wtheneck&chinofthesecond.
Caesareandeliveryisrecommendedwhenthepotentialforlocking
isidentified
Therearetwotypesoflockedtwins:breech/vertexand
vertex/vertex.
Ifonefetushasbeenpartiallyborn'attemptscanbemadeto
disimpactthetwinsmanually'suchasbytheZavanellimaneuver,
withaviewtoperforminganassisteddeliverywith

---

ventouseorforceps.
Ifthediagnosisismadeonlyafterthefirstlockedtwinhasdiedin
thebirthcanal,orifitisnotexpectedtosurvive,thefirsttwinmaybe
decapitatedanditsheadPusheduptoallowsafedeliveryofthe
secondtwin.

---

161.Trueaboutfemalepelvis:
a)Obstetricconjugateis2cmlessthanDiagonalconjugate
b)Obestetricalconjugateisthedistanceb/wthemidpointofthe
sacralpromontorytoprominentbonyprojectioninthemidline
ontheinnersurfaceofthesymphysispubis
c)Intertuberousdiameteris8cm
d)Bispinousdiameteris10.5cm
e)None
CorrectAnswer-A:B:D
Ans.a.Obstetricconjugateis2cmlessthanDiagonal
conjugate;b.Obestetricalconjugateisthedistanceb/wthe
midpointofthesacralpromontorytoprominentbony
projectioninthemidlineontheinnersurfaceofthesymphysis
pubis;d.Bispinousdiameteris10.5cm
Obstetricconjugate:Itisthedistanceb/vthemidpointofthesacral
promontorytoprominentbonyprojectioninthemidlineontheinner
surfaceatthesymphysispubis.
Itmeasures10cm.
Itcannotbeclinicallyestimatedbutktoinferredfromthediagonal
conjugate
1.5-2cmtobedeductedorbylateralradiopelvimetry.
Diagonalconjugate:Itisthedistanceb/wtheLowerborderof
symphysispubistothemidpointonthesacralpromontory.It
measures12cm.
Bispinousdiameterofmidpelvis(10.5cm):Itmeasuredistanceb/w
thetwoischialspine
Intertuberousdiameter(11cm):Itmeasuresb/winnerbordersof
ischialtuberosities"

---

ischialtuberosities"

---

162.Feature(s)ofchronichypertensionin
pregnancy:
a)Hypertensionoccurringafter20weekofpregnancy
b)Hypertensionoccurringbefore20weekofpregnancy
c)>10timescommoninobesewomen
d)Hypertensionbeforeonsetofpregnancy
e)Hypertensionoccurupto12weekpostpartum
CorrectAnswer-B:D
Ans.b.Hypertensionoccurringbefore20weekofpregnancy;d.
Hypertensionbeforeonsetofpregnancy
ChronicHypertensioninPregnancy:
Itisdefinedasthepresenceofhypertensionofanycause
antedatingorbeforethe20thweekofpregnancy&itspresence
beyondthe12thweekafterdelivery.
ThehighriskfactorsforCHDare:age(>40years),duration
ofhypertension(>15years),levelofBP(>160/ff0mmHg),presence
ofanymedicaldisorder(renovascular)&presenceofthrombophilia.

---

163.Inaprimifemale.Differentialdiagnosis
ofshockincludes:
a)Uterineinversion
b)Postpartummassivehaemorrhage
c)Amnioticfluidembolism
d)Postpartumeclampsia
e)None
CorrectAnswer-A:B:C
Ans.a.Uterineinversion;b.Postpartummassivehaemorrhage;
c.Amnioticfluidembolism
Inversionofuterus:Shockisextremelyprofoundmainlyof
neurogenicorigin.
Hemorrhagicshock:Associatedwithpostpartumor
postabortalhemorrhage,ectopicpregnancy,placentaprevia,
abruptionplacenta,ruptureoftheuterusandobstetricsurgery:
Shockassociatedwithdisseminatedintravascularcoagulation,
intrauterinedeadfetussyndromeandamnioticfluidembolism.
Septicshock(endotoxicshock):Hypotension(systolicBPmmHg)is
duetosepsisresultinginderangementsincellularandorgansystem
dysfunction.
Hypotensionpersistsinspiteofadequatefluidresuscitation.
Associatedtypicallywithsepticabortion,chorioamnionitis,
pyelonephritis,andrarelypostpartumendometritis.

---

164.Inpregnancy,counsellingfortherapeutic
terminationisgenerallydoneincaseof:
a)Eisenmengersyndrome
b)Multivalvulardisease
c)Congenitalheartdisease
d)Marfansyndrome
e)Primarypulmonaryhypertension
CorrectAnswer-A:D:E
Ans.a.Eisenmengersyndrome;d.Marfansyndrome;e.
Primarypulmonaryhypertension
PlaceofTherapeuticTermination:Indication
Absolutetermination:Primarypulmonaryhypertension,
Eisenmengersyndrome&pulmonaryveno-occlusiondisease
Relativeindications:ParouswomenwithgradeIII&IVcardiac
lesions;GradeI&IIwithprevioushistoryofcardiacfailureinearly
monthsorinb/wpregnancy

---

165.OCPisabsolutelycontraindicatedin:
a)Age>40yearwithsmoking
b)Carcinomabreast&genitalia
c)H/oEpilepsy
d)Thrombophlebitis
e)Hyperlipidemia
CorrectAnswer-A:D
Ans.a.Age>40yearwithsmoking;d.Thrombophlebitis
AbsolutecontraindicationofcombinedOCP:
Arterialorvenousthrombosis
Activeliverdisease
Pregnancy
Severehypertension
Stroke
Liveradenoma
Carcinoma
Undiagnosedgenitaltractbleeding
Valvularheartdiseaseischemicheartdisease
Angina
Diabeteswithvascularcomplication
Focalmigraine
Severehypercholesterolemia
Smokersoverage35years
Livertumor
Estrogen-dependentneoplasm,e.g.,breastcancer
Breastfeeding(within6weekspostpartum)
Majorsurgeryorprolongedimmobilization

---

---

166.Infertilityisdefinedas:
a)Ifacouplefailstoachievepregnancyafterl8monthof
unprotected&regularintercourse
b)Ifacouplefailstoachievepregnancyafter15monthof
unprotected&regularintercourse,itisanindicationto
investigatethecouple
c)Ifacouplefailstoachievepregnancyafter1yearof
unprotected&regularintercourse
d)Termedprimaryifconceptionhasneveroccurred
e)Itistermedsecondaryifconceptionhasneveroccurred
CorrectAnswer-C:D
Ans.c.IfacouplefailstoachievepregnancyafterIyearof
unprotected&regularintercourse;d.Termedprimaryif
conceptionhasneveroccurred
Infertility:
Infertilityimpliesapparentfailureofacoupletoconceive
Ifacouplefailstoachievepregnancyafter1yearofunprotected&
regularintercourse,itisanindicationtoinvestigatethecouple.This
isbasedonobservationthat80-85%ofnormalcouplesachieves
conceptionwithin1year;75%in6month&50%in3months.
Itistermedprimaryifconceptionhasneveroccurred6secondaryif
thepatientfailstoconceiveafterhavingachievedaprevious
conception

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167.Whichofthefollowingis/aretrue
regardingmanagementofectopic
pregnancy:
a)IntrauterinesacmaybevisiblebyTVSwhenthe?hCGlevelsis
>1000mIU/ml
b)Hemoperitoneumisindicationformedicaltreatment
c)Methotrexateisdrugofchoice
d)Laparoscopycanbeusedfordiagnosis
e)None
CorrectAnswer-A:C:D
Ans.a.IntrauterinesacmaybevisiblebyTVSwhenthe?hCG
levelsis>1000mIU/ml;c.Methotrexateisdrugofchoice;d.
Laparoscopycanbeusedfordiagnosis
Serial?hCGlevelsareusuallyrequiredwhentheinitialultrasound
performedfailstodemonstrateeitherintra-orextrauterine
pregnancy.
At?hCGlevelsofapproximately2000mIU/ml,aviableintrauterine
pregnancyshouldbeseenbyvaginalultrasound.
LaparoscopyofDirectvisualizationofthefallopiantubesandpelvis
diagnosticlaparoscopyoffersareliablediagnosisinmostcasesof
ectopicpregnancyandareadytransitiontodefinitiveoperative
therapy.
MethotrexateTherapyisthedrugofchoice

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168.MostcommonsiteofCINis:
a)Squamo-columnarjunction
b)Ectocervix
c)Endocervix
d)Nabothiangland
e)All
CorrectAnswer-A
Ans.a.Squamo-columnarjunction
CIN:Themetaplasiaextendsfromtheoriginalsquamocolumnar
junction(squamosquamous)outsidetothenewlydeveloped
(physiologicallyactive)squamocolumnarjunction(now
squamocolumnar)inside.Thisareaistransformationzone.

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169.TrueaboutMayer-Rokitansky-Kuster-
Hausersyndrome
a)45XY
b)Upper2/3vaginaabsent
c)Ovaryatrophic
d)Uterusabnormality
e)Amenorrhoea
CorrectAnswer-B:D:E
Ans.b.Upper2/3vaginaabsent;d.Uterusabnormality;e.
Amenorrhoea
InandrogeninsensitivitysyndromeapatienthasXYkaryotypeand
functioningtesteshowever,thebodycannotrespondtotestosterone
duetomutationsintheandrogenreceptor.
FeaturesofMeyerRokitanskykusterHauser(Mullerian
agenesissyndrome)
Sporadicinheritance
Karyotype46xx
Normalbreastdevelopment
Normal(adie))andpubichair
Uterusabsent
Vaginaabsent
Cervixabsent
Ovarynormal
Testosterone(femalelevels)
Associatedanomalies
Thepresentationofcompletemullerianagenesis(MeyerRokitansky

---

kusterHausersyndrome)maybeconfusedwithandrogen
insensitivitysyndrome.
Presentation
Mullerianagenesis
Inheritancepattern
Sporadic
Karyotype
46xx
Breastdevelopment
Yes
Axillaryandpubichair Yes
Uterus
No
Gonad
Ovary
Testosterone
Femalelevels
Associatedanomalies Yes

---

170.Trueaboutventricularseptaldefect:
a)MCcongenitalheartanomaly
b)Presentationdependsonsizeoflesion
c)Membranoustypeclosesearlythanmusculartype
d)Mid-diastolicmurmur
e)CHFneverdevelops
CorrectAnswer-A:B
Ans.a.MCcongenitalheartanomaly;b.Presentationdepends
onsizeoflesion
MuscularVSDhavethehighestlikelihoodofspontaneousclosure
PatientswithVSDbecomesymptomaticaround6to10weeksof
agewithcongestivecardiacfailure.
VSDisthemostcommoncardiacmalformationandaccountsfor
25/oofcongenitalheartdisease.Defectsmayoccurinanyportionof
theventricularseptum,butmostareofthemembranoustype.
Thesedefectsareinaposteroinferiorposition,anteriortotheseptal
leafletofthetricuspidvalve.
VSDsbetweenthecristasupraventricularisandthepapillarymuscle
ofconusmaybeassociatedwithpulmonarystenosisandother
manifestationsofthetetralogyofFallot.

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171.ThefollowingstatementisTRUEforPityriasisRosea:
a)Selflimiting
b)Chronicrelapsing
c)Lifethreateninginfection
d)Causedbydermatophytes
e)None
CorrectAnswer-A
Ans.A.Selflimiting
Pityriasisroseaisanacuteexanthematouspapulosquamous
eruptionoftenwithacharacteristicselflimitingcourse.
Theetiologyisnotknown.
HHV-7morefrequently,Ht{V-6lessfrequently
(Itisnotcausedbydermatophytes).
Itispresentduringthespringandfall.
Morphology:
Heraldpatch,FirtreeorChristmastreeappearance
Site:
Trunkalonglineofcleavage;sometimes(20%)lesionsoccur
predominantlyonextremities&neck(inversepattern)
Ref:Harrison'sPrinciplesofInternalMedicine16thEditionPage
292;Roxburgh's-CommonSkindisease17thEditionPage17;
Fitzpatrick'sDermatology5thEditionPage7369;Illustrated
TextbookofDermatology:Pasricha3rdEditionPage7134;
IllustratedSynopsisofDermatology&STDs,NeenaKhanna1st
EditionPage742-44
Accordigntoananthanarayanmicrobiologybook9thed/p.595:

---

Causatiyeagent:yeastlikefungusmalasseziafurfur(formelyPityro
sporumorbiculare).
Site:Uppertrunk,neck6upperarm.
Thisachronic,usuallyasytnptomatic,invohtementofthestartum
corneum.
Theoldnametineaversicolorshouldbediscardedaspityrtasis
eersicolorisnotcausedbydermatophytes.

---

172.TrueaboutImpetigocontagiosa:
a)Asboe-hausensign
b)Honeycolouredcrust
c)Causedbystaph.aureus
d)Contagious
e)Bullousdisorder
CorrectAnswer-B:C:D:E
Ans.(B)Honeycolouredcrust(C)Causedbystaph.aureus
(D)Contagious(E)Bullousdisorder
[Ref:NeenaKhanna4th/245;Roxburgh\Dermatology17th/z!4;
Harrison19th/350;18th/400]
Impetigocontagiosa:
Thinwalledbullae(seldomseen)onanerythematousbase,ruptures
raPidlytoformanexudativeplaquecoveredwithhoney-colored
rust.
Theprimarylesionisasuperficialpustulethatrupturesandformsa
characteristicyellow-brownhoney-coloredcrust
Causedby:Staph.aureus,S.pyogenesorboth.
Siteofpredilection:Face(periorificial,especiallyaroundthemouth&
nose),extremities&scalp
Complications:Eczematization&acutepoststreptococcal
glomerulonephritis

---

173.Dermatitisherpetiformis:
a)Causedbyherpes
b)Affectmainlyflexorsurface
c)Associatedwithglutensensitiveenteropathy
d)Dapsoneisusedintreatment
e)None
CorrectAnswer-C:D
Ans.(C)Associatedwithglutensensitiveenteropathy
(D)Dapsoneisusedintreatment
[Ref:NeenaKhanna4th/80-81;Harrison19th/3373,18th/427-28]
DermatitisHerpetiformis:
Etiology:
Gluten-sensitiveenteropathyisalwaysassociated&probably
responsibleforskinlesions
Site:
Extensors&pressurepoints
Morphology:
Groupederythematouspapules(lessfre-quent),vesicles(more
frequent)&excoriatedlesions(mostfrequent)
Treatment:
Dapsoneworksdramatically.Aglutenfreedietonlyslowly.So
combinethetwo&thenreducedoseofdapsone.

---

174.Maculopapularrashsareseeninall
except:
a)Scarletfever
b)Measles
c)Exanthemsubitum
d)Infectiousmononucleosis
e)Germanmeasles
CorrectAnswer-A
Ans.A.Scarletfever
[Ref:NeenaKhanna4th/282;Hanison19th/128-30;18tV149-
51'Park23ril/144-45,147,151]
MaculopapularViralExanthems:
Measles(Rubeola):maculopapularconfluentrashwhichevolvesin
acranio-caudalfashion&fadeswithscaling.
Germanmeasles:Erythematousdiscretemacularrash.
Erythemainfectiosum(fifthdisease)
Exanthemsubitum(roseola,sixthdisease)
Infectiousmononucleosis
Epidemictyphus
Endemic(murine)typhus
Scrubtyphus
Rickettsialspottedfevers
HumanMonocytotropicehrlichiosis
Leptospirosis
Lymedisease
Typhoidfever

---

Denguefever
Note:
Scarletfever:
Causesconfluentdesquamativeerythemas.

---

175.Androgenicalopeciainfemaleiscaused
by:
a)Myxedema
b)Cushingdisease
c)Stein-Leventhalsyndrome
d)Addison'sdisease
e)None
CorrectAnswer-C
Ans.C.Stein-Leventhalsyndrome
[RefNeenaKhanna4th/133-34;Roxburgh'sDermatology17th/270;
Hanison19th/j55,18th/408,2920,2897]
AndrogeneticAlopecia(Malepattern;Femalepattern):
Associations
Inwomen,featuresofhyperandrogenismmaybepresentin
theformofhirsutism,acne&clitoromegaly.
Alwaysruleoutpolycysticovarydisease(PCOD).
Stein-Leventhalsyndrome,alsocalledpolycysticovary
syndrome(PCOS)
Myxedema:
Hairtexturemaybecomefine,andadiffusealopeciaoccursinupto
40%ofpatients,persistingformonthsafterrestorationof
euthyroidism.

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176.Findingsinpsoarisisincludes:
a)Parakeratosis
b)Involvingalmost100%ofBasalcellinmultiplication
c)Micro-munroabscess
d)AutoimmunediseasewithT-cellinvolvement
e)Frequentlyinvolvingmucosalsurface
CorrectAnswer-A:B:C:D
Ans.(A)Parakeratosis(B)Involvingalmost100%ofBasalcell
inmultiplication(C)Micro-munroabscess(D)Autoimmune
diseasewithT-cellinvolvement
Psoriasis:
Type1helperTcelldiseasewithincreasedTh1cytokines(IFN-y&
IL-2)&reductionofanti-inflammatorycytokinesIL-10.
Histologically,scalylesionsshowhyperkeratosis&parakeratosis.
Auspitzsign-Characteristicsfindingofplaqueinwhichremovalof
scalesleadstopinpointbleeding.
GrattageTesla:onscratchingscalesappear.
Koebner/Isomorphicphenomenon:
Appearsatthesiteofminorinjurysuchasscratchorgraze.
Characteristicofpsoriasis.
lnNails
Onycholysis(separationofthenailplatefromthenailbed)
Thimble-pittingofnailplate
Brownblackdiscoloration

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177.Trueaboutbullouspemphigoid:
a)Nikolslcysignpositive
b)Bullaspreadsignpositive
c)Commoninchildren
d)Dariersign
e)Itchingiscommon
CorrectAnswer-E
Ans.E.Itchingiscommon
[NeenaKhenna4th/77-79]
BullousPemphigoid:
Autoimmunedisorder
Itchy,tensehemorrhagicblistersonskin
Mucosallesioninfrequent
Age60-80yr
Gender:equalincidenceinmale&females
Bullaspreadsign&Nikolsy'ssignareusuallynegative

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178.Allaretrueaboutlichenplanusexcept:
a)Notassociatedwithoralulcer
b)Wikham'sstriaepresent
c)Colloidbodyonhistology
d)Morphologycanberepresentedby5'P'
e)Koebner'sorisomorphicphenomenonmaybepresent
CorrectAnswer-A
Ans.A.Notassociatedwithoralulcer
[RefNeenaKnnna4th/56-60;RoxburgheDermatologist17thll4;
Harrison19th/349,I8tW399-400]
LichenPlanus:
Orallesions(Laceyreticulatepattern):
Itmaybeasymptomaticorpatientmaycomplainofburning
sensationespeciallyoneatingspicyfoods.
Whenviewedunderamagnifyinglens,surfaceofthelesionshas
whitestreaks(Wickham'sstriae)
Morphology(5Ps):Pruritic,Polygonal,Purple(butviolaceousisthe
termtouse),Plane(flattopped),papules.
Age:10-40year
184.Koebnerorisomorphicphenomenonmaybepresent
Histopathology:colloidbody,basalcelldegeneration,bandlike
upperdermalinfiltrate,Maxfoseph'sspace,thickenedgranularlayer

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179.Whichiscausedbybacteria:
a)Analwart
b)Lymphogranulomavenereum
c)Molluscumcontagiosum
d)Condylomatalattum
e)None
CorrectAnswer-B:D
Ans.(B)Lymphogranulomavenereum(D)Condylomatalattum
[RefNeenaKhanna4th/270]
AnogenitalwartiscausedbyHPV-6,11,16,18,31&33
LymphogranulomavenereumiscausedbyChlamydiatrachomatis
serovarsLl,L2&L3
Condylomalata:Itisfoundinsecondarysyphilis(Treponema
pallidum)
Molluscumcontagiosumiscausedbythepoxvirus.

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180.AllaretrueregardingLaryngealMask
Airwayexcept:
a)Bigoraltumoriscontraindicationforitsuse
b)MaybeusedwhenintubationwithETTisnotpossible
c)Canbeusedinchild'seyesurgery
d)MaybeusedinCPR
e)None
CorrectAnswer-E
Ans.(E)NONE
[RefAjayYadav5th/42-43;LeeAnaesthesia13th/206-08;Morgo4
Anesthesia4th/97;DorschDorschanesthesiaequipment5th/488;
Miller\anesthesia6th/I627]
Advancedcardiaclifesupport(PartofCPR):
Forbreathing-Advancedmethodlikeendotrachealtube,LMA,
combitubeortracheostomytube.
LaryngealMaskAirway(LMA):
Asanalternativetointubationwheredifficultintubationisanticipated
Anelectivemethodforminorsurgerieswhereanesthetistwantsto
avoidintubation(Likeeyesurgeryinchildren).
Contraindication:oropharyngealmass.
LMAprovidesanalternativetoventilationthroughafacemaskor
endotrachealtube(ETT).
LMAhasprovenparticularlyhelpfulasatemporarymeasureif
patientswithdifficultairways(thosewhocannotbeventilatedor
intubated)becauseofitseaseofinsertion&relativelyhighsuccess
rate(95-99%).

---

C/IforLMAincludes:patientwithpharyngealpathology(e.g.,
abscess),pharyngealobstruction,fullstomach(e.g.,pregnancy,
hiatalhernia)orlowpulmonarycompliance

---

181.Whichofthefollowingcircuitis
preferredinchildforspontaneous
respiration:
a)MaplesonA
b)Jackson&Reescircuit
c)MaplesonC
d)MaplesonE
e)MaplesonF
CorrectAnswer-A
Ans.(A)MaplesonA
[RefAjayYadav5th/35;DorschAnesthesiaEquipment5th/213-215;
MorganAnesthesia5th/i3;4th/35-37]
PediatricBreathingCircuits:
TypeEMaplesonCircuit:
ItisAyre'sTpiecewithcorrugatedtubing.
Itisapediatriccircuit
Asitdoesnothavebreathingbagsoitisnotacompletecircuit(It
wasmadecompletebyattachingabreathingbagbyattachinga
breathingbagbyJackson&Rees).
TypeEisbasicallyacircuitonlyforspontaneousrespiration(asit
doesnotcontainbreathingbag)butcanbeutilizedforcontrolled
ventilationbyintermittentlyoccludingtheendofexpiratorylimb

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182.Weaningisgenerallydoneby:
a)SIMV
b)Controlledmodeventilation(CMV)
c)CPAP
d)PressurecontrolledVentilation
e)AssistedcontrolledVentilation
CorrectAnswer-A:C
Ans.A,SIMV&C,CPAP
[RefAjayYadav5th/239-40;Morgan5th/1298;Milleranesthesia6th]
Weaning:
Meansdiscontinuingtheventilatorsupport.
WeaningprocessmayvaryfromPatienttoPatient,hospitalto
hospital(dependingonthetypeofventilatoravailable)6clinicianto
clinician4ispossibletoweanpatientinanymodeofventilation
exceptcontrolmodeventilation
TechniquesforWeaning:
Thecommontechniquestoweanapatientfromtheventilator
includeSIMVpressuresupport,orperiodsofspontaneousbreathing
aloneonaT-pieceoronlowlevelsOfCPAP
Mandatoryminuteventilationhasalsobeensuggestedasanideal
weaningtechniques,butexperiencewithitislimited.
MostoftenaPPLiedapproachisthatpatientfromcontrol/assist
controlmodeventilationisshiftedtoSIMV&thenkeepon
decreasingtherateofbreathdeliveredbyventilatorgraduallytillit
becomes1to2breath/min

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183.Achildonimmediatepostoperative,is
complainingofnausea&vomitingafter
squintsurgery.Whichofthefollowing
drugsmaybenotusedduringoperation
incontrollingthissymptom:
a)Propofol
b)Ketamine
c)Dexamethasone
d)Ondansetron
e)Palonosetron
CorrectAnswer-A:C:D
Ans.A,PropofolC,Dexamethasone&D,Ondansetron
[RefAjayYadavSth/132;LeeAnaesthesial3th/630]
StrabismusSurgeryinPaediatricPatient:
Keyfeaturesinrelationtostrabismusareoculocardiacreflexin
responsetosurgicalmovementofglobe,postoperativenausea&
vomiting(PONV)&theassociationofstrabismuswithoccult
myopathies&possiblymalignanthyperthermia.
Antiemesisisimprovedbyuseofpropofoloninduction&
maintenance&bythepreemptiveuseofboth5-hydroxy-tryptamine
inhibitors&dexamethasone,
OpioidsshouldbeavoidedbecauseregularNSAIDSareas
effective.
TopicalNSAIDS(Ketorolac0.5%oo/o,diclofenacl%)havebeen
usedwithsomesuccess.

---

Theincidenceofoculocardiacreflexcanbereducedbytheuseof
ketamineatinduction&bytheuseofmedialcanthalinjectionof
localanaesthetic(lidocaine),whichalsoreducestheneedfor
postoperativeanalgesia

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184.Whichofthefollowingfluidusedin
perioperativeperiodisisotonic:
a)RL
b)DNS
c)5%Dextrose
d)HES
e)NS
CorrectAnswer-A:C:D:E
Ans.A,RLC,5%DextroseD,HES&E,NS
[RefAjayYadav5th/12-15;LeeAnaesthesiap.232-33;Morgan
5th/1164]
RingerLactateSolution(RL,Hartmansolution):
Lactateismetabolizedtobicarbonateinliver
RingerlactateiscrystalloidofchoiceforbloodlossrePlacement.
RLisslightlyhypotonic.
NormalSaline:
0.99%NaClisotonicsolution.
PreferredoverRLfortreating:hypochloremicmetabolicalkalosis,
braininjury(Catinlactatecanincreasetheneuronalinjury)&
hyponatremia
DextroseNormalSaline:
Hypertonic.
bestusedasmaintenancefluid.
HydroxyethylStarch(Colloid):
Types:Hetastarch&Pentastarch

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185.18-FDGstandsfor:
a)18-Fluorodeoxyglucose
b)18-Fluorodioxyglucose
c)18-Fluorodeoxygalactose
d)18-Fluorodioxygalactose
e)18-Fluorodeoxyglycogen
CorrectAnswer-A
Ans.(A)18-Fluorodeoxyglucose
[RefSumerSethi2nd/16;Grainger&AllisonRadiology6th/141]
18F-2-Fluoro-2-deoxy-D-glucose(FDG)
DyeusedinPETscans.
Themostcommonlyusedradiolabeledtraceris18F-2-Fluoro-2-
deoxy-D-glucose(FDG).
InPEThelpsassessmetabolicfunctionssuchasoxygenand
glucoseconsumptionandbloodflow.

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186.Half-lifeofradiumis:
a)14day
b)27day
c)1626years
d)5.25yr
e)None
CorrectAnswer-C
Ans.(C)1626years
[Ref:Harrison19the/p263e-3]
Half-lifeofRa-226:1626years

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187.1curieisequivalentto:
a)1.7x1010disintegration/second
b)2.7x1010disintegration/second
c)3.7x1010disintegration/second
d)4.7x1010disintegration/second
e)5.7x1010disintegration/second
CorrectAnswer-C
Ans.(C)3.7x1010disintegration/second
[Ref:SumerSethi2nd/94-95;Grainger&AllisonRadiology6th/118;
RadiologybyS.Bhailury2nd/197;Harrison19th/263e-1,18th/1788;
http://www.nrc.gov/reading-rm/doc-collections/cfr]
RadiologybyS.Bhadury2ndl197:Writes:
1Bq=1disintegration/second
1Curie(Ci)=3.7x10(10)disintegration/second
1Ciisequalto37gigabecquerel
1gray(Gy)=100rads10mGy=1rad1mGy=100mradGray
(Gy)istheSIunitofabsorbeddose.
Onegrayisequaltoanabsorbeddoseof1foule/kilogram(100
rads).

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188.RadiationnotemittedbyCo-60:
a)arays
b)13rays
c)yrays
d)Positron
e)6rays
CorrectAnswer-A:D:E
Ans.A,araysD,Positron&E,6rays
[Ref:Harrison19th/263e3,18th/1790;SumerSethi2nd/88;Grainger
(tAllisonRadiology6th/118]
Cobalt(Co-60)-beta,gammaraysemitted.

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189.Whichofthefollowingareasarenot
examinedinFAST:
a)Perisplenic
b)Perihepatic
c)Suprapubic
d)Chest
e)None
CorrectAnswer-E
Ans.(E)NONE
[Ref:L6B26th/187;Manipal4th/886]
FAST:4acousticwindow-pericardial,perihepatic,perisplenicor
pelvic.
Thefourclassicareasthatareexaminedforfreefluidarethe
perihepaticspace(alsocalledMorison'spouchorthehepatorenal
recess),perisplenicspace,pericardium&pelvis.

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190.Whichofthefollowingistrueregarding
catatonia
a)Prominentsensorysymptom
b)Prominentmotorsymptom
c)ECTisTOCforlifethreateningcatatonia
d)MaybeassociatedwithCNSdisease
e)None
CorrectAnswer-B:C:D
Ans.B,ProminentmotorsymptomC,ECTisTOCforlife
threateningcatatonia&D,MaybeassociatedwithCNSdisease
[Ref:Kaplan6Sadock\1lth/292,343-46,1068;Ahuja7th/57-s9,
2255th/60-61,1423;NewOxfordTextbookofPsychiatry1st/167;
Harrison19th/1771,17th/147]
Catatonia:
CatatoniawasfirstdescribedbyKahlbaum,whodescribeda
syndromewithprominentmotor&behavioralsymptoms.
Characterizedbymotorabnormalitiessuchascatalepsy,mutism,
posturing&negativism.
Itcanbeassociatedwithanothermentaldisorder(e.g.,
schizophreniaorbipolardisorder)orduetoanothermedical
condition(e.g.,neoplasm,headtrauma,hepaticencephalopathy
ECTisappropriateforcatatoniaduetoageneralmedicalcondition,
especiallyifthecatatoniaislifethreatening(e.g.,inabilitytoeat)or
hasdevelopedintolethal(malignant)catatonia.

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191.Allaretrueaboutnarcolepsyexcept:
a)Daydreaming
b)Hypnagogichallucinations
c)Cataplexy
d)Suddensleep
e)DecreasedREMlatency
CorrectAnswer-A
Ans.(A)Daydreaming
[RefNeerajAhuja7th/Ij8-39;Kaplan&SailocklsTextbookof
psychiatry11th/547-50;Harrison19th/189,t7th/172-ZB;CMDT
2016/1072]
Narcolepsy:
Disordercharacterizedbyexcessivedaytimesleepinessoften
dkturbetlnighttimesleepanddisturbancesinREMsleep.
HallmarkofthisdisorderisdecreasedREMlatency,I.e.decreased
latentperiodbeforethefirstREMperiodoccurs.
NormalREMlatencyis90-100minutes,innarcolepsy,REMsleep
occurswithin10minutesoftheonsetofsleep.
Classicaltetradofsymptoms:
Sleepattacks(MC)
Cataplexy
Hallucinationsatsleeponset(Hypnagogic)anduponwaking
(Hypnopompic)
Sleepparalysis.

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192.Whichofthefollowingistrueabout
OCD:
a)Anxiety
b)Compulsion
c)Hallucination
d)Obscession
e)Egoalien
CorrectAnswer-A:B:D:E
Ans.A,AnxietyB,CompulsionD,Obscession&E,Egoalien
[RefAhuja7th/9s-98]
ObsessiveCompulsiveDisorder(OCD):
Representedbyadiversegroupofsymptomsthatincludeintrusive
thoughts,rituals,preoccupations,andcompulsions.
Washeriscommonesttype
PersonswithOCDarecommonlyaffectedbyothermental
disorders.
Theobsessionsorcompulsionsaretime-consumingandinterfere
significantlywiththeperson'snormalroutine,occupational
functioning,usualsocialactivities,orrelationships.
ApatientwithOCDmayhaveanobsession,compulsion,orboth.
Features:
EgoAlien
Isolationeffect
Undoing.
Repetitivebehaviour.
Butisunable&resultsinirresistible.

---

---

193.FeaturesofManiaincludes:
a)Cheerfulness
b)Anhedonia
c)Catatonia
d)Delusionofgrandeur
e)Negativethinking
CorrectAnswer-A:D
Ans.(A)Cheerfulness(D)Delusionofgrandeur
[Refkaplan&Sadock'sTextbookofPsychiatry11th/358,364;Ahuja
7th/69-71,12]
ManicEpisode:
Anhedonia(inabilitytoexperiencePleasure)mayoccurinboth
schizophrenia&depression.
Elevatedmoodcanpassthrough4stages,dependingonthe
severityofmanicepisode-euphoria(mildelevation),elation
(moderateelevation),emulation(severeelevation)&ecstasy(very
severeelevation).
Personismoretalkativethanusual.
Increasedpsychomotoractivity.
Delusions(orideas)ofgrandeur(grandiosity),withmarkedlyinflated
self-esteem.
Delusionofpersecutionmaysometimesdevelopsecondaryto
delusionofgrandeur.

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