Download PGI PG PGI 2014 May Solved Question Paper

1.Allaretrueaboutulnarnerveexcept:
a)RootvalueC8TI
b)Passthroughcubitaltunnel
c)Supplyflexordigitorumsuperficialis
d)Supplyflexorcarpiulnaris

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e)Passesbehindmedialepicondyle
CorrectAnswer-C
Ans.c.Supplyflexordigitorumsuperficialis
Nervecourse:
RootvalueofulnarnerveisC7,C86T1.

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Ulnarnerve(C8,T1)arisesfromthemedialcordofthebrachial
plexus&descendsintheintervalb/wtheaxillaryartery&vein
Atelbow,ulnarnervepassesbehindthemedialepicondyle
Thecubitaltunnelisachannelwhichallowstheulnarnervetotravel
overtheelbow

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Variousbranchesofulnarnerveare:?
Inarm:Nobranch.
Inforearm:Therearefollowingbranches:?
Muscular:Inproximalpartofforearmitsuppliesflexorcarpiulnaris
andmedialhalfofflexordigitorumprofundus.

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Cutaneous:Therearetwocutaneousbranchesinforearm:-
Superficialterminalbranch:Itsuppliespalmarisbrevisandskinof
palmarsurfaceofmedial11/2fingers.
Palmarcutaneousbranch:Suppliesskinoverthehypothenar
eminence.

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Dorsal(posterior)cutaneousbranch:Suppliesskinovermedial1/3
ofdorsumofhandanddorsalsurfaceofmedial11/2fingers.

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Inhand:Ulnarnerveentersthepalmbypassingsuperficialtoflexor
retinaculumanddividesintotwoterminalbranches:?
Deepterminalbranch:Itsuppliesadductorpollicis,allinterossei,

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medialtwo(3rd&4th)lumbricalsandallhypothenarmusclesexcept
palmarisbrevis(i.e.abductordigitiminimi,flexordigitiminimi,
opponensdigitiminimi).

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2.Branchofinternaliliacarteryis/are:
a)Inferiorvesicalartery

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b)Inferiorepigastricartery
c)Iliolumbarartery
d)Internalpudendalartery
e)Obturatorartery
CorrectAnswer-A:C:D:E

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Ans.a.Inferiorvesicalartery;c.Iliolumbarartery;d.Internal
pudendalartery;e.Obturatorartery
Branchesofanteriordivisionofinternaliliacarteryare:
Superiorvesical
Middlerectal

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Inferiorvesical(inmales),
Internalpudendal,
Vaginal(infemales),
Uterine(infemales)
Obturator

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Inferiorgluteal.
Branchesofposteriordivisionare:
Iliolumbar
Lateralsacral
Superiorgluteal.

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3.Compressionofcervicalribcancauses:
a)Thenarhypertrophy
b)Neurovascularsymptom
c)Reynaud'sphenomenon
d)C8Tlparaesthesia

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e)All
CorrectAnswer-B:C:D
Ans.b.Neurovascularsymptom;c.Reynaud'sphenomenon;d.
C8Tlparesthesia
Thelowertrunkofthebrachialplexus(C8,Tl),togetherwiththe

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subclavianarterymaybeangulatedoveracervicalrib(thoracic
outletsyndrome).
Thereisaslowinsidiousonsetofwastingofthesmallmusclesof
thehand,whichoftenstartsonthelateralsidewithinvolvementof
thethenareminence&firstdorsalinterosseous.

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Thereispain&paraesthesiainthemedialaspectoftheforearm
extendingtothelitdefinger

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4.Trueaboutattachmentofsuprapleural
membrane:
a)AttachedtoClavicle

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b)Attachedtolstrib&itscostalcartilage
c)Attachedto2ndrib&itscostalcartilage
d)Attachedtojunctionofmanubrium&bodyofsternum
e)Attachedtotipofthetransverseprocessofthe7thcervical
vertebrae

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CorrectAnswer-B:E
Ans.b.Attachedtolstrib&itscostalcartilage;e.Attachedto
tipofthetransverseprocessofthe7thcervicalvertebrae
SuprapleuralMembrane:
Itistentshapedfibroussheetattachedlaterallytothemedialborder

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ofthelstrib&costalcartilage.
Mediallyitattachedtothefasciainvestingthestructurespassing
fromthethoraxintotheneck.
Itisattachedatitsapextothetipofthetransverseprocessofthe
7thcervicalvertebrae

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5.Whichofthefollowingsinusesopeninto
middlemeatus:
a)Frontalsinus
b)Anteriorethmoidalsinus
c)Posteriorethmoidalsinus

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d)Maxillarysinus
e)Sphenoidsinus
CorrectAnswer-A:B:D
Ans.a.Frontalsinus;b.Anteriorethmoidalsinus;d.Maxillary
sinus

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Partoflateralnasal Openings
wall
Inferior
Nasolacrimalduct
Frontalsinus,Maxillarysinus,Anterior

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Middle
ethmoidalsinus
Superior
Posteriorethmoidalsinus
Sphenoethmoidal

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Sphenoidsinus
recess

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6.TrueaboutanatomyofEustachiantube:
a)Aeratemiddleear
b)Openduringswallowing

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c)Lager&widerinadultthanchildren
d)Morehorizontalininfant&children
e)Openinoropharynx
CorrectAnswer-A:B:D
Ans.a.Aeratemiddleear;b.Openduringswallowing;d.More

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horizontalininfant&children
TheEustachiantube/auditorytubeintheadultis36mmin
length.(Range32-38mm)Fromitstympanicend,itruns
downwardforwardandmediallyjoininganangleof45?with
horizontal.

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Ininfants,thetubeisshorter,widerandismorehorizontal.
Thetympanicendoftheeustachiantubeisbonyandissituatedin
theanteriorwallofmiddleear.
Thepharyngealendofthetubeisslitlikeandissituatedinthe
lateralwallofthenasopharynx,1-1.25cmbehindtheposteriorend

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ofinferiorturbinate.
NormallyEustachiantube(ET)isclosedandopensintermittently
duringyawning,swallowingandsneezingthroughactivecontraction
ofTensorvilipalatinimuscle.
Normaltubalfunction:

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Abilityoftubetoequilibratepositive&negativepressurestoambient
pressure.
Donebothinpatientswithperforatedorintacttympanicmembrane.

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7.Trueaboutpalatinetonsil:
a)Cryptsislinedbysquamousepithelium

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b)SuppliedbyIXCN
c)Tonguedepressorisusedforexamination
d)Arterialsupplyisbytonsillarascendingbranchofgrater
palatineartery
e)Presentinoropharynx

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CorrectAnswer-A:B:C:E
Ans.(A)Cryptsislinedbysquamousepithelium;(B)Supplied
byIXCN;(C)Tonguedepressorisusedforexamination;(E)
Presentinoropharynx
Palatinetonsil

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ThePalatinetonsilsaretwoprominentmassessituatedoneon
eithersidebetweentheglossopalatineandpharyngopalatine
arches.
Eachtonsilconsistsfundamentallyofanaggregationoflymphoid
tissueunderlyingthemucousmembranebetweenthepalatine

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arches.
Inthechildthetonsilsarerelatively(andfrequentlyabsolutely)
largerthanintheadult
Thefolliclesofthetonsilarelinedbyacontinuationofthemucous
membraneofthepharynx,coveredwithstratifiedsquamous

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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

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d)Mydriasisinipsilateraleye
e)Visualloss
CorrectAnswer-A:B
Ans.a.Miosis;b.Vasodilationinipsilateralarm
HorneroccurduetoinjuryofTlsympathetictrunk.Thereisptosis,

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miosis,anhydrosis(vasodilation&lackofthermalsweating),
enophthalmos(sunkenglobe),lossofcilio-spinalreflex,narrow
palpebralfissureofaffectedside

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9.Trueaboutparietalperitoneum:
a)Suppliedbylower5thoracic&1stlumbar

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b)Suppliedbylower4thoracic&upper3lumbar
c)Painissomaticinnature
d)Stretchingofparietalperitoneumcausepain
e)None
CorrectAnswer-A:C

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Ans.a.Suppliedbylower5thoracic&1stlumbar;c.Painis
somaticinnature
ParietalPeritoneum:
Itissensitivetopain,temperature,touch&pressure
Theparietalperitoneumliningtheanteriorabdominalwallissupplied

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bythelower6thoracic&1stlumbarnervesthatis,thesamenerves
thatinnervatetheoverlyingmuscles&skin.
Thecentralpartofdiaphragmaticperitoneumissuppliedbythe
phrenicnerve;peripherally,diaphragmaticperitoneumissuppliedby
lowersixthoracicnerves.

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Theparietalperitoneuminthepelvisismainlysuppliedbythe
obturatornerve,abranchofthelumbarplexus

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10.Trueregardingsaphenousvein:
a)Longsaphenousvein-formedascontinuationofmedialsideof
deepvenousarch

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b)Longsaphenousvein-situatedposteriortomedialmalleolus
c)Longsaphenousvein-closelyrelatedtosaphenousnerve
d)Shortsaphenousvein-openintogreatsaphenousvein
e)Shortsaphenousvein-associatedwithsuralnerve
CorrectAnswer-A:C:D:E

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Ans.a.Longsaphenousvein-formedascontinuationofmedial
sideofdeepvenousarch;c.Longsaphenousvein-closely
relatedtosaphenousnerve;d.Shortsaphenousvein-openinto
greatsaphenousvein;e.Shortsaphenousvein-associated
withsuralnerve

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LongSaphenousVein
Formedbytheunionofthemedialendofdorsalvenousarchwith
themedialmarginalvein
Passesupwardsinfrontofthemedialmalleolus,crossesthelower
one-thirdofthemedialsurfaceoftibiaobliquely&runsalongits

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medialbordertoreachthebackoftheknees
ThesaphenousnerverunsinfrontofthegreatsaphenousVein
Small/ShortSaphenousVein:
Formedonthedorsumoffootbytheunionofthelateralendof
dorsalvenousarchwiththelateralmarginalvein

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Entersthebackofthelegbypassingbehindthelateralmalleolus
Connectedwiththegreatsaphenousvein&withthedeepveins&is
accompaniedbythesuralnerve

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11.TrueaboutHering-Breuerreflex:
a)Signalinitiatedthroughmechanoreceptorreceptorsoflung

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b)SignalinitiatedthroughChemoreceptoroflung
c)SignalinitiatedthroughCarotid&aorticbody
d)Transmitsignalsthroughthevagusnerve
e)None
CorrectAnswer-A:D

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Ans,(A)Signalinitiatedthroughmechanoreceptorreceptorsof
lung(D)Transmitsignalsthroughthevagusnerve
[Ref:Ganong25th/662,24th/664;Guyton12th/372;A.K.lain5th/461,
463,465]
Hering-BreuerinflationReflex-LunginflationSignalsLimit

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Inspiration:
Hering-Breuerinflationreflexisanincreaseinthedurationof
expirationproducedbysteadylunginflation,andtheHering-Breuer
deflationreflexisadecreaseinthedurationofexpirationproduced
bymarkeddeflationofthelung.

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Inhumanbeings,theHering-Breuerreflexprobablyisnotactivated
untilthetidalvolumeincreasestomorethanthreetimesnormal
(greaterthanabout1.5litersperbreath).
LungInflationSignalsLimitInspiration-TheHerireuerInflation
Reflex:

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Stretchreceptorstomechanoreceptorclass.
Stretchreceptors,locatedinthemuscularportionsofthewallsofthe
bronchiandbronchiolesthroughoutthelungs,transmitsignals
throughthevagiintothedorsalrespiratorygroupofneuronswhen
thelungsbecomeoverstretched.

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12.Trueaboutbloodsupplyofkidney:
a)Flowis600ml/mineachkidney
b)Itreceivesmorebloodsupplyperunitmassthanthebrain
c)Renalmedullahavemoresupplythanrenalcortex
d)Itisunderdirectsympatheticcontrol

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e)None
CorrectAnswer-A:B:D
Ans.(A)Flowis600ml/mineachkidney(B)Itreceivesmore
bloodsupplyperunitmassthanthebrain(D)Itisunderdirect
sympatheticcontrol

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[Ref:Ganong25th/602,674,24th/676-77;Guyton12th/466-67]
Essentiallyallthebloodvesselsofthekidneys,includingtheafferent
andefferentarterioles,arerichlyinnervatedbysympatheticnerve
fibers.
Bloodflowtothetwokidneysisnormallyabout22percentofthe

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cardiacoutput,or1100mlmin
Theouterpartofthekidney,therenalcortex,receivemostofthe
kidney'sbloodflow.
Bloodflowinrenalmedullaaccountsforonly1to2%ofthetotal
renalflow

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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

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e)Secretesmucusrichfluid
CorrectAnswer-B
Ans.B.Itliesinduodenum&ileum
[RefGuyton12th/400;A.K.lain5th/202-03]
Brunner'sGland:

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Sub-mucousglands&aretortuous,long&penetratethemuscularis
mucosa
Drainsintothecryptsoflieberkuhn.
Numerousinfirstpartofduodenum(duodenalcaporbulb)meager
belowthecommonopeningofbile&pancreaticducts.

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Ingestionoffattyfoodorsecretininjectionproduceslargevolumeof
thickalkalinemucoussecretionwhichprobablyhelpstoprotectthe
duodenalmucosafromthegastricacid.
Intheduodenumthereareinadditionthesmall,coiledacinotubular
duodenalglands(Brunner'sglands

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Functions:
Protectstheduodenalwallfromdigestionbythehighlyacidicgastric
juiceemptyingfromthestomach.
Mucuscontainsalargeexcessofbicarbonateions,whichaddtothe
bicarbonateionsfrompancreaticsecretionandliverbilein

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neutralizingthehydrochloricacidenteringtheduodenumfromthe
stomach"

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14.Bloodbrainbarrierisabsentin?
a)Adenohypophysis
b)Neurohypophysis

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c)Hypothalamus
d)Thalamus
e)None
CorrectAnswer-B
Ans.is'b'i.e.,Neurohypophysis

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Bloodbrainbarriersexistbothatthechoroidplexusandatthetissue
capillarymembranesinessentiallyallareasofthebrainparenchyma
exceptinsomeareosofthehypothalamus,pinealgland,adarca
posttema,wheresubstancesdiffusewithgreatereaseintothetissue
spaces.

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FourareasthatareoutsideofBBBare(l)theposteriorpituitary
(neurohypophysis)andtheadjacentventralpartofthemedian
eminenceofthehypothalamus,(2)theareapostrema,(3)the
organumvasculosumofthelaminaterminalis(OVLT,supraoptic
crest),and(4)thesubfornicalorgan(SFO).

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Referredtocollectivelyasthecircumventricularorgans

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15.Oxygenbindingtohemoglobincause
allostericactivation.Thisallosteric
propertyofHbresultsin:
a)Maintainingironinferrousstate(Fe2+)

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b)Increaseoxygensupplytotissue
c)Increasesoxygenbinding
d)Increases2,3-DPGinblood
e)None
CorrectAnswer-B:C

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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.

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EachFe2+combineloosely&reversiblywithonemoleculeof
oxygen.
Combinationofhaemwithoxygeniscalledoxygenation&not
oxidation,becauseaftercombinationwithorygen,ironinhaemstay
inFe2+state

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OxygenationofHemoglobinTriggersConformationalChanges
intheApoprotein:
Hemoglobinsbindfourmoleculesof02pertetramer,oneperheme.
AmoleculeofO2bindstoahemoglobintetramermorereadilyif
otherO2moleculesarealreadybound.

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Termedcooperativebinding,thisphenomenonpermitshemoglobin
tomaximizeboththequantityofO2loadedatthePO2ofthelungs

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andthequantityofO2releasedatthePO2oftheperipheraltissues.
TheAllostericPropertiesofHemoglobinsResultfroMTheir
QuaternaryStructures.

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Thepropertiesofindividualhemoglobinsareconsequencesoftheir
quaternaryaswellasoftheirsecondaryandtertiarystructures.
Thequaternarystructureofhemoglobinconfersstrikingadditional
properties,absentfrommonomericmyoglobin,whichadaptsittoits
uniquebiologicalroles.

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16.Secretionofinsulinisincreasedby:
a)Fattyacid
b)Aminoacid
c)Adrenaline
d)Acetylcholine

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e)Somatostatin
CorrectAnswer-A:B:D
Ans.(A)Fattyacid(B)Aminoacid(D)Acetylcholine
[RefGanong25TH/439,24th/441;Guyton12th/615]
IncreaseinsulinSecretion:

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Increasedbloodglucose
increasedbloodfreefattyacids
Increasedbloodaminoacids
Gastrointestinalhormones(gastrin,cholecystokinin,secretin,gastric
inhibitorypeptide)

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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

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e)Increaseinextracelluarsodium
CorrectAnswer-A
Ans.A.Myelination
[RefGanong25TH/94,24th/91;Guyton12th/72-7j;A.K'lain5th/147]
Greaterthediameterofagivennervefibre,thegreaterisitsspeed

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(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

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e)Itprovide80%calorieneedofbody
CorrectAnswer-A:B:C:E
Ans.A,Itsupplies4kcalspergramB,Itincreasesinsulin
secretionC,Storedinliver&E,Itprovide80%calorieneedof
body

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[Ref:Harper30th/176;Park23rd/613;LippincottBiochemistry
6th/329:Ganong25TH/24,24th/441;A.KIain5th/622-29]
Carbohydratemetabolism:
After12to18hoursoffasting,liverglycogenisalmosttotally
depleted.

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Theliverservesasreceiving,manufacturing,storing&distributing
centreforglucose.
Liverglycogenisnearlyexhaustedafter10-18houroffasting.
Provides4k/calspergrams(protein-4;fat-9;dietaryfibre-2)
Themainsourceofenergyindietsiscarbohydratesare

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carbohydratesderivedlargelyfromcereals.
Thesecerealsconstituteabout80%ofourdiet&provides50-80%
ofdailyenergyintake.

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19.Calcitriolinchildrenisformedin:
a)Glomerulus

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b)Bowmanncapsule
c)PCT
d)DCT
e)Collectingduct
CorrectAnswer-C

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Ans.(C)PCT
[Ref:Ganong25th/377-78,24th/461Nelson19th/204;A.K.lain
Sth/730:OPGhai8th/112]
Calcitriolisproducedinthecellsoftheproximaltubuleofthe
nephroninthekidneysbytheactionof25-hydroxyvitaminD31-

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alpha-hydroxylase,amitochondrialoxygenaseandanenzyme
whichcatalyzesthehydroxylationof25-hydroxycholecalciferol
(calcifediol).
TheactIVItyoftheenzymeisstimulatedbypTH.
ThereactionisanimportantcontrolpointinCa2+homeostasis.

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20.Whichofthefollowingis/arePainscale:
a)McGillPainQuestionnaire
b)Visualanaloguescale
c)ColouredAnalogueScale
d)Alloftheabove

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e)Noneoftheabove
CorrectAnswer-D
Ans.A,McGillPainQuestionnaireB,Visualanaloguescale&
C,ColouredAnalogueScale
ListofPainMeasurementScales:

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Wong-BakerFACESPainRatingScale
Visualanalogscale(VAS)
McGillPainQuestionnaire(MPQ)
NeckPainandDisabilityScale-NPAD
Lequesnealgofunctionalindex.

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BehavioralPainScale(BPS)
BriefPainInventory(BPI)
ClinicalGlobalImpression(CGI)
Critical-CarePainObservationTool(CPOT)
COMFORTscale

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FacesPainScale-Revised(FPS-R)

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21.Terminalproduct(s)ofphenylalanineis:
a)Fumarate
b)AcetylCoA
c)Oxaloacetate

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d)Acetoacetate
e)None
CorrectAnswer-A:B:D
Ans:a.Fumarate,b.AcetylCoA&d.Acetoacetate
[RefHarper30th/285,304,29th/269,290;Lippincott6th/263,262;

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Satyanarayan3rd/345-47;Vasudevan5th/202-03]
"Thepredominantmetabolismofphenylalanineoccursthrough
tyrosine.Duringthecourseofdegradation,phenylalanine&tyrosine
areconvertedtometabolite,fumarate&acetoacetate,whichcan
serveasprecursorsforthesynthesisofglucose(fumarate-Itisan

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intermediateofthecitricacidcycle&canalsoserveasprecursorfor
gluconeogenesis)&fat(acetoacetate-Itisaketonebodyfromwhich
fatcanbesynthesized)".
Phenylalaninehydroxylaseisanenzymethatcatalyzesthe
hydroxylationofthearomaticside-chainofphenylalanineto

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generatetyrosine.
Phenylalanineisfirstconvertedtotyrosine.Subsequentreactions
arethoseoftyrosine"(Harper30th/304,29th/288)"Hydroxylationof
phenylalanineproducetyrosine.Metabolismofphenylalanine&
tyrosinemerge,leadingultimatelytotheformationoffumarateer

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acetoacetate.phenylalanine&tyrosineare,therefore,both
glucogenicorketogenic.

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22.NADPHisproducedby:
a)Pyruvatedehydrogense
b)Isocitratedehydrogense

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c)a-ketoglutarylDehydrogense
d)SuccinateDehydrogense
e)Malatedehydrogense
CorrectAnswer-A:B:C:E
Ans:a.Pyruvate...,b.Isocitrate....c.a-ketoglutaryl...,&e.

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Malate...,
[RefHarper30th/169,29th/177;Lippincott6th/109-13,155;Shinde
7th/321]
MethodofATP
Pathway Reactioncatalyzedby

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ATP
formation
1.Pyruvate
1.Respiratorychain
5

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dehydrogenase
oxidationof2NADH
2.Isocitrate
2.Respiratorychain
5

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dehydrogenase
oxidationof2NADH
3.a-Ketoglutarate
3.Respiratorychain
Citric

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5
dehydrogenase
oxidationof2NADH
acid
4.Substratelevel

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cycle
4.Succinatethiokinase
2
phosphorylation
5.Succinate

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5.Respiratorychain
3
dehydrogenase
oxidationof2ADH2
6.Malate

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6.Respiratorychain
5
dehydrogenase
oxidationof2NADH

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23.Opticallyinactiveaminoacidis/are:

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a)Threonine
b)Thyronine
c)Valine
d)Glycine
e)Serine

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CorrectAnswer-D
Ans:d.Glycine[RefVasudevan5th/20;Shinde7th/78]
Aminoacidshavinganasymmetriccarbonatomexhibitoptical
activity.Asymmetryariseswhen4differentgroupsareattachedto
thesamecarbonatom

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Glycineisthesimplestaminoacids&hasnoasymmetriccarbon
atom&thereforeshowsnoopticalactivity.Allothersareoptically
active
Themirrorimageformsproducedwithreferencetothealphacarbon
atom,arecalledD&Lisomers

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Isoleucineerthreoninehave2opticallyactivecentres&therefore
eachhas4diastereoisomers

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24.Informing3Dstructureofprotein
followingcomponentshelp:
a)Hydrogenbonds

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b)Aminoacidsequence
c)Interactionbetweenaminoacidsidechains
d)Chaperon
e)allofthese
CorrectAnswer-E

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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

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interactions(electrostaticbonds)&hydrophobicinteractionsalso
contributetothetertiarystructureofprotein.
Theunique3dimensionalstructureofthenativeconformationis
determinedbyitsprimarystructure,thatis,itsaminoacidsequence,
Interactionsb/wtheaminoacidsidechainsguidethefoldingofthe

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polypeptidechaintoformsecondary,tertiary&(sometimes)
quaternarystructures,whichcooperateinstabilizingthenative
conformationoftheprotein.
Inaddition,aspecializedgroupofproteinnamedchaperonesis
requiredfortheproperfoldingofmanyspeciesofproteins.

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25.Testusedforproteinis/are:
a)Westernblot
b)Southernblot
c)ELISA
d)CHIPessay

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e)Dotblotting
CorrectAnswer-A:C:D
Ans:a.Westernblot,c.ELISAd.CHIPessay
[RefHarper30th/457,29th/439;Lippincott6th/484,473,485;
Satyanarayan3rd/589]

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Westernblot-Measuresproteinamount
ELISA-detectsproteins(antigenorantibodies)

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26.FullformofLCATis:
a)Lecithincholesterolacyltransferase
b)Lecithincholineacyltransferase

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c)Lecithincholesterolalkyltransferase
d)Lecithincholinealcoholtransferase
e)LecithinCoAtransferase
CorrectAnswer-A
Ans:a.Lecithincholesterol...[RefHarper30th/272,29th/242,

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256;Lippincott6th/234-36]
PlasmaLCATIsResponsibleforVirtuallyAllPlasmaCholesteryl
EsterinHumans(Harper29th/256).LCATactivityisassociatedwith
HDLcontainingapoA-I.AscholesterolinHDLbecomesesterified,it
createsaconcentrationgradientanddrawsincholesterolfrom

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tissuesandfromotherlipoproteins,thusenablingHDLtofunctionin
reversecholesteroltransport.
Thisprotein,associatedwithHDL,isfoundinplasmaofhumansand
manyotherspecies.Itfacilitatestransferofcholesterylesterfrom
HDLtoVLDL,IDL,andLDLinexchangefortriacylglycerol,relieving

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productinhibitionofLCATactivityinHDL.

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27.Whichvitamindeficiencycausedementia:
a)VitaminA
b)VitaminC
c)VitaminB12

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d)VitaminB1
e)Nicotinicacid
CorrectAnswer-C:D:E
Ans:c.Vitamin...,d.Vitamin...&e.Nicotinic...[RefLippincott
6th/379-80;Harrison19th/463]

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Niacinornicotinicaciddeficiencycausespellagra.Thesymptomof
pellagraprogressthroughthethreeDs:dermatitis,diarrhea
&dementia"
Niacinpellagra:pigmentedrashofsun-exposedareas,brightred
tongue,diarrhea,apathy,memoryloss,disorientation

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FolateMegaloblasticanemia,atrophicglossitis,depression,T
homocysteine
VitaminMegaloblasticanemia,lossofvibratoryandposition
B12sense,abnormalgait,dementia,impotence,lossofbladder
andbowelcontrol,Thomocysteine,Methylmalonicacid

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VitaminCScurvy:petechiae,ecchymosis,coiledhairs,inflamed
andbleedinggums,jointeffusion,poorwoundhealing,fatigue
VitaminAXerophthalmia,nightblindness,Bitot'sspots,follicular
hyperkeratosis,impairedembryonicdevelopment,immune
dysfunction

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---

28.Whichofthefollowingorgancannotuse
ketonebody:
a)Brain
b)RBC
c)Muscle

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d)Heart
e)Liver
CorrectAnswer-A:E
Ans:a.Brain,e.Liver[RefHarper30th/150,211-12,29th/161,
211-12;Lippincott6th/196;Vasudevan5th/1451.

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Ketonebodiescanbeusedbyextrahepatictissuesuchasskeletal&
cardiacmuscle,intestinalmucosa&renalcortex.Eventhebraincan
useketonebodiestohelpmeetitsenergyneedsifthebloodlevels
risesufficiently.
Theketonebodiesareformedintheliver;buttheyareutilizedby

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extrahepatictissues.Theheartmuscle&renalcortexpreferthe
ketonebodiestoglucoseasfuel.Tissuelikeskeletalmuscle&brain
canalsoutilizetheketonebodiesasalternatesourcesofenergy,if
glucoseisnotavailable.

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29.

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Allofthefollowingarepartofinnate
immunityexcept:
a)Complement
b)NKcells
c)Macrophages

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d)Tcells
e)None
CorrectAnswer-D
Ans.(d)TcellsRefHarrison17/e;p2021,2031,18/e,p2651.2668
ComponentsoftheAdaptiveImmuneSystem

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Thymus-derived(T)lymphocytes-Tcellprecursorsin
thethymus;naivematureTlymphocytesbeforeantigen
exposure;memoryTlymphocytesafterantigencontact;
Cellular
helperTlymphocytesforBandTcellresponses;

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cytotoxicTlymphocytesthatkillpathogen-infectedtarget
cells.
Bone-marrow-derived(B)lymphocytes-Bcellprecursors
inbonemarrow;naiveBcellspriortoantigenrecognition;
Humoral

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memoryBcellsafterantigencontact;plasmacellsthat
secretespecificantibody.
Solubleproteinsthatdirectfocusandregulate
Cytokines specificTversusBlymphocyteimmuneresponses.
MajorComponentsoftheInnateImmuneSystem

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Pattern
Ctypelectins,leucine-richproteins,scavenger
recognition
receptors,pentraxins,lipidtransferases;

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receptors(PRR) integrins

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a-Defensins,8-defensins,cathelin,protegrin,
Antimicrobial
granulysin,histatin,secretory
peptides
leukoproteaseinhibitor,andprobiotics

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Macrophages,dendriticcells,NKcells,NK-T
Cells
cells,neutrophils,eosinophils,mastcells,
basophils,andepithelialcells.
ClassicandaltAutocrine,paracrineernative

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Complement
complementpathway,andproteinsthat
components
bindcomplementcomponents
Autocrine,paracrine,endocrinecytokinesthat

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mediatehostdefenceandinflammation,aswellas
Cytokines
recruit,direct,andregulateadaptive
immuneresponses

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30.Whichofthefollowingdiseaseoccursdue

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toDNAmoleculerepairdefect:
a)Krabe'sdisease
b)Angelmannsyndrome
c)Xerodermapigmentosum
d)Marfansyndrome

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e)Ataxiatelangiectasia
CorrectAnswer-C:E
Ans:c.Xeroderma...,e.Ataxia...[RefHarper30th/390,29th/374,
28th/330-333;Lippincott6th/410-13;Harrison18th/496,
17th/395]

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Angelmannsyndromeresultsfromgeneticdisorderthatresultsfrom
defectingenethatencodesubiquitin";"Marfansyndrome:Itis
causedbymutationingeneforfibrillin";"Krabbedisease:dueto13
?galactosidaseenzymedeficiency.
XerodermaPigmentosum(XP):Anautosomalrecessivegenetic

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disease;morethan10genesareinvolved;Theclinical
syndromeincludesmarkedsensitivitytosunlight(ultraviolet)with
subsequentformationofmultipleskincancersandpremature
death,Theriskofdevelopingskincancerisincreased1000-to
2000-fold.

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31.cDNAisusedingeneamplificationin
bacteriainsteadofgenomicDNA
because:
a)Easytoreplicatebecauseofsmallsize
b)cDNAlacksintronwhereasthisispresentingenomicDNA

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c)Promotorarenotfoundinbacteria
d)Completegenomecannoteasilyreplicatedinbacteria
e)None
CorrectAnswer-A:B:D
Ans:a.Easy...,b.cDNA...&d.Complete[RefHarper30th/455-

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56,29th/438-39;Lippincott6th/469-70;Vasudevan5th/449]
BecausecDNAhasnointervening,itcanbeclonedintoan
expressionvectorforthesynthesisofeukaryoticproteinsby
bacteria";"cDNAlacksintrons&thecontrolregionsofthegene,
whereasthesearepresentingenomicDNA"(Lippincott6th/469)

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"Bacterialpromotersarerelativelysimple.
cDNAlibrariescontainthoseDNAsequencesthatonlyappearas
processedmessengerRNAmolecules&thesedifferfromonecell
typetoanother.AcDNAlibrarycomprisescomplementaryDNA
copiesofthepopulationofmRNAsinatissue.

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cDNAprobesareusedtodetectDNAfragmentsonSouthernblot
transfersandtodetectandquantitateRNAonNorthernblot
transfers

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32.FunctionofmiRNAis/are:
a)Genesilencing

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b)Geneactivation
c)Transcriptioninhibition
d)Translationrepression
e)BreakingofmessengerRNA
CorrectAnswer-A:D:E

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Ans:a.Gene...,d.Translation...&e.Breaking...[RefHarper
30th/368,29th/351-52;Lippincott6th/459;Vasudevan5th/436]
RNAinterferenceisamechanismofgenesilencingthrough
decreasedexpressionofmRNA,eitherbyrepressionoftranslation
orbyincreaseddegradation.

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miRNAbindtomatchingpiecesofmessengerRNA,turnitintoa
doublestrand&keepitfromdoingitsjob.Theprocesseffectively
blockstheproductionofcorrespondingprotein.
miRNAsaretypically21-25nucleotidesinlengthandaregenerated
bynucleolyticprocessingoftheproductsofdistinct

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genes/transcriptionunits.miRNAprecursorsaresinglestrandedbut
haveextensiveintramolecularsecondarystructure.

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33.WhichofthefollowingisCD15&CD30
positive:
a)LymphocytepredominanceHodgkin'slymphoma

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b)Mantlecelllymphoma
c)Burkit'slymphoma
d)MixedcellularityHodgkin'slymphoma
e)DiffuselargeBcelllymphoma
CorrectAnswer-D

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Answer-D.MixedcellularityHodgkin'slymphoma
CD15-
Granulocytes;alsoexpressedbyReed-Sternbergcellsandvariants
inclassicalHodgkinlymphoma
CD30-

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ActivatedBcells,Tcells,andmonocytes;alsoexpressedbyReed-
SternbergcellsandvariantsinclassicalHodgkinlymphoma.

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34.Bcellantigensare:
a)CD1
b)CD2

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c)CD3
d)CD19
e)CD20
CorrectAnswer-D:E
Answer-(D)CD19(E)CD20

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CD1-CorticalthymocytesandLangerhanshistiocytes
CD3-Thymocytes,peripheralTcells
CD19-Marrowpre-BcellsandmatureBcellsbutnotplasmacells
CD20-Marrowpre-BcellsafterCD19andmatureBcellsbutnot
plasmacells

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35.Trueaboutprotooncogene:
a)Onlyfoundinvirus
b)Onlyfoundinmalignantcell
c)Normallyinvolvedincellcycleproliferation
d)Canbeconvertedtooncogene

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e)Onmutationitcausescancer
CorrectAnswer-C:D:E
Answer-(C)Normallyinvolvedincellcycleproliferation(D)Can
beconvertedtooncogene(E)Onmutationitcausescancer
Genesthatpromoteautonomouscellgrowthincancercellsare

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calledoncogenes,andtheirnormalcellularcounterpartsarecalled
protooncogenes.
Proteinsencodedbyprotooncogenesmayfunctionasgrowthfactor
malignantsandreceptors,signaltransducers,transcriptionfactors,
andcell-cyclecomponents.

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36.Thrombosisispredisposedby:
a)ProteinSdeficiency
b)Complementdeficiency
c)Antiphospholipidantibodysyndrome
d)Homocysteinuria

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e)All
CorrectAnswer-A:C:D
Answer-(A)ProteinSdeficiency(C)Antiphospholipidantibody
syndrome(D)Homocysteinuria
Hypercoagulablestates-

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Primary(Genetic)-
ProteinCdeficiency
ProteinSdeficiency
Homozygoushomocystinuria
Secondary(acquired)-

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MI
Atrialfibrillation
Prostheticcardiacvalves
DIC
Thrombocytopenia

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37.Pancytopeniacanoccurin:
a)CML
b)Kala-azar
c)Typhoid
d)Hairycellleukemia

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e)None
CorrectAnswer-B:D
Answer-(B)Kala-azar(D)Hairycellleukemia
Primarybonemarrowdiseases-
Myelodysplasia

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Paroxysmalnocturnalhemoglobinuria
Myelofibrosis
BonemarrowlymphomaHairycellleukemia
Sarcoidosis
Tuberculosis

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Leishmaniasis

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38.Non-smallcelllungcarcinomais/are
associated:
a)K-ras
b)EGFR

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c)WT1
d)P53
e)All
CorrectAnswer-A:B:D
Answer-(A)K-ras(B)EGFR(D)P53

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K-RASmutationsareseenprimarilyinadenocarcinoma.
p53andRBtumorsuppressorgenesarefrequentlymutated-
Squamouscellcarcinomas
EGFR-Adenocarcinoma

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39.Trueaboutcarotidbodytumor:

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a)Slowgrowingtumour
b)Uncapsulated
c)MostlyBilateral
d)Mostlybenign
e)All

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CorrectAnswer-A:D
Answer-(A)Slowgrowingtumour(D)Mostlybenign
Raretumouroccurb/w3rd&6thdecadeoflifewithslightfemale
preponderance
Afewarebilateral&someshowfamilialincidence

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Grosslytheyaresmall,firm,darktan,encapsulatednodules
Tumoursareusuallybenignwithonlyasmallnumberofcases
producingprovenmetastases.
Thereisoftenalonghistoryofaslowlyenlarging,painlesslumpat
thecarotidbifurcation.

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40.Whichofthefollowingis/aretrueabout
autosomaldominantpolycystickidney
diseaseexcept:
a)Manypatientsmaybeasymptomatictill3rdor4thdecade
b)Pancreaticcyst

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c)Associatedwithhypertension
d)Subarachnoidhaemorrhageismostcommonextrarenal
complication
e)None
CorrectAnswer-D

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Answer-D.Subarachnoidhaemorrhageismostcommonextra
renalcomplication
ADPKDischaracterizedbytheprogressivebilateralformationof
renalcrisis.
Inheritance-autosomaldominant

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Characterizedbymultipleexpandingcystsofbothkidneys.
Ingrossappearance,thekidneysarebilaterallyenlarged.
Thepainmayresultfromrenalcystinfection,haemorrhage,or
nephrolithiasis.
'Intravenousurographypolycystickidneydisease:Thespiderlegs,

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deformityofthecalyces
Focalrenalcystsaretypicallydetectedinaffectedsubjectsbefore
30yearsofage.
Complications-
Hematuria,flankpain,urinarytractinfection,renalstones,

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hypertension

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---

41.Whichofthefollowingisnotafeatureof
reversiblecellinjury?
a)Diminishedgenerationofadenosinetriphosphate(ATP)
b)Formationofamorphousdensitiesinthemitochondrialmatrix

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c)Formationofblebsintheplasmamembrane
d)Detachmentofribosomesfromthegranularendoplasmic
reticulum
e)Creationofmyelinfigures
CorrectAnswer-B

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Answer-B.Formationofamorphousdensitiesinthe
mitochondrialmatrix
Largeflocculent,amorphousdensitiesinthemitochondrialmatrix
occurasaresultofirreversiblecelldamage.
Membranedamageplaysacentralroleinthepathogenesisof

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irreversiblecellinjury.
Itismorphologicallyassociatedwithsevereswellingofthe
mitochondria,damageofplasmamembranesandswellingof
lysosomes.

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42.Redinfarctoccurin:

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a)Intissueswithdualcirculations
b)Occuronlywhenbotharterial&venousobstructionoccurs
simultaneously
c)Organswhicharepreviouslycongested
d)Organswithloosetissue

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e)All
CorrectAnswer-A:C:D
Answer-(A)Intissueswithdualcirculations(C)Organswhich
arepreviouslycongested(D)Organswithloosetissue
Redinfarcts(Haemorrhagic):occurwith:

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Venousocclusions(egovariantorsion);
Inloosetissues(suchaslungs);
Intissueswithdualcirculation(e.g.Lung&S.intestine)
Intissuesthatwerepreviouslycongestedbecauseofsluggish
venousoutflow.

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Whenflowisreestablilshedtoasiteofpreviousarterialocculusion
andnecrosis.

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43.Trueaboutfibrolamellarcarcinomaof
liver:
a)Betterprognosisthantypicalhepatocellularcarcinoma

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b)Associatedwithcirrhosis
c)AFP-positive
d)Occurinyoungeradults
e)Morecommoninfemales
CorrectAnswer-A:D:E

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Answer-(A)Betterprognosisthantypicalhepatocellular
carcinoma(D)Occurinyoungeradults(E)orecommonin
females
Itisadistinctivevariantofhepatocellularcarcinoma
Itisseeninyoungadults(20-40yrsofage)

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Ithasequalsexincidence
Ithasbetterprognosis
IthasnoassociationwithHBVorcirrhosis
Itisgrosslyencapsulatedmass.
AFPelevationisnotseeninFibrolamellarCa

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---

44.Whichofthefollowingis/aretrueabout
Prothrombintime:
a)Assessextrinsicpathways
b)TinLiverdisease
c)LinVit.Kdeficiency

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d)Normalvalueis2-4minute
e)None
CorrectAnswer-A:B
Answer-(A)Assessextrinsicpathways(B)TinLiverdisease
Prothrombiatimeassayassessesthefunctionoftheproteinsinthe

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extrinsicpathways.
Normalvalue-10to14sec
Evaluationofextrinsic&commonpathway.
Increasedinoralanticoagulationtherapy,DICandliverdisease,
VitaminKdeficiency.

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---

45.TrueaboutThromboticthrombocytopenic
purpura:
a)Indirecthyperbilirubemia
b)Spherocytosiswiththrombocytopenia
c)Scistocytosiswiththrombocytopenia

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d)Thrombiformation
e)All
CorrectAnswer-A:C:D
Answer-(A)Indirecthyperbilirubemia(C)Scistocytosiswith
thrombocytopenia(D)Thrombiformation

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Itischaracterizedbyapentad-
Micromgiopathichemolyticanemia,thrombcytopenia,renalfailure,
neurologicfindings,andfever.
TTPdiagnosisincludeanincreasedlactatedehydrogenaseand
indirectbilirubin,decreasedhaptoglobin,andincreasedreticulocyte

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count.
Theperipheralsmearshouldbeexaminedforevidenceof
schistocytes.

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46.Inwhichofthefollowingdiseases
antineutrophilcytoplasmic

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antibodies(ANCA)arenotfound:
a)Polyarteritisnodosa
b)Microscopicpolyangitis
c)Wegenergranulomatosis
d)Bechetsyndrome

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e)Churg-Strausssyndrome
CorrectAnswer-A:D
Answer-(A)Polyarteritisnodosa(D)Bechetsyndrome
ANCApositive
Wegner'sgranulomatosis

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Microscopicpolyarteritis
Churg'strausssyndrome
Renal-limitedvaculitis
(crescentricglomerulonephritis)

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47.Anti-nuclearantibodiesarenotfoundin:

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a)SLE
b)DiffuseScleroderma
c)Druginducedlupus
d)Limitedsceleroderma
e)Sarcoidosis

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CorrectAnswer-E
Answer-(E)Sarcoidosis
Foundin-
Druginducedlupus
Sjogren'ssyndrome

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Scleroderma
Polymyositis
Dermatomyositis
Arthritis

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48.at30yrofage,bloodformingbone

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marrowarefoundin
a)Sternum
b)Sacrum
c)Pelvis
d)Upperendtibia

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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

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proximalepiphysealregionsofthehumerusandfemur.

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49.Pericardialeffusionis/areseeninall
except:
a)Uraemia
b)SLE

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c)Rheumaticfever
d)Myxedema
e)Hyperthyroidism
CorrectAnswer-E
Answer-(E)Hyperthyroidism

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Infectious
Viral
Bacterial
Fungal
Parasite

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Rickettsia
Postinjury
Trauma
Surgery
Myocardialinfarction

--- Content provided by FirstRanker.com ---

Radiation
Metabolicdiseases
Uremia
Medications
Systemicdiseases

--- Content provided by FirstRanker.com ---

Rheumatoidarthritis
Systemiclupuserythematosus

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Sarcoidosis
Scleroderma
Dermatomyositis

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AmyloidosisTumors
Aorticdissection

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50.Epidermalgrowthfactoris/areformedby:
a)Platelet
b)Fibroblast

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c)Mastcell
d)Endothelialcell
e)Keratinocyte
CorrectAnswer-A:E
Answer-(A)Platelet(E)Keratinocyte

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Inhealingwoundsoftheskin,EGFisproducedbykeratinocytes,
macrophages,andotherinflammatorycellsthatmigrateintothe
area.

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51.Cyclindependentkinase-2(CDK-2)acts
via:

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a)CyclinA
b)CyclinB
c)CyclinC
d)CyclinD
e)CyclinE

--- Content provided by FirstRanker.com ---

CorrectAnswer-A:E
Answer-(A)CyclinA(E)CyclinE
FormsacomplexwithcyclinEinlateG1,whichisinvolvedinthe
G1/Stransition.
FormsacomplexwithcyclinAattheSphasethatfacilitatesthe

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G2/Mtransition.

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52.WhichofthefollowingpairofGreceptor
iscorrectlymatchedwithitsaction:
a)Gi-Activationofcalciumchannel
b)Gq-Tcytoplasmiccalcium

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c)Gs-Openingofcalciumchannel
d)Go-Openingofpotassiumchannel
e)Gt-Activationofpotassiumchannel
CorrectAnswer-B:C:D
Ans.B,Gq-TcytoplasmiccalciumC,Gs-Openingofcalcium

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channel&D,Go-Openingofpotassiumchannel
[RefKDT7th/a5-49;Katzung31]
GsopenCa2+channelsinmyocardium6skeletalmuscle,whileGi
&GoopenK+channelinheart&smoothmuscleasweIIasinhibit
neuronalCa2+channel

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GReceptor:
Gs:Adenylylcyclaseactivation,Ca2+channelopening
Gi:Adenylylcyclaseinhibition,K+channelopening
Go:Ca2+channelinhibition.
Gq:PhospholipaseCactivation

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53.Mineralocorticoidreceptorsantagonist(s)
is/are:
a)Spironolactone
b)Triamterene
c)Epleroenone

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d)Amiloride
e)Acetazolamide
CorrectAnswer-A:C
Ans.(A)Spironolactone&(C)Epleroenone
[RefKDT.Tth/578;Katzung12th/261-62]

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PotassiumSparingDiuretics
Aldosteroneantagonists:Spironolactone,eplerenone
InhibitorsofrenalepithelialNa+channel:Triamterene,Amiloride
MOA:
Actbydirectpharmacologicantagonismofmineralocorticoid

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receptors(spironolactone,eplerenone)orbyinhibitionofNatinflux
throughionchannelsintheluminalmembrane(amiloride,
triamterene).

---

54.Allofthefollowingareactionsof
muscarinicantogonists,except:

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a)Decreasegastricsecretions
b)Decreaserespiratorysecretions
c)Contractradialmusclesofiris
d)FascilitatesAVconduction
e)None

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CorrectAnswer-C
Ansis'c'i.e.Contractradialmusclesofiris
Radialmusclesareinnervatedbysympatheticsystemsnotby
parasympathetic(muscarinic)system
Irismusclesthatcontrolthesizeofpupil

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Therearetwotypesofmusclesiniristhatcontrolthesizeof
pupil:
1. Theirissphincterorconstrictorpupillae(circularmuscles):These
musclesareinnervatedbytheparasympatheticsystemandcause
constrictionofpupil(miosis).

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2. Theirisdilatorordilatorpupillae(radialmuscles):Thesemuscles
areinnervatedbysympathetic(a,adrenergic)systemandcause
dilatationofpupil(mydriasis)
So,pupilsizemaybealteredbyfollowingmechanismsbydifferent
ANSdrugs:

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A.Mydriasis(dilatationofpupil)
Sympathomimeticdrugs(a,agonists):Bycontractionofradial
muscles(dilator).
Antimuscarinicdrugs:Byblockingtheactionofcircularmuscles

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(pupillarysphincter).

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B.Miosis(constrictionofpupil)
1. Parasympathomimetic(muscarinic)drgus:Bystimulatingthe
contractionofcircularmuscles(pupillarysphincter).
2. Sympatholyticdrugs(a,antagonists):Byblockingtheactionofradial
muscles(irisdilator)Aboutotheroptions

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Muscarinicantagonists(antimuscarinicdrugs)decreasebothgastric
andrespiratory(bronchial)secretionsoAntimuscarinicdrugs
facilitateAVconduction(seepreviousexplanations).

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55.UnwantedinteractionsofMAOinhibitors
occurwith:

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a)Levodopa
b)Hydrochlorothiazide
c)Reserpine
d)Pethidine
e)None

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CorrectAnswer-A:C:D
Ans.A,LevodopaC,Reserpine&D,Pethidine
NonSelectiveMAOInhibitors:Interactions:
Cheesereaction-
Varietiesofcheese,beer,wine,pickledmeat&fish,yeastextract

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containlargequantitiesoftyramine,dopaetc.
InMAOinhibitedpatientscausehypertensivecrisis&
cerebrovascularaccidents.
Cold&coughremedies-Ephedrine.
Reserpine,guanethidine,tricyclicantidepressants

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Levodopa:
Excitement&hypertension.
Antiparkinsoniananticholinergics:
Hallucinations&symptomssimilartothoseofatropinepoisoning
Barbiturates,alcohol,opioids,antihistamines:

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Actionsofthesedrugisintensified&prolonged.Respirationmay
fail..
Pethidine:
Highfever,sweating,excitation,delirium,convulsions&severe

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respiratorydepression.

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Note:
HydrochlorothiazidedruginteractionsnotincludeMAO-Inhibitors

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56.Whichofthefollowingis/aretrueabout
Sulfonylureaexcept:
a)Increaseinsulinsecretion

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b)Causehypoglycemia
c)Causeweightloss
d)Disulfiram-likereactionafteralcoholintake
e)Safeinpregnancy
CorrectAnswer-C:E

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Ans.C,Causeweightloss&E,Safeinpregnancy
[RefKDT7th/270-73;Katzung12th/754-5]
Sulfonylureas:
Provokeabriskreleaseofinsulinfrompancreas.
Hypoglycemiaisthemostcommonproblem.

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MajorityofdiabeticsstartedonSUstendtogain1-3kg.
Flushing&disulfiram-likereactionafteralcoholoccurinsome
individualstakingSUs
Safetyduringpregnancyisnotestablished.

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57.Weightgainisnotseenwith:

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a)Clozapine
b)Risperidone
c)Olanzapine
d)SSRI
e)Zotepine

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CorrectAnswer-D
Ans.(D)SSRI
[RefKDT7th/aal,442;Katzung12d/512,509]
ClozapineMetaboliccomplications(Major)-Weightgain,
hyperlipidemia&precipitationofdiabetes.

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Olanzapinecausesweightgain.
Risperidonecausesweightgain&incidenceofnewonsetdiabetes
islessthanwithclompine
increasedappetite&weightgainisnoteilwithmostTCAs&
trazodone,butnotwithSSRIs,SNRIs&bupropion.

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Zotepine:Weightgain,hyperglycemia&dyslipidemiaareLikelyas
withclozapine
Quetiapine:Weightgain&riseinbloodsugarismoderate.
Aripiprazole:Littletendencytoweightgain.

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58.Whichofthefollowingis/aretrueabout

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dobutamine:
a)Selective(32receptoragonist
b)Tventricularfillingpressure
c)Halflifeisabout2min
d)Dopaminereceptoragonist

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e)None
CorrectAnswer-C
Ans.(C)Halflifeisabout2min
[R4KDf7th/134;Katzung12th/141-42,218,225;Goodman&
Gilman11th/251]

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Dobutamine:
Derivativeofdopamine,butnotaDlotD2receptoragonist.
Hasactiononalpha&betareceptorsalso.
Yet,onlyprominentactionofclinicallyemployeddosesisincreased
forceofcardiaccontraction&outPut,withoutsignificantchangein

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heartrate,peripheralresistance&BP.
Consideredtobearelativelyselectivebeta-1agonist.
Half-lifeofabout2minutes&onsetofactionisrapid.
UsedasaninotroPicagentinpumpfailureaccompanying
myocardialinfarction,cardiacsurgery&forshorttermmanagement

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ofseverecongestiveheartfailure.

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59.Apersonhasgiven0.175gmoraldigoxin
withbioavailabilty70%.Theamountof
drugreachinginsystemiccirculationis:
a)0.175

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b)0.175x0.7
c)0.175/7
d)0.175+0.7
e)0.175+1/0.7
CorrectAnswer-B

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Ans.(B)0.175x0.7
[RdKDT7th/16,515;Katzungt2th/43]
Amountofdrugreachinginsystemiccirculation=drugdosegivenx
bioavailability
=0.175gmx70/100

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=0.175gmx0.7

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60.TrueaboutPlacebo:
a)Itworksonlyinpsychiatricperson
b)Responseisbothobjective&subjective
c)Effectalsoseeninnormalperson

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d)Itisaninertsubstance
e)None
CorrectAnswer-B:C:D
Ans.B,Responseisbothobjective&subjectiveC,Effectalso
seeninnormalperson&D,Itisaninertsubstance

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[RefKDT7th/67;Katzung12th/72]
Placebo:
Aninertsubstancewhichisgiveninthegarbofamedicine.
Workbypsychodynamicratherthanpharmacodynamicmeans&
oftenproducesresponsesequivalenttotheactivedrug

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Placebodoinducesphysiologicalresponses,e.g.,theycanrelease
endorphinsinbrain-causinganalgesia.
Substancescommonlyusedasplaceboarelactosetablets/capsules
&distilledwaterinjection.
Themanifestationofthisphenomenoninthesubjectistheplacebo

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response(Latin,'Ishallplease')andmayinvolveobjective
physiologicandbiochemicalchangaaswellaschangesin
subjectivecomplaintsassociatedwiththedisease

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61.Treatmentofnocardiainfectionincludes:
a)Ampicillin

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b)Floroquinolones
c)Azithromycin
d)Cotrimoxazole
e)Amikacin
CorrectAnswer-A:B:D:E

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Ans.A,AmpicillinB,FloroquinolonesD,Cotrimoxazole&
E,Amikacin
[RefKDf7th/706,755;Hanisonlgth/1087]
Nocardiosis:
SulfonamidesareofvalueintreatinginfectionsduetoNocardiagrp.

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Sulfisoxazoleorsulfadiazinemaybegivenindosagaof6-8gdaily
andiscontinuedforseveralmonthsafteraIImanifestationshave
resolved.
administrationofasulfonamidewith2ndgen.antibiotic(ampicillin,
erythromycin,ardstreptomycin)advised.

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CoTrimoxazoleisusedinnocardiosis.

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62.Trueaboutmorphine:
a)ActasantagonistonIAreceptorwithnoagonistaction
b)Activationinliver
c)Halflife4hr

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d)Causemiosis
e)Clearancetimeisaround20hr
CorrectAnswer-B:D:E
Ans.(B)Activationinliver(D)Causemiosis(E)Clearancetime
isaround20hr

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[Ref:KDT7th/469-75;Katzung13th/531-44;Goodman&Gilman
p62-66]
Morphine:
Primarilymetabolizedinliverbyglucuronideconjugation.
Morphine-6-glucuronideisanactivemetabolite(morepotentthan

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morphineonpopioidrecePtors),whichcontributetoanalgesia.
AnothermetabolitemorPhine-3-glucuronidehasneuroexcitatory
proPerty.
Plasmahalflifemorphineaverages2-3hours
Effectofaparenteraldoselasts4-6hours.

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EliminationisalmostcomPletein24hours.
MorphinestimulateEdingerWestphalnucleusof3rdnerveis
stimulatedproducingmiosis.
NomeiosisoccurontopicalaPPlicationofmorPhinetotheeye,
sincethisisacentralaction

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---

63.Whichofthefollowingis/aretrueabout
phenytoin-
a)InactivationbyLiverenzyme
b)CausesVitB12deficiency
c)Causesthiaminedeficiency

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d)Gumhypertrophyiscommonestside-effect
e)InhibitorofCYP3A4/5
CorrectAnswer-A:D
Ans.(A)InactivationbyLiverenzyme(D)Gumhypertrophyis
commonestside-effect

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[Ref:KDT7th/a13-15;Katzung13th/2100-N2;AtoZDrugFacts
2003byDaildS.Tatro;Goodman6Gilman11th/335;Hanison
l9ttt/2554'18th/893,888]
Phenytoin:
MetabolizedinliverbyhydroxylationinvolvingCYP2C9&2C19as

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wellasbyglucuronideconjugation.
Megaloblasticanaemia:ltdecreasedfolateabsorption&increaseits
excretion.
ItinterfereswithmetabolicactivationofVitD&withcalcium
absorPtion/metabolism.

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Gumhypertrophy:commonest(20%incidence)
PotentinducerofCYP2C8/9,CYP3A4/5&someotherCYPs.
ItcompetitivelyinhibitsCYP2C9/19

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64.DrugsactiveagainstMRSA:
a)Vancomycin

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b)Ceftriaxone
c)Linezolid
d)Piperacillin-tazobactam
e)Meropenam
CorrectAnswer-A:C

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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

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choiceforthetreatmentofMRSAinfections.
Imipenema,Dalfopristino/Quinpristin,Mupirocin,Teicoplaninaare
alsoeffectiveagainstMRSA
Ceftarolineisa5thgen.cephalosporinwithbactericidalactivity
againstMRSA(includingstrainswithreducedsusceptibilityto

--- Content provided by FirstRanker.com ---

vancomycinanddaptomycin)-Approvedforuseinnosocomial
pneumoniasandforskinandsofttissueinfections.
Otherdrugsare-Linezolid,daptomycin,Quinupristin/dalfopristin.

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65.Trueaboutdaptomycin:
a)Causesdiarrheaasside-effect

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b)Itisaglycopeptideantibiotic
c)Causemyopathy
d)Itcanbeusedorally
e)Excretionthroughkidney
CorrectAnswer-C:D

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Ans.(C)Causemyopathy(D)Itcanbeusedorally
[RefKatzung13th/783-85;Goodman&Gilman11th/1197-98:
Harrison19th/961]
Daptomycin:
CycliclipopeptidefermentationproductofStreptomyces

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roseosPorus.
Newly-approvedantibacterialagent,thefirstlipopeptideagenttobe
releasedontothemarket.
ItsspectrumofactivityislimitedtoGram-positiveorganisms,
includinganumberofhighlyresistantspecies(MRSA,VISA,VRSA,

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VRE)
MOA:
Precisemechanismofactionisnotknown,butifappearstobindto
anddepolarizethecellmembrane,causingPotassiumeffluxand
rapidcelldeath.

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Features:
Onlyadministeredintravenously.
Clearedrenally.
Approximately80%oftheadministereddoseisrecoveredinurine.
Cancausemyopathy,andcreatinephosphokinaselevelsshouldbe

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monitored.

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66.Trueaboutdoxorubicin:
a)Antineoplasticdrug
b)Alkylatingagent
c)TopoisomeraseIIIinhibitor

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d)Anthracyclineantibiotic
e)Cardiotoxic
CorrectAnswer-A:D:E
Ans.(A)Antineoplasticdrug(D)Anthracyclineantibiotic
(E)Cardiotoxic

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[RefKDT7th/867;Katzung13th/934-35]
Doxorubicin:
Anthracyclineantibiotichavingantitumoractivity
Itintercalateb/wDNAstrands&blockDNAaswellasRNA
synthesis.

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TheyarealsocapableofcausingbreaksinDNAstrandsby
activatingtopoisomerase-2&generatingquininetypefreeradicals.
Cardiotoxicadverseeffect.

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67.TNF-ainhibitorsare:
a)Bevacizumab

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b)Ranibizumab
c)Adalimumab
d)Infliximab
e)Etanercept
CorrectAnswer-A:B:D

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Ans.(A)Bevacizumab(B)Ranibizumab(D)Infliximab
TNFalpha-inhibitor:Etanercept,infliximab,certolizumah,
golimumab,&Adalimumab.
MOA:
BindsTNF-alpha,aproinflammatorycytokine.

--- Content provided by FirstRanker.com ---

BlockingTNF-alphafrombindingtoTNFreceptorsoninflammatory
cellsurfacesresultsinsuppressionofdownstreaminflammatory
cytokinessuchasIL-1&IL-6andadhesionmoleculesinvolvedin
leukocyteactivationandmigration.
Anincreasedriskoflymphomaiscommontoeachoftheseagents.

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68.Whichofthefollowingisacommonside-
effectofCisplatin-
a)Diarrhea
b)Vomiting
c)Pulmonaryfibrosis

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d)Alopecia
e)None
CorrectAnswer-B
Ans.is'b'i.e.,Vomiting
Mostcommonside-effectofCisplatinis:Vomiting(highlyemetic

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drug).
Themostimportantdosedependenttoxicityisrenalimpairment.
Amifostineislabelledforreductionofcisplatininduced
nephrotoxicity.
Tinnitus,deafness,sensoryneuropathy&hlperuricaemiaareother

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problems.
Shocklikestatesometimesoccurduringi.vinfusion.

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69.WhichofthefollowingCLASPhuman
experiment:
a)MaincenterfortheexperimentwasGeneva

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b)MaincenterfortheexperimentwasTokoyo
c)MaincenterfortheexperimentwasinUnitedkingdom
d)Heparinlowdosegiven
e)Drugusedinexperimentsignificantlyreduceseclampsiain
subjects

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CorrectAnswer-C
Ans.C.MaincenterfortheexperimentwasinUnitedkingdom
[Ref;http:/www.researchgate.net;
httP://www.ncbi.nlm,nih.gov/pubmed/7905809]
CLASPhumanexperiment:

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Correspondenceto:CLASPCo-ordinatingCentre,Harkness
Building,RadcliffeInfirmary,OxfordOX26HE,UK-http://
www,researchgate.net
CLASP
Theimpactofaspirinonproteinuricpreeclampsiaanditsfetal

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sequelaeinCLASPwascertainlysmallerthaninsomeprevious
reviews.
Theresultsofavailabletrialsdonotsupportthewidespreadroutine
prophylacticortherapeuticuseofantiplatelettherapyinpregnancy
amongallwomenjudgedtobeatriskofpre-eclampsiaorIUGR.

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Overall,theuseofaspirinwasassociatedwithareductionofonly
12%intheincidenceofproteinuriapre-eclampsia,whichwasnot
significant.

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NorwasthereanysignificanteffectontheincidenceofIUGRorof
stillbirthandneonataldeath.

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70.Duringseparation,sexualintercourse
betweenhusband&wife:
a)Non-bailableoffence
b)Onlyacrimeifcomplainedbyvictim
c)ItisdefinedunderIPC376C

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d)Minimumpunishmentof2year
e)Minimumpunishmentof5year
CorrectAnswer-B:D
Ans:b.Only...,d.Minimum...[RefReddy33rd/412;http:
llindianlawcases.com/Act-Indian.Penal.Code,1860-1835]

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Section376B,I.P.C:Whoeverhassexualintercoursewithhisown
wife,whoislivingseparately,whetherunderadecreeofseparation
orotherwise,withoutherconsent,shallbepunishedwith
imprisonmentofeitherdescriptionforatermwhichshallnotbeless
thantwoyearsbutwhichmayextendtosevenyears&shallalsobe

--- Content provided by FirstRanker.com ---

liabletofine.
Section376C,I.P.C:Whoever,beingthesuperintendentor
managerofajail,remandhomeorotherplaceofcustody
establishedbyorunderanylawforthetimebeinginforceorofa
woman'sorchildren'sinstitutiontakesadvantageofhisofficial

--- Content provided by FirstRanker.com ---

positionandinducesorseducesanyfemaleinmateofsuchjail,
remandhome,placeorinstitutiontohavesexualintercoursewith
him,suchsexualintercoursenotamountingtotheoffenceofrape,
shallbepunishedwithimprisonmentofeitherdescriptionforaterm
whichmayextendtofiveyearsandshallalsobeliabletofine.

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71.Trueabouteuthanasiaareall,
except:
PGI14
a)PassiveeuthanasiaislegalinIndia
b)ActiveeuthanasiaisallowedintheUK

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c)PhysicianassistedsuicideislegalinsomeStatesoftheUS
d)ActiveeuthanasiaislegalinNetherlandsandBelgium
e)None
CorrectAnswer-B
Ans.(B)ActiveeuthanasiaisallowedintheUK

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72.Earlyonsetrigormortisis/areseenin:
a)TB
b)Cholera
c)Asphyxia
d)Arseni

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e)Aconite
CorrectAnswer-A:B
Ans:a.TB,b.Cholera
[RefReddy33rd/162;Parikh6th/3.171
Theonsetofrigorisearly&durationisshortindeathsfrom

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diseasescausinggreatexhaustion&wastinge.g.,cholera,typhoid,
tuberculosis,canceretc&inviolentdeathasbycut-throat,firearms,
electrocution,lightening&instrychninepoisoning
Inorganophosphatepoisoningrigidityappearsearly,COpoisoning
delaysdisappearance

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Theonsetisdelayedindeathsfromasphyxia,severehaemorrhage,
apoplexy,pneumonia&nervousdiseasecausingparalysisof
muscle
IndeathduetopoisoningfromHCN&strychnine,itstartsearly&
persistslonger

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Arsenicdelaysputrefaction"-Reddy33rd/541
"RigormortislastslongerthanusualinArsenicpoisoning,Aconiteis
extremelyunstable&isdestroyedbyputrefaction

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73.Trueaboutorganophosphoruspoisoning:
a)Atropineisbestforearlytreatment&maintenance

--- Content provided by FirstRanker.com ---

b)Pralidoximeisimportantforrestoringneuromuscular
transmission
c)Phenytoinistheprimarydrugusedforseizurecontrol
d)Mydriasispresent
e)Pralidoxime&atropineworkssynergistically

--- Content provided by FirstRanker.com ---

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;

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PharmacologybySatoskar24th/297]
OrganophosPhorusPoisoning:
AIIcaseofAnti-ChEpoisoningmustbepromptlygivenatropine2
mgi.Vrepeatedevery10mintilldryness&othersignsof
atropinizationappear.

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Continuedtreatmentwithmaintenancedosesmayberequiredfor1-
2weeks
Theuseofoximesinorganophosphatepoisoningissecondaryto
thatofatropine.Moreventheclinicalbenefitofoximesishighly
variable.

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Controlofconvulsionswithjudicioususeofdiazepam.
Ocularmanifestationsincludemarkedmiosis'ocularpain'
conjunctivalcongestion,diminishedvision,ciliaryspasm,Andbrow
ache.
Atropineinsufficientdosageeffectivelyantagonizestheactionsat

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---

muscarinicreceptorsites,andtoamoderateextentatperipheral
ganglionicandcentralsites

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74.Pinpointpupilnotseenin:
a)Aconite
b)Opium

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c)Alcohol
d)Cannabis
e)Organophosphorus
CorrectAnswer-A:C:D
Ans:a.Aconite,c.Alcohol&d.Cannabis

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[RefReddy33rd/6191]
Aconite:Thepupilsalternatelycontract&dilate(hippus),butremain
dilatedinlaterstages.Acutealcoholpoisoning:pupildilated&
reacting"
Opiumpoisoning:Thepupilsarecontractedtopinpointsize&do

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notreacttolightbutdilateduringtheagonalasphyxiaphasecaused
byrespiratorydepression&ultimateparalysis.
Phenothiazines,Resting(deepsleep),Opiates,Narcotics,Stroke
(pontinehemorrhage),Lomotil(diphenoxylate),Insecticides,
Mushrooms/Muscarinic(inocybe,clitocybe)

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---

75.Whichofthefollowingisnotniacin
positive:
a)Mycobacteriumbovis
b)Mycobacteriumsonei
c)Mycobacteriumchelonae

--- Content provided by FirstRanker.com ---

d)Mycobacteriumtuberculosis
e)Mycobacteriumsimiae
CorrectAnswer-C:D:E
Ans:c.Mycobacterium...,d.Mycobacterium...,e.
Mycobacterium..

--- Content provided by FirstRanker.com ---

[RefAnanthanarayan9th/347-48;MedicalMicrobiologyby
Greenwood16th/201;Harrison19th/1102-05]
Humantuberclebacilliformniacinwhengrownonaneggmedium
Thetestispositivewithhumantype(M.tuberculosis)negativewith
bovinetypeofthebacilli

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Itcan,however,bepositiveforM.simiae&afewstrainsof
M.cheloneii

---

76.Feedoraltransmissionoccurin:
a)HepatitisA
b)HepatitisB

--- Content provided by FirstRanker.com ---

c)HepatitisE
d)Rotavirus
e)Herpessimplex
CorrectAnswer-A:C:D
Ans:a.HepatitisA,c.HepatitisE&d.Rota..[Ref

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Ananthanarayan9th/561;Harrison19th/2013]
Herpessimplex:Humansaretheonlynaturalhosts&thesourceof
infectionaresaliva,skinlesionsorrespiratory
secretions.Transmissionoccursbyclosecontact&maybevenereal
ingenitalherpes.

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---

77.Oroyafeveriscausedby:
a)B.bacilliformis
b)B.henselae
c)B.quintana
d)B.elizabethae

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e)B.clarridgeiae
CorrectAnswer-A
Ans:a.B.bacilliformis[RefAnanthanarayan9th/412;Medical
MicrobiologybyGreenwood16th/325-26]
Bartonellosis,orCarrion'sdisease,iscausedbyB.bacilliformis

--- Content provided by FirstRanker.com ---

Bartonellosis,orCarrion'sdisease,iscausedbyB.bacilliformis.The
diseaseischaracterizedbytwodistinctphases:
1. anacutefebrilehematicphase,knownasOroyafever;and
2. aneruptivephasemanifestedbycutaneouslesions,knownas
verrugaperuana

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---

78.VectorforO.tsugamiis/are:
a)Chigger
b)L.deliensislarva
c)Xenopsyllacheopis
d)Pediculushumanuscorporis

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e)None
CorrectAnswer-A:B
Ans:a.Chigger,b.L.deliensis...(RefAnanthanarayan9th/408;
MedicalMicrobiologybyGreenwood16th/369-72;Harrison
19th/1155,1159]

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Scrubtyphusiscausedbyorientiatsutsugamushi(formerlyR.
tsutsugamushiorR.orientalis).Thevectorsaretrombiculidmitesof
genusLeptotrombidium-L.akamushiinJapan&L.deliensisinIndia.
Humansareinfectedwhenarebittenbymitelarvae(chiggers)"
0.tsutsugamushidifferssubstantiallyfromRickettsiaspeciesboth

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geneticallyandintermsofcellwallcomposition(i.e.,itlacks
lipopolysaccharide).0.tsutsugamushiismaintainedbytransovarian
transmissionintrombiculidmites.
Illnessvariesfrommildandself-limitingtofatal.Afteranincubation
periodof6-21days,onsetischaracterizedbyfever,headache,

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myalgia,cough,andgastrointestinalsymptoms.
Somepatientsrecoverspontaneouslyafterafewdays.Theclassic
casedescriptionincludesanescharwherethechiggerhasfed,
regionallymphadenopathy,andamaculopapularrash--signsthat
areseldomseeninindigenouspatients

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---

79.Weilfelixreactioninscrubtyphusis/are
positivefor:
a)OX-19
b)OX-2
c)BothOX-19&OX-2

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d)OX-K
e)OX-19,OX-2&OX-K
CorrectAnswer-D
Ans:d.OX-K[RefAnanthanarayan9th/410;Medical
MicrobiologybyGreenwood16th/373]

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Thisreactionisanagglutinationtestinwhichseraaretestedfor
agglutininstothe0antigensofcertainnon-motileProteusstrains
OX-19,OX-2&OX-X
Thebasisoftestisthesharingofanalkali-stablecarbohydrate
antigenbysomerickettsiae&bycertainstrainsofproteus,P.

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vulgarisOX19&OX2&P.mirabilisOXK.
disease
OX-19
OX-2
OX-K

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Epidemic +++
+
_
typhus
Brill-

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Usually(?
Zinsser
ve)orweakly
-
disease

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(+ve)
Endemic +++
+/-
-
typhus

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Tickborne
spotted
++
++
-

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fever

---

fever
Scrub
-
-

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+++
typhus

---

80.Minimuminfectivedoseofshigellais:
a)1-10
b)10-100

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c)103-106
d)Sameasentericfever
e)SameasV.cholera
CorrectAnswer-B
Ans:b.10-100[RefAnanthanarayan9th/287,307,341]

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Ithasbeenshownthat106pathogenicvibriosadministeredto
fastingnormalchlorhydricvolunteers,withoutfoodorbuffer,didnot
produceinfection,whilethesamedosealongwithfoodorsodium
bicarbonatecausedclinicalcholerain80-100%ofthem.
Shigellacausebacillarydysentery.Infectionoccursbyingestion.

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Theminimuminfectivedoseislow-asfewas10-100bacilliare
capableofinitiatingthedisease,probablybecausetheysurvive
gastricaciditybetterthanotherenterobacteria.

---

81.Acutehemorrhagicconjunctivitisis/are
causedby:

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a)CoxsackievirustypeA24
b)Coronavirus
c)Enterovirus-70
d)Herpessimplex
e)Adenovirus

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CorrectAnswer-A:C:E
Ans:a.Coxsackie...,c.Enterovirus-70&e.Adeno..[Ref
Ananthanarayan9th/491,493;Greenwood16th/459]
Acutehemorrhagicconjunctivitisiscausedbyenterovirustype70:
Thesymptomsaresuddenswelling,congestion,watering&painin

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theeyes.Subconjunctivalhemorrhageisacharacteristicfeature.
CoxsackievirustypeA24alsoproducesthesamedisease
Coronaviruscausesevereacuterespiratorysyndrome,Adenovirus
11alsocausesAcutehemorrhagicconjunctivitis.

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82.Zonesofoperationtheatreincludesall

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except:
a)Septiczone
b)cleanzone
c)Protectivezone
d)Sterilezone

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e)Disposalzone
CorrectAnswer-A
Ans:a-septiczone...[Refhttp:
www.peerlesshospital.com/services/ot.html]
ProtectiveZone:Areasincludedinthiszoneare:

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Reception
Waitingarea
Trolleybay
Changingroom
CleanZone:Areasincludedinthiszoneare:

--- Content provided by FirstRanker.com ---

Pre-oproom
Recoveryroom
Plasterroom
Staffroom
Store

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SterileZone:Areasincludedinthiszoneare:
OperatingSuite
ScrubRoom
AnesthesiaInductionRoom
SetupRoom

--- Content provided by FirstRanker.com ---

---

DisposalZone:Areasincludedinthiszoneare:
DirtyUtility
Disposalcorridor

---

83.Trueaboutacanthamoebainfection:
a)Causeskeratitis

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b)Contactlensincreasesriskofkeratitis
c)Causekeratitisincontactlenswearer
d)Alsocausesencephalitis
e)Immunodeficiencyisariskfact
CorrectAnswer-A:B:D:E

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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

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22nd/208]
Acanthamoebakeratitis:Ithasalsobeenseentooccurinnon-
contactlenswearers&mayberelatedtoswimmingorbathingin
contaminatedwater.
Thisisanopportunisticprotozoanpathogenfoundworldwideinthe

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environmentinwater&soil,Infectionusuallyoccurinpatientswith
immunodeficiency,diabetes,malignancies,malnutrition,SLEor
alcoholism,Itpresentschieflyas2chronic
conditions-keratitisencephalitis
Acanthamoebakeratitis:majorityofsuchcaseshavebeen

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associatedwiththeuseofcontactlens.

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84.H.parainfluenzaerequiresfactor:
a)V
b)VI
c)VII

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d)X
e)XII
CorrectAnswer-A
Ans:(A)V[RefAnanthanarayan9th/328]
FactorV&Xareaccessorygrowthfactorswhichispresentinblood-

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(Ananthanarayan9th/327)
Growth
species
requirement
Hemolysisonhorseblood

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agar
X V CO2
Hinfluenzae
+ + -
-

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Haegyptius
+ + -
-
Hducreyi
+ VARIABLE

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VARIABLE
H.parainfluenzae - + -
-
H.haemolyticus
+ + -

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+
H.
- + -
+
parahaemolyticus

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haphrophilus
+ - +
-
Hparaphrophilus - + +
-

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85.Meningococcalinfectionispredisposed
bywhichofthefollowingdeficiencyof
complementfactor
a)C1-C3
b)C3-C4

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c)C5-C9
d)C1-C4
e)Properdin
CorrectAnswer-C:E
Ans:(C)C5-C9(E)Properdin[Ref:Ananthanarayan9th/229;

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Harrison19th/2106-07
Meningococcaldiseaseisfavouredbydeficiencyoftheterminal
complementcomponents(C5-C9
Deficienciesinthealternativepathway(factorsDandproperdin)
areassociatedwiththeoccurrenceofinvasiveNeisseria

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infections.
Lastly,deficienciesofanycomplementcomponentinvolvedin
thelyticphase(C5,C6,C7,C8,and,toal*serextent,C9)
predisposeaffectedindividualstosystemicinfectionby
Neisseria.Thisisexplainedbythecriticalroleofcomplementin

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thelysisofthethickcellwallpossessedbythisclassof
bacteria.

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86.Trueabout8thpandemicofcholera:
a)Causedbyserotype0classical
b)Causedbyserotype0Eltor

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c)Causedbyserotype0139
d)ItspreadinIndonesiain1961
e)ItspreadinBangladeshin1992-93
CorrectAnswer-C:E
Ans:(C)Causedbyserotype0139&(E)Itspreadin

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Bangladeshin1992-93
Aseventofgreatsignificancewasthesuddenemergenceof
non-O-lV.cholera(formelyNAGvibrio)asthecauseof
epidemiccholera(8thpandemic).
Inoctober1992,anewnon-O-|vibriowasisolatedfroma

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choleraoutbreakinMadras(Chennai).Similaroutbrealcssoon
followedindffirentpartsofIndia.ByJanuary1993,
SomeconsiderthecholeracausedbytheserotypeOIi9strainto
betheeighthpandemicthatbeganintheIndiansubcontinent
in1992-1993,withspreadtoAsia.Thediseasehasbeenrare

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inNorthAmericasincethemid1800s,butanendemicfocus
existsontheGulfCoastofLouisianaandTexas.

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87.Whichisnotspirochetes:
a)Borrelia
b)Leptospira

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c)Fusobacterium
d)Lactobacillus
e)Varicella
CorrectAnswer-C:D:E
Ans:c.Fusobacterium.d.Lactobacillus&e.Varicella

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[Ref.Ananthanarayan9th/j71;Hanisonl9th/II32.
"Lactobacillusgenusconsistsofanaerobicgrampositivebacilli"
"Veillonellaareanaerobicgramnegativecocci".
SpirochetesareElongated,motile,flexiblebacteriatwisted
spirallyalongthelongaxisaretermedspirochetes(fromspeira,

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meaningcoil&chaite,meaninghair)
Spirochetesbelongtotheorderspirochaetales,comprising2
families-spirochaetaceae&leptospiraceae
Spirochaetaceaecontainsgeneraspirochaeta,cristispira,
treponema&borrelia,leptospiraceaecontainingthegenus

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leptospira

---

88.Whichofthefollowingis/aretrue
regardingpopulationgrowthinIndia:
a)During1921-1971:Itbecomemorethandouble
b)In1971,populationwasmorethan500million

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c)In1991,populationwasaround1billion
d)Between1971-2011,thedecadalgrowthratewas>20%
e)1921-2011,thedecadalgrowthratewasindoubledigit
CorrectAnswer-A:B:E
Ans:(A)During1921-1971:Itbecomemorethandouble,(B)In

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1971,populationwasmorethan500million(E)1921-2011,the
decadalgrowthratewasindoubledigit
[Ref:Park23rd/afl]
Totalpopulation
Decadal

--- Content provided by FirstRanker.com ---

Year
(Million)
growthrate
1901
238.4

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?
1911
252.1
0.75
1921

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251.3
(-)0.31
1931
279
11

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1941
318.7
14.22
1951
361.1

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13.31
1961
439.2
21.64
1971

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548.2
24.80
1981
683.3
24.66

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1991
846.3
23.87
2001
1028.6

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21.52
2011
1210.1

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2011
1210.1

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17.64

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89.TrueaboutPasteurizationofmilkisall
except
a)Doesnotkillthermoduricbacteria
b)Doesnotkillspores

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c)Cause>95%decreaseinbacterialcount
d)Killstuberclebacillus
e)None
CorrectAnswer-C
Ans.is'c'i.e.,"Causes>95%decreaseinbacterialcount

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Pasteurization
Pasteurizationisdonetodestroythepathogensthatmaybepresent
inmilk,whilecausingminimalchangeinthecomposition.flovour
andnutritivevalue.
Pasteurizationkillsnearly90%ofthebacteriainmilk,includingthe

--- Content provided by FirstRanker.com ---

moreheatresistant-Tuberclebacilli-Qfeverorganisms
Itdoesnotkillthethermoduricbacteria.
Itdoesnotkillbacteriaspores.
Thereare3widelvusedmethodsforpasteurization:
1. Holdermethod:Milkkeptat63-66?Cfur30minutesisrapidly

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cooledto5?C.
2. HTSTmethod:'Hightemperatureshorttime'method(Flash
method)
Ileatedto72?Cfor15sec.andthenrapidlycooledto4?C
Thisisnowthemostwidelyusedmethod.

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method:
Ultra-hightempraturemethod.

---

Rapidlyheatedintwostagesto125?Cforfewseconds.
Thesecondstageisbeingunderpressure.
Itisthenrapidlycooled.

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---

90.Trueaboutanophelesmosquito?
a)Larvaehavesiphontube
b)Larvaearesurfacefeeder
c)Larvaearebottomfeeder
d)Larvaetieatanangletowatersurface

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e)None
CorrectAnswer-B
Ans.is'b'i.e.,Larvaearesurfacefeeder
Tribe
Anophelinianopheles

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Culciniculex,aedes,
genus
Mansonia
1. Laidsingly
1. Laidinclustersor

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Eggs
2. Eggsareboat-shaped
raft,eachraft
containing100-&
containing100-250

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providedwithlateral
eggs(exceptaedes)
float
2. Eggsareoval
shaped&not

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providedwithlateral
floats
1. Restparalleltowater 1. Suspendedwithhead
surface
downwardsatan

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Larvae
2. Nosiphontube
angletowater
3. Palmatehairspresent
surface.

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onabdominalsegments
2. Siphontubepresent
3. Nopalmatehairs
Pupae
Siphontubeisbroad Siphontubeis

--- Content provided by FirstRanker.com ---

&short
long&narrow
Adult

---

Adult
1. Whenatrest,inclineda

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1.t Whenatrest,the
anangletosurface
bodyexhibitsa
2. Wingsspotted
hunchback

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3. Palpilonginboth
2. Wingsunspotted
sexes
3. Palpishortin
female

--- Content provided by FirstRanker.com ---

---

91.Whichofthefollowingis/aresourceof
mortalityrelateddata:
a)Sampleregistrationsystem
b)Deathcertificate
c)Centralbirths&deathsregistrationact

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d)Alloftheabove
e)None
CorrectAnswer-D
Ans:d.Alloftheabove[RefPark23rd/840-41]
TheSRSisadual-recordsystem,consistingofcontinuous

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enumerationofbirths&deathsbyanenumerator&anindependent
surveyevery6monthsbyaninvestigator-supervisor
Sincetheintroductionofthissystem,morereliableinformationon
birth&deathrates,age-specificfertility&mortalityrates,infant,
under-five&adultmortalityetc.havebecomeavailable.

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Theactcameintoforceon1april1970,Theactprovidesfor
compulsoryregistrationofbirths&deathsthroughoutthecountry
Thetimelimitforregisteringtheeventofbirths&thatofdeathsis21
daysuniformlyalloverIndia

---

92.Mean,Medianandmodeallarezero.The

--- Content provided by FirstRanker.com ---

typeofdistributionis?
a)Standardnormal
b)Negativelyskewed
c)Positivelyskewed
d)Jshaped

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e)None
CorrectAnswer-A
Ans.is'a'i.e.,Standardnormal

---

93.Whichofthefollowingis/areprobability
sampling:

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a)Judgesampling
b)Clustersampling
c)Simplerandomsampling
d)Snowballsampling
e)Stratifiedsampling

--- Content provided by FirstRanker.com ---

CorrectAnswer-B:C:E
Ans:(B)Clustersampling(C)Simplerandom
sampling(E)Stratifiedsampling
[RefMcGraw-HillBasic&ClinicalBiostatistics,4thEdition
Chap4;Park23rd/850;BiostatisticsbyB.K.Mahajan7th/83-91;

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BiostatisticsbyKVRao2nd/12-15;Park23rd/850]
Thebestwaytoensurethatthesamplewillleadtoreliableandvalid
inferencesistouseprobabilitysamples,inwhichtheprobabilityof
beingincludedinthesampleisknownforeachsubjectinthe
population.Fourcommonlyusedprobabilitysamplingmethodsin

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medicinearesimplerandomsampling,systematicsampling,
stratifiedsampling,andclustersampling,allofwhichuserandom
processes

---

94.Catheterplacedinwhichtypeofcolour
codedbag:

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a)Black
b)Blue
c)Yellow
d)Red
e)Transprentwhite

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CorrectAnswer-C:E
Ans:(C)Yellow,(E)Transprent:"CategoryNo.7:Solidwaste-
wastesgeneratedfromdisposableitemsotherthanthewaste
sharpssuchastubings,catheters,intravenoussetsetc)
Colour

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Typeof
Waste
Treatmentoptionsasper
coding
container

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category Schedule1
Cat.1,2,
Yellow
Plasticbag
Incineration/deepburial

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3,&6
Disinfected
Cat.
Autoclaving/microwaving/
Red

--- Content provided by FirstRanker.com ---

container/plastic 3,6,&7 Chemicaltreatment
bag
Plasticbag/
Autoclaving/Microwaving/Chemical
Blue/White

--- Content provided by FirstRanker.com ---

Cat.4,
punctureProof
Treatmentand
translucent
Cat.7.

--- Content provided by FirstRanker.com ---

container
Destruction/Shredding
Cat.5,9
Black
Plasticbag

--- Content provided by FirstRanker.com ---

Disposalinsecuredlandfill?
&10

---

95.WHOconditionedguidelinesfortreatment
ofMDRTB2016,includes4coredrugs
andaddondrugs.Addondrugsare?

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a)Bedaquiline
b)Linzolide
c)Delamnaid
d)Capreomycin
e)Moxifloxacin

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CorrectAnswer-A:C
Answer-A,BedaquilineC,Delamnaid
GroupA=levofloxacin,moxilloxacin.gatifloxacin
GroupB=amikacin,capreomycin,kanamycin,(streptomycin);
GroupC=ethionamide(orprothionamide),cycloserine(or

--- Content provided by FirstRanker.com ---

terizidone),lineznlid,clofazimine;
GroupD2=bedaquiline,delamanid

---

96.Whichofthefollowingistrueregarding
frostbite:
a)Occursattemperatureabovefreezingpoint

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b)Reperfusioninjuryismoredangerousthanfrostbite
c)Rewarmingshouldbegradual&spontaneous
d)Occursattemperaturebelowfreezingpoint
e)Intakeofhotfluidspromotesgeneralrewarming
CorrectAnswer-B:C:D:E

--- Content provided by FirstRanker.com ---

Ans:b.Reperfusion...,c.Rewarming...,d.Occurs...&e.
Intake...[RefPark23rd/748:Manipalsurgery4th/941
ReperfusioninjuryManipalsurgery4th/94
Thisdangerouseventfollowsrevascularizationoflimbs,resultingin
acutecompartmentsyndromewithcompartmentalpressure

--- Content provided by FirstRanker.com ---

exceedingcapillarypressure(30mmHg)
Mostofinjuryisbelievedtobedueto02derivedfreeradicals
Diagnosisisclinicalassuggestedbyseverepaininthelimb,
oedemaofleg&muscletenderness
Treatedbyurgentmultiplefasciotomy,decompressionfollowedby

--- Content provided by FirstRanker.com ---

debridementofdeadtissue.
Attemperaturebelowfreezing(dry-coldcondition)frostbiteoccurs;
thetissuefreeze&icecrystalsforminbetweenthecells
Affectedpartshouldbewarmedusingwaterat44?Criticism,
Warmingshouldlastabout20minutesatatime,Intakeofhotfluids

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promotesgeneralrewarming

---

97.Whichofthefollowingis/aretrueabout
RevisedNationalTuberculosisControl
Programme(RNTCP)-
a)T.B.ismandatorytonotify

--- Content provided by FirstRanker.com ---

b)SuspiciousTBpatientsarescreenedthrough2sputum
smearexaminations
c)MDR-TBisnotincludedinRNTCP
d)Casefindingisactive
e)CoveredthewholecountrysinceMarch2006

--- Content provided by FirstRanker.com ---

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

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Gupta1"/ep.826-30;Suryakantha4'1*p.921-23;National
HealthProgramsofIndiabyfungalKishore7th/ep.91]
GovernmentofIndiadeclareTBanotifiablediseaseon7thMay
2012withfollowingobjectives:-
TohaveestablishedTBsurveillancesysteminthecountry.

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ToextentmechanismofTBtreatmentadherenceandcontact
tracingofpatientstreatedintheprivatesector.
ToensureproperTBdiagnosisandcasemanagementandfurther
acceleratereductionofTBtransmission.
TomitigatetheimpendingdrugresistantTBepidemicinthecountry.

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---

98.AccordingtoWHO,recommended
treatmentforuncomplicatedplasmodium
falciparumis/are:
a)Mefloquine
b)Chloroquine

--- Content provided by FirstRanker.com ---

c)Artemether+lumefantrine
d)Artemesinonly
e)Lumefantrineonly
CorrectAnswer-C
Ans:(C)Artemether+lumefantrine[RefPark23rd/263-65;KDT

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7th/820;http://whglibdoc.who.int/
publications/2010/9789241547925_eng.pdf]
Recommendationsunchangedfromthefirsteditionofthe
Guidelines(2006);TreatmentofuncomplicatedP.falciparum
malaria

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Artemisinin-basedcombinationtherapies(ACTs)arethe
recommendedtreatmentsforuncomplicatedP.falciparummalaria.
ThefollowingACTsarerecommended:
Artemetherpluslumefantrine,artesunateplusamodiaquine,
artesunateplusmefloquine,andartesunateplussulfadoxine-

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pyrimethamine.
ThechoiceofACTinacountryorregionwillbebasedonthelevel
ofresistanceofthepartnermedicineinthecombination.
Additionalrecommendationsinthesecondeditionofthe
Guidelines(2010);TreatmentofuncomplicatedP.falciparum

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malaria

---

Artemisinin-basedcombinationtherapiesshouldbeusedin
preferencetosulfadoxinepyrimethamine(SP)plusamodiaquine
(AQ)forthetreatmentofuncomplicatedP.falciparummalaria.
Strongrecommendation,moderatequalityevidence.

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ACTsshouldincludeatleast3daysoftreatmentwithanartemisinin
derivative.
Strongrecommendation,highqualityevidence.
Dihydroartemisininpluspiperaquine(DHA+PPQ)isanoptionforthe
first-linetreatmentofuncomplicatedP.falciparummalaria

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worldwide.

---

99.Whichofthefollowingis/aretrueabout
posteriorepistaxis:
a)Posteriorpackingisdone
b)Oftenduetochronichypertension

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c)Persistentcase-ligationofanteriorethmoidalartery
d)Severebleedingincomparisonwithanteriorepistaxis
e)Morecommonlyoccurinelderly
CorrectAnswer-A:B:D:E
Answer-(A)Posteriorpackingisdone(B)Oftenduetochronic

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hypertension(D)Severebleedingincomparisonwithanterior
epistaxis(E)Morecommonlyoccurinelderly
Itislesscommon.
Itismostlyseenfromposterosuperiorpartofnasalcavity.
Seenafter40yearsofage

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Causedduetohypertensionorarteriosclerosis
Featuresshowbleedingissevere
Treatedbypostnasalpackoftenrequired

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100.Whichofthefollowingistrue?
a)Internallaryngealnerve:supplycricothyroidmuscle

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b)Internallaryngealnerve-sensorysupplybelowvocalcord
c)Internallaryngealnerve-tensevocalcord
d)Externallaryngealnerve-tensevocalcord
e)Internallaryngealnerve-sensorysupplyabovevocalcord
CorrectAnswer-D:E

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Answer-(D)Externallaryngealnerve-tensevocal
cord(E)Internallaryngealnerve-sensorysupplyabovevocal
cord
Allthemusclewhichmovethevocalcords(abductors,adductorsor
tensor)aresuppliedbyRecurrentLaryngealnerve.

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Abovevocalcords-InternalLaryngealnerveabranchofSuperior
Laryngealnerve
Belowvocalcords-RecurrentLaryngealnerve
Cricothyroidmuscle-ExternalLaryngealnerve

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101.AllaretrueaboutMeniere'sdisease

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except:
a)Triadofrecurrentvertigo,fluctuatingsensorineuralhearingloss,
andtinnitusarefound
b)Treatmentconsistsofuseofthiazide
c)Dropattackoccurs

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d)Onsetonlyafter>50year
e)None
CorrectAnswer-D
Answer-(D)Onsetonlyafter>50year
Meniere'sdiseaseisadiseaseoftheinnerear,characterizedbythe

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clinicaltriadofrecurrentvertigo,fluctuatingsensorineuralhearing
loss,andtinnitus.
Diseaseisseenintheagegroupof35-60years.
Malesareaffectedmorethanfemales.
Thetinnitusisusuallylow-pitchedandroaring&isaggravated

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duringacuteattacks.
AuralfullnessisamanifestationalwayspresentinMeniere'sattack.
Patientswithseverehydropsshouldbetreatedwithdiuretics,salt
restriction.

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102.Trueaboutpuretoneaudiometry:

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a)Thefrequencytestedis2000-9000Hz
b)Doneinsilentroom
c)Airconductionforrightearisrepresentedonaudiogramby
symbol'X'
d)Airconductionforleftearisrepresentedonaudiogramby

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symbol'0'
e)All
CorrectAnswer-B
Answer-(B)Doneinsilentroom
Inasoundproofroom,thepatient'sabilitytohearpuretonesinthe

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frequencyrangeofabout125to8000Hzismeasured.
Red"O"representsairconductionfortherightearwhileblue"X"
representsairconductionfortheleftear.

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103.Trueaboutpresbycusis:
a)DegenerationofouterHaircelloforganofCortiinsensorytype

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b)Highfrequencyisaffectedfirstinsensorytype
c)Canbetreatedwithhearingaids
d)Usuallyunilateralhearinglossoccurs
e)None
CorrectAnswer-A:B:C

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Answer-(A)DegenerationofouterHaircelloforganofCortiin
sensorytype(B)Highfrequencyisaffectedfirstinsensorytype
(C)Canbetreatedwithhearingaids
Presbycusis,orage-relatedhearingloss,isthecumulativeeffectof
agingonhearing.

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Itisaprogressiveandirreversiblebilateralsymmetricalage-related
sensorineuralhearinglossresultingfromdegenerationofthe
cochleaorassociatedstructuresoftheinnerearorauditorynerves.
Patientsofpresbycusiscanbehelpedbyahearingaid.

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104.TobyAyer'stestis/areusedfor:

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a)CSFrhinorrhoea
b)Lateralsinusthrombosis
c)Sigmoidsinusthrombosis
d)Tocheckpatencyofeustachiantube
e)None

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CorrectAnswer-B:C
Answer-(B)Lateralsinusthrombosis(C)Sigmoidsinus
thrombosis
TheTobey?Ayertestisusedforlateralsinusthrombosisby
monitoringcerebrospinalfluidpressureduringalumbarpuncture.

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Tobey-Ayertest&Crowe-Becktestareperformedinlateralsinus
thrombosis(Sigmoidsinusthrombosis)

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105.Stridoris/arecausedbyallexcept:
a)Vocalcordpalsy
b)Stenosisaftertracheostomy

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c)Ludwigangina
d)Retropharyngealabscess
e)None
CorrectAnswer-E
Answer-None

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Itisnoisyrespirationproducedbyturbulentairflowthroughthe
narrowedairpassage.
Inspiratorystridor:Oftenproducedinobstructivelesionsof
supraglottisorpharynx
Expiratorystridor:Itisproducedinlesionsofthoracictrachea,

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primary&secondarybronchi
Biphasicstridor:Itisseeninlesionsofglottis,subglottis&cervical
trachea

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106.Trueaboutorbitalrhabdomyosarcoma-
a)Arisefrompleuripotentmesenchymalcell

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b)Originfromskeletalmusclecell
c)UsuallyB/1
d)Femalepredisposition
e)Morecommoninchildren
CorrectAnswer-A:E

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Answer-(A)Arisefrompleuripotentmesenchymalcell(E)More
commoninchildren
Itisahighlymalignanttumouroftheorbitarisingfromthe
extraocularmuscles.
Usuallyoccurringbelowtheageof15years.

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Thetumourcommonlyinvolvesthesuperionasalquadrant.
Male:femaleratioof5:3
PrimaryorbitalRMSoriginatesfromprimitivepleuripotential
mesenchymalcells.

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107.AllaretrueabouttreatmentofAge

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relatedmaculardegenerationexcept:
a)Intravitrealanti-VEGFtherapy
b)Laserabalation
c)Photodynamictherapy(PDT)
d)Transpupillarythermotherapy

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e)Prognosisaftertreatmentfornon-exudativevarietyisverygood
CorrectAnswer-E
Answer-E.Prognosisaftertreatmentfornon-exudativevariety
isverygood
Age-relatedmaculardegeneration(ARMD),alsocalledsenile

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maculardegeneration,isabilateraldiseaseofpersonsofolder
individuals.
Treatment-
Roleofdietarysupplementsandantioxidantsinpreventionor
treatmentofARMD.

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Intravitrealanti-VEGFtherapy(Bevacizumab,Ranibizumab,
Pegaptanib)isthetreatmentchoice.
Photodynamictherapy(PDT)isthe2ndtreatmentofchoice.
TransPupillarythermotherapy(TTT)withadiodelaser
Doublefrequency&YAG532nmphotocoagulation

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Surgicaltreatmentintheformofsubmacularsurgery
Pharmacologicmodulationwithantiangiogenicagent.

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108.Causes(s)ofshallowanteriorchamber
is/are:
a)Anteriorsublaxationoflens

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b)PupilblockduetovitreousbulgeafterICCE
c)Anteriordislocationoflensinanteriorchamber
d)Aphakia
e)Myopia
CorrectAnswer-A:B

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Answer-(A)Anteriorsublaxationoflens(B)Pupilblockdueto
vitreousbulgeafterICCE
Primarynarrowangleglaucoma
Hypermetropia
Postoperativeshallowanteriorchamber(afterintraocularsurgery

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duetowoundleakorciliochoroidaldetachment).
Malignantglaucoma
Anteriorperforations(perforatinginjuriesorperforationofcorneal
ulcer).
Anteriorsubluxationoflens

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Intumescent(swollen)lens

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109.Trueaboutpigmentaryglaucoma:
a)Morecommoninfemales
b)Morecommoninmyopes
c)Slit-liketransilluminationdefectsinthemidperipheryis

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pathognomonicfeature
d)Occurduetocloggingupofthetrabecularmeshwork
e)None
CorrectAnswer-C:D
Answer-(C)Slit-liketransilluminationdefectsinthemid

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peripheryispathognomonicfeature(D)Occurduetoclogging
upofthetrabecularmeshwork
Itisatypeofsecondaryopen-angleglaucomawhereincloggingup
ofthetrabecularmeshworkoccursbythepigmentparticles.
Theconditiontypicallyoccursinyoungmyopicmales.

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C/F
Depositionofpigmentgranulesiniris,posteriorsurfaceofthe
cornea,trabecularmeshwork,ciliaryzonulesandthecrystalline
lens.
Iristransilluminationshowsradialslit-liketransilluminationdefectsin

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themidperiphery(pathognomonicfeature).

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110.Uveitisis/areseenasside-effectof
causedby:
a)Latanoprost
b)Moxifloxacin

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c)Cidofovir
d)Rifabutin
e)All
CorrectAnswer-B:C:D
Answer-(B)Moxifloxacin(C)Cidofovir(D)Rifabutin

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Rostaglandin-Analoguesbimatoprostandtravoprost
Rifabutin
Cidofovir
Moxifloxacin
DrugInducedUveitis

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SystemicDrugs
TopicalDrugs
1. Ritabutin
2. Bisphosphonales
1. Metipranobol

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3. Sulphonamides
2. Miolics
4. DielhylcarbanrklZine
3. Proslaglandirts
5. Cidolovir

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IntracameralDrugs
1. Gicobvir
2. Aniibidics
3. Lfrakhase

---

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Vaccines

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111.Non-exertionalclassicheatstrokeis/are
predisposedin:
a)Personwithpreviouschronicillness
b)Elderly

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c)Young&healthyperson
d)Adolescent
e)All
CorrectAnswer-A:B
Answer-(A)Personwithpreviouschronicillness(B)Elderly

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Heatstrokepresentswithahyperthermiaofgreaterthan40.6?C
(105.1?F)incombinationwithconfusionandalackofsweating.
Therearetwoformsofheatstroke-Classic(epidemic)&exertational
PatientswithCHScommonlyhavechronicdiseasesthatpredispose
toheat-relatedillness.

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Ifcoolingisdelayed,severehepaticdysfunction,renalfailure,
disseminatedintravascularcoagulation,andfulminantmultisystem
organfailuremayoccur.
Classicheatstrokeisolderpatient.

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112.Featuresofparkinsonismincludeall

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except-
a)Intentiontremors
b)Flaccidity
c)Maskface
d)Rigidity

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e)Restingtremors
CorrectAnswer-A:B
Answer-A,B,Intentiontremors,Flaccidity
FourcardinalfeaturesofPDthatcanbegroupedundertheacronym
TRAP-

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Tremoratrest,Rigidity,Akinesia(orbradykinesia)andPostural
instability.

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113.Whichofthefollowingcause(s)motor
neuropathy:
a)GBS

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b)Diphtheria
c)Diabetes
d)Fridericataxia
e)All
CorrectAnswer-A:B:D

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Answer-(A)GBS(B)Diphtheria(D)Fridericataxia
Parkinson'sdiseaseischaracterizedbyresttremor,rigidity,
bradykinesia,andgaitimpairment,knownasthe"cardinalfeatures"
ofthedisease.
Canincludefreezingofgait,posturalinstability,speechdfficulty,

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autonomicdisturbances,sensoryalterations,mooddisorders,sleep
dysfunction,cognitiveimpairment,anddementia.

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114.Whichofthefollowingis/arefeatureof
Pre-renalARFincomparisontointrinsic
renalfailure:

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a)FractionalexcretionofSodium<1
b)Renalfailureindex>1
c)Urineosmolality>500mosmol/kgH20
d)Urinecreatinine/plasmacreatinine>40
e)PlasmaBUN/creatinineratio<20

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CorrectAnswer-A:C:D
Answer-(A)FractionalexcretionofSodium<1(C)Urine
osmolality>500mosmol/kgH20(D)Urinecreatinine/plasma
creatinine>40
ComparisonoflabfindingsinAKI(1)

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Test
PrerenalAKI
IntrinsicAKI
Urinespecificgravity
>1.020

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1.010
Urinesodium,mEq/L
<20
>40
Fractionalexcretionof

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<1%(neonates
>2%(neonates
sodium
<2%)
>2.5%)

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Fractionalexcretionofurea <35%
>50%
Urineosmolality,mOsm/kg >500
<350
Ureanitrogen-creatinine

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>20
10-50
ratio

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115.Drugcausingpulmonaryfibrosisis/are:
a)Amiodarone

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b)Cisplatin
c)Gold
d)Bleomycin
e)All
CorrectAnswer-A:C:D

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Answer-(A)Amiodarone(C)Gold(D)Bleomycin
Nitrofurantoin
Bleomycin
Busulfan
CyclophosphamideMethysergide

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Phenytoin

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116.Whichofthefollowingcauses
hyperkalemia:
a)Barttersyndrome
b)RTAI

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c)RTAII
d)Tumorlysissyndrome
e)Addison'sdisease
CorrectAnswer-D:E
Answer-(D)Tumorlysissyndrome(E)Addison'sdisease

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Inadequateexcretion
A.Advancedrenalinsufficiencv
1. Chronickidneydisease
2. End-stagerenaldisease
3. Acuteoligurickidneyinjury

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B.Primaryadrenalinsufficiency
1. Autoimmune:Addison'sdisease,polyglandularendocrinopathy
2. Infectious:HlV,cytomegalovirus,tuberculosis,disseminatedfungal
infection
3. Infiltrative:amyloidosis,malignancy,metastaticcancer

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4. Drug-associated:heparin,low-molecular-weightheparin
5. Hereditary:adrenalhypoplasiacongenita,congenitallipoidadrenal
hyperplasia,aldosteronesynthasedeficiency
6. Adrenalhemorrhageorinfarction,includinginantiphospholipid
syndrome

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117.TreatmentofHyperkalemiaincludes:
a)Insulin
b)CaHCO3
c)Hemodialysis
d)p2agonist

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e)50mlof50%dextrosewithinsulin
CorrectAnswer-A:C:D:E
Answer-(A)Insulin(C)Hemodialysis(D)p2agonist(E)50mlof
50%dextrosewithinsulin
Calciumsupplementation(calciumgluconate)

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Insulinintravenousinjectionalongwithdextrosetoprevent
hypoglycemia,willleadtoashiftofpotassiumionsintocells,
secondarytoincreasedactivityofthesodium-potassiumATPase.
Bicarbonatetherapy
Salbutamol

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SodiumPolystyrenesulfonate
Non-emergencyhyperkalemiatreatment:
Loopdiuretics-ByrenalK+excretion.
Resins[Sodiumpolystyrenesulfate]-BybindingK+
Hemodialysis-ByextracorporealK+removal

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118.Whichofthefollowingisfeature(s)of
diabeticketoacidosis:
a)Decreasedtriglyceridelevel
b)Increasedfattyacidlevel
c)TLipoprotein

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d)Decreasedketonebodies
e)HighAniongapacidosis
CorrectAnswer-B:C:E
Ans:(B)Increasedfattyacidlevel(C)TLipoprotein(E)High
Aniongapacidosis[RefHarper30th/231;Lippincott6th/339,

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345;Satyanarayan4th/481,682;Harrison19th/2417-18]
DKAischaracterizedbyhyperglycemia,ketosis,andmetabolic
acidosis(increasedaniongap)alongwithanumberofsecondary
metabolicderangements,Leukocytosis,hypertriglyceridemia,and
hyperlipoproteinemiaarecommonlyfoundaswell

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Increasedlacticacidproductionalsocontributestotheacidosis.The
increasedfreefattyacidsincreasetriglycerideandVLDLproduction.
VLDLclearanceisalsoreducedbecausetheactivityofinsulin-
sensitivelipoproteinlipaseinmuscleandfatisdecreased.
Hypertriglyceridemiamaybesevereenoughtocausepancreatitis.

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Reducedinsulinlevels,incombinationwithelevationsin
catecholaminesandgrowthhormone,increaselipolysisandthe
releaseoffreefattyacids.Normally,thesefreefattyacidsare
convertedtotriglyceridesorvery-low-densitylipoprotein(VLDL)in
theliver.

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119.Whichofthefollowingis/arenotfeature
ofanorexianervosa:
a)Strictdieting
b)Hallucination
c)Amenorrhoea

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d)Distortionofbodyimage
e)Endocrineabnormalities
CorrectAnswer-B
Answer-B.Hallucination
PSYCHOLOGICALSYMPTOMS:

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DistortedBodyImage.
EMOTIONAL:
Moodswings
Increasedcommitmenttowork
BEHAVIORAL-Excessiveexercise,starvation.

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PHYSICAL:Extremeweightlossandstuntedgrowth,amenorrhea,
nippledischarge,dehydration,hypothermia,osteoporosis.

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120.Whichofthefollowingis/aretrueabout
inflammatoryboweldisease:
a)SmokingdecreasesriskofCrohn'sdisease&increasesriskof

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ulcerativecolitis
b)PANCA-ulcerativecolitis
c)Linearulcer-Crohn'sdisease
d)Pseudopolyp-Crohn'sdisease
e)Cobblestoning-ulcerativecolitis

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CorrectAnswer-B:C
Answer-(B)PANCA-ulcerativecolitis(C)Linearulcer-Crohn's
disease
ULCERATIVE
CROHN'SDISEASE

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COLITIS
Wateryorbloody
Chronicdiarrhea
diarrhea
Rectaldischargeof

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Abdominalpain
mucus,perforation
Weightloss,pyrexia,
Proctitis
abdominalmass

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Acuteintestinal
Colitis
obstruction
Multipleperianal
Proctosigmoditis

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fissures,fistula
&abscess
Toxicrnegacolon,
Fatwrappings
severehemorrhage

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{creepingrnesentry)

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ULCERATIVE CROHN'SDISEASE
COLITIS
Gross-
Gross?

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Onlythe
Inflammatoryinvolvesfullthicknessofbowelwall
mucosa
thicknessofbowelwallinvolvingserosa
involved

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Cobblestoneappearance
Superficial
Deepfissuredulcers
ulceration
Lymphadenopathy

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Exudation
Fistulapresent
Pseudopolyps Skipareas
Micro-
Cryptabscess

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common
Micro?
Inflammatory Noncaseatinggiantcellgranulomapresent
polyps
Pipestem

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colon
ULCERATIVE
CROWN'SDISEASE
COLITIS
Age-2ndto4th&7thto

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Age-2ndto4thdecade
9Thdecade
Gender-bothare
Femalesaremore
equallyaffected

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affected
Etiology-
Etiology?
Morecommoninnon/
Morecommonin

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exsmokers
smokers
Anatomical
Anatomical
distribution?

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distribution-
Commonestinileum
Alwaysinvolvesrectum 160%)
&descending
Anallesionsare

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colon/sigmoid
common

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121.Whichofthefollowingcancause
pulmonaryembolism-
a)Pregnancy

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b)OCPuses
c)Mitralregurgitation
d)Leftventricularfailure
e)Excessiveunaccustomedexercise
CorrectAnswer-A:B:D

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Answer-(A)Pregnancy(B)OCPuses(D)Leftventricularfailure
PatientFactors
Age
Obesity
Varicoseveins/superficialthrombophlibits

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Immobility
Pregnancy
PuerPerium
High-doseoestrogentherapyorOCPuse
Diseaseorsurgicalprocedure-

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Traumaorsurgery
Malignancy
Heartfailure
Paralysisoflowerlimb
Infection

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122.Whichofthefollowingcausesacute
pancreatitis:
a)Hypertriglyceridemia
b)Hypercalcemia
c)Steroid

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d)Stavudine
e)Gallstone
CorrectAnswer-A:B:C:E
Answer-(A)Hypertriglyceridemia(B)Hypercalcemia(C)Steroid
(E)Gallstone

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Gallstones(mostcommon)
Alcoholabuseisthesecondcauseofacutepancreatitis.
Occultdiseaseofthebiliarytreeorpancreaticducts,especially
microlithiasis,sludge.
Hypertriglyceridemia

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Pancreasdivisum
Pancreaticcancer
SphincterofOddidysfunction
Cysticfibrosis
Drugs-Steroids,Azathioprine,Valproate,Estrogens,L-

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Asparaginase,6-mercaptopurine,Sulfonamides,Tetracycline,Anti-
retroviralagents,Thiazidediuretics
Familialorgenetic
Hyperparathyroidism
Hypercalemia

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PostERCP
Mostcommoncausesinchildren:bluntabdominalinjuries,

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

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toxicity

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123.Paradoxical/reversesplittingofsecond
heartsoundis/areseenin:
a)AS
b)PS

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c)Completeleftbundlebranchblock
d)Pulmonaryarterialhypertension
e)All
CorrectAnswer-A:C
Answer-(A)AS(C)Completeleftbundlebranchblock

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LeftBundleBranchBlock(LBBB)istypicallyassociatedwith
ReversedorParadoxicalSplittingofS2
ParadoxicalsplittingofsecondheartsoundiscausedbydelayedA2
orearlyP2.LeftBundleBranchBlock(LBBB)isassociatedwith
delayedAorticclosure(delayedA2)duetodelayedelectrical

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activationoftheleftventricle.
ASDandRBBBareassociatedwithawidephysiological(non-
paradoxical)splitofsecondheartsoundduetodelayedpulmonic
closure(DelayedP2)whileVSDisassociatedwithawide
physiological(non-paradoxical)splitsecondheartsoundfromearly

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aorticclosure(EarlyA2).

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124.Herpesencephalitisfindingsare:
a)Mostcommonlyinvolvesfrontal&temporallobe
b)Commonlyinvolvesbasalganglia
c)HyperintenselesionintemporallobeonT1-weightedimages

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d)HyperintenselesionintemporallobeonT2-weightedimages
e)None
CorrectAnswer-A:D
Answer-(A)Mostcommonlyinvolvesfrontal&temporal
lobe(D)HyperintenselesionintemporallobeonT2-weighted

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images
HSVencephalitis-
Examplesoffocalfindingsinclude:
1. areasofincreasedsignalintensityinthefrontotemporal
2. focalareasoflowabsorption,masseffect,andcontrast

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enhancementonCT
3. periodicfocaltemporallobespikesonabackgroundofsloworlow-
amplitude("flattened")activityonEEG
80%willhaveabnormalitlesinthetempotallobe.
HyperintenseonT2-images.

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---

125.WhichofthefollowingincludedinATPIII
criteriaforMetabolicsyndrome:
a)B.P130/85
b)Triglyceride150mg/dl
c)Fastingglucose100

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d)Waistcircumferenceinfemale>80cm
e)None
CorrectAnswer-A:B:C
Answer-A,B.P130/85B,Triglyceride150mg/dlC,Fasting
glucose100

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Criteria
Harmonized
NCEP(2001) IDF(2005)
WHO(1998)
(2009)

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WC:Z90
DM.IFG.IGT,
Prerequisite
None
cm(men) None

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IR
&
280cm
(women)t
No.ofother

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and22of:
23of.
and22of: 23of:
criteria
Already

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BMI:230&for WC:3102
WC:Z90cm
Obesity
considered
WHR:>0.9

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cm(men)&
(men)e.
as
(men)&
388cm

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perquisite 3$0cm
>0.85
(women)
criterion
(women)t

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(women)
3130/135or Z:130/85
3130/85or
BP(mmHg)
Z140/90

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Rx
orRx
Rx

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BP(mmHg)
Z140/90

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Rx
orRx
Rx
<35(men)&
<40(men)

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HDL-C(mg/di)
<39(women) <40(men)&
<40(men)&
&
or

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<50
<50
<50(women)
(women)
(women)or

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orRx
orRx
Rx
TG(mg/d1)
Z150

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150orRx
2l50orRx kis()orRx
Fastingglucose
2100or
2110,la

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2100orRx
2100orfix
(mg/d1)
No
Urinary

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albumin220
ug/minor
Microalbuminuria albumin-
creatinine
ratio>30

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mg/g
tRecommendedwaistcircumferencethresholdsfortheabdominal
obesityinpeopleofAsianorigin.

---

126.Whichofthefollowingis/aretrueabout
pneumothorax:

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a)Decreasedchestmovement
b)Dullonpercussion
c)Decreasebreathingsound
d)Hyper-resonantnoteonpercussion
e)End-expiratorycrepitation

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CorrectAnswer-A:C:D
Answer-A,DecreasedchestmovementC,Decreasebreathing
soundD,Hyper-resonantnoteonpercussion
Inpneumothorax,intra-pleuralpressureequilibrateswiththe
ambientbarometricpressureandthelung'snaturalrecoiltendency

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causesittocollapse.
Pneumothoraxtendstocausecollapseofthelungsandadecreased
compliance.
ClosedPneumothorax-
Reducedchestmovement

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Hyper-resonantnoteonpercussion
Absentairentry
Mediastinalshifttooppositeside
Cointest
OpenPneumothorax-

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Crackpotsoundonpercussion
Amphoricbreathsounds
Displacementofmediastinumwithrespiration
Increasingbreathlessness,cyanosis&tachycardia

---

---

127.Aperson'sX-raychestshowing

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homogenousopacityonrightsidewith
shiftingofmediastinumonopposite
side.Mostprobablediagnosisis/are:
a)Collapse
b)Pleuraleffusion

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c)Pneumothorax
d)Consolidation
e)Post-pnemectomy
CorrectAnswer-B
Answer-(B)Pleuraleffusion

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Pneumonectomychest(Earlysip:within24hr):Partialfillingof
thorax,ipsilateralmediastinalshift&diaphragmaticelevation.
Homogenousopacity
Shiftofmediastinumtotheoppositeside
Concaveupperborder(Ellis'scurve)

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---

128.Paraneoplasticsyndromesoflung
carcinomainclude:
a)Hypercalcemia
b)SIADH
c)Hypocalcemia

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d)Hypoglycemia
e)Hypernatremia
CorrectAnswer-A:B:C
Answer-A,HypercalcemiaB,SIADHC,Hypocalcemia
Hypercalcemiaofmalignancy

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SIADH
Cushing'ssyndrome
Hypoglycemia
Malefeminization
Diarrhoeaorintestinalhypermotility

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Osteomalacia
Acromegaly
Hyperthyroidism
Hypertension

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129.Whichofthefollowinginvestigationis

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usefulforZollinger-EllisonSyndrome
(gastrinoma):
a)USG
b)MRI
c)CTscan

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d)OctreoScan
e)Endoscopicultrasound
CorrectAnswer-A:B:C:D:E
Answer-A,USGB,MRIC,CTscanD,OctreoScanE,Endoscopic
ultrasound

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Investigations-
Serumgastrinelevated
PatientshouldfirstundergoanabdominalCTscan,MRI,or
OctreoScantoexcludemetastaticdisease.
Endoscopicultrasound(EUS)permitsimagingofthepancreaswith

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ahighdegreeofresolution
Radiolabelledsomatostatinreceptorscintigraphy.
Gastrinomapatientshavefastinggastrinlevel>150-200pg/ml
BAO>15meq/hinthepresenceofhypergastrinemiais
pathognomonicofZES.

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BAO/MAOratio>0.6beinghighlysuggestiveofZES.
Themostsensitiveandspecificgastrinprovocativetestforthe
diagnosisofgastrinomaisthesecretinstudy.(Anincreaseingastrin
of120pgwithin15minofsecretininjectionhasasensitivityand
specificityof>90%forZES.)

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---

---

130.Communityacquiredpneumoniais/are
causedby:
a)Staph.aureus
b)Mycoplasmapneumoniae
c)Streptococcuspneumoniae

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d)Influenzavirus
e)Neisseriagonorrhoeae
CorrectAnswer-A:B:C:D
Answer-A,Staph.aureusB,Mycoplasma
pneumoniaeC,StreptococcuspneumoniaeD,Influenzavirus

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Streptococcuspneumoniae
Haemophilusinfluenzae
Moraxellacatarrhalis
Staphylococcusaureus
Legionellapneumophila

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Enterobacteriaceae(Klebsiellapneumoniae)andPseudomonas
sPP.
Mycoplasmapneumoniae
ChlamydiasPP.
InfluenzaA

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---

131.Treatmentoffacio-cervical
actinomycosisincludes:
a)Surgeryistreatmentofchoice
b)DrugofchoiceispenicillinG
c)Metronidazole

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d)Amoxicillin
e)All
CorrectAnswer-B:D
Answer-B,DrugofchoiceispenicillinGD,Amoxicillin
1stchoice-Penicillinoramoxicillinforsixtotwelvemonths

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2ndchoice-Doxicycline
Surgeryifthediseaseisextensive

---

132.NeoplasticlesioninAIDSincludes:
a)Analcarcinoma
b)Non-Hodgkin'slymphoma

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c)Esophagealcarcinoma
d)Burkit'slymphoma
e)Cervicalcarcinoma
CorrectAnswer-A:B
Answer-A,AnalcarcinomaB,Non-Hodgkin'slymphoma

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Kaposisarcoma(Multifocaltumorofvascularorigin)(HHV-8)
NonHodgkinlymphoma
Primarylymphomaofbrain
Invasivecancerofuterinecervix
Immunoblasticlymphoma(mostcommonlymphoma)

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PrimaryEffusionLymphoma(PEL)
Plasmacyticlymphomaoftheoralcavity
Burkitt'slymphoma(EBvirus)

---

133.Whichofthefollowingstatement(s)
is/areregardingAmericanHeart

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Association(AHA)Guideline-2015for
cardiopulmonaryresuscitation(CPR)&
Emergencycardiovascularcare(ECC):
a)Chestcompression:ventilationCompressionventilationratio
withoutadvancedairway?rate30:2irrespectiveofrescuer&

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ageofpatient
b)Compressionrate-atleast100/min
c)FailuretoachieveanETCO2of10mmHgbywaveform
capnographyafter20minutesofresuscitationhasbeen
associatedwithanextremelypoorchanceofreturnof

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spontaneouscirculation(ROSC)
d)Limitinterruptionsinchestcompressionstolessthan10
seconds
e)None
CorrectAnswer-C:D

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Answer-C,FailuretoachieveanETCO2of10mmHgby
waveformcapnographyafter20minutesofresuscitationhas
beenassociatedwithanextremelypoorchanceofreturnof
spontaneouscirculation(ROSC)D,Limitinterruptionsinchest
compressionstolessthan10seconds

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Compressionrateismodifiedtoarangeofl00to120/min.
Compressionventilationratiowithoutadvancedairway-1or2
rescuers30:2

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FailuretoachieveanETCO2ofI0mmHgbywaveform
capnographyafter20minutesofresuscitationhasbeenassociated

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

---

134.TrueaboutAmoebicliverabscess:

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a)Morecommoninrightlobe
b)Patientsusuallypresentwithfever,chills&upperquadrant
abdominalpain
c)Usuallymultiple
d)Abscesscavitycontainsanchovysauce-likefluid

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e)Mostcommonlypresentswithjaundice
CorrectAnswer-A:B:D
Answer-A,MorecommoninrightlobeB,Patientsusually
presentwithfever,chills&upperquadrantabdominal
painD,Abscesscavitycontainsanchovysauce-likefluid

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Amebicliverabscessisthemostfrequentextraintestinal
manifestationofEntamoebahistolyticainfection.
Therightlobe(posteriorsuperiorquadrant)oftheliverismore
commonlyaffectedthantheleftlobe.
Theabscesscontainsachocolate-coloredfluidthatresembles

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anchovypasteandconsistspredominantlyofnecrotichepatocytes.
Anorexia,fevernightsweats,malaise,coughandweightloss.

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135.Trueaboutulcer:
a)Arterialulcer-painless
b)Venousulcer-penetratesdeepfascia

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c)Arterialulcer-punchedout
d)Neuropathiculcer-mayinvolvebone
e)Trophiculcer-Puchedoutedge
CorrectAnswer-C:D:E
Answer-C,Arterialulcer-punchedoutD,Neuropathiculcer-may

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involveboneE,Trophiculcer-Puchedoutedge
Puchedoutedge:Itismostlyseeningummatousulcerorinadeep
trophiculcer.
Arterialulcer-Thaeulcertendstobepunchedout
Gummatousulcers,whichoccursintertiarysyphilis,havepunched-

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outindolentedge.
Neurogeniculcer-itburrowsdeepinside,mayinvolvebone&also
calledasperforatingulcer.
Venousulcer-Depth-superficial,doesnotpenetratedeepfascia.

---

136.TrueaboutBuergerdisease

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a)Affectslargerarteryonly
b)Youngermalesaremorecommonlyaffected
c)Phlebitismigransischaracteristic
d)Coldintolerance
e)Veinsmayinvolved

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CorrectAnswer-B:C:E
Answer-B,Youngermalesaremorecommonly
affectedC,PhlebitismigransischaracteristicE,Veinsmay
involved
AlsocalledasThromboangiitisObliterans

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Itisainflammatoryocclusivevasculardisorderinvolvingsmalland
mediumsizedarteriesandveinsinupperandlowerextremities.
Itinvolvestibialandradialarteriesandsometimessecondarily
extendingtoveinsandnervesofextremities.
Theclinicalfeaturesofthromboangiitisobliteransincludesatriadof

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claudicationoftheaffectedextremity,Raynaud'sphenomenon,and
migratorysuperficialveinthrombophlebitis.

---

137.Allaretrueaboutsquamouscell
carcinomaofskinexcept:
a)Itiscalledmarjolinulcerwhendevelopsinscar

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b)Radiotherapymaybeusedintreatment
c)Hematogenousspreadiscommon&occurearly
d)Maydevelopinchroniculcer
e)Lymphaticspreadischiefwayofspreading
CorrectAnswer-C

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Answer-(C)Hematogenousspreadiscommon&occurearly
SCCisamalignanttumourofkeratinisingcellsoftheepidermisor
itsappendages.
Alsoarisesfromthestratumbasaleoftheepidermis.
SCCisthesecondmostcommonformofskincancer.

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Usuallyaffectstheelderly.
SCCisalsoassociatedwithchronicinflammation.
WhenaSCCappearsinascaritisknownasaMarjolin'ulcer.
AssociatedwithUVlightexposure,chronicinflammationandviral
infection.

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"SCCistreatedbywideexcisionorradiotherepy.
Lymphaticspreadisthechiefmethodofspreadeventhoughit
occursrelativelylate.

---

138.Indicationofcircumcisionincludes:
a)Hypospadias

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b)Epispadias
c)Phimosis
d)Balanitis
e)Balanoposthitis
CorrectAnswer-C:D:E

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Answer-C,PhimosisD,BalanitisE,Balanoposthitis
Indication-religious&phimosis
Medicalindicationsforcircumcisioninboysinclude-
1. recurrentattacksofbalanoposthitis
2. recurrenturinarytractinfections

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3. Inadults,inabilitytoretractforintercourse,abnormallytight
frenulum,balanitis

---

139.Inguinalhernialsurgerymaybe
complicatedby:
a)Testicularatrophy

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b)Urinaryretention
c)Impotence
d)Constipation
e)Pain
CorrectAnswer-A:B:E

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Answer-A,TesticularatrophyB,UrinaryretentionE,Pain
Complicationduringsurgery
Injurytoiliacvessel-themostseriousbutrare
Injurytourinarybladder
Earlypostoperctiveperiod

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Pain-Painiscommonduetoincisionintheskin&somedegreeof
retractionofstructuressuchasinguinalligamentdownwards6
conjointtendonupwards
Bleeding
Urinaryretentioniscommon,moresoinmales

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Abdominaldistension
Intermediate-between3&7ila*
Seroma
Woundinfection
Late

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Inguinodynia
Testicularatrophy

---

140.Trueaboutphysiologicalhernia
a)HerniationofForegut
b)HerniationofForegut+midgut

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c)HerniationofMidgut
d)Goesbackaround4weekafterherniation
e)Goesbackaround10weekoffetusage
CorrectAnswer-C:D:E
Answer-C,HerniationofMidgutD,Goesbackaround4week

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afterherniationE,Goesbackaround10weekoffetusage
Itisanaturalphenomenonthatoccursinearlypregnancy.
Itusuallyoccursfromaround6-8weeksupuntil13weekin-utero,
afterwhichthebowelretunstotheabdominalcavity.
Atapproximately10-11weekstheabdomenenlargesandthe

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intestinesreturntotheabdominalcavity.
At-8weeksgestationalageandisduetoanumberoffactors
includingRapidgrowthofthecranialendofthemidgut(whichwill
formthesmallintestine).

---

141.Burninvolvingonelowerlimbsinadult

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correspondencetoarea:
a)4.5%
b)9%
c)13.5%
d)18%

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e)27%
CorrectAnswer-D
Answer-(D)18%

---

---

142.Trueaboutthyroidtumor:

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a)Follicular-lymphaticmetastasismorecommonthanpapillary
b)Papillary-bloodmetastasismorecommonthanfollicular
c)Hurthle-lymphaticspreadiscommon
d)Hurthle-lessaggressivethanfollicularcarcinoma
e)Follicular-invasionofcapsule&vascularspacesincapsular

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region
CorrectAnswer-D:E
Answer-D,Hurthle-lessaggressivethanfollicular
carcinomaE,Follicular-invasionofcapsule&vascularspaces
incapsularregion

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Hurthlecellcarcinomaisasubtypeoffollicularcarcinoma.
Thetumorcontainsanabundanceofoxyphiliccells,oroncocytes.
Itappearsinanolderagegroup.
Higherchanceofspreadtolymphnodecomparedtofollicular
carcinoma.

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Treatmentissurgical.
FollicularCarcinoma-
Microscopically,thereisinvasionofthecapsuleandofthevascular
spacesinthecapsularregion.
Bloodbornemetastasesaremorecommon.

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---

143.Commontumour(s)foundinanterior
mediastinum:
a)Teratoma
b)Cervicalthymoma
c)Lymphoma

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d)Schwannoma
e)Thyroidcarcinoma
CorrectAnswer-A:B:C
Answer-A,TeratomaB,CervicalthymomaC,Lymphoma
Thymoma

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Teratoma
Parathyroidadenoma
Bronchogeniccyst
Aneurysms
Lymphoma

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Lipoma
Spinallesions
Goitre

---

144.TrueaboutCongenitalhypertrophic
pyloricstenosis:

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a)Shorteningofpyloriccanalonbariumcontrastimaging
b)Elongationofpyloriccanalonbariumcontrastimaging
c)Narrowingofpyloriccanalonbariumcontrastimaging
d)ThickenedpyloricmuscleonUSG
e)ChildshouldbegivennormalsalinewithKC1

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CorrectAnswer-B:C:D:E
Answer-(B)Elongationofpyloriccanalonbariumcontrast
imaging(C)Narrowingofpyloriccanalonbariumcontrast
imaging(D)ThickenedpyloricmuscleonUSG(E)Childshould
begivennormalsalinewithKC1

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Imagingconfirmationissoughtbymostcliniciantodifferentiatefrom
gastroesophagealreflex
Precaution:Emptystomachvianasogastrictubebeforestudy&
Removecontrastatend
Elongation&narrowingofpyloriccanal

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Stringsign=passingofsmallbariumstreakthroughelongatedpyloric
channel(mostspecificsign)
Double/tripletracksign:crowdingofmucosalfoldsinpyloricchannel

---

145.Bilateralparotidswellingis/areseenin
allexcept:

--- Content provided by FirstRanker.com ---

a)Mump
b)Epstein-Barrvirus
c)Sarcoidosis
d)Brucella
e)Sjogrensyndrome

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CorrectAnswer-D
Answer-(D)Brucella
Viralinfections
Mumps
Influenza

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Epstein-Barrvirus
CoxsackievirusA
Cytomegalovirus
HIVHCV
Sarcoidosis

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Sjogren'ssyndrome
Metabolicdisorders
Diabetesmellitus
Chronicpancreatitis
Hepaticcirrhosis

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invalidquestionid

---

147.A65yearoldmalepresentedwithfemur
neckfracture.Hewasmanagedwith
closedreduction+cancellousscrew.6
monthlaterX-raywasdoneinlateral

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view.X-rayshowsnon-union&leg
shorting.Now,appropriatemanagement
optionsis/are:
a)Unipolarhemiarthroplasty
b)Bipolarhemiarthroplasty

--- Content provided by FirstRanker.com ---

c)Subtrochantericosteotomy
d)Osteosynthesis
e)Totalhiparthroplasty
CorrectAnswer-A:B:E
Ans.a.Unipolarhemiarthroplasty;b.Bipolarhemiarthroplasty;

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e.Totalhiparthroplasty
Ingeneral,operationsforununitedfracturesofthefemoral
neckcanbegroupedintoffvegeneralclasses:
Osteosynthesis,inwhichafractureisrefixedwithnewinternal
fixationdevices;

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Subtrochantericosteotomy
Prostheticreplacement(hemiarthroplasty)
Totalhiparthroplasty
Arthrodesis.
Somegeneralguidelinesareasfollows:

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---

Inadults<60yearsold,nonunionsinwhichthefemoralheadis
viablecanbetreatedbyangulationosteotomy.Thisprovidesaline
ofweightbearingmoredirectlybeneaththefemoralhead.
Inchildrenandinadults<21yearsold,nonunionsinwhichthe
femoralheadisnotviablecanbetreatedwithanarthrodesis.In

--- Content provided by FirstRanker.com ---

exceptionalcircumstances'ayoungadultmaybetreatedwitha
prosthesis.
Inadults2lto60yearsold,nonunionsinwhichthefemoralheadis
notviablecanbetreatedwithaprosthesis,atotalhiparthroplasty,
oranarthrodesis,dependingonthecircumstancesinthegiven

--- Content provided by FirstRanker.com ---

Patientandontheexperienceandpreferenceofthesurgeon.Rarely
isanarthrodesisindicatedinpatientsolderthan50yearsofageor
inpatientswithasedentaryoccupation.
lnpatients>60years,non-union,regardlessoftheviabilityofthe
femoralhead,usuallyaretreatedwithahemiarthroplastyoratotal

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hiparthroplasty'

---

148.Carpaltunnelsyndromeisassociated
withallexcept:
a)Dupuytren'scontracture
b)Myxoedema

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c)Idiopathic
d)Rheumatoidarthritis
e)Acromegaly
CorrectAnswer-A
Ans.a.Dupuytren'scontracture

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Associatedconditionsthatcanleadstocarpaltunnelsyndrome
are:
1.Idiopathic(mostcommon)
2.Pregnancy
3.Endocrinedisorders

--- Content provided by FirstRanker.com ---

Hypothyroidism
Diabetesmellitus
Myxedema
Acromegaly
Hyperparathyroidism

--- Content provided by FirstRanker.com ---

4.Depositiondisorders
Rheumatoiddisorder
Gout
Rheumaticdisorder
Amyloidosis

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Sarcoidosis
Leukemia

---

Chronicrenalfailure

---

149.Whichofthefollowingis/arenot
feature(s)ofrheumatoidarthritis

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a)Pannusformationinjoint
b)Osteosclerosisosteoclasticactivityinunderlyingbone
c)Erosionofcartilage
d)Osteophyte
e)Plasmacellinfiltrationofsynovialstroma

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CorrectAnswer-D
Ans.d.Osteophyte
Thecharacteristichistologicfeaturesinclude:
Infiltrationofsynovialstromabydenseperivascularinflammatory
cells,consistingofBcellsandCD4+helperT,plasmacellsand

--- Content provided by FirstRanker.com ---

macrophages;
Increasedvascularityowingtovasodilationandangiogenesis,with
superficialhemosiderindeposits;
Aggregationoforganizingfibrincoveringportionsofthesynovium
andfloatinginthejointspaceasricebodies;

--- Content provided by FirstRanker.com ---

Accumulationofneutrophilsinthesynovialfluidandalongthe
surfaceofsynoviumbutusuallynotdeepinthesynovialstroma;
Osteoclasticactivityinunderlyingbone,allowingthesynoviumto
penetrateintotheboneformingjuxta-articularerosions,subchondral
cysts,andosteoporosis;

--- Content provided by FirstRanker.com ---

Pannusformation-Pannusisamassofsynoviumandsynovial
stromaconsistingofinflammatorycellsgranulationtissue,and
fibroblasts,whichgrowsoverthearticularcartilageandcausesits
erosion.

---

---

150.TrueaboutfractureneckTalus:

--- Content provided by FirstRanker.com ---

a)Avascularnecrosisofbodyiscommoncomplication
b)LateralviewX-rayisimportantfordiagnosis
c)Displacedfracturerequirebelowkneeplasteronly
d)Displacedfracturerequireopenreduction&internalfixation
e)All

--- Content provided by FirstRanker.com ---

CorrectAnswer-A:B:D
Ans.a.Avascularnecrosisofbodyiscommoncomplication;b.
LateralviewX-rayisimportantfordiagnosis;d.Displaced
fracturerequireopenreduction&internalfixation
FractureTalus(Neck)

--- Content provided by FirstRanker.com ---

Talusisthemajorweightbearingstructure(thesuperiorarticular
surfacecarriesagreaterloadperunitareathananyotherbonein
body),andithasavulnerablebloodsupplyandisacommonsite
forposttraumaticischemicnecrosis.
Thebodyoftalusissuppliedmainlybyvesselswhichenterthetalar

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neckfromthetarsalcanal.Infracturesofthetalarneckthese
vesselsaredivided;ifthefractureisdisplacedtheextraoseous
plexustoomaybedamagedandbodyoftalusbecomesischemic.
Fractureofthetalarneckisproducedbyviolenthyperextensionof
ankle.Bodyoftalusfractureisusuallyacompressioninjurydue

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tofallfromheight.
Complications
Avascularnecrosisofbodyismostcontinuumcomplication.The
incidencevarieswiththeseverityofdisplacement:intypeI<10%,
intypeII-40%,intypeIII>90%.

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Malunionpredisposetoosteoarthritis.

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SecondaryOsteoarthritisofankleand/orsubtalarjointoccurs
someyearsafterinjuryinover50%ofpatients.Thereareseveral
causes:articulardamaged/tintialtrauma,malunion,distortionof
articularsurfaceandAVN.

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HawkinsClassification
TypeI Undisplaced
TypeII Displacedassociatedwithdislocationofsubtalarjoint
Displacedassociatedwithdislocationatankleaswellas-
TypeIII atsubtalarjoint

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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

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morecommonthanprimaryvariety
e)Limitationofmovements
CorrectAnswer-C:E
Ans.is'c'i.e.,Severepain&`e'i.e.,Limitationofmovements
ACUTEOSTEOMYELITIS:

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1. ItPrimary(hematogenous):-Organismsreachthebonethrough
bloodstream.
2. Secondary:-Organismgainentrydirectlythroughwoundsuchasin
compoundfracturesorsurgicaloperation.
Hematogenousosteomyelitisisthecommonestformofosteomyelitis

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andmostcommonsourceofboneandjointinfectionis
hematogenous.
Clinicalfeatures:
Metaphysisoflongboneistheearliestandmostcommonsite
involved.

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Mostcommoninchildren.
Thebonesmostcommonly:
Proximaltibial
Distalfemur
Proximalhumerus.

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Features:
Severepain,fever,malaise,chills&rigors,sweating,andeven

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shock.
Localtenderness(fingertiptenderness),raisedlocaltemperature,
Localerythemaandlimitationofmovements(typicallythelimbis

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heldstill).
Diagnosis:
X-rays
Earliestsign:periostealreaction(periostealnewboneformation)at
themetaphysis,whichtakesabout7-10days.

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Bonescan
Increaseduptakebyboneinmetaphysiswithin24hoursofonsetof
symptoms(earliestsign.

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152.Trueaboutosteoclastoma
a)Mostlymalignant

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b)Mostcommonsite-mandible&vertebrae
c)Recurrenceiscommonafterexcision
d)Locatedatepiphysis
e)All
CorrectAnswer-C:D

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Ans.c.Recurrenceiscommonafterexcision;d.Locatedat
epiphysis
Giantcelltumor(Osteoclastoma)
GCTisanosteolytictumorarisingfromtheepiphysisandis
commonbetweentheageof20-40years.

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ThoughGCTisabenigntumor,itislocallyveryaggressive.
Femalesareaffectedmorethanmales.
Pathologicalfeatures
Thecommonestsitesarelowerendoffemurandupperendoftibia.
Othercommonsitesarelowerendradiusandupperendof

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humerus.Itmayalsooccurinthespineandsacrum.
Thetumorisencompassedbyafibrouscapsuleatperiphery.
Thepresenceoftumorgiantcellsisthehallmarkofthistumor.
Clinicalfeatures
Painatthesiteofthetumour.

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Graduallyincreasinglocalswelling
Pathologicalfracturesmayoccur.
"Eggshell-crackling"sensationonpalpation.
Radiologicalfeatures
GCTisoneofthecommoncauseofasolitarylyticlesionofthe

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bone.oTheradiologicalfeaturesare:-
1. Asolitarymaybeloculated,lyticlesion.
2. Eccentriclocation,oftensubchondral.
3. Expansionoftheoverlyingcortex(expansilelesion).
4. 'Soap-bubble'appearance-Thetumorishomogenouslylyticwith

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trabeculaeoftheremnantsofbonetraversingit,givingrisetoa
loculatedappearance.
5. Nocalcificationwithinthetumor.
6. Noneorminimalreactivesclerosisaroundthetumor.
7. Cortexmaybethinnedout,orperforatedatplaces.

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8. Tumourusuallydoesnotentertheadjacentjoint.

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153.FracturesiteofMonteggiafractureis
a)Proximalulna
b)Distalendofradius
c)Distalradius

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d)Dislocationofradialhead
e)Lowerradio-ulnarjointdislocation
CorrectAnswer-A:D
Ans.a.Proximalulna;d.Dislocationofradialhead
Monteggiafracture-dislocationsareclassifiedbytheBado

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system
BadotypeIinjuriesarecharacterizedbyaproximalulnarfracture
withanteriordislocationoftheradialhead.Thisisduetoaforceful
pronationinjuryoftheforearmandisthemostcommontype.
BadotypeIIinjuriesare"reversed"Monteggiafracture-dislocation

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injuries.
Here,thereisposteriorangulationoftheulnarfracturesiteand
posteriordislocationoftheradialhead.
BadotypeIIIandIVarerareinjuries.

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154.TrueregardingDownsyndromeis?

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a)Increasedpaternalageisariskfactor
b)Karyotypingisnotneededinallpatients
c)>85%ofaffectedpatientshave1morechromosome21
d)Increasednuchaltranslucency
e)AssociatedwithearlyonsetofAlzheimer'sdisease

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CorrectAnswer-B
Answer-B.Karyotypingisnotneededinallpatients
Down'ssyndromeisthemostcommonchromosomaldisorderand
mostcommoncongenitalcauseofmentalretardation(2nd
mostcommongeneticcauseofmentalretardationisFragile-X

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sydrome).
Trisomy21-Thereisanextrachromosome21whichisdueto
meioticnondisjunctioninovum.
Themostimportantriskfactorisadvancedmaternalage(>35
Years).

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AntenatalScreeningforDownsyndrome
Followingmethodsareused:-
1. TripletestItincludes(i)Unconjugatedestrogen(estriol):decreased;
(ii)Maternalserumalphafetoprotein(MSAFP):decreased;and(iii)
hCG:increased

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2. Newmarkers:Theseare(i)IncreasedinhibinAinmaternalblood;
and(ii)DecreasedPAPA(pregnancyassociatedplasmaprotein).
3. USG:Itshows:(i)Increasednuchaltranslucency(increasednuchal
foldthickness);(ii)Ductusvenousflowreversed;and(iii)Nasalbone
hypoplasia.

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155.Whichofthefollowingischangesduring
pregnancy:
a)Inlasttrimesterbloodvolumeincreaseby50%
b)Cardiacoutputincreaseby20%inlasttrimester
c)HemodynamicchangesinpregnancycancauseCHFfollowing

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duringlabourandfollowingdeliveryinpre-existingcardiac
lesions
d)Hypercoagulabilityoccurs
e)None
CorrectAnswer-A:C:D

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Ans.(A)Inlasttrimesterbloodvolumeincreaseby50%;(C)
HemodynamicchangesinpregnancycancauseCHFfollowing
duringlabourandfollowingdeliveryinpre-existingcardiac
lesions;(D)Hypercoagulabilityoccurs
HEMATOLOGICALCHANGES:

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PARAMETERS
CHANGES
Bloodvolume(mL)
by1500(30?40%)
Plasmavolume(mL)

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by1250(40?50%)
RedCellvolume(mL)
by350(20?30%)
TotalHb(g)
by85(18?20%)

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SerumIron
TIBC
Hematocrit
Diminished
Erythropoietin

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(Neutrophilicleukocytosis-8,000to
WBCcount

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WBCcount
20,000/mm3)
Plateletcountand

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unchanged
volume
VII,VIII,X,plasmafibrinogen:
Coagulationfactors
AntithrombinIII,XI,XIII:

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ESR
Plasmafibrinolytic
activity
PlasmaProtein
(Albumin30%;Globulin;A:G)

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Concentration
CARDIOVASCULARCHANGES:
Cardiacoutput
by40%(maximumat30thweek)
(L/min)

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Strokevolume
by27%
(mL)
Heartrate
by17%

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(perminute)
Unaffectedormid-pregnancydropof
Bloodpressure
diastolicpressureby5?10mmHg
Venous

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100%
pressure
Colloidoncotic
pressure
by14%

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(mmHg)
Systemic
vascular
by21%
resistance

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(SVR)
Pulmonary
vascular
by34%
reistance(PVR)

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Totalextracellularvolume by16%
Shiftofapicalimpulselaterallyandupwardsinthe
left4'hintercostalspace

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156.InPregnancy,whichofthefollowing
decreases-

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a)SerumALT
b)SerumAlkalinephosphatase
c)SerumAST
d)SerumUrea
e)SerumCreatinine

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CorrectAnswer-D:E
Ans.d.SerumUrea;e.SerumCreatinine
IncreasedGFRcausereductionofmaternalplasmalevelsof
creatinine,bloodureanitrogen&uricacid.
Withtheexceptionofraisedalkalinephosphatelevels,otherliver

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functiontests(serumlevelsofbilirubin,AST,ALTCPKLDHare
unchanged.

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157.AllaretrueaboutPCODexcept:
a)Metforminisusedfortreatment
b)Acanthosisnigramaybeassociated

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c)Occurinpostmenopausalwomenonly
d)Associatedwithobesity
e)Infertilitymaybepresent
CorrectAnswer-C
Ans.c.Occurinpostmenopausalwomenonly

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PCOD:Infertilityisduetoanovulatorycycle
Clinicalfeature:
Youngwoman
Acanthosisnigraduetoinsulinresistance.
Thickpigmentedskinoverthenapeofneck,innerthighandaxilla.

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Hirsutism
Infertility
Oligomenorrhoea,amenorrhoea
Centralobesity:BMI>30kg/cm2;Waistline>88cm
Treatment:

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MetformintreatstherootcauseofPCOD,rectifiesendocrine&
metabolicfunctions&improvefertilityrate.Itisusedasaninsulin
sensitizer

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158.Trueaboutcervicalcancerscreeningin
female:

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a)Startfrom2lyrofageirrespectiveofsexualactivity
b)Startfrom2lyrof.ageinsexuallyactivewomen
c)After30yr,screeningisdoneevery2-3yearsif3previousPAP
negativesmear
d)In70plusagegroup,ifpreviousPAPsmearisnegative-then

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annualsurvey
e)RiskgroupshouldbescreenedthroughHPVDNAtesting
combinedwithcytology
CorrectAnswer-B:C:E
Ans.b.Startfrom2lyrof.ageinsexuallyactivewomen;c.

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After30yr,screeningisdoneevery2-3yearsif3previousPAP
negativesmear;e.Riskgroupshouldbescreenedthrough
HPVDNAtestingcombinedwithcytology.
CervicalCancerScreening:
Allsexuallyactivewomenshouldbescreenedstarting,fromtheage

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of2lyearsorafter3yearsofvaginalsexwithnoupperagelimits.
Screeningwouldbeyearlytilltheageof30.
Thereafter,itshouldbedoneatanintervalofevery2-3yearsafter3
consecutiveyearlynegativesmears.
TheriskgroupshouldbescreenedwithHPVDNAtestingcombined

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withcytology
ThenegativepredictivevalueofonenegativeHPVDNAtest&two
negativecytologytestsarealmost100%.
Whenboththetestsarenegative,thescreeningintervalmaybe

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increasedto6years.

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159.TrueaboutstageIbcervixcarcinoma
management:
a)Radiotherapyalone
b)Simplehysterectomyalone
c)Primarychemoradiation

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d)Wertheimhysterectomy+pelviclymphadenectomy
e)Simplehysterectomy+adjuvantchemotherapy
CorrectAnswer-C:D
Ans.c.Primarychemoradiation;d.Wertheimhysterectomy+
pelviclymphadenectomy

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StagesIBandIIACervicalCancer
Radiationtherapywithchemotherapygivenatthesametime.
Radicalhysterectomyandremovalofpelviclymphnodeswithor
withoutradiationtherapytothepelvis,pluschemotherapy.
Radicaltrachelectomy.

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Chemotherapyfollowedbysurgery.
Radiationtherapyalone.

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160.Whichofthefollowingis/aretrueabout
lockedtwins:
a)Firstfetus-breechpresentation&secondfetuscephalic

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presentation
b)Firstfetus-cephalicpresentation&secondfetusbreech
presentation
c)Decapitationofheadcanbedone,ifthefetusisdead
d)CaesareandeliveryisTOC

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e)Usuallydeliveredbyvaginalroute
CorrectAnswer-A:C:D
Ans.a.Firstfetus-breechpresentation&secondfetuscephalic
presentation;c.Decapitationofheadcanbedone,ifthefetusis
dead;d.CaesareandeliveryisTOC

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LockedTwin:
Thephenomenonoflockedtwinsisrare.
Fortwinstolock,thefirstfetusmustPresentbreech&second
cephalic.
Withdescentofthebreechthroughthebirthcanal,thechinofthe

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firstfetuslocksb/wtheneck&chinofthesecond.
Caesareandeliveryisrecommendedwhenthepotentialforlocking
isidentified
Therearetwotypesoflockedtwins:breech/vertexand
vertex/vertex.

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Ifonefetushasbeenpartiallyborn'attemptscanbemadeto
disimpactthetwinsmanually'suchasbytheZavanellimaneuver,
withaviewtoperforminganassisteddeliverywith

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ventouseorforceps.
Ifthediagnosisismadeonlyafterthefirstlockedtwinhasdiedin

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thebirthcanal,orifitisnotexpectedtosurvive,thefirsttwinmaybe
decapitatedanditsheadPusheduptoallowsafedeliveryofthe
secondtwin.

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161.Trueaboutfemalepelvis:
a)Obstetricconjugateis2cmlessthanDiagonalconjugate

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b)Obestetricalconjugateisthedistanceb/wthemidpointofthe
sacralpromontorytoprominentbonyprojectioninthemidline
ontheinnersurfaceofthesymphysispubis
c)Intertuberousdiameteris8cm
d)Bispinousdiameteris10.5cm

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e)None
CorrectAnswer-A:B:D
Ans.a.Obstetricconjugateis2cmlessthanDiagonal
conjugate;b.Obestetricalconjugateisthedistanceb/wthe
midpointofthesacralpromontorytoprominentbony

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projectioninthemidlineontheinnersurfaceofthesymphysis
pubis;d.Bispinousdiameteris10.5cm
Obstetricconjugate:Itisthedistanceb/vthemidpointofthesacral
promontorytoprominentbonyprojectioninthemidlineontheinner
surfaceatthesymphysispubis.

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Itmeasures10cm.
Itcannotbeclinicallyestimatedbutktoinferredfromthediagonal
conjugate
1.5-2cmtobedeductedorbylateralradiopelvimetry.
Diagonalconjugate:Itisthedistanceb/wtheLowerborderof

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symphysispubistothemidpointonthesacralpromontory.It
measures12cm.
Bispinousdiameterofmidpelvis(10.5cm):Itmeasuredistanceb/w
thetwoischialspine
Intertuberousdiameter(11cm):Itmeasuresb/winnerbordersof

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ischialtuberosities"

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ischialtuberosities"

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162.Feature(s)ofchronichypertensionin
pregnancy:
a)Hypertensionoccurringafter20weekofpregnancy

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b)Hypertensionoccurringbefore20weekofpregnancy
c)>10timescommoninobesewomen
d)Hypertensionbeforeonsetofpregnancy
e)Hypertensionoccurupto12weekpostpartum
CorrectAnswer-B:D

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Ans.b.Hypertensionoccurringbefore20weekofpregnancy;d.
Hypertensionbeforeonsetofpregnancy
ChronicHypertensioninPregnancy:
Itisdefinedasthepresenceofhypertensionofanycause
antedatingorbeforethe20thweekofpregnancy&itspresence

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beyondthe12thweekafterdelivery.
ThehighriskfactorsforCHDare:age(>40years),duration
ofhypertension(>15years),levelofBP(>160/ff0mmHg),presence
ofanymedicaldisorder(renovascular)&presenceofthrombophilia.

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163.Inaprimifemale.Differentialdiagnosis

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ofshockincludes:
a)Uterineinversion
b)Postpartummassivehaemorrhage
c)Amnioticfluidembolism
d)Postpartumeclampsia

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e)None
CorrectAnswer-A:B:C
Ans.a.Uterineinversion;b.Postpartummassivehaemorrhage;
c.Amnioticfluidembolism
Inversionofuterus:Shockisextremelyprofoundmainlyof

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neurogenicorigin.
Hemorrhagicshock:Associatedwithpostpartumor
postabortalhemorrhage,ectopicpregnancy,placentaprevia,
abruptionplacenta,ruptureoftheuterusandobstetricsurgery:
Shockassociatedwithdisseminatedintravascularcoagulation,

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intrauterinedeadfetussyndromeandamnioticfluidembolism.
Septicshock(endotoxicshock):Hypotension(systolicBPmmHg)is
duetosepsisresultinginderangementsincellularandorgansystem
dysfunction.
Hypotensionpersistsinspiteofadequatefluidresuscitation.

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Associatedtypicallywithsepticabortion,chorioamnionitis,
pyelonephritis,andrarelypostpartumendometritis.

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164.Inpregnancy,counsellingfortherapeutic
terminationisgenerallydoneincaseof:
a)Eisenmengersyndrome

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b)Multivalvulardisease
c)Congenitalheartdisease
d)Marfansyndrome
e)Primarypulmonaryhypertension
CorrectAnswer-A:D:E

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Ans.a.Eisenmengersyndrome;d.Marfansyndrome;e.
Primarypulmonaryhypertension
PlaceofTherapeuticTermination:Indication
Absolutetermination:Primarypulmonaryhypertension,
Eisenmengersyndrome&pulmonaryveno-occlusiondisease

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Relativeindications:ParouswomenwithgradeIII&IVcardiac
lesions;GradeI&IIwithprevioushistoryofcardiacfailureinearly
monthsorinb/wpregnancy

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165.OCPisabsolutelycontraindicatedin:
a)Age>40yearwithsmoking

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b)Carcinomabreast&genitalia
c)H/oEpilepsy
d)Thrombophlebitis
e)Hyperlipidemia
CorrectAnswer-A:D

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Ans.a.Age>40yearwithsmoking;d.Thrombophlebitis
AbsolutecontraindicationofcombinedOCP:
Arterialorvenousthrombosis
Activeliverdisease
Pregnancy

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Severehypertension
Stroke
Liveradenoma
Carcinoma
Undiagnosedgenitaltractbleeding

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Valvularheartdiseaseischemicheartdisease
Angina
Diabeteswithvascularcomplication
Focalmigraine
Severehypercholesterolemia

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Smokersoverage35years
Livertumor
Estrogen-dependentneoplasm,e.g.,breastcancer
Breastfeeding(within6weekspostpartum)
Majorsurgeryorprolongedimmobilization

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---

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166.Infertilityisdefinedas:
a)Ifacouplefailstoachievepregnancyafterl8monthof
unprotected&regularintercourse
b)Ifacouplefailstoachievepregnancyafter15monthof
unprotected&regularintercourse,itisanindicationto

--- Content provided by FirstRanker.com ---

investigatethecouple
c)Ifacouplefailstoachievepregnancyafter1yearof
unprotected&regularintercourse
d)Termedprimaryifconceptionhasneveroccurred
e)Itistermedsecondaryifconceptionhasneveroccurred

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CorrectAnswer-C:D
Ans.c.IfacouplefailstoachievepregnancyafterIyearof
unprotected&regularintercourse;d.Termedprimaryif
conceptionhasneveroccurred
Infertility:

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Infertilityimpliesapparentfailureofacoupletoconceive
Ifacouplefailstoachievepregnancyafter1yearofunprotected&
regularintercourse,itisanindicationtoinvestigatethecouple.This
isbasedonobservationthat80-85%ofnormalcouplesachieves
conceptionwithin1year;75%in6month&50%in3months.

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Itistermedprimaryifconceptionhasneveroccurred6secondaryif
thepatientfailstoconceiveafterhavingachievedaprevious
conception

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167.Whichofthefollowingis/aretrue
regardingmanagementofectopic

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pregnancy:
a)IntrauterinesacmaybevisiblebyTVSwhenthe?hCGlevelsis
>1000mIU/ml
b)Hemoperitoneumisindicationformedicaltreatment
c)Methotrexateisdrugofchoice

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d)Laparoscopycanbeusedfordiagnosis
e)None
CorrectAnswer-A:C:D
Ans.a.IntrauterinesacmaybevisiblebyTVSwhenthe?hCG
levelsis>1000mIU/ml;c.Methotrexateisdrugofchoice;d.

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Laparoscopycanbeusedfordiagnosis
Serial?hCGlevelsareusuallyrequiredwhentheinitialultrasound
performedfailstodemonstrateeitherintra-orextrauterine
pregnancy.
At?hCGlevelsofapproximately2000mIU/ml,aviableintrauterine

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pregnancyshouldbeseenbyvaginalultrasound.
LaparoscopyofDirectvisualizationofthefallopiantubesandpelvis
diagnosticlaparoscopyoffersareliablediagnosisinmostcasesof
ectopicpregnancyandareadytransitiontodefinitiveoperative
therapy.

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MethotrexateTherapyisthedrugofchoice

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168.MostcommonsiteofCINis:
a)Squamo-columnarjunction
b)Ectocervix
c)Endocervix

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d)Nabothiangland
e)All
CorrectAnswer-A
Ans.a.Squamo-columnarjunction
CIN:Themetaplasiaextendsfromtheoriginalsquamocolumnar

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junction(squamosquamous)outsidetothenewlydeveloped
(physiologicallyactive)squamocolumnarjunction(now
squamocolumnar)inside.Thisareaistransformationzone.

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169.TrueaboutMayer-Rokitansky-Kuster-
Hausersyndrome

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a)45XY
b)Upper2/3vaginaabsent
c)Ovaryatrophic
d)Uterusabnormality
e)Amenorrhoea

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CorrectAnswer-B:D:E
Ans.b.Upper2/3vaginaabsent;d.Uterusabnormality;e.
Amenorrhoea
InandrogeninsensitivitysyndromeapatienthasXYkaryotypeand
functioningtesteshowever,thebodycannotrespondtotestosterone

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duetomutationsintheandrogenreceptor.
FeaturesofMeyerRokitanskykusterHauser(Mullerian
agenesissyndrome)
Sporadicinheritance
Karyotype46xx

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Normalbreastdevelopment
Normal(adie))andpubichair
Uterusabsent
Vaginaabsent
Cervixabsent

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Ovarynormal
Testosterone(femalelevels)
Associatedanomalies
Thepresentationofcompletemullerianagenesis(MeyerRokitansky

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kusterHausersyndrome)maybeconfusedwithandrogen

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insensitivitysyndrome.
Presentation
Mullerianagenesis
Inheritancepattern
Sporadic

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Karyotype
46xx
Breastdevelopment
Yes
Axillaryandpubichair Yes

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Uterus
No
Gonad
Ovary
Testosterone

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Femalelevels
Associatedanomalies Yes

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170.Trueaboutventricularseptaldefect:
a)MCcongenitalheartanomaly
b)Presentationdependsonsizeoflesion

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c)Membranoustypeclosesearlythanmusculartype
d)Mid-diastolicmurmur
e)CHFneverdevelops
CorrectAnswer-A:B
Ans.a.MCcongenitalheartanomaly;b.Presentationdepends

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onsizeoflesion
MuscularVSDhavethehighestlikelihoodofspontaneousclosure
PatientswithVSDbecomesymptomaticaround6to10weeksof
agewithcongestivecardiacfailure.
VSDisthemostcommoncardiacmalformationandaccountsfor

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25/oofcongenitalheartdisease.Defectsmayoccurinanyportionof
theventricularseptum,butmostareofthemembranoustype.
Thesedefectsareinaposteroinferiorposition,anteriortotheseptal
leafletofthetricuspidvalve.
VSDsbetweenthecristasupraventricularisandthepapillarymuscle

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ofconusmaybeassociatedwithpulmonarystenosisandother
manifestationsofthetetralogyofFallot.

---

171.ThefollowingstatementisTRUEforPityriasisRosea:
a)Selflimiting
b)Chronicrelapsing

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c)Lifethreateninginfection
d)Causedbydermatophytes
e)None
CorrectAnswer-A
Ans.A.Selflimiting

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Pityriasisroseaisanacuteexanthematouspapulosquamous
eruptionoftenwithacharacteristicselflimitingcourse.
Theetiologyisnotknown.
HHV-7morefrequently,Ht{V-6lessfrequently
(Itisnotcausedbydermatophytes).

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Itispresentduringthespringandfall.
Morphology:
Heraldpatch,FirtreeorChristmastreeappearance
Site:
Trunkalonglineofcleavage;sometimes(20%)lesionsoccur

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predominantlyonextremities&neck(inversepattern)
Ref:Harrison'sPrinciplesofInternalMedicine16thEditionPage
292;Roxburgh's-CommonSkindisease17thEditionPage17;
Fitzpatrick'sDermatology5thEditionPage7369;Illustrated
TextbookofDermatology:Pasricha3rdEditionPage7134;

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IllustratedSynopsisofDermatology&STDs,NeenaKhanna1st
EditionPage742-44
Accordigntoananthanarayanmicrobiologybook9thed/p.595:

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Causatiyeagent:yeastlikefungusmalasseziafurfur(formelyPityro
sporumorbiculare).

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Site:Uppertrunk,neck6upperarm.
Thisachronic,usuallyasytnptomatic,invohtementofthestartum
corneum.
Theoldnametineaversicolorshouldbediscardedaspityrtasis
eersicolorisnotcausedbydermatophytes.

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172.TrueaboutImpetigocontagiosa:
a)Asboe-hausensign
b)Honeycolouredcrust
c)Causedbystaph.aureus
d)Contagious

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e)Bullousdisorder
CorrectAnswer-B:C:D:E
Ans.(B)Honeycolouredcrust(C)Causedbystaph.aureus
(D)Contagious(E)Bullousdisorder
[Ref:NeenaKhanna4th/245;Roxburgh\Dermatology17th/z!4;

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Harrison19th/350;18th/400]
Impetigocontagiosa:
Thinwalledbullae(seldomseen)onanerythematousbase,ruptures
raPidlytoformanexudativeplaquecoveredwithhoney-colored
rust.

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Theprimarylesionisasuperficialpustulethatrupturesandformsa
characteristicyellow-brownhoney-coloredcrust
Causedby:Staph.aureus,S.pyogenesorboth.
Siteofpredilection:Face(periorificial,especiallyaroundthemouth&
nose),extremities&scalp

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Complications:Eczematization&acutepoststreptococcal
glomerulonephritis

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173.Dermatitisherpetiformis:
a)Causedbyherpes
b)Affectmainlyflexorsurface

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c)Associatedwithglutensensitiveenteropathy
d)Dapsoneisusedintreatment
e)None
CorrectAnswer-C:D
Ans.(C)Associatedwithglutensensitiveenteropathy

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(D)Dapsoneisusedintreatment
[Ref:NeenaKhanna4th/80-81;Harrison19th/3373,18th/427-28]
DermatitisHerpetiformis:
Etiology:
Gluten-sensitiveenteropathyisalwaysassociated&probably

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responsibleforskinlesions
Site:
Extensors&pressurepoints
Morphology:
Groupederythematouspapules(lessfre-quent),vesicles(more

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frequent)&excoriatedlesions(mostfrequent)
Treatment:
Dapsoneworksdramatically.Aglutenfreedietonlyslowly.So
combinethetwo&thenreducedoseofdapsone.

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174.Maculopapularrashsareseeninall

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except:
a)Scarletfever
b)Measles
c)Exanthemsubitum
d)Infectiousmononucleosis

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e)Germanmeasles
CorrectAnswer-A
Ans.A.Scarletfever
[Ref:NeenaKhanna4th/282;Hanison19th/128-30;18tV149-
51'Park23ril/144-45,147,151]

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MaculopapularViralExanthems:
Measles(Rubeola):maculopapularconfluentrashwhichevolvesin
acranio-caudalfashion&fadeswithscaling.
Germanmeasles:Erythematousdiscretemacularrash.
Erythemainfectiosum(fifthdisease)

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Exanthemsubitum(roseola,sixthdisease)
Infectiousmononucleosis
Epidemictyphus
Endemic(murine)typhus
Scrubtyphus

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Rickettsialspottedfevers
HumanMonocytotropicehrlichiosis
Leptospirosis
Lymedisease
Typhoidfever

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Denguefever
Note:
Scarletfever:
Causesconfluentdesquamativeerythemas.

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175.Androgenicalopeciainfemaleiscaused

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by:
a)Myxedema
b)Cushingdisease
c)Stein-Leventhalsyndrome
d)Addison'sdisease

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e)None
CorrectAnswer-C
Ans.C.Stein-Leventhalsyndrome
[RefNeenaKhanna4th/133-34;Roxburgh'sDermatology17th/270;
Hanison19th/j55,18th/408,2920,2897]

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AndrogeneticAlopecia(Malepattern;Femalepattern):
Associations
Inwomen,featuresofhyperandrogenismmaybepresentin
theformofhirsutism,acne&clitoromegaly.
Alwaysruleoutpolycysticovarydisease(PCOD).

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Stein-Leventhalsyndrome,alsocalledpolycysticovary
syndrome(PCOS)
Myxedema:
Hairtexturemaybecomefine,andadiffusealopeciaoccursinupto
40%ofpatients,persistingformonthsafterrestorationof

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euthyroidism.

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176.Findingsinpsoarisisincludes:
a)Parakeratosis
b)Involvingalmost100%ofBasalcellinmultiplication
c)Micro-munroabscess

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d)AutoimmunediseasewithT-cellinvolvement
e)Frequentlyinvolvingmucosalsurface
CorrectAnswer-A:B:C:D
Ans.(A)Parakeratosis(B)Involvingalmost100%ofBasalcell
inmultiplication(C)Micro-munroabscess(D)Autoimmune

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diseasewithT-cellinvolvement
Psoriasis:
Type1helperTcelldiseasewithincreasedTh1cytokines(IFN-y&
IL-2)&reductionofanti-inflammatorycytokinesIL-10.
Histologically,scalylesionsshowhyperkeratosis&parakeratosis.

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Auspitzsign-Characteristicsfindingofplaqueinwhichremovalof
scalesleadstopinpointbleeding.
GrattageTesla:onscratchingscalesappear.
Koebner/Isomorphicphenomenon:
Appearsatthesiteofminorinjurysuchasscratchorgraze.

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Characteristicofpsoriasis.
lnNails
Onycholysis(separationofthenailplatefromthenailbed)
Thimble-pittingofnailplate
Brownblackdiscoloration

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177.Trueaboutbullouspemphigoid:
a)Nikolslcysignpositive
b)Bullaspreadsignpositive
c)Commoninchildren
d)Dariersign

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e)Itchingiscommon
CorrectAnswer-E
Ans.E.Itchingiscommon
[NeenaKhenna4th/77-79]
BullousPemphigoid:

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Autoimmunedisorder
Itchy,tensehemorrhagicblistersonskin
Mucosallesioninfrequent
Age60-80yr
Gender:equalincidenceinmale&females

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Bullaspreadsign&Nikolsy'ssignareusuallynegative

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178.Allaretrueaboutlichenplanusexcept:
a)Notassociatedwithoralulcer
b)Wikham'sstriaepresent
c)Colloidbodyonhistology

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d)Morphologycanberepresentedby5'P'
e)Koebner'sorisomorphicphenomenonmaybepresent
CorrectAnswer-A
Ans.A.Notassociatedwithoralulcer
[RefNeenaKnnna4th/56-60;RoxburgheDermatologist17thll4;

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Harrison19th/349,I8tW399-400]
LichenPlanus:
Orallesions(Laceyreticulatepattern):
Itmaybeasymptomaticorpatientmaycomplainofburning
sensationespeciallyoneatingspicyfoods.

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Whenviewedunderamagnifyinglens,surfaceofthelesionshas
whitestreaks(Wickham'sstriae)
Morphology(5Ps):Pruritic,Polygonal,Purple(butviolaceousisthe
termtouse),Plane(flattopped),papules.
Age:10-40year

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184.Koebnerorisomorphicphenomenonmaybepresent
Histopathology:colloidbody,basalcelldegeneration,bandlike
upperdermalinfiltrate,Maxfoseph'sspace,thickenedgranularlayer

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179.Whichiscausedbybacteria:
a)Analwart

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b)Lymphogranulomavenereum
c)Molluscumcontagiosum
d)Condylomatalattum
e)None
CorrectAnswer-B:D

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Ans.(B)Lymphogranulomavenereum(D)Condylomatalattum
[RefNeenaKhanna4th/270]
AnogenitalwartiscausedbyHPV-6,11,16,18,31&33
LymphogranulomavenereumiscausedbyChlamydiatrachomatis
serovarsLl,L2&L3

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Condylomalata:Itisfoundinsecondarysyphilis(Treponema
pallidum)
Molluscumcontagiosumiscausedbythepoxvirus.

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180.AllaretrueregardingLaryngealMask
Airwayexcept:

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a)Bigoraltumoriscontraindicationforitsuse
b)MaybeusedwhenintubationwithETTisnotpossible
c)Canbeusedinchild'seyesurgery
d)MaybeusedinCPR
e)None

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CorrectAnswer-E
Ans.(E)NONE
[RefAjayYadav5th/42-43;LeeAnaesthesia13th/206-08;Morgo4
Anesthesia4th/97;DorschDorschanesthesiaequipment5th/488;
Miller\anesthesia6th/I627]

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Advancedcardiaclifesupport(PartofCPR):
Forbreathing-Advancedmethodlikeendotrachealtube,LMA,
combitubeortracheostomytube.
LaryngealMaskAirway(LMA):
Asanalternativetointubationwheredifficultintubationisanticipated

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Anelectivemethodforminorsurgerieswhereanesthetistwantsto
avoidintubation(Likeeyesurgeryinchildren).
Contraindication:oropharyngealmass.
LMAprovidesanalternativetoventilationthroughafacemaskor
endotrachealtube(ETT).

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LMAhasprovenparticularlyhelpfulasatemporarymeasureif
patientswithdifficultairways(thosewhocannotbeventilatedor
intubated)becauseofitseaseofinsertion&relativelyhighsuccess
rate(95-99%).

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C/IforLMAincludes:patientwithpharyngealpathology(e.g.,

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abscess),pharyngealobstruction,fullstomach(e.g.,pregnancy,
hiatalhernia)orlowpulmonarycompliance

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181.Whichofthefollowingcircuitis
preferredinchildforspontaneous
respiration:

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a)MaplesonA
b)Jackson&Reescircuit
c)MaplesonC
d)MaplesonE
e)MaplesonF

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CorrectAnswer-A
Ans.(A)MaplesonA
[RefAjayYadav5th/35;DorschAnesthesiaEquipment5th/213-215;
MorganAnesthesia5th/i3;4th/35-37]
PediatricBreathingCircuits:

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TypeEMaplesonCircuit:
ItisAyre'sTpiecewithcorrugatedtubing.
Itisapediatriccircuit
Asitdoesnothavebreathingbagsoitisnotacompletecircuit(It
wasmadecompletebyattachingabreathingbagbyattachinga

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breathingbagbyJackson&Rees).
TypeEisbasicallyacircuitonlyforspontaneousrespiration(asit
doesnotcontainbreathingbag)butcanbeutilizedforcontrolled
ventilationbyintermittentlyoccludingtheendofexpiratorylimb

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182.Weaningisgenerallydoneby:

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a)SIMV
b)Controlledmodeventilation(CMV)
c)CPAP
d)PressurecontrolledVentilation
e)AssistedcontrolledVentilation

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CorrectAnswer-A:C
Ans.A,SIMV&C,CPAP
[RefAjayYadav5th/239-40;Morgan5th/1298;Milleranesthesia6th]
Weaning:
Meansdiscontinuingtheventilatorsupport.

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WeaningprocessmayvaryfromPatienttoPatient,hospitalto
hospital(dependingonthetypeofventilatoravailable)6clinicianto
clinician4ispossibletoweanpatientinanymodeofventilation
exceptcontrolmodeventilation
TechniquesforWeaning:

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Thecommontechniquestoweanapatientfromtheventilator
includeSIMVpressuresupport,orperiodsofspontaneousbreathing
aloneonaT-pieceoronlowlevelsOfCPAP
Mandatoryminuteventilationhasalsobeensuggestedasanideal
weaningtechniques,butexperiencewithitislimited.

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MostoftenaPPLiedapproachisthatpatientfromcontrol/assist
controlmodeventilationisshiftedtoSIMV&thenkeepon
decreasingtherateofbreathdeliveredbyventilatorgraduallytillit
becomes1to2breath/min

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183.Achildonimmediatepostoperative,is

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complainingofnausea&vomitingafter
squintsurgery.Whichofthefollowing
drugsmaybenotusedduringoperation
incontrollingthissymptom:
a)Propofol

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b)Ketamine
c)Dexamethasone
d)Ondansetron
e)Palonosetron
CorrectAnswer-A:C:D

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Ans.A,PropofolC,Dexamethasone&D,Ondansetron
[RefAjayYadavSth/132;LeeAnaesthesial3th/630]
StrabismusSurgeryinPaediatricPatient:
Keyfeaturesinrelationtostrabismusareoculocardiacreflexin
responsetosurgicalmovementofglobe,postoperativenausea&

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vomiting(PONV)&theassociationofstrabismuswithoccult
myopathies&possiblymalignanthyperthermia.
Antiemesisisimprovedbyuseofpropofoloninduction&
maintenance&bythepreemptiveuseofboth5-hydroxy-tryptamine
inhibitors&dexamethasone,

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OpioidsshouldbeavoidedbecauseregularNSAIDSareas
effective.
TopicalNSAIDS(Ketorolac0.5%oo/o,diclofenacl%)havebeen
usedwithsomesuccess.

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Theincidenceofoculocardiacreflexcanbereducedbytheuseof

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ketamineatinduction&bytheuseofmedialcanthalinjectionof
localanaesthetic(lidocaine),whichalsoreducestheneedfor
postoperativeanalgesia

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184.Whichofthefollowingfluidusedin
perioperativeperiodisisotonic:

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a)RL
b)DNS
c)5%Dextrose
d)HES
e)NS

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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):

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Lactateismetabolizedtobicarbonateinliver
RingerlactateiscrystalloidofchoiceforbloodlossrePlacement.
RLisslightlyhypotonic.
NormalSaline:
0.99%NaClisotonicsolution.

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PreferredoverRLfortreating:hypochloremicmetabolicalkalosis,
braininjury(Catinlactatecanincreasetheneuronalinjury)&
hyponatremia
DextroseNormalSaline:
Hypertonic.

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bestusedasmaintenancefluid.
HydroxyethylStarch(Colloid):
Types:Hetastarch&Pentastarch

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185.18-FDGstandsfor:
a)18-Fluorodeoxyglucose

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b)18-Fluorodioxyglucose
c)18-Fluorodeoxygalactose
d)18-Fluorodioxygalactose
e)18-Fluorodeoxyglycogen
CorrectAnswer-A

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Ans.(A)18-Fluorodeoxyglucose
[RefSumerSethi2nd/16;Grainger&AllisonRadiology6th/141]
18F-2-Fluoro-2-deoxy-D-glucose(FDG)
DyeusedinPETscans.
Themostcommonlyusedradiolabeledtraceris18F-2-Fluoro-2-

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deoxy-D-glucose(FDG).
InPEThelpsassessmetabolicfunctionssuchasoxygenand
glucoseconsumptionandbloodflow.

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186.Half-lifeofradiumis:
a)14day

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b)27day
c)1626years
d)5.25yr
e)None
CorrectAnswer-C

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Ans.(C)1626years
[Ref:Harrison19the/p263e-3]
Half-lifeofRa-226:1626years

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187.1curieisequivalentto:
a)1.7x1010disintegration/second

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b)2.7x1010disintegration/second
c)3.7x1010disintegration/second
d)4.7x1010disintegration/second
e)5.7x1010disintegration/second
CorrectAnswer-C

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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:

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1Bq=1disintegration/second
1Curie(Ci)=3.7x10(10)disintegration/second
1Ciisequalto37gigabecquerel
1gray(Gy)=100rads10mGy=1rad1mGy=100mradGray
(Gy)istheSIunitofabsorbeddose.

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Onegrayisequaltoanabsorbeddoseof1foule/kilogram(100
rads).

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188.RadiationnotemittedbyCo-60:
a)arays
b)13rays

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c)yrays
d)Positron
e)6rays
CorrectAnswer-A:D:E
Ans.A,araysD,Positron&E,6rays

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[Ref:Harrison19th/263e3,18th/1790;SumerSethi2nd/88;Grainger
(tAllisonRadiology6th/118]
Cobalt(Co-60)-beta,gammaraysemitted.

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189.Whichofthefollowingareasarenot
examinedinFAST:

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a)Perisplenic
b)Perihepatic
c)Suprapubic
d)Chest
e)None

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CorrectAnswer-E
Ans.(E)NONE
[Ref:L6B26th/187;Manipal4th/886]
FAST:4acousticwindow-pericardial,perihepatic,perisplenicor
pelvic.

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Thefourclassicareasthatareexaminedforfreefluidarethe
perihepaticspace(alsocalledMorison'spouchorthehepatorenal
recess),perisplenicspace,pericardium&pelvis.

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190.Whichofthefollowingistrueregarding
catatonia

--- Content provided by FirstRanker.com ---

a)Prominentsensorysymptom
b)Prominentmotorsymptom
c)ECTisTOCforlifethreateningcatatonia
d)MaybeassociatedwithCNSdisease
e)None

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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;

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Harrison19th/1771,17th/147]
Catatonia:
CatatoniawasfirstdescribedbyKahlbaum,whodescribeda
syndromewithprominentmotor&behavioralsymptoms.
Characterizedbymotorabnormalitiessuchascatalepsy,mutism,

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posturing&negativism.
Itcanbeassociatedwithanothermentaldisorder(e.g.,
schizophreniaorbipolardisorder)orduetoanothermedical
condition(e.g.,neoplasm,headtrauma,hepaticencephalopathy
ECTisappropriateforcatatoniaduetoageneralmedicalcondition,

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especiallyifthecatatoniaislifethreatening(e.g.,inabilitytoeat)or
hasdevelopedintolethal(malignant)catatonia.

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191.Allaretrueaboutnarcolepsyexcept:
a)Daydreaming
b)Hypnagogichallucinations

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c)Cataplexy
d)Suddensleep
e)DecreasedREMlatency
CorrectAnswer-A
Ans.(A)Daydreaming

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[RefNeerajAhuja7th/Ij8-39;Kaplan&SailocklsTextbookof
psychiatry11th/547-50;Harrison19th/189,t7th/172-ZB;CMDT
2016/1072]
Narcolepsy:
Disordercharacterizedbyexcessivedaytimesleepinessoften

--- Content provided by FirstRanker.com ---

dkturbetlnighttimesleepanddisturbancesinREMsleep.
HallmarkofthisdisorderisdecreasedREMlatency,I.e.decreased
latentperiodbeforethefirstREMperiodoccurs.
NormalREMlatencyis90-100minutes,innarcolepsy,REMsleep
occurswithin10minutesoftheonsetofsleep.

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Classicaltetradofsymptoms:
Sleepattacks(MC)
Cataplexy
Hallucinationsatsleeponset(Hypnagogic)anduponwaking
(Hypnopompic)

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Sleepparalysis.

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192.Whichofthefollowingistrueabout
OCD:
a)Anxiety
b)Compulsion

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c)Hallucination
d)Obscession
e)Egoalien
CorrectAnswer-A:B:D:E
Ans.A,AnxietyB,CompulsionD,Obscession&E,Egoalien

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[RefAhuja7th/9s-98]
ObsessiveCompulsiveDisorder(OCD):
Representedbyadiversegroupofsymptomsthatincludeintrusive
thoughts,rituals,preoccupations,andcompulsions.
Washeriscommonesttype

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PersonswithOCDarecommonlyaffectedbyothermental
disorders.
Theobsessionsorcompulsionsaretime-consumingandinterfere
significantlywiththeperson'snormalroutine,occupational
functioning,usualsocialactivities,orrelationships.

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ApatientwithOCDmayhaveanobsession,compulsion,orboth.
Features:
EgoAlien
Isolationeffect
Undoing.

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Repetitivebehaviour.
Butisunable&resultsinirresistible.

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---

193.FeaturesofManiaincludes:
a)Cheerfulness
b)Anhedonia

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c)Catatonia
d)Delusionofgrandeur
e)Negativethinking
CorrectAnswer-A:D
Ans.(A)Cheerfulness(D)Delusionofgrandeur

--- Content provided by FirstRanker.com ---

[Refkaplan&Sadock'sTextbookofPsychiatry11th/358,364;Ahuja
7th/69-71,12]
ManicEpisode:
Anhedonia(inabilitytoexperiencePleasure)mayoccurinboth
schizophrenia&depression.

--- Content provided by FirstRanker.com ---

Elevatedmoodcanpassthrough4stages,dependingonthe
severityofmanicepisode-euphoria(mildelevation),elation
(moderateelevation),emulation(severeelevation)&ecstasy(very
severeelevation).
Personismoretalkativethanusual.

--- Content provided by FirstRanker.com ---

Increasedpsychomotoractivity.
Delusions(orideas)ofgrandeur(grandiosity),withmarkedlyinflated
self-esteem.
Delusionofpersecutionmaysometimesdevelopsecondaryto
delusionofgrandeur.

--- Content provided by FirstRanker.com ---

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