Download PGI PG PGI 2014 November Solved Question Paper

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

1.Whichofthefollowingstatementistrue
aboutPinnaexcept:
a)InTreacher-Collinssyndromemalformedpinnamaybepresent
b)Madeupofelasticcartilage
c)Developfromlstpharyngealcleftonly
d)Helpsinlocalizationofsound
e)Mayinvolvesinrelapsingperichondritis
CorrectAnswer-C
Ans.c.Developfromlstpharyngealcleftonly
Firstbranchialcleftistheprecursorofexternalauditorycanal.
Aroundthesixthweekofembryoniclife,aseriesofsixtubercles
appeararoundthefirstbranchialcleft
Branchialcleftsareectodermalinorigin.
Pinnadevelopsfrom1stand2ndpharyngealarch

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2.Pairedlaryngealcartilage(s)is/are:
a)Thyroid
b)Arytenoid
c)Corniculte
d)Cricoid
e)Cuneiform
CorrectAnswer-B:C:E
Ans.b.Arytenoid;c.Corniculte;e.Cuneiform
Laryngealcartilages
Thyroid(unpaired)
Itisthelargestofalllaryngealcartilages.Itis'V'shapedwithright
andleftlamina.Bothlaminae(alae)meetanteriorlyforminganangle
of90?inmalesand120?infemales.Vocalcordsareattachedtothe
middleofthyroidangle.
Cricoid(unpaired)
Itistheonlycartilageformingacompletering,thereforeisshaped
likearing.Itarticulateswitharytenoidcartilagetoform
cricoarytenoidjoint,atypeofsynovialjoint.
Epiglottis(unpaired)
Itisleaf-shapedelasticcartilage(inadults).Itisomegashapedin
children.Itformstheanteriorwalloflaryngealinlet.
Arytenoidcartilage(paired)
EachArytenoidcartilageispyramidalinshape.Basearticulateswith
cricoidcartilage,andapexsupportsthecorniculatecartilage.Avocal
processdirectedanteriorlyandgivesattachmenttovocalcord.A
muscularprocessdirectedlaterallyandgivesattachmenttointrinsic
laryngealmuscles.

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Corniculatecartilage(ofSantorini):Paired
ArticulateswithapexofArytenoidcartilage
Cuneiformcartilage(ofWrisberg):Paired
Situatedinaryepiglotticfoldinfrontofcorniculatecartilage.

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3.Allaretrueaboutmediastinumexcept:
a)Heartpassesthroughsuperiormediastinum
b)Heartpassesthroughmiddlemediastinum
c)Thymusremnantmaypresentinmiddlemediastinum
d)PosteriorboundaryofposteriormediastinumcorrespondstoTl-
T4vertebrae
e)Lowerborderofanteriormediastinumisextendedmorethan
posteriormediastinum
CorrectAnswer-A:C:D:E
Ans.a.Heartpassesthroughsuperiormediastinum;c.Thymus
remnantmaypresentinmiddlemediastinum;d.Posterior
boundaryofposteriormediastinumcorrespondstoTl-T4
vertebrae;e.Lowerborderofanteriormediastinumisextended
morethanposteriormediastinum
Superiormediastinum:Theregionsuperiortothesternalangle
containingtheaorticarchanditsthreebranches,thesuperiorvena
cava(SVC)andthebrachiocephalicveins,thetrachea,the
esophagus,andthephrenicandvagusnerves.Thesuperior
mediastinumalsocontainsthethymus;however,inanadult,the
thymusisusuallyatrophiedandpresentsasafattymass.
Anteriormediastinum:Theregionbetweenthesternalangle,the
deepsternalsurface,thepericardialsac,andthediaphragm.The
anteriormediastinumcontainsfatandareolartissueandtheinferior
partofthethymusoritsremnant.
Middlemediastinum:Thisregioncontainsthepericardialsacand
heart.
Posteriormediastinum:Theregioncontaininganatomicstructures

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deeptothepericardialsac,includingthethoracicportionofthe
descendingaorta,theazygossystemofveins,thethoracicduct,the
esophagus,andthevagusandsympatheticnerves.

---

4.Trueaboutmedialmeniscus:
a)Madeupofhyalinecartilage
b)Injuryoflateralmeniscusismorefrequentthanmedial
meniscus
c)Cshaped
d)Fixedtomedialcollateralligament
e)Innerpartismoreavascular
CorrectAnswer-C:D:E
Ans.c.Cshaped;d.Fixedtomedialcollateralligament;e.
Innerpartismoreavascular
MedialMeniscus
LateralMeniscus
-Semilunar(c)shaped(less
-Semicircular(C)shaped(more
circular)
circular)
-Largerinradius/diameterbut -Smallerinradius/diameterbut
narrowerinbody&
widerinbody&thickerin
thinnerinperiphery
periphery
-Posteriorhornislargerthan -Anterior&posteriorhornare
anteriorhorn
uniforminsize
-Coverslesser(-65%)oftibial -Coversmore(-85%)oftibial
articularsurface
articularsurface
-Peripheralareawherepopliteus
-Entireperipheryisattached tendoncrossesthejoint
tojointcapsule(medial
throughpopliteushiatusisnot
capsularligament)
attached
-Attachedtomedialcollateral
-Notattachedtolateralcollateral
ligament
ligament

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-Attachedtobothcruciate
ligaments,andposteriorhorn
receivesanchoragetomedial
femoralcondylesbyeitherthe
-Doesnotattachtoeither
ligamentofHumphryorligamentof
cruciateligaments
Wrisberg,depending
onwhichispresent.Itisalso
attachedposteriorlytothe
fasciacoveringpopliteusmuscle
andthearcuatecomplex
atposterolateralcornerofknee.
-Lessmobilebecauseofits
-Moremobileb/oitsattachments
attachment
-Morepronetoinjury
-Lesspronetoinjury

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5.Whichofthefollowingstatementis/aretrue
aboutoculomotornerve:
a)Arisefrompons
b)Edinger-Westphalnucleusgivesrisetoparasympatheticsupply
ofoculomotornerve
c)Arisefrommedulla
d)Passesthroughinterpeduncularfossa
e)Relatedtomedialwallofcavernoussinus
CorrectAnswer-B:D
Ans.b.Edinger-Westphalnucleusgivesriseto
parasympatheticsupplyofoculomotornerve;d.Passes
throughinterpeduncularfossa
NUCLEI:
1.Generalsomaticefferent:
Throughoculomotornucleusformovementofeyeballsupplyingall
extraocularmusclesexceptSuperiorOblique(SO)andLateral
Rectus(LR).
2.Generalvisceralefferent(parasymapthetic):
ThroughEdinger-Westphalnucleusforpupillarycontractionand
accomodation.
3.Generalsomaticafferent:
Carriesproprioceptivefibresfromtheextraocularmusclesto
mesencephalicnucleusoftrigeminal.
Occulomotornucleus(forgeneralsomaticefferent)andEdinger-
Westphalnucleustogetherformoculomotornuclearcomplex.
STRUCTURE:
Midbrain

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Midbrain
Thirdnervenucleus(atthelevelofthesuperiorcolliculusventral
tothecerebralaqueduct,onthepre-aqueductalgreymatter)
RedNucleus
SubstantiaNigra
ExitthroughInterpeduncularfossa
Investedwithasheathofpiamater
Passesbetweenthesuperiorcerebellar&posterior
cerebralarteries(Nervecompressedbyaneurysmofposterior
communicatingartery)

Piercestheduramater
Passb/wfreeandattachedbordersoftentoriumcerebelli
Cavernoussinus
Receivesfilamentsfromthecavernousplexusofthesympathetic
nervoussystemandcommunicatingbranchfromV1
Superiororbitalfissure
Orbit
SuperiorandInferiorBranch

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6.Derivative(s)ofmesonephricduct
includes:
a)SomepartofprostaticUrethra
b)Seminalvesicle
c)Roundligamentofuterus
d)Vasdeferens
e)Ductusdeferens
CorrectAnswer-A:B:D:E
Ans.a.SomepartofprostaticUrethra;b.Seminalvesicle;d.
Vasdeferens;e.Ductusdeferens
TheWolffianductormesonephricductformstheepididymis,vas
deferensandseminalvesicles.Testosteronedirectsthe
developmentofWolffianduct.
Trigoneofthebladderdevelopfromthecaudalendofthe
mesonephricduct.
Apairofuretericbudgrowupwardsfromthedistalmesonephric
ductnearitsinsertionintothecloacatoformtherenalpelvis,
calycesandcollectingducts.
Mostoftheprostateglanddevelopfromthesameprimordialareaof
urogenitalsinusthatformsthevaginalplateinfemales.
TheMullerianorparamesonephricductformsthefallopiantubes,
uterusandupperthirdofthevagina.

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7.AllaretrueregardingUterusexcept:
a)Lymphvesselsfromfundusdraintopara-aorticlymphnodes
b)Broadligamentprovidesprimarysupporttouterus
c)Mainlysuppliedbyuterinearteries
d)Posteriorsurfaceisrelatedtointestine
e)All
CorrectAnswer-B
Ans.b.Broadligamentprovidesprimarysupporttouterus
BLOODSUPPLYANDLYMPHATICS:
Uterineandovarianartery
Venousdrainageisviaaplexusinthebroadligamentthatdrains
intotheuterineveins.
Lymphaticdrainage:iliac,sacral,Paraaorticandinguinallymph
nodes.
LIGAMENTS:
Pelvicdiaphragm,Uterosacralligament&Transversecervical
ligamentareprimarysupportofuterus
Thetoneofthepelvicfloorprovidestheprimarysupportforthe
uterus.Someligamentsprovidefurthersupport,securingtheuterus
inplace.Theyare:
BroadLigament:Thisisadoublelayerofperitoneumattachingthe
sidesoftheuterustothepelvis.Itactsasamesenteryfortheuterus
andcontributestomaintainingitinposition.Itdonotprovideprimary
support.

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8.Whichofthefollowingstatementis/aretrue
regardingFickprincipleofmeasurementof
cardiacoutput:
a)Cardiacoutputiscalculatedbyamountofoxygenconsumedby
wholebodyperunitmassdividedbyA-VOxygendifference
acrossthelung
b)Oxygenconcentrationinarteryismeasuredbypassingcatheter
toPulmonaryartery
c)Mixedvenousbloodismeasuredbyinsertingcatheterinto
pulmonaryartery
d)Rateofoxygenabsorptionbythelungsismeasuredby
spirometry
e)Foroxygencontentofartery,anyarteryofbodycanbechosen
CorrectAnswer-A:C:D:E
Ans,(A)Cardiacoutputiscalculatedbyamountofoxygen
consumedbywholebodyperunitmassdividedbyA-VOxygen
differenceacrossthelung(C)Mixedvenousbloodismeasured
byinsertingcatheterintopulmonaryartery(D)Rateofoxygen
absorptionbythelungsismeasuredbyspirometry(E)For
oxygencontentofartery,anyarteryofbodycanbechosen
[Ref:Ganong25th/543-44,24th/546-47;A.K.Iain5th/356;Guyton1
lth/244]
CardiacOutputMeasurement:
Fickprinciplestatesthattheamountofasubstancetakenupbyan
organ(orbythewholebody)perunitoftimeisequaltothearterial
levelofthesubstanceminusthevenouslevel(A-Vdifference)times

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thebloodflow.
Principlecanbeusedtodeterminecardiacoutputbymeasuringthe
amountofO,consumedbythebodyinagivenperiodanddividing
thisvaluebytheA-Vdifferenceacrossthelungs.
InapplyingthisFickprocedureformeasuringcardiacoutputinthe
humanbeing,mixedvenousbloodisusuallyobtainedthrougha
catheterinsertedupthebrachialveinoftheforearm,throughthe
subclavianvein,downtotherightatrium,and,finally,intotheright
ventricleorpulmonaryartery.
Rateofoxygenabsorptionbythelungsismeasuredbytherateof
disappearanceoforygenfromtherespiredair,usinganytypeof
oxygenmeter(e.gclosecircuitspirometry)
BecausesystemicarterialbloodhasthesameO2contentinallparts
ofthebody,thearterialO2contentcanbemeasuredinasample
obtainedfromanyconvenientartery.

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9.Feature(s)ofhyperprolactinemiais/areall
except:
a)Amenorrhoea
b)Decreasemilkproduction
c)Galactorrhoea
d)Hypogonadotropichypogonadism
e)Hypothyroidismmaycausehyperprolactinemia
CorrectAnswer-B
Ans.B.Decreasemilkproduction
[Ref:Ganong25th/331-33,24th/334-35;A.K.Iain5th/695-96;
Guyton11th/907,918-921,I039-40;CMDT2016/1096-97,06/
1113-14]
Hyperprolactinemia:
Duetoanycausemayresultinhypogonadotropichypogonadism.
HypogonadotropichyPogonadismoftendevelopsinpatientswith
hyperprolactinemia;itmaybereversedwithtreatmentof
hyperprolactinemia.
Womenmaynoteoligomenorrhoeaoramenorrhoea.
Galactorrhoea,definedasLactationinabsenceofnursing,is
common.
Prolactindeficiencyinhibitspostpartumlactation.
Primaryhypothyroidismisassociatedwithmildhyperprolactinemia,
probablybecauseofcompensatoryTRHsecretion

---

10.TrueaboutOxytocin:
a)Secretedfromanteriorpituitary
b)Secretedbyposteriorpituitary
c)Decapeptide
d)Gonadotropinreleasinghormone(GnRH)stimulateitssecretion
e)Causemilkejectionbycontractionofmyoepitheliumofbreast
CorrectAnswer-B:E
Ans.(B)Secretedbyposteriorpituitary(E)Causemilkejection
bycontractionofmyoepitheliumofbreast
[Ref:Ganong25th/311-13,24th/311-l3;Guytonp918,1040-41,928]
Oxytocin:
Stimulatespostpartummilkletdowninresponsetosuckling.
Nonapeptide(9aminoacids).
DiffersfromAVPonlyatpositions3and8.
Relativelylittleantidiureticeffectandseemstoactmainlyon
mammaryductstofaci-litatemilkletdownduringnursing.
Mayhelpinitiateorfacilitatelaborbystimulatingcontractionof
uterinesmoothmuscle,butitisnotclearifthisactionisphysiologic
ornecessaryfornormaldelivery.
Gonadotropin-releasinghormone(GnRH):Itissecretedfrom
hypothalamus&stimulatessecretionofFSH&LH.

---

11.Truestatementrelatingtocomplianceof
lung:
a)Increasedbysurfactant
b)Decreasedinemphysema
c)Atheightofinspirationcomplianceisless
d)Itcanbemeasuredbymeasuringintrapleuralpressureat
differentlungvolume
e)None
CorrectAnswer-A:C:D
Ans.(A)Increasedbysurfactant(C)Atheightofinspiration
complianceisless(D)Itcanbemeasuredbymeasuring
intrapleuralpressureatdifferentlungvolume
[Ref:Ganong25th/629-32,24th/629-33;Guytonllth/473-75;A.K.
Jain5th/437]
Lungcompliance:
Measuredbymeasuringintrapleuralpressureatdifferentlung
volume.
Animportantfactoraffectingthecomplianceofthelungsisthe
surfacetensionofthefilmoffluidthatlinesthealveoli.
Deficiencyofsurfactant-lesscompliance;moresurfactant-more
compliance.
Compliancedecreaseswiththeinflationofthelungsasmore
pressureisrequiredtodistendthealreadydistendedlung.
Thecurveisshifteddownwardandtotheright(complianceis
decreased)bypulmonarycongestionandinterstitialpulmonary
fibrosis;pulmonaryfibrosisisaprogressivediseaseofunknown

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causeinwhichthereisstiffeningandscarringofthelung.
Thecurveisshiftedupwardandtotheleft(complianceisincreased)
inemphysema.

---

12.Whichofthefollowingistrueregarding
GLUT-5:
a)Presentinbrain
b)PresentinAdiposetissue,skeletalmuscle&skin
c)Insulinmediatedtransporter
d)Sodiumindependenttransport
e)PresentinRBC
CorrectAnswer-D
Ans.(D)Sodiumindependenttransport
[Ref:Ganong25th/435,24th/435;Harper30th/191,28th/171;
LippincottBiochemistry4th/97]
GLUT-5isunusualinthatitistheprimarytransporterforfructose
(insteadofglucose)inthesmallintestine&thetestes.
Hassodiumindependentfacilitateddiffusionmechanism.

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13.Trueabouthormonesensitivelipase:
a)Activityisincreasedbyinsulin
b)Foundintracellular
c)ActivatedbyEpinephrine
d)Locatedinwallbloodcapillaries
e)None
CorrectAnswer-B:C
Ans.B,Foundintracellular&C,ActivatedbyEpinephrine
[Harper30th/261-62,28th/220]
Hormone-sensitivelipase:
Hormone-sensitivelipaseisactivatedbyACTH,TSH,glucagon,
epinephrine,norepinephrine,andvasopressinandinhibitedby
insulin,prostaglandinE1,andnicotinicacid
Triacylglycerolundergoeshydrolysisbyahormone-sensitivelipase
toformfreefattyacidsandglycerol.
Thislipaseisdistinctfromlipoproteinlipase,whichcatalyzes
lipoproteintriacylglycerolhydrolysisbeforeitsuptakeinto
extrahepatictissues.

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

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15.TruestatementregardingLactate
dehydrogenasedeficiency:
a)Fumaratelevelincreases
b)Exerciseintolerance
c)Musclecrampsmayoccur
d)Itoperatesinanaerobiccondition
e)ItisthekeyenzymeofKrebcycle
CorrectAnswer-B:C:D
Ans:b.Exercise...,c.Muscle...,d.Itoperate...[RefHarper
30th/171,69,28th/149-151;Harrison19th/433e2;Lippincott
4th/103,111;Chatterjea&Shinde7th/313]1
FumarateisconvertedtomalatebyfumaraseenzymeinKrebcycle
(sofumaratelevelincreasesindefectiveenzymefunctioningin
Krebscycle,notinabnormalityofglycolysisi.e.,lactate
dehydrogenasedeficiency,Lactatedehydrogenasecatalyse
conversionofpyruvicacidtolacticacid.
Lactatedehydrogenasedeficiencyisaconditionthataffectshowthe
bodybreaksdownsugartouseasenergyincells,primarilymuscle
cells.
Therearetwotypesofthiscondition:lactatedehydrogenase-A
deficiency(sometimescalledglycogenstoragediseaseXI)and
lactatedehydrogenase-Bdeficiency.
Peoplewithlactatedehydrogenase-Adeficiencyexperiencefatigue,
musclepain,andcrampsduringexercise(exerciseintolerance).

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16.Hyaloronicacidiscomposedof:
a)N-acetylglucosamine
b)N-acetylgalactosamine
c)Glucuronicacid
d)N-acetylneuramicacid
e)Iduronicacid
CorrectAnswer-A:C
Ans:a.N-acetylandc.Glucuronic[RefHarper30th/156,159,
637,640,28th/119,534-39;Lippincott4th/159,163;Chatterjeaer
Shinde7th/38]
CompositionofHyaluronicAcid:Itiscomposedofrepeatingunitsof
N-acetylglucosamine&D-Glucuronicacid.Onhydrolysis,ityields
equimolecularquantitiesofD-Glucosamine,D-Glucuronicacid&
aceticacid.
Hyaluronicacidispresentinbacteriaandiswidelydistributed
amongvariousanimalsandtissues,includingsynovialfluid,the
vitreousbodyoftheeye,cartilage,andlooseconnectivetissues.
Hyaluronicacidisespeciallyhighinconcentrationinembryonic
tissuesandisthoughttoplayanimportantroleinpermittingcell
migrationduringmorphogenesisandwoundrepair.Itsabilityto
attractwaterintotheextracellularmatrixandthereby"loosenitup"
maybeimportantinthisregard.

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17.AllarefeatureofRefsumdiseaseexcept:
a)Deficiencyofa-hydroxylase
b)Defectinpoxidation
c)Accumulationofphytanicacid
d)Peripheralneuropathy
e)Treatedbyremovingphytanicacidprecursorsfromdiet
CorrectAnswer-B
Ans:b.Defectinpoxidation[RefHarper30th/231,614,28th/I91,
493;Lippincott4th/195;Harrison19th/2681,18th/3456,236]
Refsumdiseaseisarareautosomalrecessivedisordercausedbya
deficiencyofa-hydroxylase"(Lippincott4th/195)
"Refsum'sdisease:Alphaoxidationdoesnotoccur.Alphaoxidation
ismainlyusedforfattyacidsthathaveamethylgroupatbeta-
carbon,whichblockbeta-oxidation.Thisprocessoccurmainlyin
endoplasmicreticulum&somealsoinperoxisomes.
Refsum'sdiseaseisarareneurologicdisorderduetoametabolic
defectthatresultsintheaccumulationofphytanicacid,whichis
foundindairyproductsandruminantfatandmeat.Phytanicacidis
thoughttohavepathologicaleffectsonmembranefunction,protein
prenylation,andgeneexpression"(Harper30th/231,28th/191)
Refsumdiseasecanmanifestininfancytoearlyadulthoodwiththe
classictetradof(1)peripheralneuropathy,(2)retinitispigmentosa,
(3)cerebellarataxia,and(4)elevatedCSFproteinconcentration.
Refsumdiseaseisgeneticallyheterogeneousbutautosomal
recessiveinnature.ClassicalRefsumdiseasewithchildhoodor
earlyadultonsetiscausedbymutationsinthegenethatencodes
forphytanoyl-CoAa-hydroxylase(PAHX).

---

Refsumdiseaseistreatedbyremovingphytanic
precursors(phytols:fishoils,dairyproducts,andruminantfats)
fromthediet.

---

18.Whichofthefollowingenzyme(s)
participateinproteinsynthesis:
a)DNAligase
b)DNAHelicase
c)Peptidase
d)Peptidyltransferase
e)DNApolymerase
CorrectAnswer-D
Ans:d.Peptidyltransferase
[RefHarper30th/422-24,28th/359-66,323;Lippincott4th/438-42;
Chatterjea&Shinde7th/248-501
EnzymeRequiredforTranslation
Amino-acyl-t-RNAsynthetase:Enzymerequiredforactivationof
aminoacids,Peptidesynthetase(peptidyltransferase)
TheNH2ofnewaminoacylt-RNA(AI)in'A'sitecombinewiththe
-COOHgroupofMet-t-RNAoccupyingthe'P'site.Thereactionis
catalyzedbypeptidyltransferase"."Peptidasesdegradesproteinsto
aminoacids
TheNH2ofnewaminoacylt-RNA(AI)in'A'sitecombinewiththe
-COOHgroupofMet-t-RNAoccupyingthe'P'site.Thereactionis
catalyzedbypeptidyltransferase.``peptidasesdegradesproteins
toaminoacids.
Protein
function
DNA
Deoxynucleotide
polymerases
polymerization
Processiveunwindingof
Helicases

---

Helicases
DNA
Relievetorsionalstrain
Topoisomerases thatresultsfromhelicase-
inducedunwinding
InitiatessynthesisofRNA
DNAprimase
primers
Single-strand
Preventpremature
bindingproteins
reannealingofdsDNA
Sealsthesinglestrand
nickbetweenthenascent
DNAligase
Okazakichainand
fragmentsontagging
strand

---

19.Trueaboutpeptidebondformation:
a)TheNH2groupofnewaminoacylt-RNAatAsitecombinewith
the-COOHgroupofMet-t-RNAoccupyingthe'P'site
b)TheNH2groupofnewaminoacylt-RNAat'P'sitecombine
withthe-COOHgroupofMet-t-RNAoccupyingthe'Asite
c)Reactioniscatalyzedbypeptidyltransferase
d)Peptidebondformationrequireenergy
e)None
CorrectAnswer-A:C
Ans:a.TheNH2andc.Reaction...[RefHarper30th/422-25,
28th/359-66;Lippincott4th/438-42;Chatterjeate?Shinde7th/248-
501]
Thea-aminogroupofthenewaminoacyl-tRNAintheAsitecarries
outanucleophilicattackontheesterifiedcarboxylgroupofthe
peptidyl-tRNAoccupyingthePsite(peptidylorpolypeptidesite).At
initiation,thissiteisoccupiedbyaminoacyl-tRNAmet'.
Thisreactioniscatalyzedbyapeptidyltransferase,acomponent
ofthe28SRNAofthe60Sribosomalsubunit.Thisisanother
exampleofribozymeactivityandindicatesanimportant--and
previouslyunsuspected--directroleforRNAinproteinsynthesis.
Becausetheaminoacidontheaminoacyl-tRNAisalready
"activatornofurtherenergysourceisrequiredforthisreaction.The
reactionresultsinattachmentofthegrowingpeptidechaintothe
tRNAintheAsite.

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20.AllaretrueregardingUreacycleexcept:
a)Ureaformedfromammonia
b)Ratelimitingenzymeisornithinetranscarbamoylase
c)RequireEnergyexpenditure
d)Malateisbyproductofureacycle
e)Onenitrogenofureacomesfromforaspartate
CorrectAnswer-B:D
Ans:b.Ratelimiting...,d.Malate...[RefHarrison19th/434e3-5,
18th/3216,3219;17th/2472-74;Harper30th/290-96,
28th/243;Shinde7th/450-51;Vasudevan5th/180-81]
Ureahastwoaminogroups,onederivedfromammonia&other
fromaspartate.Carbonatomissuppliedfromcarbondioxide.
Rate-limitingenzyme(pacemakerenzyme)ofUreacycle:
CarbamoylphosphatesynthetaseI(CPSIIisinvolvedinpyrimidine
synthesis)"(Harper28th/245).
Rate-limitingenzymeofGlycogenSynthesis:Glycogensynthase
(nottoohardthere)
Rate-limitingenzymeofGlycogenlysis:Glycogenphophorylase
(phophorylasebreaksphosphatebond,whichmeansactivated
glycogenreleasesalotofenergy)
Rate-limitingenzymeofHMPShunt:Glucose-6Phosphate
dehydrogenase(badtolosethisinRBCs)
Rate-limitingenzymeofdenovopyrimidinesynthesis:Carbamoyl
phosphatesynthaseII(CPSIisinvolvedinureacycle)

---

21.Whichofthefollowingistrueregarding
phenylketonuria:
a)Dietaryphenylalaninerestrictionisusedintreatment
b)OccurduetodeficiencyofPhenyalaninehydroxylaseenzyme
c)Occurduetoincreaseactivityofphenyalaninehydroxylase
enzyme
d)Tyrosinemustbesuppliedindiet
e)Dietshouldcontainhighphenylalaninecontainingfooditems
CorrectAnswer-A:B:D
Ans:a.Dietary...,b.Occur...,d.Tyrosine...[RefHarrison
19th/434e1-3,18th/3217-18;Harper30h/304-306,28th/254;
Lippincott4th/270-72]
InpatientswithPKU,tyrosinecannotbesynthesizedfrom
phenylalanine&therefore,itbecomesanessentialaminoacidthat
mustbesuppliedinthediet
Dietaryphenylalaninerestrictionisusuallyinstitutedifblood
phenylalaninelevelsare>300umol/L(5mg/dL).
Treatmentconsistsofaspecialdietlowinphenylalanineand
supplementedwithtyrosine,sincetyrosinebecomesanessential
aminoacidinphenylalaninehydroxylasedeficiency.
Aboutone-thirdofallpatientswithphenylketonuriaandthemajority
ofthosewithmilderforms(phenylalanine<1200umol/Lat
presentation)showincreasedtolerancetodietaryproteinsand
improvedmetaboliccontrolwhentreatedwithtetrahydrobiopterin(5-
20mg/kgperday),anessentialcofactorofphenylalanine
hydroxylase.Thisdrugshouldbeusedinadditiontodietarytherapy.

---

Pregnancyriskscanbeminimizedbycontinuinglifelong
phenylalanine-restricteddietsandassuringstrictphenylalanine
restriction2monthspriortoconceptionandthroughoutgestation.

---

22.InBenedicttest,redcolouris/are
producedby:
a)Sucrose
b)Inositol
c)Fructose
d)Lactose
e)Maltose
CorrectAnswer-C:D:E
Ans:c.Fructose,d.Lactose,e.Maltose[RefLippincott4th/84-
85;ChatterjeaFrShinde7th/31;Satyanarayan3rd/16]
Inositolisalsocalledasmusclesugar.Chemicallyitishexahydroxyl
cyclohexane"(ChatterjeadShinde7th/190)
Reducingsugarscanreactwithchromogenicagents(fore.g,
Benedict'sreagentorFehling'ssolutionorBarfoed'stest)causing
thereagenttobereduced&coloured,withanomericcarbonofthe
sugarbecomingoxidized"(Lippincott4th/84;Satyanarayan3rd/16).
InBenedict'stest,reactionofreducingsugarwithBenedict'sreagent
produceredcolourofcuprousoxide.

---

23.Truestatementsare:
a)VitaminAindose20,000unitmaybeusedduringlactationto
preventVitAdeficiencytoinfants
b)HighdoseofVitaminCmaycauserenalstone
c)VitaminEreducesriskofatherosclerosis
d)Folicaciddeficiencycausemicrocyticanaemia
e)BananaisarichsourceofVit.B6
CorrectAnswer-A:B:C:E
Ans:a.Vitamina....,b.High...,c.Vitamine...,e.Banana...[Ref
Harrison19th/96e1-7,18th/599;Harper30th/547-62,28th/47178;
Lippincott4th/374]
Vit.Ctoxicity:Oxalatekidneystonesareoftheoreticconcern
becauseascorbicacidismetabolizedtooxalate,butstoneformation
hasnotbeenfrequentlyreported"(CMDT06/1275)"Prophylaxis
againstxerophthalmia:Lactatingmothersshouldbegiven20,000
IUorallyonceatdeliveryorduringthenext2months.Thiswillraise
theconcentrationofvitaminAinthebreastmilk&therefore,helpto
protectthebreastfedinfant"(Khurana5th/466)
"Folicaciddeficiencycausemegaloblasticanaemia(macrocytic)"
(Lippincott4th/374)
"Vit.Ereducestheriskofatherosclerosis"(Vasudevan5th/291)
"Banana:Itisaverygoodsourceofvitamin-B6(pyridoxine),
providesabout28%ofdaily-recommendedallowance.

---

24.Thiamineactasco-enzymefor:
a)Transketolase
b)Pyruvatedehydrogenase
c)Alcoholdehydrogenase
d)Transaminase
e)None
CorrectAnswer-A:B
Ans:a.Transketolase,b.Pyruvate...[RefHarper30th/555,
28th/52;Chatterjea&Shinde7th/166-67]
"NAD+(byvitaminB3)actsasacoenzymeforalcohol
dehydrogenase"(ChatterjeaShinde7th/171)
Pyridoxalphosphate(byvitaminpyridoxine,B6)actsascoenzyme
fortransaminaseslikeaminotransferase.
thiaminepyrophosphateactsascoenzymein:Pyruvate
dehydrogenasemn(oxidativedecarboxylation),a-oxoglutararte
dehydrogenasecomplex(oxidativedecarboxylation),transketolase
(transketolationreaction),tryptophanpyrrolase,pyruvate
carboxylase(non-oxidativedecarboxylation).

---

25.Thiaminedeficiencycause(s):
a)Glossitis
b)Polyneuropathy
c)Pellagra
d)Angularstomatitis
e)Cardiomegaly
CorrectAnswer-B:E
Ans:b.Polyneuropathy,e.Cardiomegaly[Re(Harrison
19th/96e-3,18th/594-96;Harper30th/555-56,28th/468]
Wetberiberipresentsprimarilywithcardiovascularsymptoms,due
toimpairedmyocardialenergymetabolismanddysautonomia,and
canoccurafter3monthsofathiamine-deficientdiet.Patients
presentwithanenlargedheart,tachycardia,high-outputcongestive
heartfailure,peripheraledema,andperipheralneuritis.
Patientswithdryberiberipresentwithasymmetricperipheral
neuropathyofthemotorandsensorysystemswithdiminished
reflexes.Theneuropathyaffectsthelegsmostmarkedly,andthese
patientshavedifficultyrisingfromasquattingposition.

---

26.Korsakoffpsychosis?
a)Thiaminedeficiency
b)Folatedeficiency
c)Niacindeficiency
d)Niacindeficiency
e)None
CorrectAnswer-A
Ans.is'a'i.e.,Thiaminedeficiency
Alcoholicpatientswithchronicthiaminedeficiencyalsomayhave
centralnervoussystem(CNS)manifestationsknownasWernicke's
encephalopathy,consistingofhorizontalnystagmus,
ophthalmoplegia(duetoweaknessofoneormoreextraocular
muscles),cerebellarataxia,andmentalimpairment.
Whenthereisanadditionallossofmemoryandaconfabulatory
psychosis,thesyndromeisknownasWernicke-Korsakoff
syndrome.Despitethetypicalclinicalpictureandhistory,Wernicke-
Korsakoffsyndromeisunderdiagnosed"(Harrison19th/96e-3,
18th/597)
ThereareSixMajorSymptomsofKorsakoff'sSyndrome:
Anterogradeamnesia:Inabilitytoformnewmemories
Retrogradeamnesia:Severelossofmemoriesformedbeforethe
onsetofthecondition
Confabulation:Thatis,inventedmemorieswhicharethentakenas
trueduetogapsinmemorysometimesassociatedwithblackouts
Minimalcontentinconversation
Lackofinsight
Apathy:Thepatientsloseinterestinthingsquicklyandgenerally

---

appearindifferenttochange.

---

27.Glycogenstoragedisorderis-
a)Niemann?Pickdisease
b)Gaucherdisease
c)Tay-Sacksdisease
d)Pompe'sdisease
e)McArdlesdisease
CorrectAnswer-D
GlycogenstoragediseasetypeII,alsocalledPompedisease,is
anautosomalrecessivemetabolicdisorder[1]whichdamages
muscleandnervecellsthroughoutthebody.Itiscausedbyan
accumulationofglycogeninthelysosomeduetodeficiencyofthe
lysosomalacidalpha-glucosidaseenzyme.Itistheonlyglycogen
storagediseasewithadefectinlysosomalmetabolism,andthefirst
glycogenstoragediseasetobeidentified,
Thediseaseiscausedbyamutationinagene(acidalpha-
glucosidase:alsoknownasacidmaltase)onlongarm
ofchromosome17.
Mostcasesappeartobeduetothreemutations.Atransversion(T
G)mutationisthemostcommonamongadultswiththisdisorder.
ThismutationinterruptsasiteofRNAsplicing.
Thegeneencodesaprotein--acidalpha-glucosidase(EC3.2.1.20)
--whichisalysosomalhydrolase.Theproteinisanenzymethat
normallydegradesthealpha-1,4andalpha-1,6linkages
inglycogen,maltoseandisomaltoseandisrequiredforthe
degradationof1?3%ofcellularglycogen.Thedeficiencyofthis
enzymeresultsintheaccumulationofstructurallynormalglycogen
inlysosomesandcytoplasminaffectedindividuals.

---

clinicalfeatures:
Accumulationofglycogeninlysosomes:Juvenileonsetvariant,
musclehypotonia,deathfromheartfailurebyage2;adultonset
variant,muscledystrophy

---

28.TrueaboutDNAhyperchromatism:
a)Itisincreaseofabsorbance
b)Measuredbyabsorbanceat260nm(inaspectrophotometer)
c)ItoccurswhentheDNAduplexisdenatured
d)DoublestrandedDNAismorehyperchromicthanssDNA
e)None
CorrectAnswer-A:B:C
Ans:(A)Itisincreaseofabsorbance(B)Measuredby
absorbanceat260nm(inaspectrophotometer)(C)Itoccurs
whentheDNAduplexisdenatured[RefHarper30th/361,
28th/303;Satyanarayan3rd/78;Lippincott4th/397-98]
Hyperchromicityistheincreaseofabsorbance(opticaldensity)ofa
material.Themostfamousexampleisthehyperchromicityof
DNAthatoccurswhentheDNAduplexisdenatured
Itistheincreaseofabsorbance(opticaldensity)ofamaterial.The
mostfamousexampleisthehyperchromicityofDNAthatoccurs
whentheDNAduplexisdenatured.
'Atawavelengthof260nm,ssDNAhasahigherrelative
absorbancethandoesdoublestrandedDNA"(Lippincott
4th/397-98)
TheUVabsorptionisincreasedwhenthetwosingleDNAstrands
arebeingseparated,eitherbyheatorbyadditionofdenaturantor
byincreasingthepHlevel.
Lossofhelicalstructurecanbemeasuredbyincreasein
absorbanceat260nm(inaspectrophotometer),Theopposite,a
decreaseofabsorbanceiscalledhypochromicity
Renatuartion(reannealing)istheprocessinwhichtheseparated

---

complementaryDNAstrandscanformadoublehelix

---

29.AllaretrueaboutDNAmethylation
except:
a)Itusuallyoccursinthecytosine
b)Canaltersthegeneexpressionpatternincells
c)Roleingenomicimprinting
d)Noroleincarcinogenesis
e)Essentialfornormaldevelopment
CorrectAnswer-D
Ans:(D)Noroleincarcinogenesis[RefHarper30th/438;
Harrison19th/101e-4,18th/668,679;Robbins9th/319-20,893,
8th/306;Satyanarayan3rd/359,572;Lippincott4th/460-62;
ChatterjeaShinde7th/346,426;en.wikipedia.org/wiki/
DNA_methylation]
CytosineinthesequenceCGofDNAgetsmethylatedtoform5'-
methylcytosine.AmajorportionofCG(about20%)inhumanDNA
existsinmethylatedform.
InDNA,methylationusuallyoccursintheCpGislands,aCGrich
region,upstreamofthepromoterregion.Inhumans,DNA
methylationiscarriedoutbyagroupofenzymescalledDNA
methyltransferases.
DNAmethylationstablyaltersthegeneexpressionpatternincells
suchthatcellscan"rememberwheretheyhavebeen"ordecrease
geneexpression
DNAmethylationisessentialfornormaldevelopmentandis
associatedwithanumberofkeyprocessesincludinggenomic
imprinting,X-chromosomeinactivation,suppressionofrepetitive

---

elements,andcarcinogenesis.
Adenineorcytosinemethylationispartoftherestrictionmodification
systemofmanybacteria,inwhichspecificDNAsequencesare
methylatedperiodicallythroughoutthegenome.
Withinthebacterium,methylationprotectsthehostDNAfrom
cleavagebyitsownrestrictionenzyme.UnmethylatedforeignDNA
isnotprotectedfromcleavage.

---

30.Allaretrueregardingepigenetics
mechanismexcept:
a)Non-heritable
b)AcetylationofHistone
c)Hereditary
d)MethylationofDNA
e)Xchromosomeinactivation
CorrectAnswer-A
Ans.(A)Non-heritable
Epigeneticsisdefinedasthestudyofheritablechemical
modificationofDNAorchromatinthatdoesnotaltertheDNA
sequenceitself.Exampleofsuchmodificationincludemethylationof
DNA&themethylationeracetylationofhistones.
Epigeneticmodificationiscriticalfornormaldevelopmentincluding-
regulationoftissuespecificgeneexpression,X-chromosome
inactivation&genomicimprinting.
Anepigeneticmodificationreferstoachangeinthe
genome,heritablebycellprogeny,thatdoesnotinvolveachangein
theDNAsequence.TheinactivationofthesecondXchromosomein
femalecellsisanexampleofanepigeneticsilencingthatprevents
geneexpressionfromtheinactivatedchromosome.

---

31.Whichofthefollowingistrueregarding
DNAdouble-strandbreaksrepairpathway
a)Homologousrecombinationrequirealonghomologous
sequencetoguiderepair
b)Non-homologousend-joiningdoesnotrequirealong
homologoussequencetoguiderepair
c)HomologousrecombinationrepairsDNAbeforethecell
d)Non-homologousend-joiningrepairsDNAbeforethecellenters
mitosis
e)Non-homologousendjoiningisprominentDSBrepair
mechanisminmammals
CorrectAnswer-A:B:C:E
Ans:a.Homologus...,b.Non-homologous...,c.Homologous...,
e.Non-homologous...[RefHarper30th/389-91,
Satyanarayan3rd/532;Robbins9th/430-31,8th/302;http:
www.ncbi.nlm.nih.gov/pubmed/20192759]
Non-homologousendjoining(NHEJ)isthepredominanttypeofDSB
repairinmammaliancells,asopposedtolowereukaryotes.
DSBinDNAaredangerous;Theyresultingeneticrecombination
whichmayleadtochromosomaltranslocation,brokenchromosome
&finallycelldeath;DSBscanberepairedbyhomologous
recombinationornon-homologousendjoining;Homologous
recombinationoccursinyeastswhileinmammals,non-homologous
endjoiningdominates
Double-StrandBreaksRepairMechanism
1. Double-strandbreakscanberepairedthroughhomologous

---

recombinationorthroughnon-homologousendjoining(NHEJ).
2. NHEJisaDNArepairmechanismwhich,unlikehomologous
recombination,doesnotrequirealonghomologoussequenceto
guiderepair.
3. WhetherhomologousrecombinationorNHEJisusedtorepair
double-strandbreaksislargelydeterminedbythephaseofcell
cycle.HomologousrecombinationrepairsDNAbeforethecellenters
mitosis(Mphase).
4. DNAdouble-strandbreaks(DSB)arepresumedtobethemost
deleteriousDNAlesionsastheydisruptbothDNAstrands.
5. Homologousrecombination(HR),single-strandannealing,andnon-
homologousendjoiningareconsideredtobethepathwaysfor
repairingDSB.

---

32.Groupofallelesthatarecloselylinked
togetheratagenomiclocus&inherited
togetherasaclusteris/are:
a)Idiotype
b)Haplotype
c)Genotype
d)Phenotype
e)None
CorrectAnswer-B
Ans.(B)Haplotype([RefsHarrison19th/435,18th/497,505;
Robbins9th/195,8th/177])
Theentirehumangenomenowcanbedividedintoblocksknownas
haplotypes,whichcontainvaryingnumbersofcontiguoussingle
nucleotidepolymorphismsonthesamechromosomethatarein
linkagedisequilibrium&henceinheritedtogetherasacluster
Ahaplotypereferstoagroupofallelesthatarecloselylinked
togetheratagenomiclocus.
Haplotypesareusefulfortrackingthetransmissionofgenomic
segmentswithinfamiliesandfordetectingevidenceofgenetic
recombination,ifthecrossovereventoccursbetweenthealleles.

---

33.ThesizeofMicrosatelliterepeatsequence
is:
a)<1kb
b)2-6bp
c)1-3kb
d)>3kb
e)5-20bp
CorrectAnswer-B
Ans:b.2-6bp
sequencesof2-5bprepeatedupto50times.Mayoccurat50000-
100000locationsinthegenome"-Harper30th/377-78,28th/404
Short(2-6bp),inherited,tandemrepeatunitsofDNAoccurabout
50,000-100,000timesinthehumangenome.
Becausetheyoccurmorefrequently--andintheviewoftheroutine
applicationofsensitivePCRmethods--theyarereplacingRFLPsas
themarkerlociforvariousgenomesearches.

---

34.FeatureofVonHippelLindausyndrome:
a)Mutationinchromosome13
b)Mutationinchromosome3
c)Pancreaticcyst
d)Cerebellarhemangioblastoma
e)All
CorrectAnswer-B:C:D
Answer-(B)Mutationinchromosome3(C)Pancreaticcyst
(D)Cerebellarhemangioblastoma
Thisisanautosomal-dominantdiseaseinwhichaffectedindividuals
developtumorsincerebellarhemispheres,theretina,and,less
commonly,thebrainstemandspinalcord.
ThegeneforvonHippel-Lindaudisease,atumor-suppressorgene,
islocatedonchromosome3p25-26.
Thecerebellarcapillaryhemangioblastoma,istheneurologic
manifestationofthedisease.
Retinalangiomas,Pheochromocytomaarealsoassociatedtumours.

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35.Allarethefeature(s)ofHermansky-
pudlaksyndromeexcept:
a)Autosomaldominantinheritance
b)Oculocutaneousalbinism
c)Bleedingdisorder
d)Pulmonaryfibrosis
e)Pain
CorrectAnswer-A
Answer-A.Autosomaldominantinheritance
Itisarareautosomalrecessivedisorderwhichresultsin
oculocutaneousalbinism,bleedingproblemsduetoaplatelet
abnormality(plateletdysfunction),storageofanabnormalfat-protein
compound.
Chromosome10q23isaffected.
Thereareeightclassicformsofthedisorderinwhichlasttypeof
disorderisduetogenePallidin(PLDN)
Themajorcomplicationofthedisorderispulmonaryfibrosis.

---

36.Differencebetweenactive&restingcell
dependonwhichphaseofcellcycle:
a)GO
b)G1
c)G2
d)M
e)S
CorrectAnswer-A
Answer-A.GO
Thecellcycleconsistsoffourdistinctphases-
G1phase
Sphase
G2phase
Mphase
Quiescent/senescent-
GapO
Arestingphasewherethecellhasleftthecycleandhasstopped
dividing.

---

37.Notfeature(s)ofapoptosis:
a)MediatedbyCaspases
b)InhibitionofEndonucleaseactivity
c)Membraneblebareseen
d)Chromatincondensation
e)Associationwithinflammation
CorrectAnswer-B:E
Answer-(B)InhibitionofEndonucleaseactivity(E)Association
withinflammation
Caspaseactivatesendonuclease(neuronalapoptosislacks
caspases,thusactivationofAIF)
MORPHOLOGICALFEATURES:
Convolutionofcellmembrane
Leadingtoformationofcytoplasmicblebs(althoughcellmembrane
remainsintact).
Chromatincondensation(pyknosis)/nuclearcompaction
Doesnotelicitanyinflammatoryresponseduetointactcell
membrane.

---

38.TrueaboutmitochondrialDNA:
a)Linear
b)Circular
c)Transmittedbymotheronly
d)Transmittedbybothparents
e)ContainslessgenethannuclearDNA
CorrectAnswer-B:C:E
Answer-(B)Circular(C)Transmittedbymotheronly
(E)ContainslessgenethannuclearDNA
Insexualreproduction,mitochondriaarenormallyinherited
exclusivelyfromthemother;themitochondriainmammaliansperm
areusuallydestroyedbytheeggcellafterfertilization.
UGAcodesfortryptophan,Codesfor13proteins,Circulardouble
strandedDNA,MitochondrialdiseaseoccurduetoPointMutations
andLarge-ScaleRearrangements.
Theremaining22tRNAand2rRNA-encodinggenesarededicated
totheprocessoftranslationofthe13mtDNAencodedproteins.

---

39.TrueaboutIntravascularhemolysis:
a)Increasedserumhaptoglobin
b)IncreaseStercobillininurine
c)Increaseplasmamyoglobin
d)Increasedfecalexcretionofurobilin
e)Hemosiderinuria
CorrectAnswer-D:E
Answer-(D)Increasedfecalexcretionofurobilin
(E)Hemosiderinuria
Intravascularhemolysisismanifestedby
1. hemoglobinemia
2. hemoglobinuria
3. jaundice
4. hemosiderinuria
Decreasedserumhaptoglobinischaracteristicofintravascular
hemolysis.
CommonFeaturesofHemolyticDisorders-
Hbreduced
MCV,MCH-increased
Reticulocytes-increased
Bilirubin-increased

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40.Causesofunconjugated
hyperbilirubinemiainclude?
a)Sepsis
b)Criggler-Najarsyndrome
c)Rotorsyndrome
d)Gilbertsyndrome
e)Intravascularhemolysis
CorrectAnswer-A:B:D:E
Answer-A,B,D,E,Sepsis,Criggler-Najarsyndrome,Gilbert
syndrome,Intravascularhemolysis
Unconjugatedhyperbilirubinemia:-
Increasedproductionofbilirubinfromhemoglobin,Sothatthe
capacityoflivertoconjugatebilirubinisoverwhelmedbyincreased
production,e.g.
1. Hemolyticanemia(bothintravascularandextamascular)sHereditary
sphnocytosis,G6PDdefciency.
2. Inefrectiveerythropoiesis-Thalassemia,Perniciousanemia.
3. Reducedhepaticuptakeofbilirubinfrombilirubin-albumincomplex
>Drugs,
4. Infections:-Sepsis,UTI
5. Impairedhepaticconjugation.

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41.Rheumaticheartdiseaseis/are:
a)Endocarditis
b)Constructivepericarditis
c)Mostcommonlyinvolvetrisucpidvalve
d)Breadbutterpericarditis
e)Pancarditis
CorrectAnswer-A:D:E
Answer-(A)Endocarditis(D)Breadbutterpericarditis
(E)Pancarditis
AcuterheumattccarditisdurlngtheactivephaseofRFmayprogress
tochronicrheumaticheartdisease(RHD).
DuringacuteRF,diffuseinflammationandAschoffbodiesfound
threelayersoftheheart-
pericardium,myocardiumorendocardiumlesioniscalleda
pancarditis.
ChronicRHDischaracterizedbyorganizationoftheacute
inflammationandsubsequentfibrosis.
Thecardinalanatomicchangesofthemitral(ortricuspid)valveare
leafletthickening,commissuralfusionandshortening'and
thickeningandfusionofthetendinouscords.
Inchronicdisease,themitralvalvelsvirtuallyalwaysabnormal.
RHDisthemostfrequentcauseofmitralstenosis.
Fibrousbridgingacrossthevalvularcommissuresandcalcification
create"fishmouth"orbuttonholestenoses.
Carditis,
Subcutaneousnodules,
Erythemamarginatumoftheskin,and

---

Sydenhamchorea,aneurologicdisorderwithinvoluntary
purposeless,rapidmovements

---

42.TrueaboutCysticfibrosis-
a)OccursdueCFTRgenemutationonchromosome7
b)Meconiumileusispresentin>90%cases
c)CFTRgenecanbedetectedantenately
d)Poorbodygrowth
e)Alloftheabove
CorrectAnswer-A:C:D
Answer-A,C,D,OccursdueCFTRgenemutationon
chromosome7(C)CFTRgenecanbedetectedantenately
(D)Poorbodygrowth
Theprimarydefectincysticfibrosisresultsfromabnormalfunction
ofanepitheltalchloridechannelproteinencodedbythecystic
fibrosistransmembraneconductanceregulator(CFTR)geneon
chromosome7.
Contentsoftheintestinallumenaredifficulttoexcretewhichresults
inmeconiumileus.
SequencingtheCFTRgeneisthegoldstandardfordiagnosisof
cysticfibrosisPoorbodygrowth

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43.Percutaneousliverbiopsyis/are
contraindicatedin:
a)Ascites
b)Hemangiomaofliver
c)Plateletcount<60000/0
d)Hepaticmetastasis
e)Echinococcuscystinliver
CorrectAnswer-A:B:C:E
Answer-(A)Ascites(B)Hemangiomaofliver(C)Plateletcount
<60000/0(E)Echinococcuscystinliver
Thrombocytopenia
Ascites
Difficultbodyhabitus
Suspectedhemangiona
Suspectedechinococcalinfection
Uncooperativepatient

---

44.TrueaboutAlcoholiccirrhosis:
a)Predominantlymacronodularpattern
b)Bileductproliferaton
c)Mallorybodyhardlyseen
d)Disturbednormalarchitecture
e)All
CorrectAnswer-B:C:D
Answer-(B)Bileductproliferaton(C)Mallorybodyhardlyseen
(D)Disturbednormalarchitecture
Fibrosiscanbecentilobular,pericellular,orperiportal.
Thereisdisruptionofthenormallayerarchitectureandreplacement
oflivercellsbyregenerativenodules.
Inalcoholiccirrhosis,referredtoasmicronodular.
Withcessationofalcoholuse,largernodulesmayform,resultingin
amixedmicronodularandmacronodularcirrhosis.
Scatteredlargernodulescreatea"hobnail"appearanceonthe
surfaceoftheliver.
TheetiologicalcluetodiagnosisintheformofMallorybodiesishard
tofindinafully-developedalcoholiccirrhosis.

---

45.AllaretrueaboutLesch-Nyhansyndrome
except:
a)Hyperurecaemia
b)Mentalretardation
c)Stoneproduction
d)Occurequallyinbothsexes
e)X-linked
CorrectAnswer-D
Answer-D.Occurequallyinbothsexes
AcompletedeficiencyofHPRT,theLesch-Nyhansyndrome,is
characterizedbyhyperuricemia,self-mutilativebehavior,
choreoathetosis,spasticity,andmentalretardation.
ThisisarareX-linkeddisorderofpurinemetabolismthatresults
fromHPRTdeficiency.
Thehyperuricemiaresultsfromurateoverproductionandcancause
uricacidcrystalluria,nephrolithiasis,obstructiveuropathy,andgouty
arthritis.
AffectsMalesonly.
Etiology-hereditary
Treatment-
Allopurinol

---

46.Marker(s)ofLangerhanscell
histiocytosis:
a)CD1a
b)S100
c)CD3
d)CD5
e)CD30
CorrectAnswer-A:B
Answer-(A)CD1a(B)S100
TheproliferatingLangerhanscellsinLangerhanscellhistiocytosis
areHLA-DRpositiveandexpresstheCD1antigen.
ThehallmarkofLCHispositivityforS-100protein&CD1a
positivity.

---

47.Breastcanceris/areassociatedwith:
a)Familialadenomatouspolyposis
b)Ataxia-telangiectasia
c)Peutz-Jegherssyndrome
d)Cowdendisease
e)VonHippelLindausyndrome
CorrectAnswer-B:C:D
Answer-(B)Ataxia-telangiectasia(C)Peutz-Jegherssyndrome
(D)Cowdendisease
VonHippelLindausymdromeisnotassociatedwithbreast
carcinoma.
Familialadenomatouspolyposisisassociatedwithcolorectal
carcinoma&someothercancerbutnotbreastcancer.
STK11/LKB1(Peutz-Jegherssyndrome)
PTEN(Cowdendisease)

---

48.Hyperglycemiais/areassociatedwith:
a)Cushingdisease
b)Addisondisease
c)Pheochromocytoma
d)Hyperthyroidism
e)Acromegaly
CorrectAnswer-A:C:D:E
Answer-(A)Cushingdisease(C)Pheochromocytoma
(D)Hyperthyroidism(E)Acromegaly
Endocrinopathiesassociatedwithhyperglycemia-
Acromegaly
Cushingsyndrome
Hyperthyroidism
Pheochromocytoma
Glucagonoma

---

49.Malignancyassociatedwith
hypercalcemia:
a)Breastcancer
b)Smallcelllungcancer
c)Non-smalllungcancer
d)Prostatecancer
e)Multiplemyeloma
CorrectAnswer-A:C:D:E
Answer-A,BreastcancerC,Non-smalllungcancerD,Prostate
cancerE,Multiplemyeloma
Lungcarcinoma,breastcarcinoma,andmultlplemyelomaaccount
formorethan50%ofallcasesofmalignancy-associated
hypercalcemia.
Gastrointestinaltumarsandprostatecarcinomaarelesscommon
causesofhypercalcemia.

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50.Calciumlevelisincreasedin:
a)Parathyroidadenoma
b)Thiazidediuretics
c)Chronicrenalfailure
d)HypervitaminosisD
e)Cirrhosis
CorrectAnswer-A:B:C:D
Answer-(A)Parathyroidadenoma(B)Thiazidediuretics
(C)Chronicrenalfailure(D)HypervitaminosisD
Hyperparathyroidism
Adenoma
Thiazidediuretics

---

51.Cause(s)ofmegaloblasticanaemia
include:
a)Anticonvulsantdrugs
b)Pregnancy
c)Resectionofileum
d)Gastrectomy
e)Crohn'sdisease
CorrectAnswer-A:B:C:D:E
Answer-All(A)Anticonvulsantdrugs(B)Pregnancy
(C)Resectionofileum(D)Gastrectomy(E)Crohn'sdisease
I.VITAMINB1DEFICIENCY
Inadequatedietaryintakee.g.strictvegetarians,breast-fed
infants,
Malabsorption
1. Gastriccauses:perniciousanaemia,gastrectomy,congenital
lackofintrinsicfactor.
2. Intestinalcauses:tropicalsprue,ilea!resection,Crohn's
disease,intestinalblindloopsyndrome,fish-tapeworm
infestation.
II,FOLATEDEFICIENCY
Inadequatedietaryintakee.g.inalcoholics,teenagers,infants,old
age,poverty.
Malabsorptione.g.intropicalsprue,coeliacdisease,partial
gastrectomy,jejuna!resection,CrohIfsdisease.
Excessdemand
1. Physiological:pregnancy,lactation,infancy.

---

2. Pathological:malignancy,increasedhaematopoiesis,chronic
exfoliativeskindisorders,tuberculosis,rheumatoidarthritis.
Excessurinaryfolatelosse.g.inactiveliverdisease,congestive
heartfailure.
III.OTHERCAUSES
Impairedmetabolisme.g.inhibitorsofdihydrofolate(DHF)
reductasesuchasmethotrexateandpyrimethamine;alcohol,
congenitalenzymedeficiencies.
Unknownetiologye.g.inDiGuglielmo'ssyndrome,congenital
dyserythropoieticanaemia,refractorymegaloblasticanaemia.

---

52.Feature(s)offibroadenomaofbreast
include:
a)Clearlydefinededgeonpalpation
b)Hormoneresponsivetumor
c)Containbothepithelial&stromalelements
d)Well-encapsulated
e)Commonaftermenopause
CorrectAnswer-A:B:C:D
Answer-(A)Clearlydefinededgeonpalpation(B)Hormone
responsivetumor(C)Containbothepithelial&stromal
elements(D)Well-encapsulated
Fibroadenomasareeasytomove,withclearlydefinededgeso
calledasbreastmouse.
Mostcommonbenignbreasttumoroffemalebreast.
Theyarefrequentlymultiple&bilateral.
Fibroadenomasarebenignsolidtumorscomposedofstromaland
epithelialelements.
Onexcision,fibroadenomasarewell-encapsulatedmasses.
Fibroadenomasdonothavemalignantpotential.

---

53.TrueaboutNeutrophil:
a)Engulfbacteria
b)Multilobed
c)Neutrophilgranulesareslightlybasicandstainweaklywiththe
azurophiliccomponentofRomanowskystains
d)Neutrophiliaoccurinacutebacterialinfection
e)Primarygranulesisalsocalledspecificganules
CorrectAnswer-A:B:C:D
Answer-(A)Engulfbacteria(B)Multilobed(C)Neutrophil
granulesareslightlybasicandstainweaklywiththeazurophilic
componentofRomanowskystains(D)Neutrophiliaoccurin
acutebacterialinfection
'Neutrophilcontainprimaryorazurophilgranules&secondaryor
specificgranules
Neutrophiliaoccurinacutebacterialinfection.
Thenucleusofneutrophilsnormallycontainsuptofoursegments.
Characteristicfeaturesare-Condensed,multilobednucleus
Function-
Hydrolyticsubstratedegradation
Killingestedbacteria
Regulateinflammation

---

54.AllaretrueaboutHistamineexcept:
a)Secretedbymacrophage
b)Vasoconstrictionofarterioles
c)Smoothmusclecontraction
d)Mediateinflammation
e)None
CorrectAnswer-A:B
Answer-(A)Secretedbymacrophage(B)Vasoconstrictionof
arterioles
'Histamineinducessmoothmusclecontractionindiversetissues.
Histamineiswidelydistributedintissues,therichestsourcebeing
themastcells.
Histaminecausesdilationofthearteriolesandincreasesthe
permeabilityofvenules
Itactsonthemicrocirculation.

---

55.Whichofthefollowingstatement(s)is/are
true:
a)InRobertsoniantranslocationthebreaksoccurclosetothe
centromeresofeachchromosome
b)Aneuploidyisabnormalchromosomenumbercausedbyeither
gainorlossofchromosome
c)Comparativegenomichybridisation(CGH) Haploidisnormal
isatechniquethatpermitsthedetectionof number&
chromosomalcopynumber
compositionof
chromosome
d)Haploidisnormalnumber&compositionofchromosome
e)All
CorrectAnswer-A:B:C
Answer-(A)InRobertsoniantranslocationthebreaksoccur
closetothecentromeresofeachchromosome(B)Aneuploidy
isabnormalchromosomenumbercausedbyeithergainorloss
ofchromosome(C)Comparativegenomichybridisation(CGH)
isatechniquethatpermitsthedetectionofchromosomalcopy
number
Aneuploidy:Anabnormalchromosomenumbercausedbyeither
gainorlossofchromosomes.
Haploid:Onlyone-halfthenormalcomplement,thatis,23
chromosomes
Comparativegenomichybridisation(CGH)isatechniquethat
permitsthedetectionofchromosomalcopynumberchangeswithout
theneedforcellculturing.
Robertsoniantranslocation(orcentricfusion):Itisatranslocation

---

Robertsoniantranslocation(orcentricfusion):Itisatranslocation
betweentwoacrocentricchromosomes.Typicallythebreakoccur
closetothecentromeresofeachchromosome.

---

56.Allofthethefollowingstatement(s)is/are
trueexcept:
a)DenevergroupF-containXchromosome
b)DenevergroupC-containXchromosome
c)DenevergroupG-containacrocentricchromosome
d)BarbodyisinactiveXchromosome
e)Innormalfemalesgenerallyoneofthechromosomes
undergoesXinactivationinsomaticcells
CorrectAnswer-A
Answer-(A)DenevergroupF-containXchromosome
TheclassificationofchromosomesbasedonDenvergroup
classification
Chromosome
RelativePositionof
Size
Class
Centromere
Large
GroupA(1-3)
Metacentric
Large
GroupB(4-5)
Submetacentric
Medium
GroupC(6-12,X)
Submetacentric
Medium
GroupD(13-15)
Acroentric
Relatively
GroupE(16-18)
Submetacentric
shot
GroupF(19-20)
MetacentricorSubmetacentric
short
GroupG(21-22,Y)
Acroentric
Short

---

57.Fomepizolecanbeusedin:
a)Methanolpoisoning
b)Organophosphoruspoisoning
c)Ethyleneglycolpoisoning
d)Barbituratepoisoning
e)None
CorrectAnswer-A:C
Ans.(A)Methanolpoisoning(C)Ethyleneglycolpoisoning
[Ref:KDT7th/395-96;Katzung12th/398,400,1033]
Fomepizole:
Competitiveinhibitoroftheenzymealcoholdehydrogenase,foundin
theliver.
Thisenzymeplaysakeyroleinthemetabolismofethyleneglycol
andmethanol.
Fomepizoleismosteffectivewhengivensoonafteringestionof
ethyleneglycolormethanol.
Delayingtheadministrationoffomepizoleallowsforthegeneration
ofharmfulmetabolites

---

58.Whichofthefollowingdruginteractwith
Warfarin:
a)ACEinhibitor
b)Azithromycin
c)Fluconazole
d)Aspirin
e)Benzodiazepine
CorrectAnswer-C:D
Ans.(C)Fluconazole(D)Aspirin
[RefKDT7th/62i,503;Katzung12th/610]
DrugCausingEnhancedAnticoagulantActionofWarfarin:
Aspirin:inhibitplateletaggregationebcauseG.Ibleeding
Nevercephalosporins(ceftriaxone,cefoperazone):Cause
hypoprothrombinemia
BroadSpectrumantibiotics:Inhibitgutflora6reducevit.Kproduction
Longactingsulfonamide,indomethacin,phenytoin&probenecid:
Displacewarfarinfromplasmaproteinbinding.
Chloramphenicol,erythromycin,celecoxib,cimetidine,allopurinol,
amiodarone&metronidazole:Inhibitwarfarinmetabolism
Tolbutamide&phenytoin:Inhibitwarfarinmetabolism&viceversa.
Liquidparaffin(habitualuse):Reducevit.Kabsorption
DrugCausingReducedAnticoagulantActionofWarfarin:
Barbiturates(butnotbenzodiazepines),carbamazepine,rifampin,&
griseofulvin:InducethemetabolismoforalAnticoagulant.
OralcontraceptiveIncreasebloodlevelsofclottingfactors

---

59.Allofthefollowingistrueabout
hydroxyureaexcept:
a)Causemyelosuppression
b)Oralbioavailabilityisveryless
c)UsedinCML
d)Actasradiosensitizer
e)Usedinsicklecellanaemia
CorrectAnswer-B
Ans.B.Oralbioavailabilityisveryless
[Ref:KDT7th/868;Kntzung12th/582]
Hydroxyurea:
Hydroxyureaisananalogofureawhosemechanismofaction
involvestheinhibitionofDNAsynthesisbyinhibitingtheenzyme
ribonucleotidereductase,resultingindepletionofdeoxynucleoside
triphosphatepools.
ThisagentexertsitseffectsintheSphaseofthecellcycle.
Nearly100%oralbioavailability.
Mainlyusedinchronicmyelogenousleukemia,blastcrisisofacute
myeloidleukemia,psoriasis&sicklecellanaemia.
Myelosuppressionistheilose-limitingtoxicity.

---

60.Allaretrueabouthydrochlorothiazide
except:
a)Causehyperglycemia
b)InhibitNa-Clsymport
c)Increasescalciumexcretioninurine
d)Causehyperuricaemia
e)Usedintreatmentofrenalstone
CorrectAnswer-C
Ans.C.Increasescalciumexcretioninurine
[RefKDT7th/5%-86;Katzung12th/260-61,270]
Hydrochlorothiazide:
InhibitsNa+-Cl-symportpredominantlyintheDCT.
EnhanceCa2+reabsorption&decreaseurinecalciumexcretion
(causeshypercalcemia).
Thiazidecausecarbohydrateintolerance&causepreciPitationof
diabetes
Toxicity:
Hypokalemicmetabolicalkalosisandhyperuricemia
ImpairedCarbohydrateTolerance.

---

61.ATTdrugwithsignificantrenalexcretion
is/are:
a)INH
b)Rifampicin
c)Pyrazinamide
d)Amikacin
e)Streptomycin
CorrectAnswer-A:C:D:E
Ans.(A)INH(C)Pyrazinamide(D)Amikacin(E)Streptomycin
[RefKDT7th/767;Katzung12th/841]
Rifampin:
Itismetabolizedinthelivertoanactivedeacetylatedmetabolite
whichisexcretedmainlyinbile,someinurine.
Urine&secretionsmaybecomeorange-red
INH:
Itisextensivelymetabolizedinliver;mostimportantpathwaybeing
N-acetylationbyNAT2.
Theacetylatedmetaboliteisexcretedinurine
Pyrazinamide:
Extensivelymetabolizedinliver&excretedinurine.
Pyrazinamidemetabolitesarerenallycleared.
Aminoglycosides(streptomycin&amikacin)arenotmetabolized.

---

62.Whichofthefollowingstatementabout
protonpumpinhibitorsis/aretrueexcept:
a)Hit&rundrug
b)Acidicmediumisessentialforactivity
c)ActonH+/K+ATPase
d)Formsanintegralcomponentofanti-H.pyloriregimens
e)Actbestinalkalinemedium
CorrectAnswer-E
Ans.E.Actbestinalkalinemedium
[RefKDT7thBa,651-52;Katzung12th/1085-89]
Hit&rundrugs:
Effectslastmuchlongerthanthedrugitself),e.g.,reserpine,
guanethidine,MAOinhibitors,omeprazole.
OneofthePPIsisanintegralcomponentofallanti-H.pylori
regimensalongwith2(tripledrug)or3(quadrupledrug)
antimicrobial.
SinceanacidicpHintheparietalcellacidcanaliculiisrequiredfor
drugactivation&sincefoodstimulateacidproduction,thesedrugs
ideallyshouldbegivenabout30minutesbeforemeals.
Protonpumpinhibitorsareadministeredasinactiveprodrugs.

---

63.TrueaboutamphotericinB:
a)Liposomalpreparationisavailable
b)Orallyabsorbed
c)Usedonlyinintravenousform
d)Proteinsynthesisinhibitor
e)None
CorrectAnswer-A
Ans.A.Liposomalpreparationisavailable
[Ref:KDT7th/787-89;Katzung12th/934,849-52,1066]
AMBisnotabsorbedorally,itcanbegivenorallyforintestinal
candidiasiswithoutsystemictoxicity.
Administeredi,v,assuspensionmadefromdeoxycholate(DOC),it
getswidelydistributedinthebody.
Itcanbealsoadministeredtopicallyforvaginitis,otomycosis
LiposomalAMB:
Ithasbeenproducedtoimprovetolerabilityofi.v.infusion,reduceits
toxicity&achievetargeteddelivery.
ItdeliversAMBparticularlytoreticuloendothelialcellsinliver&
spleen-especiallyvaluableforkalaazar&inImmunocompromised.

---

64.Antibioticwhichactsthroughcellwall
inhibition:
a)Penicillin
b)Daptomycin
c)Aminoglycoside
d)Cephalosporin
e)Imipenam
CorrectAnswer-A:D
Ans.(A)Penicillin(D)Cephalosporin
[RefKDT7th/689-90;Katzungp803]
MechanismofActionofDrugs:
Inhibitcellwallsynthesis:Penicillins,Cephalosporins,Cycloserine,
Vancomycin,Bacitracin.
Causeleakagefromcellmembranes:Polypeptides-Polymyxins,
Colistin,Bacitracin.Polyenes-AmphotericinB,Nystatin,Hamycin.
Inhibitproteinsynthesis:Tetracyclines,Chloramphenicol,
Erythromycin,Clinda-mycin,Linezolid.
Causemisreadingofm-RNAcodeandaffectpermeability:
Aminoglycosides-Streptomycin,Gentamicin,etc.
InhibitDNAgyrase:Fluoroquinolones-Ciprofloxacinandothers.
InterferewithDNAfunction:Rifampin.
InterferewithDNAsynthesis:Acyclovir,Zidovudine.
Interferewithintermediarymetabolism:Sulfonamides,Sulfones,
PAS,Trimethoprim,Pyrimethamine,Metronida-zole.

---

65.Whichoffollowingstatementistrueabout
canagliflozin:
a)SGLT-2inhibitor
b)BlocksNa/glucosesymport.
c)Causesglycosuria&polyuria
d)Increaseschanceofvaginalinfections
e)None
CorrectAnswer-A:C:D
Ans.(A)SGLT-2inhibitor(C)Causesglycosuria&polyuria
(D)Increaseschanceofvaginalinfections
[RefKDT7th/270:http://tvww.diabetesincontrol.eom]
Canagliflozin:
Antidiabeticdrugusedtoimproveglycemiccontrolinpatientswith
type2diabetes.
SGLT-2inhibitor.
?Sodium-glucoseco-transPorter-2(SGLT-2)inhibitorsareanew
groupoforalmedicationsusedfortreatingtype2diabetes
ProducesbeneficialeffectsonHDLcholesterolandsystolicblood
pressure,buttheseeffectsareoffsetbyincreasedLDLcholesterol.
Vaginalyeastinfectionsandurinarytractinfectionsarethemost
commonsideeffects
Canagliflozinislesseffectiveinpatientswithmoderaterenalfailure
endprobablyineffectiveinsevererenalfailureandtype1diabetics

---

66.Whichoffollowingis/aretrueabout
metformin:
a)Causelacticacid
b)PPARyagonist
c)ContraindicatedinRenalfailure
d)Causehypoglycemia
e)GIdisturbancesarecommonsideeffect
CorrectAnswer-A:C:E
Ans.(A)Causelacticacid(C)ContraindicatedinRenalfailure
(E)GIdisturbancesarecommonsideeffect
[Ref.KDT7th/275-76;Katzung12th/757]
Metformin:
PPARyagonist(peroxisomeproliferator-activatedreceptorl)
Causelittleornohypoglycemia
ReportedtoimprovelipidprofilesintypeIIDm(decreasedLDL).
Contraindicatedinrenaldisease,alcoholism,hepaticdisease,or
conditionspredisposingtotissueanoxia(e.g.,chronic
cardiopulmonarydysfunction),becauseofanincreasedriskoflactic
acidosis,inducedbybiguanidedrugsinthepresenceofthese
diseases.

---

67.Peripheralneuropathyis/arecausedby:
a)Vincristine
b)Sulfonamide
c)Amiodarone
d)Paclitaxel
e)None
CorrectAnswer-A:C:D
Ans.(A)Vincristine(C)Amiodarone(D)Paclitaxel
[Ref:Harrison19th/2686-88,18th/3463-66;KDT7th/706]
Sulfonamidenotmentionedinlistofdrugscausingneuropathies

---

68.Commonaction(s)ofepinephrine&
norepinephrineincludes:
a)Skinvasodilation
b)Bronchialmusclecontraction
c)IncreasesystolicBP
d)IncreaseHR
e)Renalvasoconstriction
CorrectAnswer-C:E
Ans.(C)IncreasesystolicBP(E)Renalvasoconstriction
[RefKDT7th/124-133;Gooilman&Gillmanllth/2z4-248;Ganong
25th/353-56]
Epinephrinecausebronchialmusclerelaxation(throughbeat-2
receptor)whereasnorepinephrinehasnoaetion(noactiononbeat-
2.
Bothepinephrine&norepinEphrineincreasesrenalvascular
resistance&thusreducerenalbloodflow.

---

69.Validdrugcombinationsare:
a)Sulfamethoxazole+trimethoprim
b)Penicillin+Tetracycline/chloramphenicol:Pneumococci
c)Piperacillin-Tazobactam
d)Enalapril-Hydrochlorothiazide
e)Ibuprofen&serratiopeptidase
CorrectAnswer-A:C:D:E
Ans.(A)Sulfamethoxazole+trimethoprim(C)Piperacillin-
Tazobactam(D)Enalapril-Hydrochlorothiazide(E)Ibuprofen&
serratiopeptidase
[RefKDT7th/698-99,725,61-62;Katzung12th/801]
Tazobactampharmacokineticsmatcheswithpiperacillinwithwhichit
hasbeencombinedforuseinsevereinfectionsLikeperitonitis,
pelvic/urinary/respiratoryinfectionscausedbybeta-lactamase
producingbacilli.
ACEinhibitors/ARBsareparticularlysynergisticwithdiuretics;this
combinationisverygoodforpatientswithassociatedCHForLVH.
Serratiopeptidaseisaproteolyticenzyme(protease)producedby
enterobacterSerratiasp.BrandnameNildol-SP(400+15)is
combinationofSerratiopeptidase&Ibuprofen(RoyalSapphire
RemediesTablet.

---

70.APatientpresentedinemergencyroom
withseveremalaria.Hewasgiven
artusunateat0hr,12hr,24hr&then
onceadaytill3day.Whichofthe
followingstatement(s)is/arecorrect
regardingfurthermanagementofthe
patient
a)Patientmaylaterswitchedtooraldrugifpatientabletotolerate
b)Dextrosedripshouldbestarted
c)Artesunateshouldneverbegivensingly
d)Steriodisbeneficial
e)None
CorrectAnswer-A:B:C
Ans.(A)Patientmaylaterswitchedtooraldrugifpatientableto
tolerate(B)Dextrosedripshouldbestarted(C)Artesunate
shouldneverbegivensingly
[Ref:KDT7th/819-21;Park23rd/262-67;Harrison19th/1379-81,
18th/1698-1705]
Artemisininderivativesmustneverbegivenasmonotherapyfor
uncomplicatedmalaria.
Therapidlyactingdrugs,ifusedalone,canleadtothedevelopment
ofparasiteresistance
Whenthepatientisunconscious,thebloodglucoselevelshouldbe
measuredevery4-6hrs.

---

AllpatientsshouldreceiveacontinuousinFusionofdextrose,and
bloodconcentrationsideallyshouldbemaintainedabove4mmol/L.

---

71.Whichofthefollowingis/aretrue
regardingplasmaconcentrationtime
curveofadrug:
a)Peakconcentrationdeterminebioavailability
b)Intramuscularadministrationhavecurvedifferentfromoral
administration
c)Areaundercurvedeterminetherapeuticresponse
d)Bioavailabilityofanorallyadministereddrugcanbecalculated
bycomparingtheareaundercurveafteroral&afteri.v.
administration
e)Changesintherateofabsorptionandextentofbioavailability
caninfluenceboththedurationofactionandtheeffectiveness
ofthesametotaldoseofadrugadministeredindifferent
formulations
CorrectAnswer-B:D:E
Ans.(B)Intramuscularadministrationhavecurvedifferentfrom
oraladministration(D)Bioavailabilityofanorallyadministered
drugcanbecalculatedbycomparingtheareaundercurveafter
oral&afteri.v.administration(E)Changesintherateof
absorptionandextentofbioavailabilitycaninfluenceboththe
durationofactionandtheeffectivenessofthesametotaldose
ofadrugadministeredindifferentformulations
(Ref:KDT7th/16-17;Katzung12th/43-44)
Theareaunderthebloodconcentration-timecurve(areaunderthe
curve,orAUC)canbeusedtocalculatetheclearanceforfirst-order
elimination.

---

usedasameasureofbioavailability.
Bioavailabilityvariationassumespracticalsignificancefordrugswith
lowsafetymargin(iligoxin)orwheredosageneedsprecisecontrol
(oralhypoglycemics,oralhypocoagulants).

---

72.Notindicatedforanaerobiccolitis
treatment:
a)Metronidazole
b)Aminoglycoside
c)Amikacin
d)Piperacillin-tazobactam
e)Imipenem
CorrectAnswer-B
Ans.(B)Aminoglycoside
[Ref:KDT7th/838;Hanison19th/1101,18th/1338-39;Katzung
12th/904-05]
Treatmentofanaerobicintra-abdominalinfections:
Oral:
Moxifloxacin400mgevery24hour
IV:
Moderatetomoderatelysevereinfections
Ertapenem1gevery24hours
Ceftriaxone1gevery24hours(orciprofloxacin400mgevery12
hours,ifpenicillinallergic)plusmetronidazole500mgevery8hours
or
Tigecycline100mgoncefollowedby50mgevery12hoursor
Moxifloxacin400mgevery24hours
Severeinfections:
imipenem,0.5gevery6-8hours;meropenem1gevery8hours;
doripenem0.5gevery1hour;piperacillin/tazobactam
4.5gevery8hours

---

---

73.Gunshotinjurymaycause(s):
a)Abrasioncollar
b)Gutterfracture
c)Railtrackinjury
d)Incisedlikeinjury
e)Laceratedlikeinjury
CorrectAnswer-B:D:E
Ans:a.Abrasion...,b.Gutt...,d.Incis...,e.Lace...,[RefReddy
32nd/205,235;Parikh6th/4.43-44]
Gutterfracture:Theyareformedwhenpartofthethicknessofthe
boneisremovedsoastoformagutter,e.g.,inobliquebulletwound.
Abrasioncollar(Marginalabrasion):Abrasioncollarsurroundsthe
dirtcollar.Theabradedcollarisreddishatfirst,butbecomesreddish
brownasitdries.Somecontusionispresentinabradedcollar&as
such,itisalsocalled"contusioncollar".Thesetwofeaturesare
proofofanentrancefirearmwound.
Glancingwounds(strikingsomeoneorsomethingatananglerather
thandirectlyandwithfullforce)maysimulateincisedorlacerated
wounds.
Slitlikeexitwoundsareoccasionallyencountered.Theyaredueto
thebulletexitingonitsboardsideorduetoexitofafragmented
bone.Suchinjuriesmaysimulateincisedwoundsorstabwounds

---

74.Notcharacteristicsofpoisonoussnake:
a)Smallscalesonhead
b)Largescalesonbelly&coverentirebreadth
c)Short&solidfangs
d)Compressedtail
e)Usuallynocturnalinhabit
CorrectAnswer-C
Ans:c.Short...[RefReddy32nd/528;Parikh6th/9.40-9.41]
Non-poisonous
Trait
Poisonoussnake
snake
Largewiththe
1.Head
A-small(vipers)
exceptionsas
mentioned,under
scales
B-large&
thepoisonous
snakes
(a)(ifthereisanopeningorpitb/w
theeye&nostril(pitviper)
(b)thirdlabialtouchestheeye&
nasalshields(cobraorcoralsnake)
(c)Nopits&thirdlabialdoesnot
touchthenose&eye&centralrowof
scaleson
backenlarged;undersurfaceofthe
mouthhasonlyfourinfralabials,the
fourthbeingthelargest(kraits)
Smallliketheseon
2.Belly
Large&coverentirebreadth
thebackor

---

thebackor
moderatelylarge,
scales
butdonotcover
theentirebreadth
3.Fangs Hollowlikehypodermicneedles
Short&solid
4.Teeth
Twolongfangs
Severalsmallteeth
Notmuch
5.Tail
Compressed
compressed
6.Habits Usuallynocturnal
Notso

---

75.Whichofthefollowingisnotcomponent
oftypicalembalamingagent:
a)Nacitrate
b)Naborate
c)Formaldehyde
d)Glycerine
e)None
CorrectAnswer-E
Ans:(E)None[RefReddy32nd/166;Parikh6th/8.23]Table
(Reddy32nd/166):Atypicalembalming
Embalmingchemicalsareavarietyofpreservatives,sanitisingand
disinfectantagents,andadditivesusedinmodernembalmingto
temporarilypreventdecompositionandrestoreanaturalappearance
forviewingabodyafterdeath
Sodiumborote(Buffer)500g
Sodiumcitrote(Anticoogulent)900g
Glycerine(Wettingagent)600ml
Sodiumchloride(ControlpH)800g
Eosin(Cosmetic)-->30ml
Solublewintergreen(Perfume)90ml
Water(Vehicle)UPto10litres
Formalin(Preservative)1.5litres

---

76.TrueaboutPugilisticattitude:
a)Flexionofhip&knee
b)Occurduetocoagulationofproteinbyburning
c)Extensionofelbow
d)Flexionoffingers
e)None
CorrectAnswer-A:B:D
Ans:a.Flexionofhip&knee,b.Occurduetocoagulationof
proteinbyburning,d.Flexionoffingers,[RefReddy32nd/307;
27th/286;Parikh6th/4.156-4.157]
PugilisticAttitude(Boxing,FencingorDefenceAttitute)n
Reddy27th/286;Reddy32nd/307
Itisthepostureofabodywhichhasbeenexposedtogreatheat
Thelegsareflexedatthehipsandknees,thearmsareflexedat
elbowsandwristsandheldoutinfrontofthebody,headslightly
extended,allfingersarehookedlikeclaws.
"Pugilisticattitudeispresentwhetheralivingordeadbodyisburnt&
hasthereforenomedico-legalsignificance")
Contractionofparaspinalmusclesoftencausesamarked
opisthotonus,inanattitudecommonlyadoptedbyboxers.
Thisstiffeningisduetothecoagulationofproteinsofthemuscles
anddehydrationwhichcausecontraction.Theflexormusclesbeing
bulkierthanextensorscontractmoreduetowhichjointsofalllimbs
areflexed
Itoccurswhetherthepersonwasaliveordeadattimeofburning

---

77.Whichofthefollowingcanbegroundfor
divorce:
a)Sterilefemale
b)Impotentman
c)Diabetes
d)Prematureejaculation
e)Pre-existingincurablementaldisorder
CorrectAnswer-B:E
Ans:b.impo..,e.Pre-existing...
Impotencyisagroundforannullingmarriage.InParmaswamipillai
v.SornathammalAIR1969itwasheldthatthemarriageofawoman
withanimpotentmanisvoidable.
PrematureEjaculation:Maybe/maynotbegroundMay
beGroundforDivorceifitLeadstoImpotency
Mentaldisordercanbecomeagroundforfilingadivorceifthe
spouseofthepetitionersuffersfromincurablementaldisorderand
insanityandthereforecannotbeexpectedfromthecoupletostay
together.

---

78.NottrueregardingVoyeurism:
a)S.354C,IPCdefinepunishment
b)Forfirstoffenceimprisonmentof1-3yearwithfine
c)Forrepeatoffenceimprisonmentmayextendto5-10year
d)Cognizableoffence
e)Repeatoffenceisconsideredasnon-bailableoffence
CorrectAnswer-C
Ans:c.Forrepeat...[RefReddy32nd/394,413;Parikh6th/5.55;
Reddy27th/367;CriminalAmendmentBill,2013]
VoyeurismorScoptophilia
Itisdefinedasonewho,experiencesrecurrent,intense,sexually
arousingfantasies,sexualurgesorbehavioursinvolvingtheactof
observinganunsuspectingpersonwhoisnaked,intheprocessof
disrobingorengagedinsexualactivity
VoyeurismorScotophiliaisdefinedasthedesiretowatchsexual
intercourseortoobservegenitalsofothers.Q
Mostoftenthevictimisstranger
Masturbationatthesceneorlatertomemoriesofwatchingthe
unsuspectingstrangerisnormallythesourceofsexualpleasure
Itisrareinfemale

---

79.AllaretrueaboutEbolavirusinfection
except?
a)Airdroplerismostcommonmodeoftransmission
b)Haemorrhagicmanifestationmayoccur
c)Thaiforesttype-mostcommonspeciesinepidemics
d)presentsassuddenonsetoffeverandsorethroat
e)Casefatalityratemaybehighas70%
CorrectAnswer-A:C
Ans.is'a'i.e.,Airdroplerismostcommonmodeof
transmission&'c'i.e.,Thaiforesttype-mostcommonspecies
inepidemics]RefPark24m/ep.374]
Thevirusistransmittedthroughdirectcontactwithblood,organs,
bodysecretionsorotherbodyfluidsofinfectedanimalslike
chimpanzees,gorillas,monkeys,fruitbatsetc.
Humantohumantransmissionisthroughbloodorbodyfluidsofan
infectedsymptomaticpersonorthroughexposuretoobjects(sucha
needle)thathavebeencontaminatedwithinfectedsecretions.
Itisnottransmittedthroughair,water,orfood.
Thevirusistransmittedthroughdirectcontactwithblood,organs,
bodysecretionsorotherbodyfluidsofinfectedanimalslike
chimpanzees,gorillas,monkeys,fruitbatsetc.
Humantohumantransmissionisthroughbloodorbodyfluidsofan
infectedsymptomaticpersonorthroughexposuretoobjects(such
asneedle)thathavebeencontaminatedwithinfectedsecretions
Itisnottransmittedthroughair,water,orfood
Theillnessischaracterizedbysuddenonsetoffever,intense

---

weakness,musclepain,headache,sorethroat,vomiting,diarrhea,
rash,impairedkidneyandliverfunctionandinsomebothinternal
andexternalbleeding.
ThevirusfamilyFiloviridaeincludesthreegenera:Cuevavirus,
Marburgvirus,andEbolavirus.
WithinthegenusEbolavirus,fivespecieshavebeenidentified:
Zaire,Bundibugyo,Sudan,RestonandTalForest.
Thefirstthree,Bundibugyoebolavirus,Zaireebolavirus,and
Sudanebolavirushavebeenassociatedwithlargeoutbreaksin
Africa.

---

80.AllaretrueaboutToxoplasmainfection
except:
a)Mayoccurduetoingestionofoocystfromcat'sfaeces
b)Mayspreadbyorgantransplantation
c)Toxoplasmosisissymptomaticinusuallyimmunocompetent
person
d)Infectionissevere&progressiveinimmunocompromisedhost
e)Humaninfectionisdeadendforparasite
CorrectAnswer-C
Ans:c.Toxoplasmosis...[RefPanikerParasitology6th/100:
Harrison19th/1398-1405,
Infectivestageforman:Oocystwithsporozoites&tissuecystwith
bradyzoites
Freshlypassedoocystisnotinfective(needsdevelopmentinthe
soil)
Humaninfectionisdeadendfortheparasite
TheprincipalsourceofhumanToxoplasmainfectionremains
uncertain.
Transmissionusuallytakesplacebytheoralrouteandcanbe
attributabletoingestionofeithersporulatedoocystsfrom
contaminatedsoilorbradyzoitesfromundercookedmeat
Intrauterineinfectionfrominfectedmothertobabies.Rarelybyblood
transfusionortransplantationfrominfecteddonors.

---

81.Whichofthefollowingdisease(s)is/are
nottoxinmediated:
a)Diphtheria
b)Tetanus
c)Pertussis
d)Anthrax
e)Syphilis
CorrectAnswer-E
Ans:e.Syphilis...[RefAnanthanarayan8th/233,317;Greenwood
Microbiology16th/91]
Virulentstrainsofdiphtheriabacilliproduceaverypowerfulexotoxin.
Thepathogeniceffectsofthebacillusareduetotoxin.
Pertussistoxin(PT):ThisispresentonlyinBordetellaepertussis.It
playanimportantroleinthepathogenesisofwhoopingcough.PT
toxoidisthemajorcomponentofacellularpertussisvaccines
Theanthraxtoxinisacomplexofthreefractions:theedemafactor
(OForFactorI),theprotectiveantigenfactor(PAorFactorII)&the
lethalfactor(LForFactorIII)"
Toxinsinhibitingproteinsynthesis:1)ShigelladysenteriaeI(Shiga
toxin)2)Diphtheria3)Pseudomonas4)Verotoxin1=Shigaliketoxin
ofE.coli)

---

82.Commonlyusedstain(s)foridentifying
fungusinclude(s):
a)Periodicacid-Schiff(PAS)stain
b)VonKossastain
c)Muraminesilverstain
d)Gomori'smethenaminesilver
e)Giemsastain
CorrectAnswer-A:D
Ans:a.Periodic...,d.Gomori's...[Ref:Ananthanarayan
8th/601:Harrison19th/1330,18th/1637]
ThePAS&methenaminesilverstainsarevaluablemethodsforthe
demonstrationoffungalelementsintissuesection.Thecommonest
culturemediausedinmycologyareSabouraud'sglucoseagar,
Czapek-Doxmedium&Cornmealagar.
ThevonKossastainisusedtoquantifymineralizationincellculture
andtissuesection.
Giemsastainisusedincytogeneticsandforthehistopathological
diagnosisofmalariaandotherparasites.
Thestainsmostcommonlyusedtoidentifyfungiareperiodicacid-
SchiffandGomorimethenaminesilver.Candida,unlikeotherfungi,
isvisibleongram-stainedtissuesmears.Hematoxylinandeosin
stainisnotsufficienttoidentifyCandidaintissuespecimens.
Whenpositive,anIndiainkpreparationofcerebrospinalfluid(CSF)
isdiagnosticforcryptococcosis.Mostlaboratoriesnowuse
calcofluorwhitestainingcoupledwithfluorescentmicroscopyto
identifyfungiinfluidspecimens.

---

---

83.Non-treponemaltestincludes:
a)RPR
b)VDRL
c)FTA-ABS
d)TPHA
e)TPI
CorrectAnswer-A:B
Ans:a.RPR,b.VDRL[RefAnanthanarayan8th/375-76:Harriosn
19th/1137-38,18th/1384;CMDT2016/1464;Greenwood
Microbiology16th/347]
Therearetwogeneralcategoriesofserologictestsforsyphilis:(1)
Nontreponemaltestsdetectantibodiestolipoidalantigenspresentin
thehostaftermodificationbyTpallidum.(2)Treponemaltestsuse
liveorkilledTpallidumasantigentodetectantibodiesspecificfor
pathogenictreponemes.
TheRPRandVDRLtestsarerecommendedforscreeningorfor
quantitationofserumantibody.Thetiterreflectsdiseaseactivity,
risingduringtheevolutionofearlysyphilisandoftenexceeding1:32
insecondarysyphilis.Aftertherapyforearlysyphilis,apersistentfall
byfourfoldormore(e.g.,adeclinefrom1:32to1:8)isconsidered
anadequateresponse.
TreponemaltestsmeasureantibodiestonativeorrecombinantT
pallidumantigensandincludethefluorescenttreponemalantibody-
absorbed(FTA-ABS)testandT.pallidumparticleagglutination
(TPPA)test,bothofwhicharemoresensitiveforprimarysyphilis
thanthepreviouslyusedhemagglutinationtests.
Themostwidelyusednontreponemalantibodytestsforsyphilisare

---

therapidplasmareagin(RPR)andVenerealDiseaseResearch
Laboratory(VDRL)tests,whichmeasureIgGandIgMdirected
againstacardiolipin-lecithincholesterolantigencomplex.

---

84.WhichoffollowingCulturemedia
combinationis/aretrueexcept:
a)Thayer-Martinmedia:Gonorrhoea
b)Chocolateagar-:enrichedmedia
c)Lowenstein-JensenMedium:Mycobacteriumtuberculosis
d)Muller-Hintonagar:Corynebacteriumdiphtheriae
e)MacConkey'sagar:Nonlactosefermentersformcolourless
colonies
CorrectAnswer-D
Ans:d.Muller-Hinton...[RefAnanthanarayan8th/39-43,229]
Thayer-MartinisausefulselectivemediaforNeisseria
gonorrhoeae''.
Mueller-HintonisenrichedmediaforNeisseria.
Cdiphtheriaeandothercorynebacteriagrowaerobicallyonmost
ordinarylaboratorymedia.OnLoeffler'sserummedium,
corynebacteriagrowmuchmorereadilythanotherrespiratory
organisms,andthemorphologyoforganismsistypicalinsmears.
Lowenstein-JensenMedium.Itisusedtoculturetuberclebacilli.It
containsegg,malachitegreenandglycerol.
ChocolateAgarorHeatedBloodagar:Preparedbyheatingblood
agar.Itisusedforcultureofpneumococcus,gonococcus,
meningococcusandHaemophilus.Heatingthebloodinactivates
inhibitorofgrowths.

---

85.Allofthefollowingaretrueregarding
legionellaexcept:
a)Causepontiacfever
b)Aerobicgramnegativebacilli
c)Cangrowonsimplemedium
d)GrowonBCYEagar
e)Communicablefrominfectedpatientstoothers
CorrectAnswer-C:E
Ans:c.Cangrowon....e.Communicable...[Ref
Ananthanarayan8th/400-401:Harrison19th/1014-17,18th/1236
39;Greenwood16th/320-21;CMDT09/1278]
MembersoftheLegionellaceaeareaerobicgram-negativebacilli
thatdonotgrowonroutinemicrobiologicmedia.Bufferedcharcoal
yeastextract(BCYE)agaristhemediumusedtogrowLegionella.
PontiacfeverQ,causedbyLegionellaPneumophila,isamilder,
nonfatalinfluenza-likeillnesswithfever,chills,myalgia.

---

86.Allaretrueaboutgonorrheaexcept:
a)Gonorrhoeameansflowofseed
b)Dischargemaycontainneutrophil
c)Initiallydischargeisscanty&mucoidinurethritis
d)Causedbygrampositivecocci
e)Symptomismoresevereinfemalethanmales
CorrectAnswer-D:E
Ans:d.Caused...,e.Symptom...[RefHarrison19th/1005,
18th/1220-25;Ananthanaran8th/227-30,7th/227-229;
GreenwoodMicrobiology16th/247-248;CMDT09/1287]
ThenamegonorrheaderivesfromtheGreekwordsgonos(seed)&
rhoia(flow)e.9-describedaconditioninwhichsemenflowedfrom
themaleorganwithouterection.
AcuteurethritisQisthemostcommonclinicalmanifestationof
gonorrhoeainmales&althoughsomemenremainasymptomatic.
Urethraldischarge&dysuria,usuallywithouturinaryfrequencyor
urgency,arethemajorsymptoms.

---

87.WhichofthefollowingisFalseregarding
H.Pyloriinfection:
a)Withchronicinfectionureasebreathtestbecomenegative
b)H.Pyloriinfectionremainlifelongifuntreated
c)Endoscopyisdiagnostic
d)Toxigenicstrainsusuallycausesulcer
e)None
CorrectAnswer-A
AnswerisA.Withchronicinfectionureasebreathtestbecome
negative(Withchronicinfectionureasebreathtestbecomes
negative)
UreasebreathtestdetectsH.pyloninfectionby'bacterialurease
activity'andremainspositivetillthebacteriahasnotbeeneradicated
withtreatment.Thusureasebreathtestbecomesnegativeonlyafter
eradicationoforganismfollowingtreatmentandnotwithchronic
Mfection.
Despiteasubstantialhumoralantibodyresponseinfectionpersists
indefinitely(persistslifelongifuntreated)
InvasivediagnostictestarebasedonEndoscopic,endoscopyisa
diagnosticapplication.
H.pyloriproducesseveralvirulencefactorsthathavebeen
implicatedinthedamageofmucosa.

---

88.Allstatementsaretrueaboutmycetoma
except:
a)Eumycetomaiscausedbybacteria
b)Surgeryisimportantcomponentoftreatment
c)Usuallypainless
d)Diagnosiscanbemadebyexaminationoflesion
e)Canaffectlower&upperextremities
CorrectAnswer-A
Ans:a.Eumycetoma...[RefAnanthanarayan8th/393,608:
Harrison19th/1355,18th/258,1667,1329,e34-16f;Neenakhana
lst/228;Greenwood16th/223-224,578]
Treatmentofeumycetomainvolvesbothsurgicalextirpationofthe
lesionanduseofantifungalagents.Surgicalremovalofthelesions
ofeumycetomaismosteffectiveifperformedbeforeextensive
spreadhasoccurred.
MycetomaorMaduraMycosisorMaduraFoot:Mycetomasare
chronic,slowlyprogressiveinfectionsofthesubcutaneoustissue,
usuallyofthefoots&rarelyoftheotherpartsofthebodylike
handsQ,glutealregion&thigh.
Maduromycosis(alsoknownaseumycetoma)isthetermusedto
describemycetomacausedbythetruefungiandbyphylogenetically
diverseorganisms.ActinomycoticmycetomaiscausedbyNocardia
andActinomaduraspecies.

---

89.StainusedforMycobacterium
tuberculosisis/are:
a)Ziehl-Neelsentechniqueofstaining
b)Auramine-rhodaminestain
c)Gomorimethenaminesilverstain
d)Kinyounstain
e)Gramstaining
CorrectAnswer-A:B:D
Ans:a.Ziehl-Neelsentechni...,b.Auramine-rhodaminesta...,d.
Kinyounstain
[RefHarrison19th/1113;Ananthanarayan9th/346-48;Lippincott
Microbiology3rd/21;Jawetz27th/38;TextBookofDiagnostic
microbiologybyConnieR.Mohan3rd/691;Greenwood16th/15]
WhenstainedwithcarbolfuchsinbyZiehl-Neelsenmethodorby
fluorescentdyes(Auramine0,Rhodamine),mycobacterium
tuberculosisreistdecolourisationby20%sulphuricacid&are
thereforecalledacidfast.
Ziehl-Neelsenmethoddphenol-auramineproceduresaremethods
ofgreatpracticalimportanceinthediagnosisofmycobacterial
diseases".
TheKinyounmethod,orKinyounstain,isanacid-fastprocedure
usedtostainanyspeciesofthegenusMycobacteriumandNocardia
species.Itinvolvestheapplicationofaprimarystain(carbol
fuchsin),adecolorizer(acid-alcohol),andacounterstain(methylene
blue)"

---

90.Trueaboutnon-industrialanthrax:
a)Mayoccurinbutcher
b)Animalhairisasourceofinfection
c)Commonlyoccursinfactoryworker
d)Stomoxyscalcitransinsectmaytransmittheinfection
e)Itisazoonosis
CorrectAnswer-A:B:D:E
Ans:(A)Mayoccurinbutcher,(B)Animalhairisasourceof
infection,(D)Stomoxyscalcitransinsectmaytransmitthe
infection,(E)Itisazoonosis,
[RefAnanthanarayan8th/245:GreenwoodMicrobiology
16th/225-29;Harrison19th/261e1-3,18th/1768-70]
Cutaneousanthraxgenerallyoccursonexposedsurfacesofthe
armsorhands,followedinfrequencybythefaceandneck.Apruritic
papuledevelops1-7daysafterentryoftheorganismsorspores
throughascratch.
Cutaneousanthraxusedtobecausedbyshavingbrushesmade
withanimalhair
Stomoxyscalcitrans&otherbitingsinsectsmayoccasionally
transmitinfectionmechanically

---

91.Zoonoticdiseasesare-
a)Salmonellosis
b)Plague
c)Anthrax
d)All
e)None
CorrectAnswer-D
Ans.(D)All

---

92.Allofthefollowingis/aretrueregarding
candidiasis:
a)Commonlyinvolvemucosa&skin
b)Notinvolvenails
c)Causedbyyeastlikefungus
d)Diabetesismostimportantriskfactor
e)Causesmeningitisinimmunocompromisedpersons
CorrectAnswer-B
Ans:(B)Notinvolvenails.[RefAnanthanarayan8th/607-08:
Harrison19th/1342-44,18th/165153]
Itisaninfectionofskin,mucosa&rarelyofinternalorgans
Itiscausedbyyeastlikefungus,Candidaalbicans&occasionallyby
othercandidaspecies
Ubiquitousinnature,theseorganismsarefoundoninanimate
objects,infoods,andonanimalsandarenormalcommensalsof
humans.Theyinhabitthegastrointestinaltract(includingthemouth
andoropharynx),thefemalegenitaltract,andtheskin.
Itisanopportunisticendogenousinfection,thecommonest
predisposingfactorbeingdiabetes.

---

93.Feature(s)ofTaeniacapitisis/areall
except:
a)Maypresentsasaboggyswelling
b)Mostcommonlyoccursinelderly
c)Maypresentasblackdot
d)Causedbytrichophyton&microsporumbutnotby
epidermophyton
e)Scutulumformation
CorrectAnswer-B
Ans:(B)Mostcommonlyoccursinelderly.[RefNeenakhanna
3rd/244;Ananthanarayan8th/604-06:Greenwood16th/574]
T.capitis:Causedbymicrosporumanyspeciescf.Trichophyton
mostspecies-Ananthanarayan8th/606,Tineacapitisis
dermatophytosisorringwormofthescalpandhair.Age:Invariablya
child.
thechiefcauseof"blackdot"Tineacapitis,producessporeswithin
thehairshaft(endothrix).Thesehairsdonotfluoresce;theyare
weakenedandtypicallybreakeasilyatthefollicularopening.In
prepubescentchildren,epidemictineacapitisisusuallyself-limiting.

---

94.Whichofthefollowingis/aretrueabout
pasteurerllamultiocuda:
a)Maycausemeningitis
b)Transmittedbyunpasteurizedmilk
c)Causediseaseexclusivelyinhuman
d)Gram-negativecoccobacillus
e)None
CorrectAnswer-A:D
Ans:(A)Maycausemeningitis&(D)Gram-negative
coccobacillus[RefAnanthanarayan8th/326:Greenwood
Microbiology16th/334-35;Park23rd/655;Harrison19th/183e-3,
18th/12351
P.multocidaisabipolar-staining,gram-negativecoccobacillusthat
colonizestherespiratoryandgastrointestinaltractsofdomestic
animals;oropharyngealcolonizationratesare70-90%incatsand
50-65%indogs.
Patientsattheextremesofageorwithseriousunderlyingdisorders
(e.g.,cirrhosis,diabetes)areatincreasedriskforsystemic
manifestations,includingmeningitis,peritonitis,osteomyelitisand
septicarthritis,endocarditis,andsepticshock,butcaseshavealso
occurredinhealthyindividuals.
Pmultocidacanbetransmittedtohumansthroughbitesor
scratches,viatherespiratorytractfromcontactwithcontaminated
dustorinfectiousdroplets,orviadepositionoftheorganismon
injuredskinormucosalsurfacesduringlicking.

---

95.Whichofthefollowinghasincubation
periodof<5day:
a)Salmonellatyphi
b)Vibrioparahaemolyticus
c)Campylobacterjejuni
d)Shigelladyseneteriae
e)Yersiniapestis
CorrectAnswer-B:C:D:E
Ans:b.Vibrioc.Campylobacterd.Shigellaande.Yersinia...
[RefAnanthanarayan8th/293,299,506,312;Harrison18th/1294;
Greenwood16th/300;]
Vibrioparahaemolyticus:Afteranincubationperiodof4hrto4days,
symptomsdevelop&persistsforamedianperiodof3days"
(Harrison18th/1294)
"Shigellaecausebacillarydysentery.Ithasashortincubationperiod
(1-7days,usually48hours)'(Ananthanarayan8th/285)
"Campylobacterjejuni:Theincubationperiodis1-7days"?
Ananthanarayan8th/398
"Entericfever(Salmonellatyphi):Theincubationperiodisusually7-
14daysbutmayrange3-56days"(Ananthanarayan8th/293)
"Salmonellagastroenteritis(causedbyanysalmonellaotherthan
s.typhi):Clinicallythediseasedevelopsaftershortincubationperiod
of24hoursorless,withdiarrhea,vomiting,abdominalpain&fever".

---

96.Verrugaperuanaiscausedby:
a)B.Bacilliformis
b)B.Henselae
c)B.Quintana
d)B.Elizabethae
e)B.Grahamil
CorrectAnswer-A
Ans:(A)Bbacilliformis..[RefAnanthanarayan8th/411-
12:Harrison19th/1083,1079,18th/13191
Bartonellosis,orCarrion'sdisease,iscausedbyB.bacilliformis.The
diseaseischaracterizedbytwodistinctphases:(1)anacutefebrile
hematicphase,knownasOroyafever;and(2)aneruptivephase
manifestedbycutaneouslesions,knownasverrugaperuana"
(Harrison19th/1083,18th/1319)
VerrugaPeruanaorPeruvianWart:Itischaracterizedbyaneruptive
phase,inwhichthepatientsdevelopacutaneousrashproducedby
aproliferationofendothelialcellsandisknownas"Peruvianwarts"
or"verrugaperuana".

---

97.Trueaboutstaphylococcusaureus-
a)Microaerophilic
b)Producelemonyellowcolonies
c)Growswith10%Nacl
d)Allaretrue
e)None
CorrectAnswer-C
Ans.is'c'i.e.,Growswith10%Nacl[Ref:Ananthanarayan9thle
p.199-202]S
staphylococcusisfacultativeanaerobe.OptimumpHforgrowthis
7.4-7-6andoptimumtemperatureis37?C.
Staphaureusproducesgoldenyellowpigment,whichismaximumat
22?C.
Mostofthestaphylococcusspeciesgrowinthepresenceof10%
NaCl.
OnnutrientagarslopethereischaracteristicOilpaintappearance.
Forprimaryisolation,sheepbloodagarisrecommended.Human
bloodshouldnotbeusedatitmaycontainantibodiesorother
inhibitors
StaphaureusGoldenyellowcolonies
Staphepidermidis(alsocalledstaphalbus)Whitecolonies
StaphcitrusLemonyellowcolonies

---

98.Whichofthefollowingviralexanthema
combinationis/arecorrectexcept:
a)Varicella-norelationofrashwithfever
b)Rubella-palatalpetechiaemayoccur
c)Roseola-rashappearafterfeversubsides
d)Measles-rashoccursbehindtheearsalonghairline
e)Chickenpox-pleomorphicrashesoccur
CorrectAnswer-A
Ans:a.Varicella-norelationofrashwithfever.[RefPark
23rd/144-145,148:0.Ghai7th/185;Harrison19th/1194,18th/149,
153]
Varicella(Chickenpox):Acharacteristicfeatureofrashisits
peomorphismi.e,allstageofrash(papules,vesicles&crusts)may
beseensimultaneouslyatonetime,inthesamearea.Temperature
risewitheachfreshcropofrash"(Park23rd/144-45)"Exanthem
subitum(roseola)iscausedbyhumanherpesvirus6andismost
commonamongchildren

---

99.Whichofthefollowingactis/arepassed
afterindependence:
a)ESIact
b)Factoryact
c)MTPact
d)Epidemicdiseaseact
e)SARDAact
CorrectAnswer-A:B:C
Ans:(A)ESIact(B)Factoryact(C)MTPact
Theprohibitionofchildmarriageact,2006(PCMA)wasenacted
repealingthechildmarriagerestraintactof1929inordertoprohibit
childmarriageratherthanonlyrestrainingthem"(Park23rd/589,
21st/542)
"ESIactpassedin1948(amended1975,1984&1989"(Park
23rd/815,21st/756)
"Indianfactoriesactpassedin1948"(Park23rd/815,21st/542)
"Medicalterminationofpregnancyactwaspassedin1971"(Park
23rd/506,21st/468)

---

100.Whichofthefollowingis/aretrueabout
leprosy:
a)Positiveskinsmearatanysiteisconsideredmultibacillary
leprosy
b)Grenzzoneisseeninlepromatousspectrum
c)ItiseradicatedfromIndiain2000
d)12monthofMDTisrecommendedformultibacillaryleprosy
e)Multidrugtherapyisgiven
CorrectAnswer-A:B:D:E
Ans:(A)Positiveskinsmearatanysiteisconsidered
multibacillaryleprosy(B)Grenzzoneisseeninlepromatous
spectrum(D)12monthofMDTisrecommendedfor
multibacillaryleprosy(E)Multidrugtherapyisgiven
"Grenzzoneoccurinlepromatousleprosy"(NeenaKhanna3rd/227)
"Multibacillaryleprosy:with6skinlesions,aswellasallsmear
positivecases"(KDT7th/783)
"Thereisnoplaceformonotherapyintreatmentofleprosy"-(Neena
Khanna3rd/229)
"Slitskinsmear:AllpatientswhoareAFBpositiveshouldbegiven
multibacillarytreatment,irrespectiveoftheclinicalpresentation"
(NeenaKhanna3rd/227)
33state/UTwehaveachievedeliminationlevel(prevalencerate<1
per10,000population).Only3states/UTviz.Bihar,Chattisgarher
DerNHavelihasPRof2-4per10,000population"(Park23rd/316)
"Paucibacillaryleprosy:Apersonhaving1-5skinlesionseWoronly
onenerveinvolvement"(Park2Ist/292)

---

"Multibacillaryleprosy:Apersonhaving6ormoreskinlesionsd-/or
morethanonenerveinvolvement"

---

101.Whichofthefollowingis/arefeaturesof
septictank:
a)Minimumcapacityshouldbe500gallons
b)Watertightseal
c)Recommendedforlargecommunities
d)Seededwithripesludgedrawnfromanotherseptictank
e)Anaerobicprocesstakesplace
CorrectAnswer-A:B:D:E
Ans:a.Minimumcapacityshouldbe500gallonsb.Watertight
seald.Seededwithripesludgedrawnfromanotherseptic
tanke.Anaerobicprocesstakesplace[RefPark23rd/760,
21st/701]
Theseptictankiswater-tightmasonrytankintowhichhousehold
sewageisadmittedfortreatment.
Capacity:Thecapacityofaseptictankwilldependuponthenumber
ofusers.Acapacityof20-30gallonsor2.5-5c.ft.perpersonis
recommendedforhouseholdseptictanks.Theminimumcapacityof
aseptictankshouldbeatleast500gallons
Septictanksarenotrecommendedforlargecommunities
Airspace:Thereshouldbeaminimumairspaceof30cmb/wthe
levelofliquidinthetank&theundersurfaceofthecover
Retentionperiod:Septictanksaredesignedinthiscountrytoallowa
retentionperiodof24hours

---

102.TrueaboutStandarddeviation:
a)1SDcovers95%population
b)Normalstandarddeviatedeviationfromthemeaninanormal
distribution
c)Representmeasurementofdispersions
d)Itisbetterindicatorofvariabilitythanrange
e)None
CorrectAnswer-B:C:D
Ans:b.Normalstandarddeviatedeviationfromthemeanina
normaldistributionc.Representmeasurementof
dispersionsd.Itisbetterindicatorofvariabilitythanrange[Ref
Park23rd/847-49,21st/786;BiostatisticsbyBKRao2nd/54;
MethodsinBiostatisticsbyBKMahajan7th/57,60-68;
Basiceb,clinicalBiostatisties4th/30]
Deviationfromthemeaninanormaldistributionorcurveiscalled
relativeorstandardnormaldeviateorvariate&isgiventhesymbol
Z.ItismeasuredintermofSDs&indicateshowmuchan
observationisbiggerorsmallerthanmeaninunitofSD.SoZwillbe
aratio.
Thestandarddistributioncurve(Normaldistribution)isaperfectly
symmetrical,bellshapedcurvesuchthatthemean,medianand
mode,allhavethesamevalueandcoincideatthecentre,Standard
DistributionCurve(Normal)Q:Mean=Median=Mode

---

103.Wildpolioisstillendemicin:
a)India
b)Pakistaan
c)Afganistan
d)Bangladesh
e)Nigeria
CorrectAnswer-B:C:E
Ans:b.Pakistaan,c.Afganistan,e.Nigeria[RefPark23rd/203,
21st/182I
Till2011,poliowasendemicin4countries-Pakistan,Afghanistan,
India&Nigeria(Mnemonic-PAIN).Butin2014,only3countries
(Afghanistan,NigeriaandPakistan;Mnemonic-PAN)remainpolio-
endemic,downfrommorethan125countriesin1988.
Completingthreefullyearswithoutreportinganycaseofpolio,India
celebratedalandmarkachievementinpublichealthon11February
2014?thevictoryoverpolio.Indiahasnotreportedanycaseof
poliosinceatwo-yearoldgirlgotpolioparalysison13January2011
inHowrahdistrictofWestBengal.

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104.TrueaboutcensusinIndia:
a)Firstcensusconductedin1851
b)DirectorGeneralofHealthServicesofIndia(DGHS)issupreme
officerforconductingcensus
c)Literacyrateisalsoincludedincensus
d)ConductedinaccordancetoCensusact,1948
e)ConductedinMidyear
CorrectAnswer-C:D
Ans:c.Literacy...,d.Conducted...(Ref:Park23rd/840]
ThefirstregularcensusinIndiawastakenin1881&conductedat
regularintervalof10year.
Thecensusisusuallyconductedattheendofthefirstquarterofthe
firstyearineachdecade,thereasonbeing,mostpeopleareusually
residentintheirownhomesduringthatperiod
Thelegalbasisofthecensusisprovidedbythecensusactof1948
Thesupremeofficerwhodirects,guides&operatesthecensusis
theCensusCommissionerforIndia
Apartfromdemographicinformation,economic&social
characteristicofpopulationarealsoincludedincensus(including
literacyrate)

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105.Whichofthefollowingcarcinomais
causedbyasbestos:
a)Mesothelioma
b)Bronchialcarcinoma
c)Laryngealcarcinoma
d)Breastcancer
e)None
CorrectAnswer-A:B:C
Ans:a.Mesotheliomab.Bronchialcarcinomac.Laryngeal
carcinoma[RefPark23rd/807,2Ist/748;Robbins9th/690-91;
Harrison19th/168889;Chapman4th/536]
"Mesotheliomahaveastrongassociationwithcrocidolitevarietyof
asbestos"
Carcinomabronchus&Lung(squamouscelloradenocarcinoma)Q
Pleuralandperitonealmesotheliomae
Gastrointestinalcarcinoma(coloncancer)
Laryngealcarcinoma
LungcancerQisthemostfrequentcancerassociatedwithasbestos
exposure.
Theexcessfrequencyoflungcancer(allhistologictypes)in
asbestosworkersisassociatedwithaminimumlatencyof15-19
yearsbetweenfirstexposureanddevelopmentofthedisease.

---

106.Trueaboutcroup:
a)CausedbyH.influenzae
b)X-rayPAviewshowssteeplesignofsubglotticnarrowing
c)Stridorispresent
d)Supraglotticedemaispresent
e)Commonlypresentin6month-3yearagegroup
CorrectAnswer-A:B:C:E
Answer-(A)CausedbyH.influenzae(B)X-rayPAviewshows
steeplesignofsubglotticnarrowing(C)Stridorispresent
(E)Commonlypresentin6month-3yearagegroup
Croup(Laryngotracheobronchitis)
Laryngotracheobronchitisisthemostcommoninfectiouscauseof
obstructioninchildrenusuallyoccurringbetweentheagesof6
monthsand3years.
Malechildren(boys)arecharacteristicallymorefrequentlyinvolved
thanfemales(girls)
Etiology
ItisaviralinfectionmostfrequentlycausedbyParainfluenzavirus.
Pathology
Themostcharacteristicpathologicalfeatureisedemaformationin
thesubglotticarea.
Presentation
Gradualonsetwithaprodromeofupperrespiratorysymptoms
Hoarsenessandbarkingcough(croupycough)
Stridor(initiallyinspiratorythanbiphasic)
Feverisusuallylowgrade(orabsent)althoughmayoccasionallybe
highgrade

---

Droolingsischaracteristicallyabsentandthereisnodysphagia
(seeninepiglottitis)
Imaging(Xray)
Symmetric'steeple'or'funnelshaped'narrowingofthesubglottic
region(steeplesign)
Hypopharyngealwideningordistension
Normalepiglottisandaryepiglotticfolds

---

107.TrueaboutMobiussyndrome:
a)10thCNinvolvement
b)7thCNinvolvement
c)Abductiondefect
d)Esotropia
e)6thCNinvolvement
CorrectAnswer-B:C:D:E
Answer-(B)7thCNinvolvement(C)Abductiondefect
(D)Esotropia(E)6thCNinvolvement
"Itischaracterizedbybilateralfacialweakens(i.eVIICN),whichis
oftenassociatedwithabducensnerveparalysis(i.e.VICN)
Facialpalsyiscommonlybilateral,frequentlyasymmetric.
Ectropion,epiphora,andexposurekeratopathymaydevelop.
Theabductiondefectmaybeunilateralorbilateral.
ThecranialnervesVandVIIIareaffected.
Esotropiaiscommon.
Surgicalcorrectionoftheesotropiaisindicated

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108.Allaretrueaboutnasopharyngeal
fibromaexcept:
a)Mostcommonageofpresentationis20-50yr
b)Radioresistanttumour
c)Highlyvascular
d)Benigninnature
e)Surgeryistreatmentofchoice
CorrectAnswer-A:B
Answer-(A)Mostcommonageofpresentationis20-50yr
(B)Radioresistanttumour
Itisararetumour,thoughitisthecommonestofallbenigntumours
ofnasopharynx
Itislocallyinvasive&destroystheadjoiningstructures
Tumourisseenalmostexclusivelyinmalesinagegroupof10-20
years.
Rarely,itmaybeseeninolderpeople&females
Mostcommonpresentation:profuse6recurrentepistaxis
Itismadeupofvascular&fibroustissue.Mostly,thevesselsare
justendothelium-linedspaceswithnomusclecoat
Surgicalexcisionisnowthetreatmentofchoice
Radiotherapyhasbeenusedasaprimarymodeoftreatment

---

109.Whichofthefollowingfeature(s)of
rhinoscleromais/aretrueexcept:
a)Atrophyofnasalmucosa
b)Causedbyfungus
c)Treatmentbyantifungaldrug
d)Causedbybacteria
e)Causativeorganismmaybeculturedfrombiopsymaterial
CorrectAnswer-B:C
Answer-(B)Causedbyfungus(C)Treatmentbyantifungaldrug
Rhinoscleromaisarare,slowlyprogressinggranulomatousdisease
oftheupperrespiratorytractcausedbyKlebsiellarhinoscleromatis.
Nasaldiseasepresentswiththreetypicalstages:(1)catarrhal(2)
proliferative(3)cicatrical.
Rhinoscleromamaybefoundinallagegroups,buttypicallyyoung
adults20?30yearsoldaremostfrequentlyaffected.
Airbornetransmissioncombinedwithpoorhygiene,crowdedliving
conditions,andpoornutritioncontributestoitsspread.
Bothstreptomycin&tetracyclinearegiventogether

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110.Trueaboutchoanalatresia:
a)Unilateralatresiashouldbeoperatedwithin6monthofage
b)Occurd/tpersistenceofbucconasalmembrane
c)B/1atresiausuallypresentswithrespiratorydifficulties
d)Bilateralatresiamaycausecyanosis
e)Diagnosedbyfailuretopassacatheterfromnosetopharynx
CorrectAnswer-B:C:D:E
Answer-(B)Occurd/tpersistenceofbucconasalmembrane
(C)B/1atresiausuallypresentswithrespiratorydifficulties
(D)Bilateralatresiamaycausecyanosis(E)Diagnosedby
failuretopassacatheterfromnosetopharynx
Choanalatresiaisanabnormalityofcanalizationduring
developmentofthenasalpassages.
Itinvolvesboneand/orsofttissueandmayresultineitherpartial
(choanalstenosis)orcompleteobstructionoftheposteriornasal
airway.
Themostwidelyacceptedmechanismforthedevelopmentof
choanalatresiaisthepersistenceofthebucconasalmembrane
beyondthesixthweekofgestation.
ChoanalatresiaisassociatedwithCHARGEsyndrome:Coloboma
ofeye,Heartdefects,ChoanalAtresia,Retardedgrowth,Genital
defectsandEardefects.
B/LatresiaPresentswithrespiratoryobstructionasthenewborn
laterdevelopscyanosis.
Operativecorrectionofunilateralobstructionmaybedifferedfor
severalyears.

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111.Whichofthefollowingistrueregarding
mandibularfracture:
a)Inferioralveolarnervedamagemayoccur
b)Panorexradiographisveryhelpfulinmanagement
c)Ramusisthemostcommonsiteoffracture
d)Condylarfracturehealsspontaneously&requirenoactive
intervention
e)Condylarfractureismostcommonsite
CorrectAnswer-A:B:E
Answer-(A)Inferioralveolarnervedamagemayoccur
(B)Panorexradiographisveryhelpfulinmanagement
(E)Condylarfractureismostcommonsite
Condylarprocessfracturesofthemandiblearemostcommon.
Clinicalfeatures
Pain,Swelling,Deformitywithtrismusormalocclusionofteeth.
ManyPatientswithmandibularfracturesexperiencetraumatothe
inferioralveolarnerve.
Treatment:
Thefractureisreducedandfixedby:
ClosedreductionorOpenreduction.

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112.Complicationofmodifiedradical
mastoidectomyinclude(s):
a)Conductivehearingloss
b)Facialnerveinjury
c)Changeintastesensation
d)Sensoryhearingloss
e)All
CorrectAnswer-E
Answer-E.All
Facialparalysis
Perichondritisofpinna
Injurytoduraorsigmoidsinus
Labyrinthitis,ifstapesgetsdisclosed
Severeconductivedeafnessof50dBormore.Thisisdueto
removalofallossicla&tympanicmembnne
Cavityproblems

---

113.TrueaboutEthmoidalsinus:
a)Fullydevelopedby25yr
b)Consistsof3-18sinusoneachside
c)Absentatbirth
d)Laminapapyraceaseparatefromorbit
e)Anteriorethmodalgroupcells-openintosuperiormeatus
CorrectAnswer-B:D
Answer-(B)Consistsof3-18sinusoneachside(D)Lamina
papyraceaseparatefromorbit
Ethmoidalcellsaredividedintoanteriorethmoidalgroupwhich
apeasintothemiddlemeatus&posteriorethmoidalgroup.
Presentatbirth
Reachadultsizeby12years
Theirnumbervariesfrom3to18
Thethinpaperlikelaminaofbone(laminapapyracea)separatingair
cellsfromtheorbit.

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114.Whichofthefollowingstatement(s)
is/aretrueaboutlabyrinthitis:
a)Initiallyquickcomponentofnystagmusoccurtowarddiseased
earbutinlaterstageshifttowardhealthyear
b)Mayoccurasacomplicationofchronicsuppurativeottitismedia
c)Resolvespontaneouslyin1-6wk
d)Medicaltreatmentaloneissufficient
e)Vertigomaybepresent
CorrectAnswer-A:B:E
Answer-(A)Initiallyquickcomponentofnystagmusoccur
towarddiseasedearbutinlaterstageshifttowardhealthyear
(B)Mayoccurasacomplicationofchronicsuppurativeottitis
media(E)Vertigomaybepresent
Thisisacommoncomplicationofotitismedia.
Therearethreetypesr
Circumscribed(fistulaoflabyrinth)
Diffuseserous&
Diffusesuppurativelabyrinthitis
Mildcasecomplainofvertigo&nausea.
Surgicaltreatmentincludes:Myringotomy

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115.Notselfretaininghandheldretractor(s)
is/are:
a)Mollison'smastoidretractor
b)Jansen'smastoidretractor
c)Lempert'sendauralretractor
d)DavisRetractor
e)All
CorrectAnswer-D
Answer-D.DavisRetractor
Theseretractorsdonotneedanassistanttoholdtheminplace.
Itholdtissueapartandlockitinplace.
Handheldretractor-
HohmannRetractor
LaheyRetractor
SennRetractor
Blair(Rollet)Retractor
RigidRake
FlexibleRake
RagnellRetractor
Linde-RagnellRetractor
DavisRetractor

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116.Lateralwalloforbitis/areformedby:
a)Lesserwingofsphenoid
b)Frontalprocessofzygomaticbone
c)Greaterwingofsphenoid
d)Lacrimalbone
e)Maxilla
CorrectAnswer-B:C
Answer-(B)Frontalprocessofzygomaticbone(C)Greater
wingofsphenoid
Thelateralwallisthethickestwalloftheorbit,importantbecauseit
isthemostexposedsurface,highlyvulnerabletobluntforcetrauma.
Anteriorsurfaceofgreaterwingofsphenoid
Orbitalsurfaceoffrontalprocessofzygomaticbone

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117.TrueaboutLeberopticneuropathy:
a)X-linkeddisease
b)Primarilyaffectsmale
c)Discbecomepale&atrophic
d)Transmittedfrommothertochild
e)Mitochondrialinheritance
CorrectAnswer-B:C:D:E
Answer-(B)Primarilyaffectsmale(C)Discbecomepale&
atrophic(D)Transmittedfrommothertochild(E)Mitochondrial
inheritance
Leber'shereditaryopticneuropathyischaracterizedbysequential
subacuteopticneuropathyinmalesaged11-30years.
Theunderlyinggeneticabnormalityisapointmutationin
mitochondrialDNA.
SincemitochondrialDNAisexclusivelyderivedfrommother.
Itischaracterizeedbybilateral,painless,subacutevisualfailurethat
developsduringyoungadultlife.
Theydevelopblurringaffectingthecentralvisualfieldofoneeye.
Visuallossisbilateralatonset.
Laterinatrophicphase,discbecomesatrophicandpale.

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118.Riskfactorforcystoidmacularedema
include(s)allexcept:
a)Hypertensiveretinopathy
b)Vitreousloss
c)Diabetesmellitus
d)Cataractsurgeryisanimportantcause
e)Lowerincidencewithintracapsularcataractextractionthan
extracapsularcataractextraction
CorrectAnswer-E
Answer-E.Lowerincidencewithintracapsularcataract
extractionthanextracapsularcataractextraction
Causesofmacularedemaare-
Metabolicalteration:-Diabetes,retinitispigmentosa,Inherited
cystoidmacularedema(CME).
Ischemia;-CRVO,Diabeticretinopathy,severehypertensive
retinopathy,HELLPsyndrome,vasculitis.
Mechanicalforce:-Vitreoustractiononthemacula.
Inflammation:-Intermediateuveitis,Post-operativeCME,choroidal
inflammatorydiseases.
Pharmacotoxicity:-Epinephrine(inAphakia),Betaxolal,
Latanoprost.

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119.Allaretrueaboutcongenitalptosis
except
a)Stimulusdeprivationamblyopiamayoccuriftreatmentis
delayed
b)Lidlagondowngaze
c)Prominenceoflidcrease
d)Lossoflidcrease
e)Associatedwithweaknessofthelevatorpalpebraesuperioris
CorrectAnswer-C
Answer-C.Prominenceoflidcrease
Ptosisisdroopingofuppereyelid.
Congenitalmyogenisptosis-
Itisthemostcommontypeofptosis.
Associatedwithcongenitalweaknessoflevatorpalpebraesperioris.
Characterisedbydroopingofeyelidswithabsentlidcreseandlid
lagondowngaze.

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120.Feature(s)ofInfantileglaucomais/are
except:
a)Aniridiamaybeassociated
b)Treatmentincludestrabeculotomy
c)Buphthalmoscanoccur
d)Corneaisthin&clear
e)MaybeassociatedwithSturge-webersyndrome
CorrectAnswer-B
Answer-B.Treatmentincludestrabeculotomy
Congenitalptosisisusuallyaresultofalocalizeddystrophyofthe
levatormuscleinwhichthestriatedmusclefibers
arereplacedwithfibroustissue.
Thelidcreaseisdecreasedorabsent.
Amblyopiamayoccurinchildrenwithptosis.
Ifadroopyeyelidispresentatbirthorwithinthefirstyearoflife,the
conditioniscalledcongenitalptosis.
Itisassociatedwithcongenitalweakens(maldevelopment)ofthe
levatorpalpebraesuperioris(LPS).
Treatmentincludestrabeculotomy.

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121.TrueaboutArcussenilis:
a)Fattyinfiltration
b)Axialcornealdegeneration
c)Depositionoccurinstromaofperipheralcornea
d)Amyloiddeposit
e)Involvelimbus
CorrectAnswer-A:C
Answer-(A)Fattyinfiltration(C)Depositionoccurinstromaof
peripheralcornea
Itreferstoananndarlipidinfiltrationofcornealperiphery.
Affectselderlypatients.
Theareasofthecornea&scleranearthelimbus&perivascular
areasofthescleraareneverinvolved
Lipidaccumulationisfoundintheperipheralcornealstroma.

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122.Trueaboutmoderateflareuveitis:
a)Categorisedasgrade1+
b)Categorisedasgrade2+
c)Categorisedasgrade3+
d)Hazycornea
e)Clearirisdetail
CorrectAnswer-B:E
Answer-(B)Categorisedasgrade2+(E)Clearirisdetail
Itisduetoleakageofproteinparticlesintotheaqueoushumour
fromdamagedbloodvessels.
Theflareisgradedfrom'0'to+4-
0-noaqueousflare
+1justdetectable
+2moderateflarewithclearirisdetails
+3markedflare
+4intenseflare

---

123.Ectopialentisis/areassociatedwith:
a)Homocystinuria
b)Alportsyndrome
c)Lowesyndrome
d)Marfansyndrome
e)Sulphiteoxidasedeficiency
CorrectAnswer-A:D:E
Answer-(A)Homocystinuria(D)Marfansyndrome(E)Sulphite
oxidasedeficiency
Marfansyndrome
Homocystinuria
Weil-Marchesanisyndrome
Sulfiteoxidasedeficiency
Hyperlysinemia

---

124.Feature(s)ofTICTinclude:
a)Constrictedpupil
b)Tachycardia
c)Bradycardia
d)Hypertension
e)Respiratorydepression
CorrectAnswer-C:D:E
Answer-(C)Bradycardia(D)Hypertension(E)Respiratory
depression
Bloodpressureelevationaccompaniedbybradycardiaand
respiratoryslowingclassicallyresultsfromraisedintracranial
pressure.
Lossofthenormalautoregulationofbloodpressureandpulse,called
theCushingsreflexisahallmarkofseverebraininjuryorimminent
crisis.
Anisocoria,unequalpupilsize,isanothersignofserioustraumatic
braininjury.

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125.Whichofthefollowingis/aretrue
regardingAsthma&COPD:
a)COPDshowslessreversibilitytobronchodilatorswhileasthma
showssignificantimprovement
b)Asthmahasagradualprogressionofdyspneaonexertion,
punctuatedbyacuteexacerbationsofshortnessofbreath.while
mostCOPDpatientshavenormalbreathingthemajorityofthe
time
c)COPDpatientsmayhaveacuteexaberationswhileasthmatic
patientshaverecurrentepisode
d)Steroidtherapyismorebeneficialtoasthmapatientsthan
COPDpatients
e)Neutrophilshaveprimaryaroleinpathogenesisofasthma&
eosinophilshaveprimaryroleinCOPD
CorrectAnswer-A:C:D
Answer-(A)COPDshowslessreversibilitytobronchodilators
whileasthmashowssignificantimprovement(C)COPD
patientsmayhaveacuteexaberationswhileasthmaticpatients
haverecurrentepisode(D)Steroidtherapyismorebeneficialto
asthmapatientsthanCOPDpatients
PatientswithCOPDhasagradualprogressionofdyspneaon
exertion,punctuatedbyacuteexacerbationsofshortnessofbreath.
Mostasthmaticshavenormalbreathingwithrecurrentepisodesof
dyspneaduetotriggeringfactor.
COPDisseenspecificallyinsmokers.
Asthmaticsoftenshowanacuteresponsetoinhaled
bronchodilators.

---

bronchodilators.
COPDisgenerallynotresponsivetooralcorticosteroidtherapy.
Inhaledcorticosteroidsareoneofthemosteffectivewaysof
controllingasthma.
Eosinophilicinfiltrationisacharacteristicfeatureofasthmaticairway.
InCOPDthereismacrophageactivation&neutrophilrecruitmentin
airway.

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126.Whichofthefollowingis/aretrueabout
SubarachnoidHemorrhage(SAH):
a)SaccularaneurysmismostcommoncauseofSAHafterhead
trauma
b)Severeheadachemaypresent
c)CTangiographyhelpinlocalizinganeurysm
d)CTscanisinvestigationofchoiceforacuteSAH
e)DigitalsubtractionangiographyisbetterthanCTangiography
forSAH
CorrectAnswer-B:C:D
Answer-(B)Severeheadachemaypresent(C)CTangiography
helpinlocalizinganeurysm(D)CTscanisinvestigationof
choiceforacuteSAH
Suddenlossofconsciousnessmaybeprecededbyabriefmoment
ofexcraciatingheadache.
ThehallmarkofaneurysmalruptureisbloodintheCSF.
Caseshaveenoughbloodtobevisualizedonahighqualitynon
contrastCTscan&bindwithin72hrs.
Alumbarpunctureshouldbperformedtoestablishthepresenceof
subarachnoidblood.

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127.FeatureofGranulomatosiswith
polyangiitis:
a)Nasalpolyp
b)PerforatedNasalseptum
c)Persistantsinus
d)Crustingofnasalmucosa
e)Collapseofnasalbridge
CorrectAnswer-B:C:D
Answer-(B)PerforatedNasalseptum(C)Persistantsinus
(D)Crustingofnasalmucosa
Granulomatosiswithpolyangiitis(Wegener)isadistinct
clinicopathologicentitycharacterizedbygranulomatousvasculitisof
theupperandlowerrespiratorytractstogetherwith
glomerulonephritis.
Disseminatedvasculitisinvolvingbothsmallarteriesandveinsmay
occur.
Nasalfindingsincludecrustinggranulations,septalperforation&a
saddlenose
Destructionoftheseptumwithacharacteristicimplosionofthenasal
bridge.

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128.Allaretrueaboutrenalarterystenosis
except:
a)ACEinhibitorscanbeusedinbilateralrenalarterystenosis
b)ACEinhibitorscanbeusedinunilateralrenalarterystenosis
c)ACEinhibitorsarebestdrugtocontrolDMassociated
hypertension
d)Excision&Graftingistreatmentofchoice
e)Angioplastywithorwithoutstenting,andsurgicalbypassused
onlyinrefractorycases
CorrectAnswer-A:D
Answer-(A)ACEinhibitorscanbeusedinbilateralrenalartery
stenosis(D)Excision&Graftingistreatmentofchoice
ACEinhibitorsarecontraindicatedinbilateralrenalarterystenosis.
ACEinhibitorsareusefulinrenovascularhypertension.
ARFisprecipitatedbyACEinhibitorsinpatientswithb/lrenal
stenosis
Atheroscleroticischemicrenaldiseaseaccountsfornearlyallcases
ofrenalarterystenosis.
Renalangiographyisthegoldstandardfordiagnosis.

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129.ECGchange(s)inpulmonaryembolism
mayincludes:
a)STelevationinVI&aVR
b)TwaveinversioninVItoV4
c)S1Q3T3pattern
d)Leftaxisdeviation
e)Rightbundlebranchblock
CorrectAnswer-A:B:C:E
Answer-(A)STelevationinVI&aVR(B)TwaveinversioninVI
toV4(C)S1Q3T3pattern(E)Rightbundlebranchblock
Sinustachycardiaisthemostfrequentandnonspecificfindingon
electrocardiographyinacutepulmonaryembolism.
FeaturessuggestingacuterightheartstrainontheECGoccur
relativelyinfrequently,theseinclude.
Acuterightaxisdeviation
Ppulmonale
Rightbundlebranchblock
InvertedTwaves
STsegmentchangesinrightsidedleads.
EarlierthefollowingE.C.G.changeswereconsideredhighly
predictiveofacutepulmonaryembolism,buttheseobservations
werefoundinlessthan12%ofpatientswithpulmonaryemboliin
recentstudies.
TheseE.C.G.featuresare-
SwaveinleadI
QwaveinleadIII

---

InvertedTinleadIII(S1Q31.3)
SwavesinleadI,IIandIII("S1,S2S3)

---

130.Apatienthasshorth/oincreasedjugular
venouspressure,weakperipheralpulse
&lowB.P.Likelycondition(s)maybe:
a)Tensionpneumothorax
b)Venousgasembolism
c)Pulmonaryembolism
d)Cardiactemponade
e)Septicshock
CorrectAnswer-A:B:C:D
Answer-(A)Tensionpneumothorax(B)Venousgasembolism
(C)Pulmonaryembolism(D)Cardiactemponade
"SepticshockhaslowCVPwithhighcardiacoutput.
Venousgasembolism:Itcancauseacutecorpulmonale&
cardiovascularcollapse.
Tensionpneumothorax:Thereisdecreasedvenousreturntothe
heartdtcardiacoutputfallsleadingtohypotension.
Cardiactemponade(Pericardialeffusion)shouldbeconsideredin
anypatientwithhypotension,lowvolumepulse&raisedlVP.

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131.Trueaboutinsulinoma:
a)Encapsulated
b)Mostlymultiple
c)AssociatedwithMEN-I
d)Enucleationisthetreatmentofchoiceforbenigntumour
e)Histologysimilartonormal(3-cells
CorrectAnswer-A:C:D:E
Answer-(A)Encapsulated(C)AssociatedwithMEN-I
(D)Enucleationisthetreatmentofchoiceforbenigntumour
(E)Histologysimilartonormal(3-cells
Insulinomaisusuallysolitaryandwellencapsulatedtumour
10%aremultiple(alwaysassociatedwithMEN1)and10%are
malignant.
Microscopically,thetumouriscomposedofcordsandsheetofwell-
dffirentiatedBeta-cellswhichdonotdifferfromnormalcells.
Enucleationisthetreatmentofchoiceforbenigninsulinomas.

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132.Whichofthefollowingistrueregarding
pseudobulbarpalsy:
a)Dysphagia
b)Jawjerkbrisk
c)Absentgagreflex
d)Tonguefasciculationpresent
e)Plantarreflexisextensor
CorrectAnswer-A:B:E
Answer-(A)Dysphagia(B)Jawjerkbrisk(E)Plantarreflexis
extensor
Dysarthria
Dysphagia
Gagreflex
Jawjerkhyperactive
Emotionallability
Intellectualimpairment

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133.ApatientpresentedwithhighpH,low
arterialCO2&lowplasmaHCO3-level.
Whichofthefollowingstatementistrue
regardingthepresentation&various
causes:
a)Compensatedrespiratoryalkalosis
b)Chronicrenalfailure
c)Persistentvomiting
d)Cerebro-vascularaccident
e)Hepaticfailure
CorrectAnswer-A:D:E
Answer-(A)Compensatedrespiratoryalkalosis(D)Cerebro-
vascularaccident(E)Hepaticfailure
HighpHmeans-alkalosis
DecreaseCO,meansrespiratoryalkalosis
LowHCO3-levelmeansmetabolicacidosis
Thereforeitisacaseofrespiratoryalkalosiswithmetabolicacidosis
(Compensatedrespiratoryalkalosis)

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134.Whichofthefollowingistrueabout
treatmentofasthma:
a)LongactingP2agonistforacuteattack
b)Longacting32agonistforlongtermtreatment
c)Shortacting(32agonistforacuteattack
d)I.VSteroidforsevereasthmaexacerbation
e)Inhaledsteroidforpersistentasthma
CorrectAnswer-B:C:D:E
Answer-(B)Longacting32agonistforlongtermtreatment
(C)Shortacting(32agonistforacuteattack(D)I.VSteroidfor
severeasthmaexacerbation(E)Inhaledsteroidforpersistent
asthma
Oralcorticosteroidsshouldgenerallybeprescribedforearly
administrationathomeinpatientswithmoderatetosevereasthma

---

NAEPP3recommendationsemphasizedailyanti-inflammatory
therapywithinhaledcorticosteroidsasthecornerstoneoftreatment
ofpersistentasthma.

---

135.Side-effect(s)ofinhalationalsteroid
is/areallexcept:
a)Adrenalsuppression
b)Cataract
c)Osteoporosis
d)Hypoglycemia
e)Skinthinning
CorrectAnswer-D
Answer-D.Hypoglycemia
Localsideeffectsincludehoarseness(dysphonia)andoral
candidiasis
growthretardationinchildrenortoosteoporosisinadults.
bruising,petechiae
Hyperglycemia&pituitary-adrenalsuppression

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136.Allaretrueaboutsyncopeexcept:
a)Consciousnessislost
b)Morecommoninstandingthanlyingpostion
c)Vasovagaltypeiscommon
d)Returnofconsciousnessisslow&takehours
e)Shortduration
CorrectAnswer-D
Answer-D.Returnofconsciousnessisslow&takehours
Syncopeisatransient,self-limitedlossofconsciousnessdueto
acuteglobalimpairmentofcerebralbloodflow.
Asyncopalattackbeginswhenthepatientisusuallyinanupright
position(sittingorstanding)Returnofconsciousnessisprompt.
Vasovagalsyncopeisduetoexcessivevagaltoneorimpairedreflex
controloftheperipheralcirculation.
ThemostfrequenttypeofvasodepressorsyncoPeisvasovagal
hypotensionorthecommonfaint.

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137.TrueabouthemophiliaB:
a)Factor8deficiency
b)Factor9deficiency
c)X-linkeddisorder
d)ClinicallyindistinguishablefromhemophiliaA
e)Freshfrozenplasmagivenfortreatment
CorrectAnswer-B:C:D
Answer-(B)Factor9deficiency(C)X-linkeddisorder
(D)ClinicallyindistinguishablefromhemophiliaA
HemophiliaisanX-linkedrecessivehemorrhagicdiseasedueto
mutationsintheF8gene(hemophiliaAorclassichemophilia)orF9
gene(hemophiliaB).
Malesubjectsareclinicallyaffected.
Clinically,hemophiliaAandhemophiliaBareindistinguishable.
Hemophiliaisclassifiedas-
severe(<1%),
moderate(l-5%),
ormild(6-30%)
Clinicalfeatures-
Bleedingintothejoints(hemarthrosis),softtissues,andmuscles.
Investigations-
HemophiliaB-NormalBT&PT&increasedPTT
Treatment-
Thediseaseistreatedwithinfusionsofrecombinantfactoru.

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138.Unequalpulseinupper&lower
extremeties(i.e.,radio-femoraldelay)
is/areseenin:
a)Aorticdissection
b)Post-ductalcoarctationofaorta
c)Supra-valvularAorticstenosis
d)Sub-valvularAorticstenosis
e)Takayasu'ssyndrome
CorrectAnswer-B
Answer-(B)Post-ductalcoarctationofaorta
InqualitybetweenTwoRadialPulse(Radio-RadialDelay)
Thoracicinletsyndrome(cervicalrib'scalenesyndrome)
Aneurysmofaorta
Takayasu'sdisease
Pre-subclaviancoarctation
SuPravalvularaorticstenosis
Atherosclerosisofaorta

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139.Drug(s)giveninthyroidcrisis:
a)Esmolol
b)Iodine
c)Hydrocortisone
d)Aspirin
e)Propylthiouracil
CorrectAnswer-A:B:C:E
Answer-(A)Esmolol(B)Iodine(C)Hydrocortisone
(E)Propylthiouracil
TREATMENT-
Propylthiouracil(drugofchoice)
StableiodideblocksthyroidhormonesynthesisviaWolff-Chaikoff
effect.
Potassiumiodide
Porpranolol,esmolol
Glucocorticoids,Hydrocortisone
Calciumchannelblocker

---

140.Whichofthefollowingdyadsofdisease-
neurotansmitteriscorrect:
a)Myastheniagravis-Acetycholinereceptor
b)Spasticity-GABA
c)Lambert-Eatonmyasthenicsyndrome-Acetycholine
d)Stiff-personsyndrome-Glycine
e)Parkinson'sdisease-Dopamine
CorrectAnswer-A:C:E
Answer-(A)Myastheniagravis-Acetycholinereceptor
(C)Lambert-Eatonmyasthenicsyndrome-Acetycholine
(E)Parkinson'sdisease-Dopamine
Acetylcholine(ACh)-Myastheniagravis,Lambert-Eatonsyndrome,
Botulism,Alzheimer'sdisease
Dopamine-Parkinson'sdisease
Norepinephrine(NE)-Mooddisorder,anxiety,Orthostatic
tachycardiasyndrome
Serotonin-Mooddisorder,Migrainepainpathway
GABA-Stiff-personsyndrome,epilepsy
Glycine-Spasticity

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141.AllaretrueaboutMenetrier'sdisease
except:
a)Increasedgastricacidsecretion
b)Protein-losinggastropathy
c)Mainlyaffectsbody&fundus
d)Nomalignantpotential
e)Transforminggrowthfactor-aisoverexpressed
CorrectAnswer-D
Answer-(D)Nomalignantpotential
Menetrier'sdiseaseisanunusualconditioncharacterisedby
hypertrophyofthegastricmucosalfolds,mucusproduction&
hypochohydria.
Itisapremalignantcondition.
ThemucosalfoldsinMenetrier'sdiseaseareoftenmostprominentin
thebodyandfundus.
CausedbyexcessivesecretionofTGF.
Clinicalfeatures-
Hypoproteinaemia
Anaemia
Increasedriskofgastricadenocarcinomaassociatedwithprotein
losingenteropathy.
MaygetconfusedwithZollinger-Ellisonsyndrome.

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142.AccordingtoSurvivingSepsis
Guidelines2013,whichofthefollowing
is/arecorrectregardingsepsis&septic
shocktreatmentguideline:
a)Urineoutputshouldbe>2m1/kg
b)Meanarterialpressuregoalshouldbe65mmHg
c)Dopamineasthefirstchoicevasopressor
d)Colloidisinitialfluidofchoiceintheresuscitation
e)Administrationofeffectiveintravenousantimicrobialswithinthe
firsthourofrecognition
CorrectAnswer-B:E
Answer-(B)Meanarterialpressuregoalshouldbe65mmHg
(E)Administrationofeffectiveintravenousantimicrobialswithin
thefirsthourofrecognition
Crystalloidsastheinitialfluidofchoiceintheresuscitaiionofsevere
sepsisandsepticshock.
Norepinephrineasthefirstchoicevasopressor.
Dopamineasanalternativevasopressoragenttonorepinephrine
onlyinhighlyselectedpatients.
Thegoalsduringthefirst6hoursofresuscitationshouldbe
(GradelC):
Meanarterialpressure(MAP)65mmHg;
Centralvenouspressure(CVP)8-12mmHg(12-15mmHgin
Patientsreceivingmechanicalventilationorwithknownpreexisting
decreasedventricularcompliance)
Urineoutput0.5mL/kg/hr(35mL/hrforsomeoneweighing70kg

---

or154lbs)
Centralvenousoxygensaturation(fromthesuperiorvenacava)
70%,ormixedvenousoxygensaturation(fromapulmonaryartery
catheter)65%

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143.Braindeathcanbeassessedby:
a)Apnoeatest
b)CTscan
c)MRIscan
d)Cerebralangiography
e)TranscranialDoppler
CorrectAnswer-A:D:E
Answer-(A)Apnoeatest(D)Cerebralangiography
(E)TranscranialDoppler
Spinalcordreflexesmaybepreservedincoma&re-examination
(not<2hourapart)isoptional.
Apneatestshouldbedoneatlastbecauseofitsharmfuleffectson
intracranialpressure.
IsoelectricEEG,absentbrainstemauditoryevokedpotentials&
absenceofcerebralperfusion(onangiography,radioisotopescanor
transcranialDoppler)areconfirmatorybutnotrequiredtests.

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144.Presentation(s)ofBechetsyndrome
mayinclude:
a)Erosivearthritis
b)Recurrentaphthousulcersofthemouth
c)Uveitis
d)Genitalulcer
e)Pathergytest
CorrectAnswer-B:C:D:E
Answer-(B)Recurrentaphthousulcersofthemouth(C)Uveitis
(D)Genitalulcer(E)Pathergytest
Behcet'ssyndromeisamultisystemdisorderpresentingwith
recurrentoralandgenitalulcerationsaswellasocularinvolvement.
Non-deformingarthritisorarthralgiasareseenin50%ofpatients
andaffectsthekneesandankles.
Recurrentoralulcerationplustwoofthefollowing:
Recurrentgenitalulceration
Eyelesions
Skinlesions
Pathergytest
ThehallmarkofBehcetdiseaseispainfulaphthousulcerationinthe
mouth.
Eitheranteriororposterioruveitisposterioruveitismaybe
asymptomatic

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145.Whichofthefollowingistrueabout
Pheochromocytoma:
a)Sestabimiscanisdonebeforesurgery
b)Mostlyaremalignant
c)Surgeryismainstayoftreatment
d)Priorablockerisgiven
e)Priorpblockerisgiven
CorrectAnswer-C:D:E
Answer-(C)Surgeryismainstayoftreatment(D)Priorablocker
isgiven(E)Priorpblockerisgiven
Sestambiscanningisthepreferredwayinwhichtolocalizediseased
parathyroidglandspriortooperation.
Pheochromocytoma&paragangliomaarecatecholaminesproducing
tumoursderivedfromsympatheticandparasympatheticnervous
system.
TheyarederivedfromChromaffincells.
Treatment-
Laproscopicresection
Alphaadrenoreceptorblocker(phenoxybenzamine)-block
catecholamineexcess
Betablockade-tachycardiaorarrhythmias
Centralvenouscatheter&invasivearterialmonitoringused.
AdultDoseofClonidineforClonidineSuppressiontestis0.3mg
(0.3mg/70kg)administeredorally.ClonidineSuppressionTest
Completetumorremovalistheuhimatetherapeuticgoal,,canbe
achievedbypartialortotaladrenalectomy.

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146.MIBG(metaiodobenzylguanithidine)is
analogueto:
a)Epinephrine
b)Adenine
c)Norepinephrine
d)Guanine
e)Phenylephrine
CorrectAnswer-C
Answer-(C)Norepinephrine
Pheochromocytomacanbelocalizedusingradioactivetracers
including131I-or123l-metaiodobenzylguanithidine(MIBG),111ln-
somatostatinanalogues,or18F-dopa(ordopamine)Positron-
emissiontomography(PET).

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147.Whichofthefollowingistrueregarding
adrenocorticalcarcinomas:
a)IncreasedurinaryexcretionofVMA
b)Doesnotcausemetastasis
c)Surgeryismainstaytreatment
d)AssociatedwithLi-Fraumenisyndrome
e)None
CorrectAnswer-C:D
Answer-(C)Surgeryismainstaytreatment(D)Associatedwith
Li-Fraumenisyndrome
IncreasedVMAexcretionintotheurinecanoccurin
Neuroblastomas,pheochromocytomas,andotherneuroendocrine
tumors.
TworareinheritedcausesofadrenalcorticalcarcinomasareLi-
FraumenisyndtomeandBeckwith-Wiedenannsyndrome.
Metastasestoregionalandperiaorticnodesarccommon.
ACCcarriesapoorprognosisandcurecanbeachievedonlyby
completesurgicalremoval.

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148.A40yearoldladyfromHimanchal
Pradeshhasfever&escharonbody.
Bloodinvestigationrevealed:Hb=12
gm%,TLC=9800/1.11,Platelet80000.
Whichofthefollowingdrug(s)maybe
usedinhertreatment:
a)OralDoxycycline
b)Meropenem
c)Azithromycin
d)Tetracycline
e)Chloramphenicol
CorrectAnswer-A:C:D:E
Answer-(A)OralDoxycycline(C)Azithromycin(D)Tetracycline
(E)Chloramphenicol
Theclinicalmanifestationsofalltheacutepresentationsaresimilar
duringthefirst5days:feverheadache,andmyalgiaswithorwithout
nausea,vomiting,andcough.
Clinicalmanifestations-includingoccurrenceofamacular,
maculopapular,orvesicularrash;eschar;pneumonitis;and
meningoencephalitis.
Doxycyclineisthedrugofchoiceformostoftheseinfections.
Tetacyclineisdrugofchoiceforspecifictreatmentofallrickettsial
diseases.
Longacting(doxycycline,minocycline)nowmakesingledose
treatmentpossible.

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149.Allaretrueabout"a"waveexcept:
a)Itisoftenthelargestpositivewavevisible
b)Giantwaveinatrialfibrillation
c)Tricuspidstenosisproducesgaintwave
d)Heartblockdiminishmagnitudeofawave
e)Producedbyrightatrialcontraction
CorrectAnswer-B:D
Answer-(B)Giantwaveinatrialfibrillation(D)Heartblock
diminishmagnitudeofawave
Awavereffectsrightatrialpresystoliccontractionandoccursjust
aftertheelectrocardiographicPwave,precedingthefirstheart
sound(S1).Aprominentalphawaveisseeninpatientswithreduced
rightventricularcompliance;acannonawaveoccurswith
atrioventricufar(AV)dissociationandrightatrialcontractiondgainst
aclosedtricuspidvalve.
Inapatientwithawidecomplextachycardia,theappreciationof
cannonawavesinthejugularvenouswaveformidentifiesthe
rhythmasventricularinorigin.
TheAwaveisnotpresentwithatrialfibrillation.

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150.Whichoftheconditioncausepericarditis
duetohypersensitivity:
a)SLE
b)Rheumaticfever
c)Dresslersyndrome
d)Uraemia
e)Myxedema
CorrectAnswer-A:B:C
Answer-(A)SLE(B)Rheumaticfever(C)Dresslersyndrome
A.Rheumaticfever
B.Collagenvasculardisease(systemiclupuserythematosus,
rheumatoidarthritis,ankylosingspondylitis,scleroderma,acute
rheumaticfever,granulomatosiswithpolyangiitis(Wegener's)
C.Drug-induced(e.9.,procainamide,hydralazine,phenytoin,
isoniazide,minoxidil,anticoagulants,methysergide)
D.Post-cardiacinjury
1. Postmyocardialinfarction(Dressler'ssyndrome)
2. Postpericardiotomy
3. Posttraumatic

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151.Allaretrueaboutacuteradiation
pneumonitisexcept:
a)Fevernotpresent
b)Steroidisbeneficial
c)X-raychestfindingcorrelatespoorlywithsymptom
d)Developimmediatelyafterradiotherapy
e)All
CorrectAnswer-A:D
Answer-(A)Fevernotpresent(D)Developimmediatelyafter
radiotherapy
Twophasesofthepulmonaryresponsetoradiationare
apparent:
acutephase(radiationpneumonitis)
chronicphase(radiationfibrosis)
Clinicalfeatures-
manifestedbyfever,dyspneaoutofproportiontothevolumeoflung
irradiated,pleuraleffusion.
Withsteroidthetapy,thesesymptomsmayresolvecompletelyin
somepatientswithoutlong-termefects.
Epithelialcellatypiaandfoamcellwithinvesselwallsarealso
characteristicofradiationdamage.

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152.TrueaboutKallmansyndrome:
a)Amenorrhoea
b)Hypergonadotrophicstate
c)Anosmia
d)Failureofsecondarysexualdevelopment
e)None
CorrectAnswer-A:C:D
Answer-(A)Amenorrhoea(C)Anosmia(D)Failureofsecondary
sexualdevelopment
Kallmannsyndromeiscausedfromdefectivegonadotropinreleasing
hormone(GnRH)synthesis.
Clinicalfeatures-
Anaemia&hyposmiaduetoolfactorybulbagenesis&hypophasia.
Colorblindness,opticatrophy,nervedeafness.
Cleftpalate,cryptoorchidism&mirrormovements(neurological
defects)
Inmales-delayedpuberty,micropenis.
Infemales-primaryamenorrhea,failureofsecondarysexual
development.
LowLH&FSHlevels&sexsteroids.

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153.GlasgowcomascaleE3M4V5represents:
a)Spontaneouseyeopening
b)Eyeopeningwithpainstimulus
c)Incomprehensiblesound
d)Orientedconversation
e)Decorticateposturing
CorrectAnswer-D
Answer-(D)Orientedconversation
Domain
Response
Score
Spontaneous
4
Tospeech
3
Eyeopening
Topain
2
None
1
Oriented
5
Confused
4
Bestverbalresponse Inappropriate
3
Incomprehensible
2
None
1
Obeying
6
Localizing
5
Withdrawal
4
Bestmotorresponse Flexing
3
Extending
2
None
1
3
Deepcomaordeath
Totalscore
15
Fullyalertandoriented

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Fullyalertandoriented

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154.Complication(s)ofSalivarygland
operation:
a)Subcutaneousfistula
b)Oppositeglandcompensatoryhypertrophy
c)Gustatorysweating
d)FacialNervedamage
e)All
CorrectAnswer-A:C:D
Answer-(A)Subcutaneousfistula(C)Gustatorysweating
(D)FacialNervedamage
ComplicationsofParotidGlandSurgery-
Temporaryfacialnerveweakness
Transectionofthefacidnerveandpermanentfacialweakness
Sialocele
Facialnumbness
Permanentnumbnessoftheearlobeassociatedwithgreatauricular
nervetransection
Frey'ssyndrome(Gustatorysweating)
ComplicationsofSubmandibularGlandExcision
Marginalmandibularnerveinjury;
Lingualnerveinjury;
Hypoglossdnerveinjury
Complicationsofparotidectomy-
Flapnecrosis
Facialnervepalsy
Fluidcollection

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Salivaryfistula
Frey'ssyndrome

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155.Punchedoutulceris/areseenin:
a)Arterialulcer
b)Venousulcer
c)Tubercularulcer
d)Basalcellcarcinoma
e)Gummatousulcer
CorrectAnswer-A:E
Answer-(A)Arterialulcer(E)Gummatousulcer
Puchedoutedge:Itismostlyseeningummatousulcerorinadeep
trophiculcer.
Arterialulcer-Thaeulcertendstobepunchedout
Gummatousulcers,whichoccursintertiarysyphilis,havepunched-
outindolentedge.

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156.Whichofthefollowingis/aretrue
regardingrenaltransplantationexcept:
a)Curvilinearincisionismadeinlowerquadrant
b)Transplantedkidneyisplacedinretroperitonealposition
c)Recipientskidneyisfirstremovedfromrenalfossatomake
spacefordonorkidney
d)Anastomosisofexternaliliacarterywithrenalartery
e)Donorrenalveinisanastomosedwithexternaliliacvein
CorrectAnswer-C
Answer-(C)Recipientskidneyisfirstremovedfromrenalfossa
tomakespacefordonorkidney
Alowerqusdrantcurvilinear(Gibson)incisionismade,andtheiliac
vesselsareexposedthrougharetroperitonealapproach.
Therenalarterycanbeanastomosedend-to-endtotheinternaliliac.
Anend-to-sideanastomosisoftherenalarterytotheexternaliliac
arteryismorefrequentlydone.
Theureter,whichiskeptreasonablyshorttoavoidtheriskofdistal
ischaemia,isthenaaastomosedtothebladder.

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157.Whichofthefollowingplanof
managementis/arecorrectwithregardto
Cleftlip&cleftpalateinchildren:
a)Unilateralliponly-1yearofage
b)Bilaterallip-1yearofage
c)Bilaterallipshouldberepairedat5month
d)Bothsoft&hardpalateat1yearinonesetting
e)Cleftlipandsoftpalateat5-6months&hardpalateat15-18
monthsofage
CorrectAnswer-C:E
Answer-(C)Bilaterallipshouldberepairedat5month(E)Cleft
lipandsoftpalateat5-6months&hardpalateat15-18months
ofage
Cleftingofthelipand/orpalateisfelttooccuraroundtheeighth
weekofembryogenesis,eitherbyfailureoffusionofthemedial
nasalprocessandthemaxillaryprominenceorbyfailureof
mesodermalmigrationandpenetrationbetweentheepithelialbilayer
oftheface.
Repair
Ruleoftens:Forincreasedanestheticsafety,aninfantshould
1. Be10weeksold.
2. Weigh10pounds.
3. Haveahemoglobinlevelofatleast10mg/dL.

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158.Suturenumber2-0correspondsto
diameterof:
a)0.21mm
b)0.24mm
c)0.27mm
d)0.30mm
e)0.33mm
CorrectAnswer-D
Answer-(D)0.30mm
Theavailablesizesanddiametersofsutureare:
6-0=0.07mm
5-0=0.10mm
4-0=0.15mm
3-0=0.20mm
2-0=0.30mm
0=0.35mm
1=0.40mm
2=0.5mm

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159.Whichofthefollowingis/arecorrect
regardingeczemaofbreast&Paget's
diseaseofnipple:
a)Generallyeczemaisunilateralwhereaspaget'sdiseaseis
bilateral
b)Eczemamaybeassociatedwithlactation
c)NipplemaybedestroyedinPaget'sdiseasewhileitnormally
intactineczema
d)InversionofnipplemayoccurinPaget'sdisease
e)Associatedwithbreastlumpineczema
CorrectAnswer-B:C:D
Answer-(B)Eczemamaybeassociatedwithlactation
(C)NipplemaybedestroyedinPaget'sdiseasewhileit
normallyintactineczema(D)Inversionofnipplemayoccurin
Paget'sdisease
Paget'sdiseaseofnipple-
Occursalmostexclusivelyinwomen.
Mayoccuratanyagefrom24to84,althoughitismostcommon
aroundthemenopause.
Almostalwaysassociatedwithunderlyingcarcinomaofthebreast
Unilateral,persistenteczematous-typechangeofthenipplewith
erythemaandscaling.
Itchingorburningsensation.
Destructionofthenipple.

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160.Correctcombination(s)ofHerniawith
theircontent:
a)Littrehernia:Meckle'sdiverticulum
b)Richter'shernial-smallintestine
c)Pantaloon-hernialsaconeithersideofinferiorgastricartery
d)Hernia-en-glissade-urinarybladder
e)Maydl'shernia-intestine
CorrectAnswer-A:B:C:D:E
Answer-(A)Littrehernia:Meckle'sdiverticulum(B)Richter's
hernial-smallintestine(C)Pantaloon-hernialsaconeitherside
ofinferiorgastricartery(D)Hernia-en-glissade-urinarybladder
(E)Maydl'shernia-intestine
Richter'sherniaisaherniainwhichthesaccontainsonlyaportion
ofthecircumferenceoftheintestine.
Maydl'sHernia-normal-lookingloopsofintestinearepresentinthe
sac
SlidingHernia(Hernia-en-glissade)-oneithersidebyaportionof
thebladder
Saddle-bag,pantaloonhernia-Thistypeofherniaconsistsoftwo
sacsthatstaddletheinferiorepigastricartery
Littrehernia-AherniacontainingaMeckel'sdiverticulum

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161.Whichofthefollowingistrueabout
esophagusexcept:
a)Serosanotpresent
b)Middle&lowerthirdmadeupofstriatedmuscle
c)Loweroesophagealsphincterisazoneofrelativelyhigh
pressure
d)InachaliacardiaLOStoneisincreasedsothatfoodcannot
passbelow
e)Ithassidetoside&antero-posteriorcurvatures
CorrectAnswer-B
Answer-(B)Middle&lowerthirdmadeupofstriatedmuscle
Epitheliumisstratifiedsquamousnon-keratinizedepithelium.
Muscularismucosacontainsonlylongitudinallayerandnocircular
layer.
Mucosaisthetoughestandstrongestlayer.
Serosaisabsent.
Muscularisexternaismadeupofskeletalmusclefibersonlyinthe
upperthird,smoothmusclesonlyinthelowerthirdandbothtypesof
musclefibersinmiddlethird.Atupperendthelongitudinalcoatsplits
intotwobundlesandthetriangularintervalbetweenthemiscalled
Laimer'stringlewhichisfilledwithcircularmusclefiber

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162.Allaretrueaboutfullthicknessrectal
prolapseexcept:
a)Elderlyareatrisk
b)Commoninchildren
c)Morecommoninfemale
d)sensationofincompleteevacuation
e)Mayassociatedwithaweakpelvicfloor
CorrectAnswer-B
Answer-B.Commoninchildren
Commonlnelderlywomenwhoaremultipara
ConstiPationisimportantfeature
Tenesmuscommon
Somedegreeofincontinenceoffaeces&flatusisalwayspresent.

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163.Correctstatement(s)abouthypospadias
is/are:
a)Urethralopeningonventralaspect
b)Chordaeondorsalaspect
c)Maybeassociatedwithpeniletorsion
d)Proximalvarietiesaremorecommon
e)Couponsspongiosumisdeficient
CorrectAnswer-A:C
Answer-A,C,Urethralopeningonventralaspect(C)Maybe
associatedwithpeniletorsion
Thereisincompletedevelopmentoftheprepuce,calledadorsal
hood,inwhichtheforeskinisonthesidesanddorsalaspectofthe
penileshaftandabsentventrally.
Thereisavariabledegreeofchordae(aventralcurvatureofthe
penismostapparentonerection)
"Peniletorsionisafairlycommoncongenital(presentfrombirth)
conditionthatcanaffectanymaleinfant.

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164.Whichofthefollowingistrueabout
digitalrectalexamination:
a)Indexfingerisused
b)InBPHrectalmucosaisfreewhereasinprostatecancer
mucosaofrectumisadhered
c)Puborectalisisfeltanteriorly
d)Analsphincterlengthcannotbeassessed
e)None
CorrectAnswer-A:B
Answer-(A)Indexfingerisused(B)InBPHrectalmucosais
freewhereasinprostatecancermucosaofrectumisadhered
Duringdigitalrectalexaminationinamale,thefingersequentially
palpatesontheanteriorwall,theprostategland,theseminal
vesicles,andtherectovesicalpouch.
Posteriorlyisthehollowofthesacrumandthecoccyx.
Ontheanteriorwallofthefemale,theuterinecervix,theuterine
fundus(ifretroverted),andtherectouterinepouchwillbefelt.
Therectalwallispalpatedformassesandnarrowingofthelumen.

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165.Truestatement(s)aboutlaproscopic
cholecystectomy:
a)Cosmeticallybetter
b)Bleedingismorecommoninopencholecystectomythan
laproscopiccholecystectomy
c)Veressneddleisusedinclosedtechnique
d)Lalprocsopewithattachedvideocameraisinsertedthrough
umbilicalport
e)Previousabdominalsurgeryisabsolutecontraindication
CorrectAnswer-A:C:D
Answer-(A)Cosmeticallybetter(C)Veressneddleisusedin
closedtechnique(D)Lalprocsopewithattachedvideocamera
isinsertedthroughumbilicalport
Initially,asmallincisionismadeintheupperedgeoftheumbillcus.
Withtheclosedtechniqueaspecialhollowinsufflationneedle
(Veressneedle)thatisspring-loadedwitharetractablecuttingouter
sheathisinsertedintotheperitonealcavityandusedforinsufflation.
Bleedinghasbeenthemostcommoncauseforconversiontoan
openprocedure.

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166.AllaretrueaboutBPHexcept:
a)Submucosalglandhyperplasiaintransitionzone
b)Penileurethaelongation
c)Prostaticurethramaybecompressed
d)Lessthan20m1/secondpeakflowrateisstrongindicationfor
TURP
e)BPHoccurduetogrowthinperipheralzoneofprostate
CorrectAnswer-B:D:E
Answer-(B)Penileurethaelongation(D)Lessthan
20m1/secondpeakflowrateisstrongindicationforTURP
(E)BPHoccurduetogrowthinperipheralzoneofprostate
BenignProstaticHyperplasia(BPH)
Prostateitisdividedintotheperipheralzone(PZ),whichliesmainly
posteriorlyandfromwhichmostcarcinomasarise,andacentral
zone(CZ).
Thereisalsoaperiurethraltransitionalzone(TZ),fromwhichmost
benignptostatichyperplasia(BPH)arises.
BPHtypicallyafectsthesubmucousgroupofglandsinthe
transitionalzone.
Aflowrate<10mls-1willbesufiicientformosturologiststo
recommendtreatment.

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167.Whichofthefollowingincreasesriskof
urinarystones:
a)Increasedurinarycitrate
b)1stCalciumlevelinblood
c)HypervitaminosisA
d)Hypoparathyroidism
e)Decreaseinurinarycolloid
CorrectAnswer-B:C:E
Answer-(B)1stCalciumlevelinblood(C)HypervitaminosisA
(E)Decreaseinurinarycolloid
DeficiencyofvitaminA
Alteredurinarysolutesandcolloids
Decreasedurinarycitrate
Renalinfection
Inadequateurinarydrainageandurinarystasis
Prolongedimmobilization
Hyperparathyroidism

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168.Trueaboutduodenaldiverticula:
a)MostcommonoftheGITdiverticula
b)Commonlyoccuronmedialborder
c)Oftenpresentinperiampullaryregion
d)Itshouldbetreatedaggressivelyduetohighmalignantpotential
e)Itcancausepancreatitisbyproducingobstructionatthe
openingoftheduct
CorrectAnswer-B:C:E
Ans.(B)Commonlyoccuronmedialborder(C)Oftenpresentin
periampullaryregion(E)Itcancausepancreatitisbyproducing
obstructionattheopeningoftheduct
Diverticulaoftheduodenumrepresentingthesecondmostcommon
sitefordiverticulumformationafterthecolon.
Duodenaldiverticulaoccurtwiceasofteninwomen.
Twothirdstothreefourthsofduodenaldiverticulaarefoundinthe
periampullaryregion.
Majorcomplicationsofduodenaldiverticulaincludeobstructionof
thebiliaryorpancreaticducts.
Hemorrhage;perforation;andrarely,blindloopsyndrome
OnlythosediverticulaassociatedwiththeampullaofVaterare
significantlyrelatedtocomplicationsofcholangitisandpancreatitis.
Surgicaltreatmentisrequiredforcomplications&rarelyfor
persistentsymptoms.

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169.Psammomabodiesis/areseenin:
a)Medullarycarcinomaofthyroid
b)Ependymoma
c)Papillarycarcinomathyroid
d)Follicularcarcinomaofthyroid
e)Meningioma
CorrectAnswer-C:E
Answer-(C)Papillarycarcinomathyroid(E)Meningioma
Psammomabodiescanbeseenin:?
Papillarycarcinomaofthyroid.
Renalcellcarcinoma(papillarytype)
Serouscystadenomaofovary
Meningioma
Malignantmesothelioma(Peritoneal&pleural)
Somatostatinoma(Pancreas)
Prolactinomam(Pituitary)
Endometrialpapillaryserouscystadenocarcinoma

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170.Whichofthefollowingis/aretrueabout
primaryhyperparathyroidism:
a)AssociatedwithMENI&II
b)Increaseriskofrenalstone
c)About50gramofglandtissuecanbeleftduringsurgeryto
preventhypocalcemia
d)Causebenignhypertension
e)Mcsporadiccauseishyperplasia
CorrectAnswer-A:B:C
Answer-(A)AssociatedwithMENI&II(B)Increaseriskofrenal
stone(C)About50gramofglandtissuecanbeleftduring
surgerytopreventhypocalcemia
PrimaryhyperparathyroidismisduetoexcessPTHsecretionfroma
singleparathyroidadenoma,hyperplasia,andcarcinoma.
PrimaryhyperparathyroidismMEN1,MEN2A,isolatedfamilialHPT,
andfamlialHPTwithjaw-tumorsyndrome.
Inheritedinanautosomaldominant.
Theclassicquartetofstones,bones,abdominalgroansandpsychic
moansrenalcalculiandcalcinosis,pancreatitisandpsychiatric
disorderdevelops.

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171.Whichofthefollowingis/arefeaturesof
Testiculartorsionwhichisnotpresentin
epididymoorchitis:
a)Rednessofskin
b)Elevationoftestisworsenpain
c)Dopplerultrasoundscanshowabsenceofthebloodsupplyto
theaffectedtestis
d)Fever
e)Dysuria
CorrectAnswer-B:C
Answer-(B)Elevationoftestisworsenpain(C)Doppler
ultrasoundscanshowabsenceofthebloodsupplytothe
affectedtestis
Epididymoorchitis
Theinitialsymptomispain&swellingofepididymisalongwithfever,
malaise&chills
Scrotalwallbecomesred,oedematous&glossy
Testiculartorsion
Thescrotumisswollen&tendon.Thescrotummayalsobenormal
orred&oedematous.
Theonsetofrednessoftheskinandamildpyrexia.
Elevationofthetestisreducesthepaininepididymoorchitisand
makesitworseintorsion.
Dopplerultrasoundscanwillconfirmtheabsenceoftheblood
supplytotheaffectedtestis.

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172.TrueaboutTyphoidulcer:
a)Perforationiscommonin2nd&3rdweekafteronsetoftyphoid
fever
b)Perforationmaypresentatmultiplesite
c)Commonlyinvolvejejunum
d)Commonlyinvolveileum
e)Peritoneallavageiscontraindicatedforperforatedulcer
CorrectAnswer-A:B:D
Answer-(A)Perforationiscommonin2nd&3rdweekafter
onsetoftyphoidfever(B)Perforationmaypresentatmultiple
site(D)Commonlyinvolveileum
CharacteristicFeaturesofTyphoidUlcersMostcommonsiteis
mucosaofsmallintestine(Ileum)inregionoflymphoidpatches
(Payer'spatches)
Ulcersareoval
Ulcersarearrangedlongitudinally(Longitudinalulcers)
Lieinthelongaxisoftheintestinealongtheantimesentericborder
Ulcersmaybesingleormultiple
Ulcersmayerodeandcausecomplications(Bleeding/perforation)

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173.Featureof3degreeburn:
a)Painpresent
b)Transudationoffluidpresent
c)Wholedermisdestroyed
d)Erythematousinappearance
e)Blisterformed
CorrectAnswer-C
Answer-C.Wholedermisdestroyed
Thewholeofthedermisisdestroyedoftheburns.
Clinically,theyhaveahard,leatheryfeel,Theappearancecanvary
fromthatsimilartothepatient'snormalskintocharredblack
dependingupontheintensityoftheheat..Thereisnocapillayreturn
after,thrombosedvesselscanbeseenundertheskin.
Theseburnsarecompletelyanaesthetised:aneedlecanbestuck
deepintothedermiswithoutanypainorbleeding.

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174.Apatienthash/ohypertension&
diabetes.Themechanismofhigher
chanceofulcerinthispatientisdueto:
a)Hyperglycemiassuppressimmunity
b)Vascularinsufficiency
c)Atheroscleroticchanges
d)Venousstasis
e)Tropicskinchanges
CorrectAnswer-A:B:C:E
Answer-(A)Hyperglycemiassuppressimmunity(B)Vascular
insufficiency(C)Atheroscleroticchanges(E)Tropicskin
changes
Trophicchangefromperipheralneuropathy,ischaemiaasaresultof
atheroma,andlowresistancetoinfectionbecauseofexcesssugar
intheTissue.
Neuropathy,abnormalfootbiomechanics,peripheralarterialdisease
(PAD),andpoorwoundhealing.

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175.Pretermbabieshaveincreasedchance
of:
a)Heartdisease
b)Respiratorydistresssyndrome
c)Necrotisingcolitis
d)Meconiumaspirationsyndrome
e)All
CorrectAnswer-A:B:C
Ans.a.Heartdisease;b.Respiratorydistresssyndrome;c.
Necrotisingcolitis
PretermNeonate:
Respiratorysyndrome:Pulmonryoedema,Intra-alveolar
haemorrhage,Idiopathicrespiratorydistresssyndrome&
Bronchopulmonarydysplasia
Infection:Bronchopneumonia,meningitis&necrotizingenterocolitis.
Metabolic(hypoglycemia,hypocalcemia)
Retinopathyofprematurity
Asphxia
Cerebralhaemorrhage
Hypothermia
Fetalshock
HeartfailurePrecipitatedbyasphyxiawithrapiddevelopmentof
pulmonaryedema.TheremaybepatentDuctusarteriosus
Jaundice
Anaemia

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176.Whichofthefollowingcanpresentswith
cyanosisatbirth:
a)TetralogyofFallot
b)TGA
c)PDA
d)VSD
e)Atrialseptaldefect(ASD)
CorrectAnswer-A:B
Ans.a.TetralogyofFallot;b.TGA
TOF:Cyanosismaybepresentfrombirthormakeitsappearance
someyearsafterbirth.
TGA:PatientsofcompleteTGAwithintactventricularseptumare
cyanoticatbirth.
PDA,ASD&VSDareacyanoticcondition

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177.Whichofthefollowingis/aretrue
regardingdevelopmentofchildduring6
to12yr.ofage:
a)Weightincreasesbyl-2kg/yr
b)Headgrowattherateof2-3cm/yr
c)Growthoccurcontinuously
d)Growthoccurinspurts
e)Heightincreasesatrateof6-7cm/yr
CorrectAnswer-D:E
Ans.d.Growthoccurinspurts;e.Heightincreasesatrateof6-
7cm/yr
PhysicalDevelopmentDuringMiddleChildhood(6-11yrofage)
Growthduringtheperiodaverages3-3.5kg(7lb)and6-7cm(2.5
in)peryear.
Growthoccursdiscontinuously,in3-6irregularlytimedspurtseach
year,witheachgrowthspurtlasting,onaverage,8wk.
Theheadgrowsonly2-3cmincircumferencethroughouttheentire
period,reflectingaslowingofbraingrowth.

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178.TrueaboutAspergersyndrome:
a)Morecommoningirl
b)Repetitiveactivitypattern
c)Subnormalintelligenceisconsistentfeature
d)Severelanguageimpairmentsischaracteristic
e)All
CorrectAnswer-B
Ans.b.Repetitiveactivitypattern
Aspergersyndrome:
Itisfourtimesmorelikelytooccurinmalesthaninfemalesand
usuallyisfirstdiagnosedinchildrenbetweentheagesof2and6.
Thecommoncharacteristicsincludeaverageoraboveaverage
intelligence"
Thereisnoclinicallysignificantgeneraldelayinspokenorreceptive
languageorcognitivedevelopment.Self'helpskills,adaptive
behaviour,andcuriosityabouttheenvironmentduringthefirst3
yearsshouldbeatalevelconsistentwithnormalintellectual
development

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179.TrueaboutAutisticdisorder:
a)Qualitydecreaseinsocialinteraction
b)Allaffectedchildrenhavesubnormalintelligence
c)TreatmentshouldtargetedtowardSpeechdevelopment
d)Seenonlyafter3yrofage
e)Stereotypedpatternsofbehaviour
CorrectAnswer-A:C:E
Ans.a.Qualitydecreaseinsocialinteraction;c.Treatment
shouldtargetedtowardSpeechdevelopment;e.Stereotyped
patternsofbehaviour
Autisticdisordersarecharacterizedbythetriadofimpaired
socialinteraction,communicationandimagination.Theseare
associatedwithrigidrepetitivepatternofbehaviour.
Theonsetofautisticdisorderalwaysoccursbeforeage3,attwo
peakperiods.
Difficultyinconcentrationandcommunication,
Lesioninfrontalandtemporallobeandcerebellum,
Delayedspeechandlanguagedevelopment,
Problemsinformingsocialrelationshipsinearlychildhood,
Stereotypedmovements,
Poorspeech,
Lackofsocialinteraction,

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180.TrueaboutHIVinfectionininfants:
a)Mainlyoccurthroughhorizontaltransmission
b)HIVDNAPCRpositiveat3monthconfirmsdiagnosis
c)PositiveantibodytestforIgGantibodyat3monthconfirm
infectedinfant
d)Passivetransferofmaternalbodygenerallypersistsfor12
month
e)All
CorrectAnswer-B:D
Ans.b.HIVDNAPCRpositiveat3monthconfirmsdiagnosis;
d.Passivetransferofmaternalbodygenerallypersistsfor12
month
AllinfantsborntoHIV-infectedmotherstoantibodypositiveatbirth
becauseofpassivetransferofmaternalHIVantibodyacrossthe
placentaduringgestation.
Mostuninfectedinfantslosematernalantibodybetween6and12
monthofageandareknownasseroreverters.
Becauseasmallproportionofuninfectedinfantscontinuestotest
HIVantibodypositiveforupto18monthofage,positiveIgG
antibodytests,includingtherapidtests,cannotbeusedtomakea
definitivediagnosisofHIVinfectionininfantsyoungerthanthisage.
Inanychild>18monthsofage,demonstrationofIgGantibodyto
HIVbyarepeatedlyreactiveenzymeimmunoassay(EIA)and
confirmatorytest(immunoblotorimmunofluorescenceassay)
establishesthediagnosisofHIVinfection.
Viraldiagnosticassays,suchasHMNAorRNAPC&HIVculture,or
HIVp24antigenimmune-dissociatedp24

---

By4-6monthsofage,theIIIVcultureand/orPCRidentifuall
infectedinfants.

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181.Commonfeatureofmarfansyndrome&
Homocystinuria:
a)Armspan>Height
b)Ectopialentis
c)Hypermobilityofjoint
d)Mentalretardation
e)Arachnodactyly
CorrectAnswer-B:E
Ans.b.Ectopialentis;e.Arachnodactyly
Arachnodactyly:Thisfeaturecanoccuronitsown,withno
underlyinghealthproblems.However,itcanalsobeassociatedwith
certainmedicalconditions.ExamplesincludesMarfansyndrome,
Ehlers-Danlossyndrome,Loeys-Dietzsyndromeand
homocystinuria.

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182.Distalinterphalangealjointinvolvement
occurin:
a)Boutonnieredeformity
b)Swanneckdeformity
c)Malletfinger
d)Triggerfinger
e)Dupuytren'scontracture
CorrectAnswer-A:B:C
Ans.a.Boutonnieredeformity;b.Swanneckdeformity;c.
Malletfinger
Inmedicine,malletfinger,alsobaseballfinger,droppedfingerand
(moregenerally)extensortendoninjury,isaninjuryoftheextensor
digitorumtendonofthefingersatthedistalinterphalangealjoint
(DIP).
Swan-neckdeformity(PIPjointshyperextendedandDIPjoints
flexed),enlargedknuckles,andsubcutaneousnodulesareclassic
cluesforrheumatoidarthritis.
Distalinterphalangealjoint-Osteoarthritis,Psoriaticarthritis,
Reactivearthritis
Proximalinterphalangealjoint-Osteoarthritis,RA,SLE,Psoriatic
arthritis

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183.AllaretrueaboutSlippedcapitalfemoral
epiphysisexcept:
a)Avascularnecrosismayoccur
b)Usuallyoccurafterl0yearofage
c)Obesityisariskfactor
d)Frog-leglateralviewishelpful
e)Morecommoningirls
CorrectAnswer-E
Ans.e.Morecommoningirls
SLIPPEDFEMORALCAPITALEPIPHYSIS(SFCE)
Seeninadolescentchildreninagegroupof13-15yrs
Eitheroverweightorsexuallyimmature
Presentswithendocrinopathies
Hypothyroidism
Growthhormoneexcess
CRF
Craniopharyngioma
Hypogonadism
Klinefelter'ssyndromemaypresentasSFCE
Treethowan'ssignonx-ray
USGorCTmoresensitiveindetectingearlyslip
Tc99scanshowsincreaseduptake
Rxispromptsurgery

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184.Pathologicalfracturearefoundin:
a)Bonecyst
b)Osteoporosis
c)Chronicosteomyelitis
d)Osteochondroma
e)Osteogenesisimperfecta
CorrectAnswer-A:C:D:E
Ans.a.Bonecyst;b.Osteoporosis;c.Chronicosteomyelitis;d.
Osteochondroma;e.Osteogenesisimperfecta
PathologicalFracture
Afractureinanabnormalboneisreferredtoaspathological
fracture.Abnormalbonemeansabonerenderedweakbya
diseaselocalizedtoaparticularhone,orbyageneralisedbone
disorder.Bonethatfracturesspontaneously,oraftertrivialtrauma
mustberegardedasabnormaluntilprovenotherwise.Vertebral
bodies(thoracic&lumbar)arethemostoftenaffectedbonesf/b
neckfemur&lowerendradius(colle's#).Mostcommoncauseis
osteoporosis
Othercausesofpathologicalfracturesare:
LocalizedDiseases
Chronicinfectioneg.tubercular&pyogenic
osteomyelitis.
Eosinophilicgranuloma
Benignneoplasticlesions
Solitarybonecyst
Aneurysmalbonecyst
Fibrouscorticaldefect

---

Monostoticfibrousdysplasia
Chondromyxoidfibroma
Chondroma(Enchondroma)
Osteoclastoma(giantcelltumor)
Malignantbonetumor
Osteosarcoma
Ewing'stumor
Chondrosarcoma
Atrophicbonedueto
Polio
Radiation(Radiotherapy)
GeneralisedDiseases
Congenital/Developmental
Osteogenesisimperfecta
Osteopetrosis
011iersdisease(multipleenchondromatosis/dyschondroplasia).
Polyostoticfibrousdysplasia
HistiocytosisX
Gaucher'sdisease
AcquiredDisordersproducingosteopenia
Osteoporosis(mostcommoncause)
Osteomalacia
Hyperparathyroidism
Renalosteodystrophy
Paget'sdisease
Myeloma
Othermetabolicbonediseases
Rickets
Scurvy
Disseminatedmalignancyinbones
Multiplemyeloma
Myelomatosis
Metastaticcarcinoma

---

185.Commonestcauseofacute
osteomyelitis:
a)Trauma
b)Surgery
c)Fungalinfection
d)Hematogenousroute
e)Tubercularinfection
CorrectAnswer-D
Ans.d.Hematogenousroute
ACUTEOSTEOMYELITIS:
1. ItPrimary(hematogenous):-Organismsreachthebonethrough
bloodstream.
2. Secondary:-Organismgainentrydirectlythroughwoundsuchasin
compoundfracturesorsurgicaloperation.
Hematogenousosteomyelitisisthecommonestformofosteomyelitis
andmostcommonsourceofboneandjointinfectionis
hematogenous.

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186.TrueaboutOsteosarcoma:
a)Primaryosteosarcomaismostcommonlyoccurinagegroup
oflessthan20yr
b)Periostealreactionispresent
c)Presentaselevatedsofttissuemass
d)Commonlyassociatedwithosteoidosteoma
e)Formationofbonebythetumorcellsischaracteristic
CorrectAnswer-A:B:C:E
Ans.a.Primaryosteosarcomaismostcommonlyoccurinage
groupoflessthan20yr;b.Periostealreactionispresent;c.
Presentaselevatedsofttissuemass;e.Formationofboneby
thetumorcellsischaracteristic
Osteosarcomaisprimarymalignantbonetumorofbone,derived
fromprimitiveboneformingmesenchymaandcharacterizedby
osteoidformation.
Itisoftwotypes
1. Primary
2. Secondary
Associatedfeature:
Pagetdisease
Radiation
Fibrousdysplasia
Enchondromatosis
Multipleosteochondroma
Boneinfarction
Chronicosteomyelitis
Radiology:

---

TheX-rayappearancesarevariable:hazyosteolyticareasmay
alternatewithunusuallydenseosteoblasticareas.
Oftenthecortexisbreachedandthetumourextendsintothe
adjacenttissues;whenthishappens,streaksofnewbone
appear,radiatingoutwardsfromthecortexthesocalled'sunburst'
effect.
Wherethetumouremergesfromthecortex,reactivenewboneforms
attheanglesofperiostealelevation(Codman'striangle).
WhileboththesunburstappearanceandCodman'striangleare
typicalofosteosarcoma.

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187.TrueaboutClubfoot:
a)Abductionofforefoot
b)Associatedwithbreechpresentation
c)Dennis-Brownsplintused
d)Adductionofforefoot
e)Associatedwithspinabifida
CorrectAnswer-C:D:E
Ans.c.Dennis-Brownsplintusedd.Adductionofforefoote.
Associatedwithspinabifida
CTEVisthecommonestandmostimportantcongenitaldeformityof
thefoot.
Thedeformityconsistsoffollowingelements:-
1. Equinus,i.e.Plantarflexionatanklejoint(tibiotalarjoint)
2. Inversionoffootatsubtalarjoint(talocalcanealjoint)
3. Forefootadduction,atmid-tarsaljoints,especiallyattalo-navicular
joint.
4. Sometimesforefootcavus,i.e.excessivearchingofthefootatmid-
tarsaljoints.
Treatment:
Tendontransfer:-Transferoftibialis-anteriorontheoutersideof
foot.Thiscanbedoneonlyafter5years.
Dwyerosteotomy:-Medialopenwedgeosteotomyofcalcaneumto
correctheelvarus.
Gradualdifferentialdistraction:-Inthisanexternalfixator(JESSor
Illizarov)isappliedandgradualcorrectionofdeformity
>10years:-Triplearthrodesis(subtalar,calcaneo-cuboid,and
talonavicularjoints)

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188.AllaretrueaboutPott'sspineexcept:
a)ThoracicvertebraeT6-T8ismostcommonlyaffectedsite
b)Paradiscaliscommonestvariety
c)Muscularrigidity&stiffnessiscommon
d)Posteriorpartofvertebraeismoreaffectedthananteriorpart
e)BackpainisthecommonestPresentingsymptom
CorrectAnswer-A:D
Ans.a.ThoracicvertebraeT6-T8ismostcommonlyaffected
site;d.Posteriorpartofvertebraeismoreaffectedthananterior
part
Tuberculosis(TB)ofthespine(Pott'sdisease)isthemostcommon
siteofboneinfectioninTB.
Thelowerthoracicandupperlumbarvertebraearetheareasofthe
spinemostoftenaffected.
Pott'sdiseaseresultsfromhaematogenousspreadoftuberculosis
fromothersites,oftenpulmonary.Theinfectionthenspreadsfrom
twoadjacentvertebraeintotheadjoiningdiscspace.
Ifonlyonevertebraisaffected,thediscisnormal,butiftwoare
involvedtheintervertebraldisc,whichisavascular,cannotreceive
nutrientsandcollapses(seenasnarrowingofintervertebralspace
onX-rays)
CommonestspineinvolvedinspineTBis
Thoracolumbar/DorsolumbarT12-L1(Lowerthoracictobeprecise.
Thediseaseprogressesslowly.Signsandsymptomsinclude:
Localisedbackpainistheearliestandcommonestcomplaint
Paravertebralswellingmaybeseen
Neurologicalsignsmayoccur,leadingtoparaplegia.

---

Stiffness
Deformity
Constitutionalsymptoms
Diagnosis:
SpinalX-raymaynotshowearlydiseaseas50%ofbonemassmust
belostforchangestobevisibleonx-ray.However,plain
radiographscanshowvertebraldestructionandnarroweddisc
space.
MRIisusefultodemonstratetheextentofspinalcompressionand
canshowchangesatanearlierstagethanplainradiographs.Bone
elementsvisiblewithintheswelling,orabscesses,arestrongly
indicativeofPott'sdiseaseasopposedtomalignancy.
CTscansandnuclearbonescanscanalsobeused.

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189.AllaretrueaboutLNGexcept:
a)CauseEndometrialsuppression
b)Canbeusedinemergencycontraception
c)Cannotbegiventolactatingwomen
d)Devoidofestrogenicside-effects
e)All
CorrectAnswer-C
Ans.c.Cannotbegiventolactatingwomen
LNGpreventovulation&causedesynchronizationofendometrium
Itcanbeofferedtoalactatingwomen.
Ithasnooestrogen&sonoestrogenicassociatedsideeffects.
Itcanbeofferedtohypertensive,cardiac&diabeticwoman

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190.Trueaboutamnioticfluid:
a)Sameconcentrationofplasmathroughoutpregnancy
b)Formsfromtransudationofplasmathroughfetusskinbefore20
wkofgestation
c)Fetusswallowsamnioticfluid
d)Protectsfetusfrominjury
e)Mainchannelforgaseousexchange
CorrectAnswer-B:C:D
Ans.b.Formsfromtransudationofplasmathroughfetusskin
before20wkofgestation;c.Fetusswallowsamnioticfluid;d.
Protectsfetusfrominjury
AmnioticFluid:
Infirsthalfofpregnancy,thecompositionofthefluidisalmost
identicaltoatransudateofplasma.Butinlatepregnancy,the
compositionisverymuchalteredmainlyduetocontaminationof
fetalurinarymetabolites.
Therespiratoryfunctionoftheplacentamakesthefetaloxygen
supplyandfetalcarbondioxideremovalpossible
Thereisconstantexchangeofwaterb/wtheamnioticfluid
&maternalblood,thewaterbeingcompletelyreplacedeverythree
hours.
Sometimeinfifthmonththefetusbeginstoswallowamnioticfluid

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191.Trueaboutobstetricaloutlet:
a)Posteriorwallisdeficient
b)Boundedabovebytheplaneofleastpelvicdimensions
c)Anteriorwallisformedbyischialbones
d)Minimumobstetricdiameter
e)Itsplaneisplaneofleastpelvicdimensions
CorrectAnswer-B:E
Ans.b.Boundedabovebytheplaneofleastpelvicdimensions;
e.Itsplaneisplaneofleastpelvicdimensions
ObstetricalOutlet:
Itisthesegmentofthepelvisboundedabovebytheplaneofleast
pubicdimensions&belowbytheanatomicaloutlet
Itsanteriorwallisdeficientatthepubicarch;itslateralwallsare
formedbyischialbones&theposteriorwallincludeswholeofthe
coccyx.
Shape:Itisantero-posteriorlyoval
Plane:Theplaneisotherwiseknownasplaneofleastpelvic
dimensionsornarrowpelvicplane.Theplaneextendsfromthe
lowerborderofthepubissymphysistothetipofischialspines
Posteriorlytomeetthetipofthe5thsacralvertebrae.Itisnarrowest
planeinpelvis&roughlycorrespondstotheoriginoflevatorani
muscle.
Diameters:Transverse(Syn-Bispinous10.5cm),Anteroposterior
(11cm)&Posteriorsagittal(5cm)
Axis:Itisrepresentedbyalinejoiningthecentreoftheplanewith
thesacralpromontory.Itsdirectionisalmostvertical.

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192.Whichofthefollowingis/arecriteriafor
theexpectantmanagementinpre-
eclampsiaexcepts
a)Plateletcount<100000ml
b)B.p.>140/90mmHg
c)Urineoutput<400mUday
d)Persistentheadache
e)Visualdisturbances
CorrectAnswer-B
Ans.b.B.P.>140/90mmHg
CriteriaforseverePreeclampsia:
ApersistentSBPof>160mmHgsystolicorDBPof>110mmHg
Persistentsevereepigastricpain
Cerebralorvisualdisturbances
Oliguria<400ml/24hr
Proteinexcretionof>5gm/day
HELLPsyndrome
Retinalhaemorrhage,exudatesorpapilledema
Intrauterinegrowthrestrictionofthefoetus
Pulmonaryoedema

---

193.ContraindicationsforIUCD
a)Postabortalsepsismorethan1yearago
b)Presentcervicitisandvaginitis
c)PasthistoryofectopicPregnancy
d)Unknowncauseofvaginalbleeding
e)Severedysmenorrhea
CorrectAnswer-B:C:D:E
Ans:b)Presentcervicitisandvaginitis;c)Pasthistoryof
ectopicPregnancy;d)Unknowncauseofvaginalbleeding;e)
Severedysmenorrhea
ContraindicationsforplacingIUCDare:
Suspectedpregnancy
PID
Presenceoffibroids
MenorrhagiaanddysmenorrhoeaofcopperTisused.
Severeanemia
Diabeticwomenwhoarenotwellcontrolled.
Heartdisease
Scarreduterus
Previousectopicpregnancy
LevonorgestrelIUCDinbreastcancer
Preferablyavoiditsuseinunmarriednulliparouspatientbecauseof
theriskofPID.

---

194.TruestatementregardinguseofACE
inhibitorsinpregnancy:
a)Causepolyhydramnios
b)Causerenalagenesis
c)Causepulmonaryhypoplasia
d)Useduringfirst3monthissafe
e)Safeinlasttrimester
CorrectAnswer-B:C
Ans.b.Causerenalagenesis;c.Causepulmonaryhypoplasia
FetalsideeffectsofACEinhibitor:
Oligohydramnios
IUGR&fetalrenaltubulardysgenesis
Neonatalrenalfailure
Pulmonaryhypoplasia
ACEinhibitorsiscontraindicatedduringthesecondandthird
trimesterofpregnancybecauseofriskoffetalhypotension,anuria,
andrenalfailuresometimesassociatedwithfetalmalformationsor
death

---

195.Trueaboutovulation&menstruation:
a)Temperaturedecreaseattimeofovulation
b)Estrogenhavearoleinproliferativephase
c)LHsurgeoccursbeforeovulation
d)100mlbloodlossisnormal
e)All
CorrectAnswer-B:C:D
Ans.b.Estrogenhavearoleinproliferativephase;c.LHsurge
occursbeforeovulation;d.100mlbloodlossisnormal
Thedurationofbleedingisabout3-5days&estimatedbloodlossis
between50-200ml.
Themaximumpeakofestrogensecretionisseenabout48hours
beforeovulation,whereastheLHpeakoccursabout24-36hours
beforeovulation.
AsurgeinLHsecretiontriggersovulation,&ovulationnormally
occursabout9hrafterpeakofLHsurgeatmidcycle"
OvulationnormallyoccursaboutthoursafterthepeakoftheLH
surgeatmidcycle
Aconvenientbutretrospectiveindicatorofthetimeofovulationisa
riseinthebasalbodytemperature

---

196.Cause(s)ofstillbirth:
a)Prematurity
b)Syphilis
c)Abruptioplacentae
d)Diabetes
e)All
CorrectAnswer-E
Ans.e.All
ETIOPATHOLOGY:
Maternal
Gestationalhypertension
Bloodgroupincompatibility
Metabolicdisorders
Intrauterineinfections
Fetal
Majoranomalies
Umbilicalcordcomplications(looping,knotting,twisting)
Placental
Chronicplacentalinsufficiency
Placentalabruption
Chorioamnionitis

---

197.Whichofthefollowingistrueabout
endometrialcarcinoma:
a)Lessaggressiveinpost-menopausalwomen
b)Morecommonindiabetes
c)Commonafter40yrofage
d)AssociatedwithPCOD
e)Associatedwithhereditarynonpolyposiscolorectalcancer
syndrome(HNPCC)
CorrectAnswer-B:C:D:E
Ans.b.Morecommonindiabetes;c.Commonafter40yrofage
;d.AssociatedwithPCOD;e.Associatedwithhereditary
nonpolyposiscolorectalcancersyndrome(HNPCC)
RISKFACTORS:
Highlevelsofestrogen
Endometrialhyperplasia(Complexhyperplasiawith
atypiahistologicalpattern)
Polycysticovarysyndrome
Nulliparity
Infertility
Earlymenarche
Persistentanovulation
Diabetesmellitus
Hypertension
Obesity,
FamilyHistory,
UseofHormoneReplacementTherapy

---

Latemenopause
Endometrialpolypsorotherbenigngrowthsoftheuterinelining
Tamoxifen
Hyperplasia
Pelvicradiationtherapy
Breastcancer
Ovariancancer

---

198.HighlevelofhCGfoundin:
a)Twin
b)Downsyndrome
c)Choriocarcinoma
d)Coloncarcinoma
e)Ectopicpregnancy
CorrectAnswer-A:B:C
Ans.a.Twin;b.Downsyndrome;c.Choriocarcinoma
HCGisincreasedin:
Multiplefetuses
Rhincompatibility
Downsyndrome
Choriocarcinoma
Hydatidiformmole
HCGisdecreasedin:
Ectopicpregnancy
Impendingspontaneousabortion

---

199.Trueaboutplacentalabruption:
a)Pre-eclampsiaisariskfactor
b)Commoninmultigravida
c)Commoninprimigravida
d)Prematureseparationofnormalimplantedplacentae
e)Characterofbleedingisbrightredblood
CorrectAnswer-A:B:D
Ans.a.Pre-eclampsiaisariskfactor;b.Commonin
multigravida;d.Prematureseparationofnormalimplanted
placentae
Abruptioplacentae:
Itisaformofantepartumhemorrhagewherebleedingoccursdueto
prematureseparationofnormallysituatedplacenta.
Hypertensioninthepregnancyisimportantpredisposingfactor
ETIOLOGY:
PrimarycauseofAPisuncertain
Severalassociatedconditionsidentified:
Increaseinage&parity:1.3-1.5%
Pre-eclamsia:2.1-4%
Chronichypertension:1.8-3%
Pretermrupturedmembranes:2.4-4.9%
Multifetalgestation:2.1%
Cigarettesmoking:1.4-1.9%
Cocaineabuse:NA
Folicaciddeficiency
Priorabruption:10-25%
Uterineleiomyoma:NA

---

Hydromnios:2%
Symptoms
VaginalBleeding(78%)
AbdominalPain(66%)-Maybesevereandconstant,posterior
placentamaypresentwithbackpainSigns
Vitalsignssuggestiveofcardiovascularcompromise-Tachycardia,
orthostaticchangesinBloodPressureandpulse
Evaluateforexternalsignsoftrauma
Uterushypertonicortense(CouvelaireUterus)-Fundustenderto
palpation

---

200.TrueaboutTrichomonasvaginitis:
a)Importantcauseofrecurrentabortion
b)T.vaginalisisaflagellatedprotozoa
c)Metronidazoleisusedfortreatment
d)Strawberrycervix
e)Curdydischarge
CorrectAnswer-B:C:D
Ans.b.T.vaginalisisaflagellatedprotozoa;c.Metronidazoleis
usedfortreatment;d.Strawberrycervix
Trichomonasvaginits:
Itiscausedbytrichomonasvaginalis,apear-shapedunicellular
flagellateprotozoa
Onspeculumexamination,mucosaoftheportiovaginalispartof
cervixappearlikestrawberry
Infectioningenitaltractmayberesponsibleforsporadic
spontaneousabortionbutitsrelationtorecurrentabortionis
inconclusive.

---

201.TrueaboutMirena:
a)Effectivelifeis5-10yr
b)GivesprotectionagainstHMSTD
c)Contraindicatedinsuspectedpregnancy
d)Contraindicatedinbreastcarcinoma
e)Usefulincontrollingmenorrhagiainfibroid
CorrectAnswer-A:C:D:E
Ans.a.Effectivelifeis5-10yr;c.Contraindicatedinsuspected
pregnancy;d.Contraindicatedinbreastcarcinoma;e.Usefulin
controllingmenorrhagiainfibroid
Thelevonorgestrel-releasingIUS,Mirena,releases20mcgof
levonorgestrelperdayandisapprovedforcontraceptionforup
to5years.Itachieveslocalprogestinconcentrationsthatare
~1000-foldhigherthansystemiclevels.
ContraindicationsspecifictotheuseofMirenaare:
Acuteliverdiseaseortumor
Knownorsuspectedcarcinomaofthebreast
Hypersensitivitytoanycomponentofthisproduct
ContraindicationstoUseofanIntrauterineDevice:
Pregnancyorsuspicionofpregnancy
Genitalactinomycosis
Acutepelvicinflammatorydisease
Genitalbleedingofunknownetiology
Womanorherpartnerhavingmultiplesexualpartners
ApreviouslyinsertedIUDthathasnotbeenremoved
Abnormalitiesoftheuterusresultingindistortionoftheuterinecavity
Postpartumendometritisorinfectedabortioninthepast3months

---

Knownorsuspecteduterineorcervicalneoplasia,orunresolved
abnormalcytologicalsmear
Untreatedacutecervicitisorvaginitis,includingbacterialvaginosis,
untilinfectioniscontrolled
Historyofectopicpregnancyorconditionthatwouldpredisposeto
ectopicpregnancy

---

202.Feature(s)ofHaileyHaileydisease
is/are:
a)Abullousdisorder
b)Crustederosion
c)Mostcommonlypresentininfant
d)Alsocalledasfamilialbenignpemphigus
e)Intraepidermalbullousdisorder
CorrectAnswer-A:B:D:E
Ans.(A)Abullousdisorder(B)Crustederosion(D)Alsocalled
asfamilialbenignpemphigus(E)Intraepidermalbullous
disorder
[NeenaKhanna3rd/67]
HaileyHaileyDisease(FamilialBenignPemphigus):
Pemphigustypeofbullousdisorder(Intraepidermallesion)
Autosomaldominantinheritance
Presentsin3rd-4thdecade
Presentsasflaccidvesicles,crustederosions&circinateplaqueson
erythematousbase.Maybecomehypertrophic&malodorous
Majorflexures(groins,perineum,axillae&sideofneck)
Treatmentincludes:Reductionoffrictionkeepingareadry.
Combinationofpotentsteroidswithantibiotics(mainstayof
treatment)

---

203.Skinlesionofchronicliverdisease:
a)Terrynail
b)Palmarerythema
c)Purpura
d)Spidernaevi
e)None
CorrectAnswer-A:B:D
Ans.(A)Terrynail(B)Palmarerythema(D)Spidernaevi
[RefNeenaKhanna3rd/330,148;Roxburg17th/292-93]
SkininLiverDisease:
Hepaticdisease,especiallywhenthepatienthashepaticfailure,
isassociatedwith:
Pruritus:Duetoaccumulationofbilesalts,whenthereisobstructive
jaundice
Yellowishpigmentation:DuetoaccumulationofbilePigments
Spidernevi&palmarerythema:Duetoaccumulationofestrogen
drprogesterone
Whitenails:Duetohypoproteinemia

---

204.Nailchangesoflichenplanusincludes:
a)Pterygium
b)Salmonpatch
c)Subungualhyperkeratosis
d)Splinterhaemorrhage
e)Thinningofnailplate
CorrectAnswer-A:E
Ans.(A)Pterygium(E)Thinningofnailplate
[Ref;NeenaKhanna3rd/52-55;Harrison19th/i49,17th/316]
NailChangesinLichenPlanus:
Seenin15%ofpatients(mostfrequentlyinchildren)
Thinning6distalsplittingofnailplates
Longitudinalgrooves
TentingOfNailPlate
Pterygiumformation(diagnostic):
Theproximalnailfoldisprolongedontothenailbed,splitting&
destroyingthenailplate.

---

205.APatienthashypersensitivityto
neostigmine.Hehastoundergoupper
abdominalsurgery.Musclerelaxantof
choiceis:
a)Pancuronium
b)Ropacuronium
c)Vecuronium
d)Atracurium
e)Piperacurium
CorrectAnswer-D
Ans.D.Atracurium
[Ref:AjayYadav5th/116-17;Lee13th/189-95]
Atracuriumundergospontaneousdegradationinplasmacalledas
Hoffmandegradation.
Atracuriumisrelaxantofchoiceifreversalagentiscontraindicated.
Othermusclerelaxants:
(mentionedinquestion)requirereversalwithneostigmine(butNe
cannotuseneostigmineduetohypersensitivity),socannotusein
thispatient

---

206. Whichofthefollowingcondition(s)can
causeexaggeratedhyperkalemiain
patientswithuseofsuccinylcholine:
a)Burn
b)Spinalcordinjury
c)Musculardystrophy
d)Tetanus
e)Abdominalorganinjury
CorrectAnswer-A:B:C:D
Ans.(A)Burn(B)Spinalcordinjury(C)Musculardystrophy
(D)Tetanus
[RefAjayYaday5th/112-13;Lee13th/190;KDT7th/355;Barash
ClinicalAnesthesia6th/MR]
Succinylcholine&hyperkalemia:
Inpatientswithextensiveburn&softtissueinjuries.
Alsointetanus&spinalcordinjuries,neurological&muscular
disorders(stroke,cerebralpalsy&musculardystrophy).
Aftermajordenervationinjuries,spinalcordtransection,peripheral
denervation,stroke,trauma,extensiveburns,andprolonged
immobilitywithdisease

---

207.Whichofthefollowingdoesnotincrease
intracranialpressure:
a)Sodiumthiopentone
b)Desflurane
c)Mannitol
d)Sevoflurane
e)Propofol
CorrectAnswer-A:C:E
Ans.(A)Sodiumthiopentone(C)Mannitol(E)Propofol
[RefAjayYadavp.86,109;Lee/643-45]
Mannitolisusedinthetreatmentofincreasedintracranialtension.

---

208.Mechanismofactionofgeneral
anesthesiais/are:
a)GABA-Areceptor
b)GABA-Breceptor
c)NMDAreceptor
d)Na+channelblockage
e)None
CorrectAnswer-A:C
Ans.(A)GABA-Areceptor(C)NMDAreceptor
[Ref:KDT7th/372-73;AjayYadav5th/71;Lee13th/149;Miller
6th/721-22]
MechanismofGeneralAnaesthesia:
TheGABA-AreceptorgatedCl-channelisthemostimportantof
these.
Manyinhalationalagents,barbiturates,benzodiazepinesepropofol
Actionofglycineinthespinalcord&medullaisaugmentedby
barbiturate,Propofol&manyinhalationalanaesthetics.
InhibitionofexcitatorytypeofNMDAtypeofglutamatereceptor:
Ketamine&N2O.

---

209.Whichofthefollowingstatementis
correctregardingmechanismofaction
oflocalanaesthesia:
a)Blockageofrestingsodiumchannelmoreisthanactivated
sodiumchannel
b)Fasterconductingfibersblockedeasily
c)BlockNa-KATPasechannel
d)Finetouchgoesbeforepain
e)Inregionalblocki.vinjectionisused
CorrectAnswer-E
Ans.E.Inregionalblocki.vinjectionisused
[Ref,AjayYadav5th/138-140,149;Lee13th/369-374]
MOA:
Thekeytargetoflocalanestheticsisthevoltage-gatedsodium
channel.
Thebindingisintracellularandismediatedbyhydrophobic
interactions.
Localanestheticsblockvoltage-gatedsodiumchannelsandinterrupt
initiationandpropagationofimpulsesinaxons.
Localanestheticsreversiblyinhibitperipheralnerveconductionby
blockingvoltagegatedsodium&potassiumchannel.
Theaffinityofthesodiumreceptorishigherinopenorinactivated
statesthanintherestingstate.
Blockadesequenceis-sympathetic>temperature(cold)>pain(prick)
>proprioception(Lighttouchwithcotton).

---

210.TruestatementregardingIodine-131:
a)Itistheonlyisotopeofiodineusedforthyroid
b)Contraindicatedinpregnancy
c)Emitsarays
d)Emits13rays
e)Emitsyrays
CorrectAnswer-B:D:E
Ans.(B)Contraindicatedinpregnancy(D)Emits13rays
(E)Emitsyrays
[Ref:DahnertRadiologymanual5th/1087:88;ReviewofRadiology
bySumerSethi2nd/101;Harrisontgth/263e-3,18th/2932,t7g1,
17th/1360;DuttaGynaecology5th/484,4th/465;MeredithRadiation
Physics&NuclearMedicine/28]
(Iodine)I-131:
Emitsbeta&gammarays.
Contraindicatedduringpregnancy.
Foetalthyroidwillbedestroyedresultingincretinism,other
abnormalitiesifgivenduringthefirsttrimester.
I-127-Stableisotopeofiodine.
I-131-Radioactiveisotopeofmedicalimportance.
I-123-Agentofchoiceforthyroidimaging.
ForradioactiveiodinescanningI-131&I-123areused.
Fortreatmenthypothyroidism&thyroidcancerI-131isused.

---

211.Side-effects(s)ofPituitaryirradiation:
a)Hypopituiarism
b)Decreaseriskofsecondarytumor
c)Opticnervedamage
d)Increasedriskofcerebrovascularaccident
e)None
CorrectAnswer-A:C:D
Ans.(A)Hypopituiarism(C)Opticnervedamage(D)Increased
riskofcerebrovascularaccident
[RefHarrison19th/2263-64,18th/2886,2829;CMDT2016/1087,
06/1115;Devita7th/1844;LeibelPhilip2nd/489]
S/EofPituitaryirradiation:
Hypopituitarism,somedegreeofmemoryimpairment,increased
longtermnskofsecondtumor&smallvesselischemicepisode.

---

212.Falseincreaseinsizeofheartonchest
x-rayPAviewis/areseenin:
a)Rotationofpatient
b)Supineview
c)Filmtakeninexpiration
d)Pneumonia
e)None
CorrectAnswer-A:B
Ans.(A)Rotationofpatient(B)Supineview
[Ref:WHORadiographicManual2002/32-33;BasicRadiology
(Lange)2004/Heartimaging]
Causesofpseudoincreasedsizeofheart:
ChestX-rayshouldbetakeninfullinspiration&correctlycentered:
Afilmtakeninexpirationcancauseconfusion.
Itmaysimulatediseasese.g.,pulmonarycongestion,cardiomegaly
orawidemediastinum'
InSupinechestview:
TheHeartappearsenlarged&mediastinummayaPPearwide
perhaps10cm.
MediastinalWidening:
Wideningofthemediastinumismostoftenduetotechnicalfactors
suchasPatientpositioningortheprojectionused.
Rotation,incompleteinspiration,oranAPview,mayallexaggerate
thewidthofthemediastinum,aswellasheartsize.

---

---

213.X-rayfeature(s)ofLeftAtrial
Hypertrophy:
a)Bootshapedheart
b)Widenedcarina
c)Straightenedleftborder
d)Doubleatrialshadow
e)Moneybagappearance
CorrectAnswer-B:C:D
Ans.(B)Widenedcarina(C)Straightenedleftborder(D)Double
atrialshadow
[Ref:PJM20th/228;DahnertRadiologymanual5th/575,636-
637;ReviewradiologybySumerSethi6th/76-77,80]
X-rayfeatureofleftAtrialHypertrophy:
Doubleatrialshadow(Doubledensityseenthroughrightupper
border)
Straightenedleftborder
Leftbronchusliftedupwithwidenedcarina
EsophaguscurvingaroundthedilatedLeftatrium.
Splayingofmainstembronchi(i.e.Increasedcarinalangle)
Smallaorta(duetoincreaseoffuruardcardiacoutput)
Normal/UndersizedLV

---

214.AllaretrueregardingPETscanexcept:
a)Helpinassessmentofbothanatomical&functionalstatusof
tissue
b)Donotposeanyradiationexposuretopatient
c)SuperiortoCTforanatomicaldetail
d)FDGisused
e)None
CorrectAnswer-B:C
Ans.(B)Donotposeanyradiationexposureto
patient(C)SuperiortoCTforanatomicaldetail
[RefLeB25th/136-37;DahnertRadiologymanuel5th/1085;L&B
25th/136,BasicRadiologybyLange2004;raiiegTaphics.rsna.org/
content/23/2/315full]
PositronEmissionTomography(PET):
Themostcommonlyusedradiolabeledtraceris18F-2-fluoro-2-
deoxy-D-glucose(FDG),althoughothertracerscanalsobeusedin
ordertoassessmetabolicfunctionssuchasoxygenandglucose
consumptionandbloodflow.
Areasofhighmetabolicactivity(i.e.,cerebralcortex,deepgray
nuclei)demonstrategreaterradiopharmaceuticaluptakethanilo
arcasoflowmetabolicactivity,suchaswhitematterorcerebrospinal
fluid.Thebonesofthcskullandscalpsofttissuesare,forthemost
part,invisible.
Anatomicresolution,althoughnotasgoodaswithCTorMRi
imaging.
Strengths:
Allows/functionalimaging

---

Allowsimagingofthewholebody
Bonescanhasahighsensitivityformetastaticbonedisease,
fracturesandinfection
Drawbacks:
Highcost,verylimitedavailabilityandrelativelylowspatial
resolution.

---

215.Whichofthefollowingistrueregarding
MRI:
a)MRIisbetterthanCTscanforbonylesion
b)GreymatterisgreyonTIWI
c)Usesdyegadolinium
d)Gadoliniumissaferthaniodinebasedcontrastagent
e)Canbeusedinmultipleplain
CorrectAnswer-B:C:D:E
Ans.(B)GreymatterisgreyonTIWI(C)Usesdye
gadolinium(D)Gadoliniumissaferthaniodinebasedcontrast
agent(E)Canbeusedinmultipleplain
[RefSumerSethi2nd/9-10;mriscans.cliniccompare.co.uHmri-scan-
with-contrast-dye;DahnertradiologyReviewManual5th/1079;
Bhadury2nd/177;blog.radiolog.ucsf.edu;www.difren.com/dffirence
/CT-Scan-r,s-MRI]
MRI:
ThecontrastdyeusedintheseMRIScansisgenerallygadoliniumat
complicationsarerarerincomparisontothelodineorigindyewed
forX-raysandCTscan
Inspine&formusculoskeletalproblems,MRIisthepreferred
option.
MRimaginghastraditionallybeenusedforneurologicindications,
includingbraintumors,acuteischemia,infection,andcongmltal
abnormalities.
Greymatterisgrey&whitematteriswhiteonT1W1&relationship
isreversedonT2W1.

---

---

216.SIunitofradioactivityis:
March2013(c,f)
a)Rem
b)Rad
c)Becuerel
d)Curie
e)None
CorrectAnswer-C
Ans.Ci.e.Becquerel

---

217.Feature(s)ofSchizophreniais/are:
a)1stranksymptomishelpfulinmakingdiagnosis
b)Depressionmaybepresent
c)Brainventricleenlargementmaybepresent
d)Onsetoccuronlyafterageof40yr
e)Usuallyonsetoccurlaterinwomenascomparedtomen
CorrectAnswer-A:B:C:E
Ans.(A)1stranksymptomishelpfulinmakingdiagnosis
(B)Depressionmaybepresent(C)Brainventricleenlargement
maybepresent(E)Usuallyonsetoccurlaterinwomenas
comparedtomen
Schizophrenia:
Twocommonaffectivesymptom:
Reducedemotionalresponsiveness(warrantthelabelofanhedonia,
andoverlyactiveandinappropriateemotionssuchasextremesof
rage,happiness,andanxiety).
Otherfeelingtonesincludeperplexity,asenseofisolation,
overwhelmingambivalence&depression.
Onset:
Usuallylaterinwomen&oftenrunsamorebenigncourse.
(Comparedtomen).
CNSinvolvement:
Computedtomography(CT)scansofpatientswithschizophrenia
haveconsistentlyshownlateralandthirilventricularenlargement
and,somereductionincorticalvolume.
Diagnosis:
Schneider'sfirstranksymptomsofschizophreniathoughnotspecific

---

butofgeathelpinmakingdiagnosis&havesignificantlyinfluenced
thediagnosticcriteria&classificationofschizophrenia.

---

218.Whichoffollowingisperception
disorder:
a)Delusion
b)Hallucination
c)Obsession
d)Depersonalization
e)Illusion
CorrectAnswer-B:C
Ans.(B)Hallucination(C)Obsession
[RefNirajAhuja6th/14,17;Kaplan&Sailockl1th/233,281]
Perception:
Processofbeingawareofasensoryexperience&beingableto
recognizeitbycomparingitwithpreviousexperiences.
Perceptiondisordersare-hallucinations,illusions&
misinterpretations;depersonalization/derealization;somaticpassivity
phenomenon;autoscopy;abnormalvestibularsensationsetc.

---

219.Whichofthefollowingmodalityis/are
notincludedinbehaviourtherapy:
a)Roleplaying
b)Schedulingactivities
c)Gradedtaskassignment
d)Identifyingmaladaptiveassumptions
e)None
CorrectAnswer-D
Ans.D.Identifyingmaladaptiveassumptions
[RefNkajAhuja6th/85,228-30;IGplan&Saddok:sSynopsisof
Psychiatry10th/953-959]
BehavioralTechniques:
Thisincludesthevariousshort-termmodalitieslikesocialskills
trainingproblemsolvingtechniques,assertivenesstraining,self-
controltherapy,activityscheduling&decision-makingtechniques.
Amongthebehavioraltechniquesincognitivetherapyare
schedulingactivities,masteryandpleasure,gradedtask
assignments,cognitiverehearsal,self-reliancetraining,role-playing,
anddiversiontechniques.

---

220.Diazepamcanheusedfor:
a)Agitationinemergencyroom
b)Longtermtreatmentofepilepsy
c)Statusepilepticus
d)Convulsionintetanus
e)None
CorrectAnswer-A:C:D
Ans.(A)Agitationinemergencyroom(C)Statusepilepticus
(D)Convulsionintetanus
[Ref.KDT7th/a0a-05;NirajAhuja6th/209;Kaplan6Saddok!
SynopsisofPsychiatryIqth/I0I8-20]
UsesofDiazepam:
Firstlinedrugforemergencycontrolofconvulsionse,g.,status
epilepticus,tetanus'eclampsia,convulsantdrugpoisoning.
Narcoanalysisorabreation.
Antipsychoticinducedakathisia
Treatmentofalcoholwithdrawal&otherdrugwithdrawalsyndrome
Nightmares(diazepamalsoreducetheREMsleepduration)
Insomnia.
Stage4NREMsleepdisorderslikeenuresis,somnambulism
(diazepamreducedurationofstage4NREMsleep).
Agitateddepression

---

221.Benzodiazepinesusedinseizure
treatment:
a)Lorazepam
b)Tenezepam
c)Alprazolam
d)Clobazam
e)Midazolam
CorrectAnswer-A:D
Ans.(A)Lorazepam(D)Clobazam
[RefKDT7th/398]
AntiepilepticBenzodiazepines:Clonazepam,diazepam,Lorazepam
dtclobazam.
FebrileseizureOraldiazepam,midazolam&clobazamareeffective
prophylactics(Intermittent).
invalidquestionid

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