Download PGI PG PGI 2015 May Solved Question Paper

1.Whichofthefollowingstructure(s)pass
throughadductormagnus
a)Femoralvessel
b)Femoralnerve
c)Femoralsheath

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d)Saphenousnerve
e)Tibialnerve
CorrectAnswer-A
Ans.a.Femoralvessel
Femoralarterypassthroughanopeningintheadductormagnusto

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becomecontinuouswiththepoplitealartery
Femoralveinentersthethighbypassingthroughanopeninginthe
adductormagnusasacontinuationofthepoplitealvein

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2.Whichofthefollowingstatement(s)istrue
regardingaxillaryartery:

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a)Startfromupperborderofclavicle
b)Ulnarnerveliesmediallytodistall/3ofartery
c)Radialnerveliesposteriorlydistal1/3ofartery
d)Axillaryveinlieslaterallytoproximal1/3oftheartery
e)Endatlowerborderofpectoralisminor

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CorrectAnswer-B:C
Ans.b.Ulnarnerveliesmediallytodistall/3ofartery;c.Radial
nerveliesposteriorlydistal1/3ofartery
Axillaryartery
Itisthemainarteryofupperlimb.Itbeginsatthelevelofouter

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borderoffirstribasacontinuationofsubclavianartery.Itendsatthe
leveloflowerborderofteresmajortocontinueasbrachialartery.
Theaxillaryarteryiscoveredanteriorlybypectoralisminor,which
dividesitintothreeparts:?
Firstpart:-Thispartisproximaltoupperborderofpectoralisminor,

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i.e.extendsfromouterborderoffirstribtoupperborderofpectoralis
minor.ThebranchoffirstpartisSuperiorthoracicartery.
Secondpart:-Thispartisbehindpectoralisminor.Itgivesfollowing
branches.
Thoracoacromialartery:-Itpiercesclavipectoralfasciaandgives

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followingbranches:-
1. Acromial
2. Pectoral,
3. Clavicularanddeltoid.

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Lateralthoracicartery

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Thirdpart:-Thispartisdistaltolowerborderofpectoralisminor,i.e.
extendsfrompectoralisminor(lowerborder)toteresmajor(lower
border).Itgivesfollowingbranches?
Subscapularartery:-Itgivesoffcircumflexscapulararteryandthen
continuesusthoracodorsalartery.

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Anteriorcircumflexhumeralartery.
Posteriorcircumflexhumeralartery.
Anteriorandposteriorcircumflexarteries(botharebranchesof
3rdpartofaxillaryartery)formsanastomosisaroundsurgicalneckof
humerus.

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3.Facialdevelopmenttakesplaceb/w:
a)4-8week
b)8-l0week
c)12-14week
d)18-20week

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e)6-10week
CorrectAnswer-A
Ans.a.4-8week
Developmentofface
Facialdevelopmentoccursmainlybetween4thand8thweeks,and

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isinducedbymigrationofcellsofneuralcrest.
Fivefacialprimordiaappearasprominencesofmesenchyme:a
frontonasalprocess,apairofmaxillaryprocessesandapairof
mandibularprocesses.

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4.Musclehavingdoublenervesupply:

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a)Digastricmuscle
b)Omohyoidmuscle
c)Trapezius
d)Thyrohyoidmuscle
e)Adductormagnus

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CorrectAnswer-A:E
Ans.a.Digastricmuscle;e.Adductormagnus
InnervationofDigastric:
Anteriorbellyofdigastricissuppliedbynervetomylohyoid(a
branchofmandibularnerve)&posteriorbellyissuppliedbyfacial

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nerve.
Innervationofadductormagnus
Posteriordivisionofobturatornerveinnervatesmostoftheadductor
magnus
Verticalorhamstringportioninnervatedbytibialnerve(L2,L3,L4)

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5.Whichofthefollowingistrueregarding
vertebralcolumncurvature:
a)Primarycurvesareconcaveforward
b)Lumbarcurveisprimary
c)Thoraciccurvedevelopwheninfantstartwalking

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d)Cervicalappearwhentheinfantstartssupportingitshead
e)Lumbarcurveappearswhenthechildassumestheupright
posture
CorrectAnswer-A:D:E
Ans.a.Primarycurvesareconcaveforward;d.Cervicalappear

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whentheinfantstartssupportingitshead;e.Lumbarcurve
appearswhenthechildassumestheuprightposture
Thethoracicandsacralkyphoticcurvesaretermedprimarycurves,
becausetheyarepresentinthefetus.
Thecervicalandlumbarcurvesarecompensatoryorsecondary,

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andaredevelopedafterbirth.
KYPHOTICCURVE:
Thethoraciccurve,concaveforward,beginsatthemiddleofthe
secondandendsatthemiddleofthetwelfththoracicvertebra.Its
mostprominentpointbehindcorrespondstothespinousprocessof

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thesevenththoracicvertebra.Thiscurveisknownas
akyphoticcurve.
Thesacralcurvebeginsatthesacrovertebralarticulation,andends
atthepointofthecoccyx;itsconcavityisdirecteddownwardand
forwardasakyphoticcurve.

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LORDOTICCURVES:

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Thelumbarcurveismoremarkedinthefemalethaninthemale;it
beginsatthemiddleofthelastthoracicvertebra,andendsatthe
sacrovertebralangle.Itisconvexanteriorly,theconvexityofthe
lowerthreevertebraebeingmuchgreaterthanthatoftheuppertwo.

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Thiscurveisdescribedasalordoticcurve.
Theuppercervicalspinehasacurve,convexforward,thatbeginsat
theaxis(secondcervicalvertebra)attheapexoftheodontoid
processordens,andendsatthemiddleofthesecondthoracic
vertebra;itistheleastmarkedofallthecurves.Thisinwardcurveis

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knownasalordoticcurve.

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6.Pepsinogen,theinactiveformofpepsin,is
secretedby:
a)InterstitialcellofCajal
b)Chiefcell

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c)Panethcell
d)Gobletcell
e)ZymogenCells
CorrectAnswer-B:E
Ans.(B)Chiefcell(E)ZymogenCells

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[RefGanong25th/456,24th/457-59]
Thegastricmucosacontainsmanydeepglands.
Inthepyloricandcardiacregions,theglandssecretemucus.
Bodyofthestomach,includingthefundus,theglandscontain
parietal(oxyntic)cells,whichsecretehydrochloricacidandintrinsic

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factor,andchief(zymogen,peptic)cellssecretingpepsinogen.

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7.TypeIIBmusclefibersaredifferentfrom
typeIfiberwithhaving:
a)Smalldiameter
b)CalciumreWleasebysarcoplasmicreticulumislow

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c)Fastfatigable
d)Colorpink
e)Fasteracting
CorrectAnswer-C:E
Ans.(C)Fastfatigable(E)Fasteracting

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[RefGanong25th/108,24th/107t23rd/103]
ClassificationErlanger Lloyd&
Characteristics Function
&Gasser
Hunt

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offibers
Diameter-13-
20
Myelination
Proprioception-

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-Heavily
Duetofiberthickness
myelinated&
Motorsupplyto
Aalpha

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I
thick
skeletalmuscle
Conduction-
(extrafusalto

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70-120
musclespindle)
(maximum
velocity)
Diameter-4-13

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Myelination-
Touch
Abeta
II
Present

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Kinesthesia

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Conduction-
Pressure
25-70
-No

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comparable
ent
Diameter-3-6
Diameter- Myelination-
Motorsupplyto

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3-6
Slightly
intrafusalmuscle
Agamma
Myelination myelinated

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fibers(Muscle
-Slightly
Conduction-
spindles)
myelinated 15-30

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Conduction
-15-30ity-
Pain-
Diameter-1-5 "Fast/Epicritic/First"
Myelination-

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pain.
Some
Sincefibersare
Adelta
III

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myelination
relativelyfast
Conduction-5- Temperature
30
Pressure

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Touch
Diameter-1-3
Myelination-
Preganglionic
-No

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Some
autonomicfibers
Bfiber
comparable myelination
(bothsympathetic&

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entity-
Conduction-3- parasympathetic)
14
Pain-
Diameter-0.2- Slowpain

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1.0
("Protopathic
Myelination-
/Secondpain)
Cfiber

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IV
Unmyelinated Temperature
Conduction-
Pressure
0.2-2

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Postganglionic
(minimum)
autonomicfibers.

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8.Allofthesearecorrectofrenalphysiology
except:

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a)SodiumabsorptionoccursinDCT
b)Potassiumisbothsecretedandabsorbedintubules
c)GlucoseisreabsorbedinDCT
d)All
e)None

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CorrectAnswer-C
Ans.Ci.e.GlucoseisreabsorbedinDCT
RENALHANDLINGOFSUBSTANCE
InPCT:
60-70%offilteredwaterreabsorbedpassively.

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Coupledmainlytosodiumreabsorption.
Glucose&aminoacidsAbsorbedcompletely(100%).
Maximum(90%)bicarbonateabsorption.
InDCT:
Principal(P)cellsreabsorbsodium&waterfromlumen

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&secretepotassiumintolumen.
Intercalated(I)cellsreabsorbpotassium&secrete
hydrogenintolumen.
Sodiumreabsorptionapproximately7%filteredNa2+reabsorbed.
InHenleloop:

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Thindescendingsegment-
Waterreabsorption:Highlypermeabletowater.
Reabsorptionofsolutes:Impermeabletosolutes(Na2+,Cl-&
urea).

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Minimalureasecreted.

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Inthinascendinglimb:
NaCl-reabsorptionoccurs-DuetohighNaCl-permeability.
Lesspermeabletowater.
Thickascendinglimb:
Sodium,Potassium&Chloridereabsorption:

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TransportsoneNa2+,oneK+,&twoCl-.
Activesodiumabsorptionoccurs.
30%filteredNa2+reabsorbed.
Waterreabsorption:Totallyimpermeabletowater.

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9.Vasomotorinputstorostralnuclesusof

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ventomedialmedullais/arefrom:
a)Inhibitoryinputfromcaudalventrolateralmedulla
b)Excitatoryinputsfromcerebralcortexviahypothalamus
c)Inhibitoryinputsfromcerebralcortexviahypothalamus
d)Inhibitoryinputsfrombrainstemreticularformation

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e)Inhibitoryinputspainpathway
CorrectAnswer-A:B:C
Ans.(A)Inhibitoryinputfromcaudalventrolateralmedulla
(B)Excitatoryinputsfromcerebralcortexviahypothalamus
(C)Inhibitoryinputsfromcerebralcortexviahypothalamus

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[RefGanong25th/587-89,24th/589-91]
Medullarycontrolofthecardiovascularsystem:
OneofthemajorsourcesofexcitatoryinPuttosympatheticnerves
controllingthevasculatureisagroupofneuronslocatednearthe
pialsurfaceofthemedullaintheRostralVentrolateralMedulla

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(RWM).
Thisregionissometimescalledavasomotorarea
NeurovascularcompressionoftheRVLMhasbeenlinkedtosome
casesofessentialhypertensioninhumans
TheactivityofRVLMneuronsisdeterminedbymanyfactors

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FactorsaffectingtheactivityofRVLM
Excitatoryinputs:
Cortexviohypothalamus,mesencephalicperiaqueductalgray,brain
stemreticularformation,painpathway,somaticafferent
(somatosympatheticreflex),Carotid&aorticchemoreceptors

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Inhibitoryinputs:
Cortexvidhypothalamus,caudalventrolateralmedulla,caudal
medullaryraphenuclei,lunginflationafferents;carotid,aortic&
cardiopulmonarybaroreceptors

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10.Parasympatheticnervestimulationresults

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in:
a)Sphincterclosureofgallbladder
b)Increasedperistalsis
c)DecreasedGITmotility
d)Detrusormusclerelaxation

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e)Gallbladdermusculaturecontraction
CorrectAnswer-B:E
Ans.(B)Increasedperistalsis(E)Gallbladdermusculature
contraction
[RefGanong25th/257-60,24th/265;Katzung13th110-111]

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Parasympatheticnervesaremotortomusculatureofthegallbladder
&bileduct,butinhibitorytothesphincter.
SympatheticnervesfromT7-9arevasomotor&motortosphincters.
Thecranialoutflowoftheparasympatheticdivisionsuppliesthe
visceralstructuresintheheadviaoculomotor,facial,and

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glossopharyngealnerves,andthoseinthethoraxandupper
abdomenviathevagusnerves.
Pupil-Constricted(Miosis)
Ciliarymuscle-Constricted(nearvision)
Glands(Nasal,Lacrimal,Parotid,SubmandibulalGastricPancreatic)

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-Stimulationofcopioussecretion(containingmanyenzymesfor
enzyme-secretingglands)
Sweatglands-Sweatingonpalmsofhands
Bronchialmuscle-Contraction
Gallbladderandbileducts-Contracted

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LUmen-Increasedperistalsisandtone
Detrusor-Contracted
Trigone-Relaxed

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11.Whichofthefollowingarefeatureof
blood-brainbarrier:

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a)Thickbasementmembrane
b)Podocyte
c)Closelyassociatedlayerofastrocyte
d)Tightjunction
e)Decreasedvesiclesinendothelialcells

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CorrectAnswer-A:C:D:E
Ans.(A)Thickbasementmembrane(C)Closelyassociated
layerofastrocyte(D)Tightjunction(E)Decreasedvesiclesin
endothelialcells
Ref;Ganong25th/671,24th/604-06;Guyton12th/816-17

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Blood-brainbarrier(BBB):
Barriersexistbothatthechoroidplexusandatthetissuecapillary
membranesinessentiallyallareasofthebrainparenchymaexcept
insomeareasofthehypothalamus,pinealgland,and.area
postremawheresubstancesdiffusewithgreatereaseintothetissue

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spaces.
Causeofthelowpermeabilityoftheblood-brainbarrieristhe
mannerinwhichtheendothelialcellsofthebraintissuecapillaries
arejoinedtooneanother.
Theyarejoinedbyso-calledtightjunctions.

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Thatis,themembranesoftheadjacentendothelialcellsaretightly
fusedratherthanhavinglargeslit-poresbetweenthem,asisthe
caseformostothercapillariesofthebody.
Glialcellsarederivedfromneuroectoderm(macroglia:astrocytes,

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oligodendrocytes,ependyma)orfrombonemarrow(microglia).

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Glialcells(astrocytes)formalayeraroundbrainbloodvesselsand
maybeimportantinthedevelopmentofthe8BB.
Astrocytesmaybealsoberesponsiblefortransportingionsfromthe
braintotheblood

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12.ForGrowthhormonetesting,whichofthe

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followingstimulatethesecretionsof
Growthhormone:
a)Glucagon
b)Insulin
c)Cortisol

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d)Waterdeprivation
e)Arginine
CorrectAnswer-A:E
Ans.(A)Glucagon(E)Arginine
[Ref:Ganong25th/328-29,24th/330-32;Guyton12th/555-56;]

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GHTesting:
StimulateGrowthHormone:
Decreasedbloodglucose
Decreasedbloodfreefattyacids
Increasedbloodaminoacids(arginine)

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Starvationorfasting
Proteindeficiency
Trauma
Stress
Excitement

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Exercise
Testosterone
Estrogen
Deepsleep(stagesllandlV)
Growthhormone-releasinghormone

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Ghrelin

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13.Whichofthefollowingistrueabout
myoglobin:
a)Bind1molofoxygenpermoleofmyoglobin
b)Dissociationcurveisarectangularhyperbola

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c)Itscurveliesrightofthehemoglobincurve
d)BindoxygenatlowP02pressure
e)ShowBohreffect
CorrectAnswer-A:B:D
Ans.(A)Bind1molofoxygenpermoleofmyoglobin

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(B)Dissociationcurveisarectangularhyperbola(D)Bind
oxygenatlowP02pressure
RefGanong25th/641-42,24th/643-zt4;Guyton12th/96
Myoglobin:
Iron-containingpigmentfoundinskeletalmuscle.

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Containsonehemegroupwithonepolypeptidechain.
Resembleshemoglobin,butmyoglobinbinds1ratherthan4molof
O2mole.
Itsdissociationcurveisarectangularhyperbolaratherthana
sigmoidcurve.

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?Becauseit'scurveistotheleftofthehemoglobincune,asittakes
upO2fromhemoglobinintheblood.
DoesnotshowBohreffect.

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14.Mucopolysacchidosis,whichisa

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lysosomalstoragedisease,occursdueto
abnormalityin:
a)Hydrolaseenzyme
b)Dehydorgenaseenzyme
c)Lipaseenzyme

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d)Phosphatase
e)Acetyl-CoAcarboxylase
CorrectAnswer-A
Ans:a.Hydrolaseenzyme[RefHarper30th/638-39,29th/589,
599,600;Lippincott6th/163-64J

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Themucopolysaccharidosesarehereditarydiseasescausedbya
deficiencyofanyoneofthelysosomalhydrolasesnormallyinvolved
inthedegradationofheparansulfateand/ordermatansulfate
Theyareprogressivedisorderscharacterizedbyaccumulationof
glycosaminoglycansinvarioustissues,causingarangeof

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symptoms,suchasskeletalandextracellularmatrixdeformities,and
mentalretardation.
Childrenwhoarehomozygousforanyoneofthesediseasesare
apparentlynormalatbirth,thengraduallydeteriorate.Insevere
cases,deathoccursinchildhood.

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Diagnosisisconfirmedbymeasuringthepatient'scellularlevelof
thelysosomalhydrolases.Bonemarrowandcordbloodtransplants
havebeenusedtotreatHurlerandHuntersyndrome

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15.Sulphurofcysteinarenotused/utilizedin
bodyforthefollowingprocess/product:

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a)Helpinconversionofcyanidetothiocyanate
b)Thiosulphateformation
c)Introductionofsulphuratominmethionine
d)Disulfidebondformationb/wtwoadjacentpeptide
e)None

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CorrectAnswer-C
Ans:c.Introductionofsulphuratominmethionine,[RefHarper
30th/301-02,313-14,29th/285-86;Lippincott6th/263-68;Shinde
7th/471-73,578;Vasudevan5th/191;Satyanarayan3rd/361]
TheH2Sderivedfromthecysteinemaybeoxidizedtosulfites&

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thiosulfateserfurtheroxidizedtosulfate.
Cysteinetransaminatestoformbetamercaptopyruvicacid&finally
pyruvate.ThebetamercaptopyruvatecantransferStoCNtoform
thiocynate(SCN).
ThesulphurmayberemovedeitherasH2Sorelementalsulphuror

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assulfite,Cysteineondecarboxylationgivesbetamercapto
ethanolamine.ThisisusedforsynthesisofcoenzymeA.
Formationofcysteineisbyusingthecarbonskeletoncontributedby
serine&sulphuroriginatingfrommethionine.

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16.Whichoneofthefollowingstatements

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aboutproteinstructureiscorrect:
a)Proteinsconsistingofonepolypeptidecanhavequaternary
structure
b)Theformationofadisulfidebondinaproteinrequiresthatthe
twoparticipatingcysteineresiduesbeadjacenttoeachotherin

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theprimarysequenceoftheprotein
c)Thestabilityofquaternarystructureinproteinsismainlyaresult
ofcovalentbondsamongthesubunits
d)Thedenaturationofproteinsalwaysleadstoirreversiblelossof
secondaryandtertiarystructure

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e)Theinformationrequiredforthecorrectfoldingofaproteinis
containedinthespecificsequenceofaminoacidsalongthe
polypeptidechain
CorrectAnswer-E
Ans:e.Theinformationrequiredforthecorrect...[RefHarper

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3001/36-41,29th/36-40;Lippincott6th/24,13-20]
Thecorrectfoldingofaproteinisguidedbyspecificinteractions
betweenthesidechainsoftheaminoacidresiduesofthe
polypeptidechain
Thetwocysteineresiduesthatreacttoformthedisulfidebondmay

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beagreatdistanceapartintheprimarystructure(oronseparate
polypeptides),butarebroughtintocloseproximitybythethree-
dimensionalfoldingofthepolypeptidechain.Denaturationmay
eitherbereversibleorirreversible.
Quaternarystructurerequiresmorethanonepolypeptidechain.

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Thesechainsassociatethroughnoncovalentinteractions"
Primarystructuresarestabilizedbycovalentpeptidebonds.Higher
ordersofstructurearestabilizedbyweakforces--multiplehydrogen
bonds,salt(electrostatic)bonds,andassociationofhydrophobicR
groups.

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Proteindenaturationresultsintheunfoldinganddisorganizationof
theprotein'sstructure,whicharenotaccompaniedbyhydrolysisof
peptidebonds.Denaturationmaybereversibleor,morecommonly,
irreversible.

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17.Trueaboutretinol:

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a)Formpartofrhodopsin
b)Transportedfromintestinetoliverbyviachylomicrons
c)Activelytakepartinvisualcycle
d)Implicatedingrowth&differentiationoftissue
e)Notformedbyretinoicacid

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CorrectAnswer-B:D:E
Ans:b.Transportedfromintestinetoliverbyviachylomicrons,
d.Implicatedingrowth&differentiationoftissue,&e.Not
formedbyretinoicacid,
[RefHarper30th/547-51,29th/526-28;Lippincott6th/381-83;

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Shinde7th/152-56;Vasudevan5th/284-86]
Retinoicacidisproducedbyoxidationofretinal.However,retinoic
acidcannotgiverisetotheformationofretinalorretinol"
Retinoicacidisimplicatedingrowth&differentiationoftissue,itis
necessaryforthereproductivesystem.Retinol

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actslikeasteroidhormoneincontrollingtheexpressionofcertain
genes.ThismayaccountfortherequirementofVitAfornormal
reproduction
Retinylesterspresentinthedietarehydrolyzedintheintestinal
mucosa,releasingretinolandfreefattyacids.Retinolderivedfrom

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estersandfromthecleavageandreductionofcarotenesisre-
esterifiedtolong-chainfattyacidsintheintestinalmucosaand
secretedasacomponentofchylomicronsintothelymphaticsystem.
Retinylesterscontainedinchylomicronremnantsaretakenupby,
andstoredin,theliver.

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retinolisreleasedfromtheliverandtransportedtoextrahepatic

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tissuesbytheplasmaretinolbindingprotein(RBP).

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18.Inprolongfastingglycerolisformedfrom
triglyceride.Whichofthefollowing
statement(s)is/aretrueregarding

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glycerol:
a)Usedinsynthesisofchylomicron
b)Itisdirectlyusedbytissuesforenergyneeds
c)Itisformedduetoincreasedactivityoflipoproteinlipase
d)Itisformedduetoincreasedactivityofhormonesensitive

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lipase
e)Glycerolactsasasubstrateforgluconeogenesisintheliver
CorrectAnswer-D:E
Ans:d.Itisformedduetoincreasedactivityofhormone
sensitivelipase,&e.Glycerolactsasasubstratefor

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gluconeogenesisintheliver,[RefHarper30th/262,149,
29th/160-61;Lippincott6th/331,178,190].
Fasting:Inadiposetissuethedecreaseininsulinandincreasein
glucagonresultsininhibitionoflipogenesis,inactivationof
lipoproteinlipase,andactivationofintracellularhormone-sensitive

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lipase.
Thisleadstoreleasefromadiposetissueofincreasedamountsof
glycerol(whichisasubstrateforgluconeogenesisintheliver)and
freefattyacids,whichareusedbyliver,heart,andskeletalmuscle
astheirpreferredmetabolicfuel,thereforesparingglucose.

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TheglycerolproducedfromTAGdegradationisusedasa
gluconeogenicprecursorbytheliver.
LipolysisIsControlledbyHormone-SensitiveLipase,whichis

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?activatedbyACTH,TSH,glucagon,epinephrine,norepinephrine,
andvasopressinandinhibitedbyinsulin,prostaglandinE1and

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nicotinicacid
Activityofthehormone-sensitivelipaseisincreasedbyfastingand
stressanddecreasedbyfeedingandinsulin.Conversely,feeding
increasesandfastingandstressdecreasetheactivityoflipoprotein
lipase

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19.Pyruvatedehydrogenasecomplexuses
followingcoenzymes/cofactors:
a)Biotin
b)Lipoicacid
c)NAD

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d)FMN
e)TPP
CorrectAnswer-B:C:E
Ans:b.Lipotic.acid.,c.NAD&e.TPP(RefHarper30th/172-74,
29th/174-75;Lippincott6th/109-11;Satyanarayan3rd/253-54]

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PyruvateDehydrogenaseComplex(PDH)Satyanarayan
3rd/253-54
Itisfoundonlyinmitochondria,HighactivityofPDHarefoundin
cardiacmuscle&kidney
TheenzymePDHrequiresfivecofactors(coenzymes)namely-TPP,

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lipoamide(itcontainslipoicacidlinkedtoc-aminogroupoflysine),
FAD,coenzymeA&NAD+,PDHisinhibitedbyarsenite
Pyruvatedehydrogenaseirreversiblyconvertspyruvate,theend
productofglycolysis,intoacetylCoA,amajorfuelfortheTCAcycle
andthebuildingblockforfattyacidsynthesis.

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ThePDHcomplexcontainsfivecoenzymesthatactascarriersor
oxidantsfortheintermediatesofthereactions.Elrequiresthiamine
pyrophosphate(TPP),E2requireslipoicacidandCoA,andE3
requiresFADandNAD+.

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20.InconversionofpyruvatetoacetylCoA&

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CO2,whichofthefollowingcoenzymeis
used:
a)Biotin
b)Lipoicacid
c)TPP

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d)Pyridoxalphosphate
e)Tetrahydrofolate
CorrectAnswer-B:C
Ans:b.Lip...&c.TPP[RefaboveQ;Harper30th/172-74,
29th/174-75;Lippincott6th/109-11;Satyanarayan3rd/253-54]

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Pyruvatedehydrogenaseirreversiblyconvertspyruvate,theend
productofglycolysis,intoacetylCoA,amajorfuelfor,theTCA
cycleandthebuildingblockforfattyacidsynthesis".(Lippincott
6th/109-10)

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21.Trueaboutureacycle:

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a)Nitrogenoftheureacomesfromalanine&ammonia
b)UsesATPduringconversionofarginosuccinatetoarginine
c)Onconsumptionofhighamountofprotein,excessofurea
formed
d)Occurmainlyincytoplasm

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e)Synthesisofargininosuccinateconsumesenergy
CorrectAnswer-C:D:E
Ans:c.Onconsumptionofhigh...,d.Occurmainlyin
cytoplasm&e.Synthesisofarginosuccinate....[RefHarper
30th/290-96,29th/274-88;Lippincott6th/253-55;Shinde7th/450-

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51;Vasudevan5th/180-811]
Inhealthypeople,thenormalbloodureaconcentrationis1040
mg/dl.Higherproteinintakemarginallyincreasesbloodurealevel.
CitrullinePlusaspartateformsargininosuccinate,catalysedby
enzymeArgininosuccinatesynthase.ThereactionrequiresATP.

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Cleavageofargininosuccinate,catalyzedbyargininosuccinase,
proceedswithretentionofnitrogeninarginineandreleaseofthe
aspartateskeletonasfumarate(requirenoATP)".
Ureahastwoaminogroups,onederivedfromammonia&other
fromaspartate.Carbonatomissuppliedfromcarbondioxide.

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---

22.Gangliosidescontains:
a)Phosphate
b)Galactose
c)Sulphate
d)Serine

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e)Sailicacid
CorrectAnswer-B:E
Ans:b.Galactose&e.Sailicacid[RefHarper30th/218,250-51,
29th/146,136,234;Lippincott6th/209;Vasudevan5th/78;
ChatterjeaShinde7th/45,58-61].

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Agangliosideisamoleculecomposedofaglycosphingolipidwith
oneormoresialicacidslinkedonthesugarchain.
NeuNAc,anacetylatedderivativeofthecarbohydratesialicacid,
makestheheadgroupsofgangliosidesanionicatpH7,which
distinguishesthemfromglobosides.

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Gangliosidesarepresentandconcentratedoncellsurfaces,withthe
twohydrocarbonchainsoftheceramidemoietyembeddedinthe
plasmamembraneandtheoligosaccharideslocatedonthe
extracellularsurface,wheretheypresentpointsofrecognitionfor
extracellularmoleculesorsurfacesofneighboringcells.Theyare

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foundpredominantlyinthenervoussystemwheretheyconstitute
6%ofallphospholipids.

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23.AllaretrueaboutstructureofDNA
except:
a)Right-handedhelix

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b)Left-handedhelix
c)Phosphateformbackbone
d)Deoxyriboseformsbackbone
e)Nitrogenbasesformbackbone
CorrectAnswer-E

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Ans:e.Nitroge...[RefHarper30th/359-61,29th/354-60;
Lippincott6th/395-400;Ananthanarayan9th/54)
Eachchainofdoublehelixhasabackboneofdeoxyribose&
phosphateresiduesarrangedalternately.Attachedtoeach
deoxyriboseisoneofthe4nitrogenousbases:A,G,CforT"

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Ananthanarayan9th/54
ThecommonformofDNAissaidtoberight-handed.Inthetest
tube,double-strandedDNAcanexistinatleastsixforms(A-E&Z)"
Withtheexceptionofafewvirusesthatcontainsingle-stranded(ss)
DNA,DNAexistsasadoublestranded(ds)molecule,inwhichthe

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twostrandswindaroundeachother,formingadoublehelix
TheAformisproducedbymoderatelydehydratingtheBform.Itis
alsoaright-handedhelix,butthereare11basepairsperturn,
andtheplanesofthebasepairsaretilted20"
awayfromtheperpendiculartothehelicalaxis..Z-DNAisa

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left-handedhelixthatcontainsabout12basepairsperturn
(Note:deoxyribose-phosphatebackbone"zigzags,"hence,the
name'S"-DNA)

---

---

24.Whichofthefollowingisfalse:
a)RatioofA:T&G:Cisapproximatelyequalto1:1

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b)RatioofA:G&T:Cisapproximatelyequalto1:1
c)A+T=G+C
d)A+C=G+T
e)A+G=C+T
CorrectAnswer-B:C

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Ans:b.RatioofA:G...&c.A+T=G+C(RefHarper30th/360-61;
Satyanarayan3rd/73;Lippincott4th/291;Ananthanarayan
9th/54-55]
ChargaffrulestatedthatinDNAmoleculestheconcentrationof
deoxyadenosine(A)nucleotidesequalsthatofthymidine(T)

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nucleotides(A=T),whiletheconcentrationofdeoxyguanosine(G)
nucleotidesequalsthatofdeoxycytidine(C)nucleotides(G=C)
Thetwostrandsofthisdouble-strandedhelixareheldbyboth,
hydrogenbondsbetweenthepurineandpyrimidinebasesofthe
respectivelinearmoleculesandbyvanderWaalsandhydrophobic

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interactionsbetweenthestackedadjacentbasepairs.
Thepairingsbetweenthepurineandpyrimidinenucleotidesonthe
oppositestrandsareveryspecificandaredependentupon
hydrogenbondingofAwithTandGwithC
"Theratioofeachpairofbases(A?T)/(G+C)thoughconstantfor

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eachspecies,varieswidelyfromonebacterialspeciestoanother"-
Ananthanarayan9th/54

---

25.Trueaboutrestrictionenzyme:
a)Alsok/arestrictionendonuclease
b)Producestickyends

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c)Candetectmutations
d)Obtainedfromvirus
e)Breaksatsugar-phosphatebond
CorrectAnswer-A:B:E
Ans:a.Alsok/a.restriction...,b.Producestickyends&e.

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Breaksatsugar-phosphatebond.[RefHarper30th/452-54,
28th/388-90;Lippincott4th/465-66;Satyanarayana3rd/580]
REcanspecificallyrecognizeDNAwithparticularsequenceof4-6
mucleotidesandcleave.Therecognitionsequencesare
palindromicQ(i.e.,twofoldrotationalsymmetry"(Lippincott4th/466)

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Itisanenzymethatcleavedouble-strandedDNAQatspecific
recognitionnucleotideknownasrestrictionsitesQ.TocuttheDNA,
arestrictionenzymemakestwoincisions,onethrougheachsugar-
phosphatebackboneQ(i.e.eachstrand)oftheDNAdoublehelix.
Thisenzymecanrestrictviralreplicationsocalledrestriction

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enzymes.
ThecutDNAfragmentsbyREmayhavestickyends(cohesive
ends)QorbluntsendsQdependingonthemechanismusedby
enzyme.DNAfragmentswithstickyendsareparticularlyusefulfor
recombinantDNAexperiments(hybridorchimericDNAmolecules).

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TocuttheDNA,arestrictionenzymemakestwoincisions,once
througheachsugar-phosphatebackbone(i.e.eachstrand)ofthe
DNAdoublehelix.

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---

26.Whichofthefollowingis/aretrueabout
PCRexcept:

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a)UsesheatlabileDNApolymerase
b)UsesheatstableDNApolymerase
c)IstechniqueforDNAamplification
d)UsedtoyieldmultiplecopiesofDNA
e)Reversetranscriptase-PCRisusedforquantificationofRNA

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CorrectAnswer-A
Ans:a.UsesheatlabileDNApolymerase,[RefHarper30th/458-
59;Lippincott6th/479-83,5th/497-83;Chatterjeaer
Shinde7th/267-272]
SpecificityQisbasedontheuseoftwooligonucleotideprimersthat

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hybridizetocomplementarysequenceonoppositestrandsofDNA&
flankthetargetsequenceDoublestrandedDNAcanbedisruptedby
heatorhighpH,givingrisetosinglestrandedDNA.Thesingle
strandedDNAservesasatemplateforsynthesisofa
complementarystrandbyreplicatingenzymes,DNApolymerase.

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EarlyPCRreactionusedanE.coliDNApolymerasethatwas
destroyedbyeachheatdenaturationcycle.Substitutionofaheat-
stableDNApolymerase(TaqpolymeraseYfromThermusaquaticus,
obviatesthisproblem&hasmadepossibleautomationofthe
reaction,sincethepolymerasereactionscanberunat70?C

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---

27.Whichofthefollowingtechniquesare
usedfordetectionofmutation:
a)RT-PCR
b)Microarray
c)Allele-specificoligonucleotide(ASO)

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d)Westrenblot
e)DNAsequencing
CorrectAnswer-A:B:C:E
Ans:a.RT-PCR,b.Microarray,c.Allele-specific
oligonucleotide(ASO)&e.DNAsequencing,

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[RefLippincott6th/473;Harper30th/470,29th/483-85;Harrison
19th/83e,443-44,18th/508,17th/406;Vasudevan5th/454-56]
Mutationalanalysis:Morediscretesequencealterationsrelyheavily
ontheuseofPCR,whichallowsrapidgene
amplificationandanalysis.Moreover,PCRmakesitpossibleto

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performgenetictestingandmutationalanalysiswithsmallamounts
ofDNAextractedfromleukocytesorevenfromsinglecells,buccal
cells,orhairroots.DNAsequencingcanbeperformeddirectlyon
PCRproductsoronfragmentsclonedintoplasmidvectorsamplified
inbacterialhostcells"(Harrison19th/444).

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SouthernblottingcandetectDNAmutationssuchastheinsertionor
deletionofnucleotides.
Itcanalsodetectpointmutationsthatcausethelossorgainof
restrictionenzymecleavagesites.Suchmutationscausethepattern
ofbandstodifferfromthoseseenwithanormalgene.

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Acomprehensiveapproachtogenome-scalestudiesconsistsof

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microarrays,orDNAchips.Usedtodeterminethegeneexpression
patternofthousandsofgenessimultaneously.Microarraysallowthe
detectionofvariationsinDNAsequenceandareusedformutational
analysisandgenotyping.

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---

28.Whichofthefollowingis/aremostsevere/
dangerouschangeingene:
a)Deletion
b)Insertion
c)Mutation

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d)Translocation
e)Duplication
CorrectAnswer-A:B
Ans:a.Deletion&b.Insertion-Mostprobably[RefHarper
30th/416-19;Lippincott6th/434;Harrison19th/432-34;Robbins

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9th/160-61;Harshmohan7th/2551.
Deletion&Insertioncouldbepossibleanswer(Pleasegothrough
explanationgiven&otherreferencesfordecidingappropriate
answer
FrameshiftMutationsResultfromDeletionorInsertionof

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NucleotidesinDNAThatGeneratesAlteredmRNAs
Thedeletionofasinglenucleotidefromthecodingstrandofagene
resultsinanalteredreadingframeinthemRNA.
ifthreenucleotidesoramultipleofthreearedeletedfromacoding
region,thecorrespondingmRNAwhentranslatedwillprovidea

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proteinfromwhichismissingthecorrespondingnumberofamino
acids.Becausethereadingframeisatriplet,thereadingphasewill
notbedisturbedforthosecodonsdistaltothedeletion.
If,however,deletionofoneortwonucleotidesoccursjustpriortoor
withinthenormalterminationcodon(nonsensecodon),thereading

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ofthenormalterminationsignalisdisturbed.Suchadeletionmight

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resultinreadingthroughaterminationsignaluntilanothernonsense
codonisencountered.
Insertionsofoneortwoornonmultiplesofthreenucleotidesintoa
generesultinanmRNAinwhichthereadingframeisdistortedupon

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translation,andthesameeffectsthatoccurwithdeletionsare
reflectedinthemRNAtranslation.Thismayresultingarbledamino
acidsequencesdistaltotheinsertionandthegenerationofa
nonsensecodonatordistaltotheinsertion,orperhapsreading
throughthenormalterminationcodon

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29.Whichofthefollowingtechniqueis/are
usedinquantitificationofviralnucleic
acid:
a)MALDI-TOFMS
b)Branched-chainDNA(bDNA)

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c)PCR
d)Gas-LiquidChromatography
e)Biochemicalphenotyping
CorrectAnswer-B:C
Ans:(B)Branched-chainDNA(bDNA)&(C)PCR[RefHarper

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29th/26;Lippincott6th/482,485;Harrison19th/150e-3-6,183e-1,
194e-3;http://www.researchgate.net/profile/Ivo_Gut/
publication/8597456_DNA_analysis_by_MALDI-TOP]
QuantitativeNAATsareavailableforHIV(PCR),cytomegalovirus
(PCR),hepatitisBvirus(PCR),andhepatitisCvirus(PCRand

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TMA).
Branched-chainDNA(bDNA)testingisanalternativetoNAAT
(Nucleicacidamplificationtechniques)forquantitativenucleicacid
testing.Insuchtesting,bDNAattachestoasitedifferentfromthe
target-bindingsequenceoftheoriginalprobe.

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Chemiluminescence-labeledoligonucleotidescanthenbindto
multiplerepeatingsequencesonthebDNA.TheamplifiedbDNA
signalisdetectedbychemiluminescence.bDNAassaysforviral
loadofHIV,hepatitisBvirus,andhepatitisCvirushavebeen
approvedbytheFDA.

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TheadvantageofbDNA.assaysoverPCRisthatonlyasingle

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heating/annealingstepisrequiredtohybridizethetarget-binding
probetothetargetsequenceforamplification.

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30.GenesinCpPislandisinactivatedby:
a)Methylation

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b)Metrylation
c)Ubiquitisation
d)Acetylation
e)None
CorrectAnswer-A

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Ans:a.Methylation[RefLippincott6th/709;Harrison19th/101e-
4,18th/668,679;Robbins9th/893;Satyanarayan3rd/359,572;
Lippincott4th/460-62;ChatterjeaShinde7th/346,426;en.
wikipedia.org/wiki/DNA_methylationj
CpGislands:Methylationofcytosinebyamethyltransferaseis

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associatedwithsilencingoftheactivitiesofcertaingene"-Lippincott
6th/709
CytosineinthesequenceCGofDNAgetsmethylatedtoform5'-
methylcytosine.AmajorportionofCG(about20%)inhumanDNA
existsinmethylatedform.Ingeneral,methylationleadstolossof

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transcriptionalactivity&thusinactivationofgenes.
Theroleofepigeneticcontrolmechanismsinthedevelopmentof
humancancerisunclear.However,ageneraldecreaseinthelevel
ofDNAmethylationhasbeennotedasacommonchangeincancer.
Inaddition,numerousgenes,includingsometumor-suppressor

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genes,appeartobecomehypermethylatedandsilencedduring
tumorigenesis.

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31.Whichofthefollowingisnottrueabout
transcription
a)SynthesisofprecursorsforthelargeandsmallribosomalRNAs

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b)FormationoftRNAtranscript
c)RNApolymeraseIIisresponsibleforthesynthesisof
precursorsforthelargeribosomalRNAs
d)RNApolymeraseIisresponsibleforthesynthesissmall
ribosomalRNAs

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e)BindingofRNApolymeraseonDNA
CorrectAnswer-C:D
Ans.is'c'i.e.,RNApolymeraseIIisresponsibleforthe
synthesisofprecursorsforthelargeribosomalRNAs;&'d'i.e.,
RNApolymeraseIisresponsibleforthesynthesissmall

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ribosomalRNAs.
[Ref:Harrion19th/ep.427-28;Satyanarayan4thiep.546,566-68]
RNA,eukaryoteshavethreedifferentRNApolymerases:I,II,II
RNApolymeraseI:Itcatalyzesthesynthesisoflargeribosomal
RNA(rRNA),i.e.28SrRNA,18SrRNAand5.8SrRNA.

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TheserRNAsarecodedonclass-Igene,i.e.classIgeneis
transcribedbyrRNA.rRNAsarenottranslatedintoprotein.
RNApolymeraseII:?ItcatalyzesthesynthesisofmRNA,small
nuclearRNA(sn-RNA)andmiRNA.Theseproductsarecodedby
classIIgene,i.e.classIIgeneistranscribedbymRNA.ClassII

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genedifferfromclassIandIIIinthatoneofitstranscribedproducts
(mRNA)istranslatedintoprotein
RNApolymeraseIII:?ItcatalyzesthesynthesisoftRNAand5S

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rRNA.TheseproductsarecodedbyclassIIIgene.
BesidesthesethreenuclearRNApolymerases,inaeukaryoticcell,

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afourthtypeofRNApolymeraseisfoundinmitochondrialmatrix
knownasmitochondrialRNApolymerase(mtRNAP).Similarto
prokaryoticRNApolymerase,mtRNAPcatalyzesthesynthesisofall
thethreetypesofRNA,i.e.mRNA,tRNAandrRNA

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32.WhichofthefollowingRNAcontains

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unusalbases:
a)mRNA
b)rRNA
c)tRNA
d)30SRNA

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e)50sRNA
CorrectAnswer-B:C
Ans:c.tRNA[RefHarper30th/pg394.
tRNAmoleculecontainahighpercentageofunusalbases,for
example,dihydrouracilerhaveextensiveintra-chainbasepairing

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thatleadstocharacteristicsecondary6.,tertiarystructure"-
Lippincott6th/418.
ThetRNAmoleculescontainahighpercentageofunusualbases
(forexample,dihydrouracil)andhaveextensiveintrachainbase-
pairingthatleadstocharacteristicsecondaryandtertiarystructure.

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EachtRNAservesasan"adaptor"moleculethatcarriesitsspecific
aminoacid--covalentlyattachedtoits3'-end--tothesiteofprotein
synthesis.Thereitrecognizesthegeneticcodesequenceonan
mRNA,whichspecifiestheadditionofitsaminoacidtothegrowing
peptidechain

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33.Trueaboutfollicularlymphoma:
a)Lymphadenopathyisthemostcommonpresentation
b)BCL-1positive
c)CD5positive
d)Morecommoninmalesthanfemales

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e)All
CorrectAnswer-A
Answer-A.Lymphadenopathyisthemostcommon
presentation
Itisthetumorofgerminalcentre(follicularcentre),Bcells,andis

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stronglyassociatedwithchromosomaltranslocationinvolvingBcl2.
Growthpatternisnodular(follicular)ornodular(follicular)and
diffuse.
TheneoplasticcellscloselyresemblenormalgerminalcentreB
cells,expressingCD19,CD20,CD10,surfaceIg,andBcl6.

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Inmostfollicularlymphomas,centrocytespredominate.
Itusuallypresentsinmiddleageandaffectsmalesandfemales
equal.
Themostcommonpresentationforfollicularlymphomaiswithnew
painlesslymphadenopathy.

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34.TrueaboutChronicLymphocytic
Leukaemia:
a)Mostcommonleukaemiainadult
b)Proliferationcentreispathgnomonic
c)Massivesplenomegaly

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d)Radiotherapy&chemotherapyaregivenintreatment
e)None
CorrectAnswer-A:B:C
Answer-(A)Mostcommonleukaemiainadult(B)Proliferation
centreispathgnomonic(C)Massivesplenomegaly

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CLListhemostcommonformofNHL.
CLLiswhenperipheralbloodlymphocytescountisexceeding4000
cells/L.
ThetumourcellscontainshighlevelofBCL2(inhibitsapoptosis).
Clinicalfeatures-

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Splenomegaly&hepatomegaly
Hypogammaglobulinemialeadstobacterialinfectionincombination
ofneutropenia.
Treatment-
Alkylatingdrugsascyclophosphamide

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Corticosteroids
Radiotherapy&chemotherapy
SplenectomyinAIHA

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35.TrueaboutmitochondrialDNA:
a)Linear

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b)Circular
c)Transmittedbymotheronly
d)Transmittedbybothparents
e)ContainslessgenethannuclearDNA
CorrectAnswer-B:C:E

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Answer-(B)Circular(C)Transmittedbymotheronly
(E)ContainslessgenethannuclearDNA
Insexualreproduction,mitochondriaarenormallyinherited
exclusivelyfromthemother;themitochondriainmammaliansperm
areusuallydestroyedbytheeggcellafterfertilization.

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UGAcodesfortryptophan,Codesfor13proteins,Circulardouble
strandedDNA,MitochondrialdiseaseoccurduetoPointMutations
andLarge-ScaleRearrangements.
Theremaining22tRNAand2rRNA-encodinggenesarededicated
totheprocessoftranslationofthe13mtDNAencodedproteins.

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---

36.Trueaboutautosomaldominanttypeof
inheritance:
a)25%affected&50%carrier,ifoneparentaffected
b)50%affected&75%carrier,ifbothparentaffected
c)75%affected,ifbothparentaffected

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d)50%affected,ifoneparentaffected
e)Allcarrierirrespectiveofeitheroneparentaffectedorboth
parentaffected
CorrectAnswer-D
Answer-D.50%affected,ifoneparentaffected

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Autosomaldominantdisordersaremanifestedintheheterozygous
state.
Bothmalesandfemalesareaffected.
Becausetheallelessegregaterandomlyatmeiosis,theprobability
thatanoffspringwillbeaffectedis50%.

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37.Ina-thalassemia,HbBartsissaidwhen
numberofgenelociaffectedis:
a)1
b)2
c)3

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d)4
e)None
CorrectAnswer-D
Answer-D.4
Thealpha-thalassemiasarecausedbyinheriteddeletionsthatresult

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inreducedorabsentsynthesisofalpha-globinchains.
Normally,therearefouralpha-globingenes.

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38.Whichofthefollowingcellularcomponent
givespurplishbluecolourwithH&E
reagent:

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a)Reticulum
b)Elastin
c)P-selectin
d)Collagen
e)Heterochromatin

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CorrectAnswer-A:E
Answer-(A)Reticulum(E)Heterochromatin
ThemostcommonlyusedstainingsystemiscalledH&E
(HaematoxylinandEosin).
H&Econtainsthetwodyeshaematoxylinandeosin.

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Eosinproducesthreedifferenthues-
Redbloodcellsstaindarkreddishorange
Collagen(acidophilic)stainsalighterpastelpink.
Smoothmusclestainsbrightpink.
Haematoxylinisabasicdye.

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Itisusedtostainacidic(orbasophilic)structuresapurplishblue.
NucleusisstainedpurplebyH&Estaining.

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39.Whichofthefollowingistrueabout
glutathione&glutathioneperoxidase:
a)Actasscavengeroffreeradicle

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b)Glutathionehasanti-oxidantproperty
c)ReducedglutathionecanchemicallydetoxifyH202
d)OxidizedglutathionecanchemicallydetoxifyH202
e)None
CorrectAnswer-A:B:C

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Answer-(A)Actasscavengeroffreeradicle(B)Glutathione
hasanti-oxidantproperty(C)Reducedglutathionecan
chemicallydetoxifyH202
IthelpsindetoxificationofH2O2byreducingit.Superoxideanion
(O2)firstconvertedtoH2O2bysuperoxidedismutase.

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H2O2isthenreducedtoH2O2byglutathioneperioxidase,a
reactionrequiresreducedglutathione.Thus,glutathionescavenges
freeradicalsandsuperoxideanion.
Aseriesofenzymesactsasfreeradical-scavengingsystemsand
breaksdownH2O2andO2

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40.Histologicalfindingofhypertrophic
cardiomyopathyincludes:
a)Myocytedisaaray
b)Interstitialfibrosis
c)Amyloiddepositioninmuscle

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d)Myocytehypertrophy
e)Myocardialfibresarearrangedinparallelpattern
CorrectAnswer-A:B:D
Answer-(A)Myocytedisaaray(B)Interstitialfibrosis
(D)Myocytehypertrophy

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MostimportanthistologicfeaturesofthemyocardiuminHCM
are-
1. extensivemyocytehypertrophy
2. haphazarddisarrayofbundlesofmyocytes-myocytes,and
contractileelementsinsarcomereswithincells(myofiberdisarray)

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3. interstitialandreplacementfibrosis

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41.Trueaboutbcl-2:
a)TApoptosis
b)Apoptosis
c)TResistanceoftumourtotreatment

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d)Onlyassociatedwithfollicularlymphoma
e)Causemeningioma
CorrectAnswer-B:C
Answer-(B)Apoptosis(C)TResistanceoftumourtotreatment
Bcl-2inhibitsapoptosis;a(14:18)translocationresultingin

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overexpressionofthebcl-2proteininBlymphocytescauses
apoptosisofneoplasticcellstobepermanentlyinhibited,producing
follicularlymphoma.

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42.Trueaboutthrombusformation:
a)Arterialthrombusgrowindirectiontowardheart

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b)Venousthrombusgrowindirectiontowardheart
c)Venousthrombusformchickenfat
d)LineofZahnisseenmicroscopicallyinredthrombi
e)None
CorrectAnswer-B:D

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Answer-(B)Venousthrombusgrowindirectiontowardheart
(D)LineofZahnisseenmicroscopicallyinredthrombi
Arterialorcardiacthrombiusuallybeginatasiteofendothelial
injury.
Venousthrombicharacteristicallyoccurinsitesofstasis.

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Arterialthrombitendtogrowinaretrogradedirectionfromthepoint
ofattachment.
Venousthrombiextendinthedirectionofbloodflow(i.e.,towardthe
heart).
Whenformedintheheartoraorta,thrombimayhavegrossly(and

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microscopically)apparentlaminations,calledlinesofZahn.
Arterialthrombiareusuallyocclusive;themostcommonsite.

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43.Redinfarctoccurin:
a)Intissueswithdualcirculations
b)Occuronlywhenbotharterial&venousobstructionoccurs

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simultaneously
c)Organswhicharepreviouslycongested
d)Organswithloosetissue
e)All
CorrectAnswer-A:C:D

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Answer-(A)Intissueswithdualcirculations(C)Organswhich
arepreviouslycongested(D)Organswithloosetissue
Redinfarcts(Haemorrhagic):occurwith:
Venousocclusions(egovariantorsion);
Inloosetissues(suchaslungs);

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Intissueswithdualcirculation(e.g.Lung&S.intestine)
Intissuesthatwerepreviouslycongestedbecauseofsluggish
venousoutflow.
Whenflowisreestablilshedtoasiteofpreviousarterialocculusion
andnecrosis.

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44.Spindleshapedcellsis/areseeninwhich
sarcoma:
a)Osteosarcoma
b)Chondromyosarcoma
c)Embryonalrhabdomyosarcoma

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d)Leiomyosarcoma
e)Fibrosarcoma
CorrectAnswer-A:C:D:E
Answer-(A)Osteosarcoma(C)Embryonalrhabdomyosarcoma
(D)Leiomyosarcoma(E)Fibrosarcoma

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"Osteosarcoma'.Thetumourcellsmayhavevariousshapessuchas
spindledpolygonal&bizarretumourgaintcells.
Leiomyosarcomas:Theyconsistofeosinophilicspindlecellswith
blunt-ended.
Fibrosarcoma-Malignantfibrousarrangedinaherringbonepattern.

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Malignantfibroushistiocytomaofspindledfibroblastsarrangedina
storiformpatternadmixedwithlarge;ovoid,bizarremultinucleated
tumorgiantcell.
"Embryonalrhabdomyosarcoma:consistofsheetsofbothprimitive
roundatdspindledcellsinamyxoidstroma.

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"Liposarcomas-containsadipocyteswithscatteredatypicalspindle
cells.

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45.Whichofthefollowingdyadsarecorrect
a)Pulsusparadoxus-aorticregurgitation

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b)Pulsusbisferiens-mitralstenosis
c)Water-hammerpulse-aorticregurgitation
d)Pulsusparvusettardus-aorticstenosis
e)Collapsingpulse-aorticregurgitation
CorrectAnswer-C:D:E

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Answer-C,Water-hammerpulse-aorticregurgitationD,Pulsus
parvusettardus-aorticstenosisE,Collapsingpulse-aortic
regurgitation

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46.Alphafetoproteinis/areincreasedin:
a)Yolksactumour
b)Seminoma
c)Dysgerminoma

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d)Non-seminoma
e)Hepatocellularcarcinoma
CorrectAnswer-A:D:E
Answer-(A)Yolksactumour(D)Non-seminoma
(E)Hepatocellularcarcinoma

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Serumalphafetoproetinleveliselevatedinnonseminomatous
testiculartumors.
Nonseminomatoustesticulartumorsinclude:
1. Yolksacorendodermalsinustumor
2. Embryonalcarcinoma

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3. Teratomas
4. Non-seminoma

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47.TrueabouthemophiliaB:
a)Factor8deficiency
b)Factor9deficiency

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c)X-linkeddisorder
d)ClinicallyindistinguishablefromhemophiliaA
e)Freshfrozenplasmagivenfortreatment
CorrectAnswer-B:C:D
Answer-(B)Factor9deficiency(C)X-linkeddisorder

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(D)ClinicallyindistinguishablefromhemophiliaA
HemophiliaisanX-linkedrecessivehemorrhagicdiseasedueto
mutationsintheF8gene(hemophiliaAorclassichemophilia)orF9
gene(hemophiliaB).
Malesubjectsareclinicallyaffected.

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Clinically,hemophiliaAandhemophiliaBareindistinguishable.
Hemophiliaisclassifiedas-
severe(<1%),
moderate(l-5%),
ormild(6-30%)

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Clinicalfeatures-
Bleedingintothejoints(hemarthrosis),softtissues,andmuscles.
Investigations-
HemophiliaB-NormalBT&PT&increasedPTT
Treatment-

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Thediseaseistreatedwithinfusionsofrecombinantfactoru.

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48.Trueaboutprimarybiliarycirhhosis:
a)Morecommoninfemale
b)Periportalfibrosis
c)MaybessociatedwithRheumatoidarthritis&crohn'sdisease

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d)Jaundicemaybepresent
e)All
CorrectAnswer-A:B:D
Answer-(A)Morecommoninfemale(B)Periportalfibrosis
(D)Jaundicemaybepresent

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PBCisprimarilyadiseaseofmiddle-agedwomen,withafemale
predominanceof9:l.
Antimitochondrialantibodiesarethemostcharacteristic-laboratory
findinginPBC.
Etiology-portalinflammationandnecrosisofcholangiocytesC/F

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Hypercholesterolemiaiscommon
Xanthelasma,andxanthomata
Hepatomegaly,splenomegaly,ascites,andedema.
Developmentofjaundice
Investigations-

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Thediseaseisconfirmedbyliverbiopsy,whichisconsidered
diagnosticifafloridductlesionispresent.

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49.Findinginhistopathologyofbrainin
rabiesincludes:
a)Negribody

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b)Nodule
c)Neuronophagia
d)Vacuolardegenerativechanges
e)Inflammatorycell
CorrectAnswer-A:B:C:E

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Answer-(A)Negribody(B)Nodule(C)Neuronophagia
(E)Inflammatorycell
Rabiesisasevereencephalitistransmittedtohumansbythebiteof
arabiesanimal.
Macroscopically,brainshowsintenseedemaandvascular

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congestion.
Microscopically,
Widespreadneuronaldegenerationandaninflammatotyreaction
thatismostsevereintherhombencephalon.
Negribodies,thepathognomonicmicroscopicfindingcanbefound

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inpyramidalneuronsofthehippocampusandPurkinjecellsofthe
cerebellum.
PathologicstudiesshowmildinflammatorychangesintheCNSin
rabies,withmononuclearinflammatoryinfiltrationinthe
leptomeninges,perivascularregions,andparenchyma,including

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microglialnodulescalledBabesnodules.
Neuronophagiaisobservedoccasionally.

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50.Trueabouthyperacuterejectioninrenal
transplant:
a)Occurwithinfewdaysoftransplant

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b)Tcellinvolvement
c)Bloodvesselthrombosis
d)Eosinophilicinfiltration
e)Bcellinfiltration
CorrectAnswer-C

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Answer-(C)Bloodvesselthrombosis
Hperacuterejectionoccurswhenpreformedantidonorantibodiesare
presentinthecirculationoftherecipient.
Acuteantibody-mediatedrejectioniscausedbyantidonorantibodies
producedaftertransplantation.

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Itismediatedbypreformedhumoralantibody.
InacuterejectionthereisinfiItrationofT&Bcell

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51.Trueaboutglutensensitiveenteropathy:
a)Dietshouldexcludebarley,wheat&rye
b)Intestinalbiopsyisdiagonstic

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c)AntiIgAendomycialantibodyisspecific
d)Mucosalhyperplasia
e)None
CorrectAnswer-A:C
Answer-(A)Dietshouldexcludebarley,wheat&rye(C)AntiIgA

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endomycialantibodyisspecific
Intolerancetogliadinacomponentofglutenpresentinwheat,
barley,rye&oat.
Absenceorreducedheightofvilli(Flatappearance)
Crypthyperplasia,villousatrophy,Cuboidalappearanceofepithelial

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cells&increasedintraepitheliallynphocytes.
Antiendomysialantibodies
DisappearanceofIgantiendomysialantibodiesfollowinginstitution
ofaglutenfreedietisdiagnostic.
lgAantiendomysial.

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52.Mechanismofactionofgabapentinis/are:
a)EnhancesGABArelease
b)AgonistatGABAAreceptor
c)ActonNMDAreceptor
d)ProlongationofNa+ChannelInactivation

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e)Inhibitionofvoltage-gatedCa2+channels
CorrectAnswer-A:E
Ans,.(A)EnhancesGABArelease(E)Inhibitionofvoltage-
gatedCa2+channels
[Ref:K.D.T7th/419-21;Katzung12th/41j;Harrison19th/2548,

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2551-56]
Gabapentin:
MOA:
ModifythesynapticornonsynapticreleaseofGABA.
AnincreaseinbrainGABAconcentrationisobservedinpatients

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receivinggabapentin.
GabapentinistransportedintothebrainbytheL-aminoacid
transporter.
Gabapentinbindsavidlytovoltage-gatedCa2+channels.
Gabapentinalsoactpresynapticallytodecreasethereleaseof

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glutamate;thiseffectisprobablydependentonreducedPresynaptic
entryofCa2+viavoltage-activatedchannels.

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53.Whichofthefollowingis/aretrue
regardingmuscarianicactionexcept:
a)Miosis

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b)Detrusormusclecontraction
c)Dicylomineisantimuscuarnicdrugusedforsmoothmuscle
relaxation
d)CardiacmuscuranicreceptorsarepredominantlyM3type
e)salivaryglandsecretion

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CorrectAnswer-B:D
Ans.(B)Detrusormusclecontraction(D)Cardiacmuscuranic
receptorsarepredominantlyM3type
[RefKDT7th/100-103,117;Katzung12th/97-102]
CardiacmuscarinicreceptorsarepredominantlyM2type&mediate

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vagalbradycardia.
Dicyclomine:
AntagonistofM1&M3(smoothmuscle)-
MuscarinicActions
Heart:

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AttheA-Vnode&His-purkinjefibersrefractoryperiod(W)is
increased&conductionisslowed;PRinteryalinteases6partialto
completeA-Vblockmaybeproduced.
Eye:
Contractionofcircularmuscleofirismiosis

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Contractionoftheciliarymusclespasmofaccommodation,
increasedoutflowfacility,reductioninintraoculartension(especially
inglaucomatouspatients

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SmoothMuscle:
Peristalsisinureterisincreased.

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Detrusormusclecontractswhilethebladdertrigone&sphincter
relaxesvoidingofbladder.
Glands:
Secretionfromallparasympatheticallyinnervatedglandsis
increasedviaM3&someM2receptors:sweating,salivation,

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lacrimation,increasedtracheobronchial&gastricsecretion.

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54.Diseasemodifyingdrug(s)usedin
treatmentofrheumatoidarthritis:
a)Neproxen
b)Nabumetone

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c)Abatacept
d)Monoclonalantibodies
e)Methotrexate
CorrectAnswer-C:D:E
Ans.(C)Abatacept(D)Monoclonalantibodies(E)Methotrexate

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[RefK.D.T7tW211-12,871-72;Katzungt2th/642;Goodman&
Gilman\11th/1942]
DiseasemodifyingAntl-rheumatoiddrugs(DMARDs)
NonBiologicalDrugs
Immunosuppressants:Methotrexate,Azathioprine,

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Cyclosporine
Sulfasalazine
ChloroquineorHydroxychloroquine
Leflunomide
Biologicalagents

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TNF-ainhibitors:Etanercept,Wiximab,Adalimumab
IL-1antagonists:Anakinra

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55.Levetiracetamiscommonlyusedfor:
a)Juvenilemyoclonicepilepsy
b)Absenceseizure

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c)GeneralisedTonicclonicseizure
d)Complexpartialseizure
e)ActthroughGABA
CorrectAnswer-A:C:D:E
Ans.(A)Juvenilemyoclonicepilepsy(C)GeneralisedTonic

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clonicseizure(D)Complexpartialseizure(E)Actthrough
GABA
[RefKD-T7thl420-421]
Levetiracetam:
TreatmentofGeneralizedtonic-chronicseizure&simplepartial

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seizures.
TreatmentofComplexpartialseizures.
Myoclonic&atonicseizures-unresponsivecase
Adjuvanttreatmentofpartialseizuresinadults&childrenforprimary
generalizedtonic-clonicseizure&forthemyoclonicseizuresof

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juvenilemyoclonicepilepsy
Approvedasadjuvanttherapyforfocalonsetseizure.
Approvedasadjuvanttherapyforprimarygeneralizedtonic-clonic

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56.Penicillinaseresistantpenicillinis/are:
a)Methicillin

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b)Cloxacillin
c)Ampicillin
d)Dicloxacillin
e)Vancomycin
CorrectAnswer-A:B:D

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Ans.(A)Methicillin(B)Cloxacillin(D)Dicloxacillin
[Ref,K.D.T7th/721]
Penicillinase-ResistantPenicillins:
Methicillin,cloxacillin,Dicloxacillin
Thesecongenershavesidechainsthatprotectthebeta-lactamring

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fromattackbystaphylococcalpenicillinase.
Theironlyindicationisinfectionscausedbypenicillinaseproducing
staphylococci,forwhichtheyaredrugofchoice,acceptinareas
wheremethicillinresistantstaph.Aureus(MRSA)hasbecome
prevalent

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57.TrueaboutJarisch-Hexheimerreaction:
a)Occurwithinhoursaftergivingpenicillin
b)Developonlyafter1weekofPenicillintherapy
c)Aggravationofsignsandsymptomsofsyphilis
d)Itoccurduetoallergytopenicillin

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e)Mostcommoninsecondarysyphilis
CorrectAnswer-A:C:E
Ans.(A)Occurwithinhoursaftergivingpenicillin
(C)Aggravationofsignsandsymptomsofsyphilis(E)Most
commoninsecondarysyphilis

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[Ref:K.D.f7th/720;CMDT201s/1460;Harison19th/1140;Neena
Khanna4th/206;G6G11th/1181;Ananthanarayan9th/377,384]
Jarisch-HerxheimerReaction:
Penicillininjectedinasyphiliticpatient(particularlysecondary
syphilis)mayproduceshiveringfever,myalgia,exacerbationof

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lesions,evenvascularcollapse
Mayoccurafterinstitutionofchloramphenicoltherapyforsyphilis,
brucellosis&typhoidfever.
Thisisduetosuddenreleaseofspirochetallyticproducts&lastsfor
12-72hours

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Itdoesnotrecur&doesnotneedinterruptionoftherapy
Aspirin&sedationaffordreliefofsymptoms

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58.Forwhichofthefollowingdrugbacteria
acquiredrugresistancebyinactivationor
degradationbyenzyme:

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a)Quninolones
b)Aminoglycosides
c)Vancomycin
d)Ampicillin
e)Chloramphenicol

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CorrectAnswer-A:E
Ans.(A)Quninolones(E)Chloramphenicol
[Ref:KD.T7th/692-93;Ihtzung12th/792,816]
Drugdestroying:
Theresistantmicrobeselaborateanenzymewhichinactivatesthe

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drug
Manyofaminoglycosides-resistantcoliformshavebeenfoundto
produceenzymeswhichadenylateacetatephosphorylatespecific
aminoglycosidesantibiotics.
ChloramphenicolacetyltransferaseisacquiredbyresistantE.coli,

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H.influenzae&S.tyPhi.

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59.Whichofthefollowingsarefeatureof
benzodiazepinewithdrawalexcept:
a)Anxiety
b)Increasedappetite

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c)Hypersomnia
d)Baddreams
e)Tremor
CorrectAnswer-B:C
Ans.(B)Increasedappetite(C)Hypersomnia

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[RefK.D.T7th/406;NirajAhuja7th/51]
Benzodiazepinewithdrawal:
Withdrawalsymptomsaregenerallymild;maybemoreintensein
caseofultrarapideliminationdrugs
Anxiety,insomnia,restlessness,malaise,lossofappetite,bad

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dreamsisallthatoccursinmostcases
Agitation,Panicreaction,tremors&deliriumareoccasional;
convulsionsarerare
Characterizedbymarkedanxiety,irritability,tremors,insomnia,
vomitingweakness,automatichyperactivitywithpostural

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hypotension(tseizures
Depression,transientpsychoticepisode,suicidalideation,
perceptualdisturbances&rarelydeliriumhavealsobeenreportedin
withdrawalperiod

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60.Whichofthefollowingdrugismainly

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excretedbykidney:
a)Tetracyclines
b)Doxycyclines
c)Ampicillin
d)Acyclovir

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e)Rifampicin
CorrectAnswer-A:C:D
Ans.(A)Tetracyclines(C)Ampicillin(D)Acyclovir
[Ref:K.D.T7th/735,721;Katzung12th/794]
Ampicillin:Partlyexecutedinbile&reabsorbed-enterohepatic

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circulationoccurs;primarychannelofexcretioniskidney.
Acyclovir:Primarilyexcretedunchangedinurine,bothby
glomerularfiltrationdttubularsecretion..
Tetracyclines:Primarilyexcretedinurinebyglomerularrtltration;
dosehastobereducedinrenalfailure;doxycyclineisanexception.

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Rifampicin:Metabolizedinlivertoanactivelyacetylated.metabolite
whichisexcretedmainlyinbile,someinurine.

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61.Whichofthefollowingstatementsisfalse
aboutAcyclovir-
a)ItinhibitsDNAsynthesisandviralreplication

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b)Itiseffectiveagainstinfluenza
c)Ithaslowtoxicityforhostcells
d)Renalimpairmentnecessitatesdosereduction
e)None
CorrectAnswer-B

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Ans.is'b'i.e.,Itiseffectiveagainstinfluenza
Acyclovir
Itisadeoxygunosineanalogue-inhibitsDNAsynthesisby?
1. InhibitsherpesvirusDNApolymerasecompetitively.
2. GetsincorporatedinviralDNAandstopslengtheningofDNAstrand.

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TheterminatedDNAinhibitsDNApolymeraseirreversibly.
Itispreferentiallytakenupbythevirusinfectedcells.Becauseof
selectivegenerationoftheactiveinhibitorinthevirusinfectedcells
anditsgreaterinhibitoryeffectonviralDNAsynthesis,acyclovirhas
lowtoxicityforhostcells.

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Itisactiveagainstherpesgroupofvirus(HSV-l>HSV-2>VZV=
EBV.CMVisnotinhibited).
Acyclovirisprimarilyexcretedunchangedinurine,bothby
glomerularfiltrationandtubularsecretion.Renalimpairment
necessitatesdosereduction.

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62.S/Eofclofaziamineincludes:
a)Icthyosis
b)Thrombocytosis
c)Skinpigmentation
d)Gastrointestinaldisturbances

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e)Weightgain
CorrectAnswer-A:C:D
Ans.(A)Icthyosis(C)Skinpigmentation(D)Gastrointestinal
disturbances
Clofazimine:Sideeffects:

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Ichthyosis
Pigmentation-Reddish-blackdiscolorationofskin,especiallyon
exposedparts.
Discolorationofhair&bodysecretionsmayalsooccur.
Conjunctivalpigmentationmaycreatecosmeticproblem.

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Gastrointestinalsideeffects.

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63.Apersonwasonchemotherapyfor2
weekforsomemediastinaltumour.Now
hedevelopshighfrequencyhearingloss.
Mostprobablecauseofthisconditionis

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useof:
a)Cisplatin
b)Etoposite
c)Doxorubicin
d)Methotrexate

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e)None
CorrectAnswer-A
Ans.(A)Cisplatin
Ototoxicdrugs:
Cytotoxicdrugscausinghearinglossare-nitrogenmustard

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(mechlorethamine),cisplatin&carboplatin.
Cisplatin:
Tinnitus,deafness,sensoryneuropathy&hyperuricemiaareother
problem
Carboplatin:

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Nephrotoxicity,ototoxicity&neurotoxicityareIowascomparedto
cisplatin

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64.Incomparisontohaloperidol,clozapine
causes:
a)Weightgain

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b)Agranulocytosis
c)Sedation
d)Severeextrapyramidalsymptoms
e)Lesseliptogenicpotential
CorrectAnswer-A:B:C

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Ans.(A)Weightgain(B)Agranulocytosis(C)Sedation
[RefK.D.T7th/'M1;Katzung12th/509]
Haloperidol:
Producesfewerautonomiceffects,islessepileptogenic,doesnot
causeweightgain,jaundiceisrare

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SevereextraPyramidalsyndrome.
Preferreddrugforacuteschizophrenia
Clozapine:
Producesfewornoextrapyramidalsymptoms;tardivedyskinesiais
rare&prolactinleveldoesnotrise.

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Quitesedativesedation.
Higherincidenceofagranulocytosis.
Metaboliccomplicationslikeweightgain,hyperlipidemia&
precipitationofdiabetesisanothermajorlimitation.
Highdosescaninduceseizureseveninnon-epileptics.

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65.Whichofthefollowingconditionincrease
chanceofhyponatremiainpatienttreated
withantidepressant:
a)Oldage
b)Lowweight

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c)Coldclimate
d)Obesity
e)Femalesex
CorrectAnswer-A
Ans.(A)Oldage

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[Ref.NirajAhuja7th/188.]
CasesofSSRl-associatedhyponatremia&thesyndromeof
inappropriateantidiuretichormonehavebeenseeninsomepatients,
especiallythosewhoareolderortreatedwithdiuretics.

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66.Desmopressinis/areusedin:

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a)Diabetesinsipidus
b)Esophagealvarices
c)HaemophiliaA
d)VonWillebranddisease
e)HemophilaB

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CorrectAnswer-A:C:D
Ans.(A)Diabetesinsipidus(C)HaemophiliaA(D)Von
Willebranddisease
[Ref.K.D.T7th/596-97,616;Katzung12th/616,674,677;G&G
1fir/784-86]

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Desmopressin:
SelectiveV2agonist.
Uses:
Diabetesinsipidus,bedwettinginchildren&nocturiainadults,renal
concentrationtest,Haemophilia&VonWillebranddisease.

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---

67.Whichofthefollowingis/areteratogens:
a)Artemisinin
b)Aminoglycoside
c)Carbamezapine
d)Retinoicacid

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e)Phenytoin
CorrectAnswer-B:C:D:E
Ans.(B)Aminoglycoside(C)Carbamezapine(D)Retinoicacid
(E)Phenytoin
[RefK.D.TTtlr/&g,8j1;Katzung10th/975;Katzung12th/1042-43;

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

G&G11th/;DruginPregnancy&LactationbyG.Briggs6th/339]
Teratogens:
Quinine:Continuestobethedrugofchoiceforseverefalciparum
during1sttrimesterofpregnancy,becausesafetyofartemisininsis
notyetProven.

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Artesunate:Useislimitedinsecond6thirdtrimestersofpregnancy
onlywhenotherdrugsarefoundresistant.
Aminoglycosides:Avoidduringpregnancy:Riskoffoetal
ototoxicity.
ACEinhibitors:2.7foldhighermalformationrateinfetusexposed

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forACEinhibitorsinthefirsttrimester..

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68.Whichofthefollowingis/arefeaturesof
Triamcilonewithrespectto
hydrocortisone:
a)Florinatedatcarbonatom9

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b)Notusedinoralform
c)Mineralocorticoidactivitypresent
d)Morepotentthanhydrocortisone
e)Glucocorticoidactivityis5timesofhydrocortisone
CorrectAnswer-D:E

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Ans.(D)Morepotentthanhydrocortisone(E)Glucocorticoid
activityis5timesofhydrocortisone
[RefK.D.T7th/289;Katzung12th/700,703,712]
Triamcinolone:
SlightlymorePotentthanprednisolonebuthighlyselective

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glucocorticoid;4-i2mg/dayoral;5-40mgi.m,intraarticular
injection.
Alsousedtopically

---

69.Deathinhangingoccursduetoallexcept:
a)Asphyxia

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

b)vagalinhibition
c)Vagalstimulation
d)Cerebralischemia
e)Venouscongestion
CorrectAnswer-C

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Ans:c.Vagalstimulation[RefReddy33rd/339;Parikh6th/3.40
Hanging:CausesofDeath:
1. Asphyxia:Atensionof15kgonligatureblocksthetrachea
2. Venouscongestion:Thejugularveinsareblockedbyatensionin
theropeof2kg

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3. Combinedasphyxia&venouscongestion:Commonestcause
4. Cerebralanaemia:AtensionOf4-5kgonligatureblockscarotid
arteries&the20kg,thevertebralarteries
5. Reflexvagalinhibition
6. Fractureofdislocationofthecervicalvertebrae(injurytospinalcord)

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Strangulation:Causesofdeath(Reddy33rd/347)
1. Asphyxia
2. CerebralanaemiaorVenouscongestion
3. Combinedasphyxia&venouscongestion
4. Reflexvagalinhibition

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5. Fractureofdislocationofthecervicalvertebrae(rare)

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70.Dirtcollarorgreasecollarisseenin:
NEET13
a)Puncturedwoundbysharpweapon
b)Laceratedwound

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c)Firearmentrywound
d)Stabwound
e)None
CorrectAnswer-C
Ans.Firearmentrywound

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Smudgering/Leadring/Greasecollar/Dirtcollar
Thisisduetothewipeofthesoftmetalofthebullet,ordirtpresent
onit,orgreasecarriedfromthebarrel&isdepositedroundthe
entrancewoundinternaltotheabradedcollar
Thesmudgeringmaythereforebeabsentwhenthejacketedbullet

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haspassedthroughclothing
Thesmudgingincaseofleadshotorunjacketedbulletscan
bedetectedmicrochemicallyonthetarget(skin/cloth)
Theforensicvalueofbulletwipeistoestablishaholeasabullet
hole,todeterminetheentrysite,&onoccasionthesequenceof

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shotsorbullet'spassagethroughmultipleobjects.

---

71.Whichofthefollowingis/aretypeof
abrasion:
a)Pattern
b)Imprint

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c)Graze
d)Stretch
e)Scratch
CorrectAnswer-A:B:C:E
Ans:a.Pattern,b.Imprint,c.Graze&e.Scratch

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AbrasionsorGravelRash:Itisadestructionoftheskin,which
usuallyinvolvesthesuperficiallayersoftheepidermisonly.Theyare
causedbyfrictionagainstaroughsurfaceorbycompression.Some
pressure&movementbyagentonthesurfaceoftheskinis
essential.

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Scratches(linearabrasions):Itisanabrasionwithlengthbutno
significantwidth.Subtype-pointscratch&fingernailabrasions
Grazes(sliding,scrapingorgrindingabrasion):Theyarethemost
commontype.Theyoccurwhenthereismovementb/wtheskin&
someroughsurfaceincontactwithit.Subtype-brushburn,friction

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burnetc.
Pressureabrasion(crushingorfrictionabrasions):e.g.,ligaturemark
incaseofhanging&strangulation&theteethbitemarks,Impact
abrasion(contactorimprintabrasion):causedbyaroughobjectat
ornearrightangletotheskinsurface.Patternabrasion:Impact

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abrasion&pressureabrasion

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72.

---

I.P.CSectiondealingwithpunishmentfor
voluntarycausinggrievousinjury:
a)321I.P.C

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b)322I.P.C
c)323I.P.C
d)324I.P.C
e)325I.P.C
CorrectAnswer-E

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Ans:e.325I.P.C[RefReddy33rd/294-95,292;Parikh6th/4.59-
4.60]
S.321,I.C:voluntarilycausinghurt
S.322,I.P.C:voluntarilycausinggrievoushurt
S.323,I.PC:Punishmentforvoluntarilycausinghurt:

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imprisonmentuptooneyear,orfineuptoRs1000orboth
S.324,I.C:voluntarilycausinghurtbydangerousweaponsor
means(3yearimprisonment)
S.325,I.P.C:Punishmentforvoluntarilycausinggrievoushurt:
Imprisonmentforatermextendingtosevenyears&alsofine.

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S.326,I.P.C:Voluntarilycausinggrievoushurtbydangerous
weaponsormeans:Imprisonmentuptotenyears&alsofine
Grievous Injury(Sec320IPC)
Emasculation?(cuttingoffpenis,castration,or
1.

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causinglossofpoweroferectionduetospinal
injury)
2.
Permanentprivationofeithereye?
3.

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Permanentprivationofeitherear?
Privationofanymember?(part,organorlimb)or

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Privationofanymember?(part,organorlimb)or
4.
joint

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5.
Permanentdisfigurationofheadorface?
6.
Fractureordislocationofboneoratooth?
Destructionorpermanentimpairingofpowersof

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7.
anymemberorjoint?
Anyhurtwhichendangerslife?,orwhichcauses
thesufferertobe,duringthespaceof20days?,
8.

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inseverebodypain,orunabletofollowhisdaily
routine

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73.Post-mortemcaloricityis/areseenin:
a)Drowning
b)Elderly

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c)Strychninepoisoning
d)Sunstroke
e)Cholera
CorrectAnswer-C:D:E
Ans:c.Strychninepoisoning,d.Sunstroke,&e.Cholera,

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Thisisanormalphenomenonandtheriseis3.6?For2?C
Septicaemia,Infectiousdiseases,BacteremiaTetanus,Rabies,
yellowfeverAsphyxialConditionsSevereconvulsionsTetanus
StrychnineHyperpyrexiaatdeathHeatStroke(sunstroke)Pontine
HaemorrhageHighAtmosphericTemperaturePeritonitis,Meningitis,

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NephritisAlcoholpoisoning

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74.Mummificationis/arefavouredby:
a)Dryair
b)Humidair
c)Coldenvironment

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d)Drowning
e)Warmair
CorrectAnswer-A:E
Ans:a.Dryair&e.Warmair
FactorNecessaryfortheProductionofMummification

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Theabsenceofmoistureintheair
Thecontinuousactionofdryorwarmedair
"Mummification:Chronicarsenicorantimonypoisoningissaidto
favourtheprocessofmummificationindry&warmclimate"(Parikh
6th/3.31).

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---

75.Whichofthefollowingtoxicagentis
removedbyhemodialysis,butnotbygut
detoxicationthroughactivatedcharcoal:
a)Theophylline
b)Benzodiazepines

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c)Phenobarbitone
d)Ethyleneglycol
e)Ethanol
CorrectAnswer-E
Ans:e.Ethanol[RefReddy33rd/155;Parikh6th/3.8-3.9]

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Whentherehasbeenexcessivebacterialactivity,asinsepticaemic
condition,choleraotherfevers,thetemperatureofthebodyremains
raisedforthefirsttwohoursorsoafterdeath.
Theophylline,ethyleneglycol&phenobarbitone(barbiturates)are
clearedbyboth,activatedcharcoalerhaemodialysis,?

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Benzodiazepinesareclearedonlybyactivatedcharcoal,Ethanolis
removedonlybyhaemodialysisnotbyactivatedcharcoal(so
obviouslytheanswer)
Hemodialysis:Itisveryusefulforremovingethanol,methanol,
ethyleneglycol,chloralhydrate,lithium,trivalentarsenic,

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acetaminophen,bromide,Phenobarbital,salicylate,fluoride,sodium
chlorate,digitalis,methaqualone,boricacid&thiocynate
HaemodialysishasbeenemployedforremovingbarbituratesQ,boric
acid,glutethimide,methylalcoholQ,salicylatesQandthiocyanates
fromtheblood.Haemperfusionissuperiortohaemodialysisfor

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removaloflipidsolubledrugs.Exchangetransfusionisonlyfeasible

---

withsmallchildrenandhasbeenappliedtopoisoningsby
salicylates,barbiturates,ironsalts,carbonmonoxide,etc.Alltoxic
substances,includingnondialysableones,areremovedbythis
technique"(Parikh6th/8.17)"Ethyleneglycolpoisoningtreatment:

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Activatedcharcoal,gastriclavageerhaemodialysis"(Reddy
33rd/583)

---

76.Numberofpermanentteethat8years:
a)6
b)8

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c)12
d)16
e)None
CorrectAnswer-C
Ans.C.12

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Tooth
Lateralincisor
Eruption
(upper)
7to9months

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Lateralincisor
(lower)
10-12months
Firstmolar
12to14months

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Canine
17to18months
Secondmolar
20to30months
Tooth

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Eruption
Firstmolar
6to7years
Centralincisor 6to8years
Lateralincisor 7to9years

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Firstbicuspid 9to11years
Second
bicuspid
10to12years
Canine

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11to12years
Secondmolar 12to14years

---

17to25years(17-
Thirdmolar
21inParikh6th/2.7)

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---

77.Burkdholeriacepaciainfectionis/are
typicallyassociatedwith:
a)Cysticfibrosis
b)Chronicbronchitis
c)Chronicgranulomatousdisease

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d)Multiplemyeloma
e)Myeloperoxidasedeficiency
CorrectAnswer-A:C
Ans:a.Cysticfibrosis&c.Chronicgranulomatousdisease[Ref
Ananthanarayan9th/316;MedicalmicrobiologybyGreenwood

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16th/286-88;JawetzMicrobiology27th/248-49]
Burkholderiacepaciaisincreasinglybeingrecognizedasan
opportunistenvironmentalpathogen,particularlyinthosewithcystic
fibrosisorchronicgranulomatousdisease,inwhomitcausesfatal
necrotizingpneumonia"(Ananthanarayan9th/316;Greenwood

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16th/286-88)
Burkholderiacepaciaisanenvironmentalorganismthatisableto
growinwater,soil,plants,animals,anddecayingvegetable
materials.
Bcepaciagrowsonmostmediausedinculturingpatients'

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specimensforgram-negativebacteria.Selectivemediacontaining
colistinalsocanbeused.Bcepaciagrowsmoreslowlythanenteric
gram-negativerods,anditmaytake3daysbeforecoloniesare
visible

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78.T.saginataisdifferentiatedfromT.solium

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bypresenceof:
a)Hooksinscolex(head)
b)4largepigmentedsucker
c)Uterusisthin&dichotomous
d)Shortneck

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e)Eggisnotinfectivetoman
CorrectAnswer-B:C:E
Ans:b.4largepigmentedsucker,c.Uterusisthin&
dichotomous&e.Eggisnotinfectivetoman.[RefPaniker's
Parasitology7th/121;MedicalmicrobiologybyGreenwood

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16th/610-11]
Taeniasaginata
Taeniasolium
Length
5-10Medical

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2-3m
Transcriptionists
Largequadrate,
Smallandglobular,
Rostellumandhooks Rostellumandhooksare

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Scolex
areAbsent,Suckers present,
maybePigmented
Suckersnotpigmented
Neck

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Long
Short
Proglottids
1,000-2,000
Below1,000

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Measurement 20mmx5mm
12mmx6mm
Expelledpassivelyinchains
Expulsion
Expelledsingly

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of5or6
Lateralbranchesl5- Lateralbranches5-10on
Uterus
30oneachside;thin eachside;thickand
dendritic

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---

anddichotomous
dendritic
Vagina
Present
Absent

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Accessary
Absent
Present
lobeofovary
Testes

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300-400follicles
150-200follicles
Cysticercus
Cysticercuscellulosae;
bovis;presentincow

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Larva
presentinpigandalso
notin
inman
man

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Egg
Notinfectivetoman Infectivetoman

---

79.Allaretrueaboutgasgangreneexcept:
a)Type1gangreneisfournier'sgangrene
b)Devitalizedtissuepredisposetogasgangrene

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c)High02tensionintissueisimportantprecondition
d)a-toxinismaincauseofthetoxaemiaassociatedwithgas
gangrene
e)MainlycausedbyC.perfringens
CorrectAnswer-E

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Ans:E.MainlycausedbyC.perfringens[RefHarrison19th/990-
95;Ananthanarayan9th/257-59;Jawetz27th/186-87;Greenwood
16th/231-35]
C.perfringensinassociationwithmixedaerobicandanaerobic
microbescancauseaggressivelife-threateningtypeInecrotizing

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fasciitisorFournier'sgangrene.
Predisposinghostfactorsincludedebility,oldage&diabetes
a-toxinisgenerallyconsideredtobethemaincauseofthe
toxaemiaassociatedwithgasgangrene
"a-toxin:Thisisthemostimportanttoxinbiologically&isresponsible

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forprofoundtoxaemiaofgasgangrene"

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80.TrueaboutBotulinumtoxin:
a)Interferewithadrenergictransmission
b)InterferewithCholinergictransmission
c)Increasereleaseofsynapticvesicles

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d)Inhibitreleasefromsynapticvesicles
e)ActalsoonCNS
CorrectAnswer-B:D:E
Ans:b.InterferewithCholinergictransmission,d.Inhibit
releasefromsynapticvesicles&e.ActalsoonCNS[RefK.D.T

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7th/99-100,121;Ananthanarayan9th/264]
"Twotoxinsinterferewithcholinergictransmissionbyaffecting
release:botulinumtoxininhibitrelease,whileblackwidowspider
toxininducesmassivereleaseerdepletion"-K.D.T7th/99
Alocalizedinjectioncanbeusedintreatmentofanumberofspastic

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&otherneurologicalconditionsduetooveractivityofcholinergic
nerveslikeblepharospasm,spasticcerebralpalsy,strabismus,
spasmodictorticollis,nystagmus,hemifacialspasm,poststroke
spasticity,spasmodicdysphonia,axillaryhyperhydrosisetc
Itactsbyblockingtheproductionorreleaseofacetylcholineatthe

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synapses&neuromuscularjunctions
Onsetismarkedbydiplopia,dysphagia&dysarthriaduetocranial
nerveinvolvement
Asymmetricdescendingparalysisisthecharacteristicpattern,
endingindeathbyrespiratoryparalysis

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---

81.Whichofthefollowingis/aretrueabout
HIV-2:
a)HIV-2firstdetectedinWestAfricain1986
b)DonatedbloodisonlyscreenedforHIV-1,notHIV-2
c)MorevirulentthanHIV1

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d)MorecloselyrelatedtosimianimmunodeficiencyvirusthanHIV
1
e)ModeoftransmissionislikeHIV1
CorrectAnswer-A:D:E
Ans:a.HIV-2firstdetectedinWestAfricain1986,d.More

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closelyrelatedtosimianimmunodeficiencyvirusthanHIV1&
e.ModeoftransmissionislikeHIV1,
[RefAnanthanarayan9th/573,194-95;Harrison19th/1216,1222;
Greenwood16th/527]
HIVstrainsfirstisolatedfromWestAfricain1986,whichreactwith

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HIVtype1antiserumveryweaklyornotatallhavebeentermedHIV
type2,HIV2hasonly40%geneticidentitywithHIV1.
Itismorecloselyrelatedtosimianimmunodeficiencyvirusthanto
HIV1,ItismuchlessvirulentthanHIV1
ItislargelyconfinedtoWestAfrica,throughisolationshavebeen

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reportedfromsomeotherareas,includingwestern&southernIndia.
HIV-2istransmittedbythesameroutesasHIV-1-Greenwood
16th/535
Lineimmuneassays(LIAs):Theseassaysallowforapplicationof
antigensfrommorethanonevirus,therebyallowingthemtoactas

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combinationassays&todifferentiateinfectionbyHIV1&HIV2.

---

---

82.FeaturesofstageIIIHIVinfectionis/are:
a)Fever>38.5OC
b)Oralhairyleukoplakia
c)Candidiasis

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d)Diarrhoeaof>20dayduration
e)>26%CD4countinadults
CorrectAnswer-B:C
Ans:b.Oralhairyleukoplakia,c.Candidiasis[RefPark
23rd/349;Ananthanarayan9th/575;Harrison19th/1215-16,1257]

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WewillansweronapplyingbothcriteriaCDC&WHOasitis
notspecificallymentioned.
ThecurrentU.S.CDCclassificationsystemforHIVinfectionand
AIDScategorizespeopleonthebasisofclinicalconditions
associatedwithHIVinfectionandCD4+Tlymphocyte

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measurement.
AconfirmedHIVcasecanbeclassifiedinoneoffiveHIVinfection
stages(0,1,2,3,orunknown).
IftherewasanegativeHIVtestwithin6monthsofthefirstHIV
infectiondiagnosis,thestageis0,andremains0until6monthsafter

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diagnosis.
AdvancedHIVdisease(AIDS)isclassifiedasstage3ifoneormore
specificopportunisticillnesshasbeendiagnosedOtherwise,the
stageisdeterminedbyCD4testresultsandimmunologiccriteria
Ifnoneofthesecriteriaapply(e.g.,becauseofmissinginformation

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onCD4testresults),thestageisU(unknown).

---

83.Microbiologicalorganismcanberecoverd
from:
a)Sulphurgranulesofactinomycetes
b)StreptococcifromValveleafletlesioninrheumaticvalvulitis

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c)PetechialpurpuraforMeningococci
d)Corynebacteriuminpseudomembraneinthroat
e)None
CorrectAnswer-A:C:D
Ans:a.Sulphurgranulesofactinomycetes,c.Petechialpurpura

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forMeningococci&d.Corynebacteriuminpseudomembranein
throat,
[RefAnanthanarayan9th/392;Harrison19th/979;Greenwood
16th/189-90]
Isolationinculture:Sulphurgranulesorpuscontaining

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actinomycetesarewashed&inoculated"(Ananthanarayan9th/392)
Petechiallesion:Meningococcimaysometimesbedemonstratedin
petechiallesionsbymicroscopy&culture"(Ananthanarayan
9th/230)
Throatsamplesshouldbesubmittedtothelaboratoryforculturewith

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

thenotationthatdiphtheriaisbeingconsidered.Thisinformation
shouldpromptcultivationonspecialselectivemediumand
subsequentbiochemicaltestingtodifferentiateC.diphtheriaefrom
othernasopharyngealcommensalcorynebacteria:'(Harrison
19th/979)

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Thediphtheriabacilliwithinthemembranecontinuetoproducetoxin
actively.

---

Rheumaticvalvulitisismanifestationofrheumaticheartdisease.
Rhematicfeverisanacute,immunologicallymediated,multisystem
inflammatorydiseaseclassicallyoccurringafewweekafteran

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

episodeofgroupAstreptococcalinfection.
Acuterheumaticfever:Thisoccurafter1-3weekafteracute
infectionofS.pyogenssothatorganismmaynotbedetectable
whensequelaesetin.EssentiallesionischaracterizedbyAschoff
nodules.

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---

84.Allarethefeature(s)ofchancoridexcept:
a)Ulcerbleedeasily
b)Painful
c)Buboformation
d)Typicallyindurated

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

e)CausedbyH.ducreyi
CorrectAnswer-D
Ans:d.Typicallyindurated,[RefAnanthanarayan9th/331;
Robbins9th/370;Harrison19th/101213;Greenwood16th/309]
Chancroidorsoftsoreischaracterizedbytendernon-indurated

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

irregularulcersonthegenitalia
Theinfectionremainslocalized,spreadingonlytotheregionallymph
nodeswhichareenlarged&painful
"Haemophilusducreyi:Afteranincubationperiodof4-7days,the
initiallesion--apapulewithsurroundingerythema--appears.

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In2or3days,thepapuleevolvesintoapustule,which
spontaneouslyrupturesandformsasharplycircumscribedulcerthat
isgenerallynotindurated.Theulcersarepainfulandbleedeasily;
littleornoinflammationofthesurroundingskinisevident.
Approximatelyhalfofpatientsdevelopenlarged,tenderbecome

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fluctuantandspontaneouslyrupture"(Harrison18th)

---

85.Trueaboutplague:
a)Seasonalspread
b)Novaccineisavailable
c)Tetracyclineisusedbothforchemoprophylaxis&treatment

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d)Causedbygramnegativemotilebacteria
e)Allagesareequallyaffected
CorrectAnswer-A:C
Ans:a.Seasonalspread.,c.Tetracyclineisusedbothfor
chemoprophylaxis&treatment

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Epidemicgenerallyoccurincool,humidseasonsthatfavourthe
multiplicationoffleas,leadingtohigherfleaindex
Fleasdonotthriveinhot,dryweather&thetransmissionofinfection
isinterrupted
Twotypesofvaccinehavebeeninuse-Killedvaccine(preparedat

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

theHaffkineInstitute,Mumbai)&livevaccine(itisnolonger
recommended)
Streptomycin,doxycycline&chloramphenicolareeffective?Park
23rd/292-97)
Outbreaksofplagueareusuallyseasonalinnature.Innorthern

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

India,theplagueseasonstartsfromSeptemberuntilmay.The
diseasetendstodieoutwiththeonsetofhotweather.Onthe
contrary,insouthindia,therewasnodefiniteplagueseason
Temperature&humidity:Ameantemperatureof20to25deg.C,&
arelativehumidityof60%&aboveareconsideredfavourablefor

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

spreadofplague
Agent:Y.pestis-agramnegative,non-motile,cocco-bacillusthat
exhibitbipolarstainingwithspecialstains(e.gWayson'dstain)

---

Sourceofinfection:Infectedrodents&fleas&caseofpneumonic
plague

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

---

86.Whichofthefollowingispicornaviridae:
a)Poliovirus
b)Coxsackievirus
c)Rhinovirus
d)Coronavirus

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e)Reovirus
CorrectAnswer-A:B:C
Ans:a.Poliovirus,b.Coxsackievirus&c.Rhinovirus[Ref
Ananthanarayan9th/484-85,440;Harrison19th/1289-95;Jawetz
27th/5141

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Rheovirusbelongstoreoviridaefamily,Coronavirusbelongsto
coronaviridae(Ananthanarayan9th/441)
Enteroviruses,membersofthefamilyPicornaviridae,areso
designatedbecauseoftheirabilitytomultiplyinthegastrointestinal
tract.

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Despitetheirname,thesevirusesarenotaprominentcauseof
gastroenteritis.
Enterovirusesencompassmorethan100humanserotypes:3
serotypesofpoliovirus,21serotypesofcoxsackievirusA,6
serotypesofcoxsackievirusB,28serotypesofechovirus,

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enteroviruses68-71,andmultiplenewenteroviruses(beginningwith
enterovirus73)thathavebeenidentifiedbymoleculartechniques.
Humanenteroviruseshavebeenreclassifiedintofourspecies
designatedA-D.Echoviruses22and23havebeenreclassifiedas
parechoviruses1and2onthebasisoflownucleotidehomologyand

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differencesinviralproteins.
ThePicornaviridaefamilycontains12generaRhinoviruses

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historicallywereplacedinseparategenusbutarenowconsideredto
bemembersofEnterovirusgenus.

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87.Allaretrueaboutseverecombined

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immunodeficiencyexcept:
a)B&Tcelldeficiency
b)Adenosinedeaminasedeficiencymayoccur
c)Affectedchildcansurvivesbeyondadolescencewithout
treatment

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d)CantransmiteitherasX-linkedorautosomalrecessivedefect
e)Personsusceptibletorecurrent&severeinfections
CorrectAnswer-C
Ans:(C)Affectedchildcansurvivesbeyondadolescence
withouttreatment[RefAnanthanarayan9th,174-75;Robbins

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9th/239-4
Adenosinedeaminasedeficiency:Thisthefirstimmunodeficiency
diseaseassociatedwithanenzymedeficiency,Deficiencyofboth
humoral&CMIresponse.
PersonswithSCIDareextremelysusceptibletorecurrent,severe

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infectionsbyawiderangeofpathogens,includingCandidaalbicans,
Pneumocystisjiroveci,Pseudomonas,cytomegalovirus,varicella,
andawholehostofbacteria.
Themostcommonform,accountingfor50%to60%ofcases,isX-
linked,andhenceSCIDismorecommoninboysthaningirls.The

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geneticdefectintheX-linkedformisamutationinthecommony-
chain(yc)subunitofcytokinereceptors.
AutosomalrecessiveSCID:TheremainingformsofSCIDare
autosomalrecessivedisorders.Themostcommoncauseof
autosomalrecessiveSCIDisadeficiencyoftheenzymeadenosine

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---

deaminase(ADA).OtherisMutationsofanintracellularkinaseJak3
&Mutationsinrecombinaseactivatinggenes(RAG)
TheSCIDsyndromeisinheritedeitherasanX-linkedorautosomal
recessivedefect,andaffectedinfantsrarelysurvivebeyond1year
withouttreatment.

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---

88.TruestatementregardingNKcellsareall
except:
a)AlsocalledasLargegranularlymphocyte
b)Cankillviralinfectedcell
c)Formsfirstlineofdefence

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d)Cankilltumourcell
e)Noroleincellmediatedimmunity
CorrectAnswer-E
Ans:e.Noroleincellmediatedimmunity[RefAnanthanarayan
9th/137;Robbins9th/192;MedicalmicrobiologybyGreenwood

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16th/129;Harrison19th/372e6-7]
NKcellsareendowedwiththeabilitytokillavarietyofvirus-infected
cellsandtumorcells,withoutpriorexposuretooractivationbythese
microbesortumors.ThisabilitymakesNKcellsanearlylineof
defenseagainstviralinfectionsand,perhaps,sometumors

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ThefunctionofNKcellsistodestroyirreversiblystressedand
abnormalcells,suchasvirus-infectedcellsandtumorcells.NKcells
makeupapproximately5%to10%ofperipheralbloodlymphocytes.
NKcell:TheyhaveCD16&CD56Qontheirsurface.Theyrelease
severalcytolyticfactors;oneofthese,perforins,whichresembles

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complementC9,causetransmembraneporesthroughwhich
cytotoxicfactorenterthecell.NKcellactivityisaugmentedby
interferon0.
NKcell:Formpartofinnateimmunityasitdoesnotrequireprior
sensitisationbyantigen.Theircytotoxicityisnotantibody

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dependentorMHCrestricted.

---

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89.TrueaboutSwineflu:
a)Olderbirdinfluenzavaccineisequallyeffectiveinswineflu
b)Oseltamiviriseffectiveinprevention
c)Zanamivircanbeusedfortreatment

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d)Influenzavaccineprovidesimmunityjustaftervaccination.
e)None
CorrectAnswer-B:C
Ans:b.Oseltamiviriseffectiveinprevention&c.Zanamivircan
beusedfortreatment[RefPark23rd/156-59;Ananthanarayan

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9th/503]
Swineinfluenza-emergedinmarch2009asnewH1N1virus
disease,Alsocalledasswineorigininfluenza,Itspreadfromperson
toperson&causedapandemic.
PandemicinfluenzaA(H1N1)2009-Currentlysusceptibleto

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oseltamivirzanamivirbutresistanttoamantadineorrimantadine,
Treatment:oseltamiviradultoraldoseis75mgtwicedailyfor5
days.Zanamivirdoseistwoinhalation(2x5mg)twicedailyfor5
days
Chemoprophylaxis:Oseltamivirisdrugofchoicefor

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chemoprophylaxis.Itshouldbegiventill10daysafterlastexposure,
Influenzavaccineonlybecomeeffectiveabout14daysafter
vaccination.Thoseinfectedshortlybefore(1-3days)orshortlyafter
immunizationcanstillgetthedisease.,Vaccinatedindividualscan
alsogetinfluenzacausedbyadifferentstrainofinfluenzavirus,for

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whichthevaccinedoesnotprovideprotection

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90.Laboratoryfinding(s)ofapatienthaving
chronichepatitisBinfectionwithlowviral
load:
a)HBsAg

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b)Anti-HBs
c)Anti-HBe
d)Anti-HBcIgG
e)HBeAg
CorrectAnswer-A:C:D

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Ans:a.HBsAg,c.Anti-HBe&d.Anti-HBcIgG[Ref
Ananthanarayan9th/546-48;Park23rd/215;Harrison19th/2016-
181
Thefirstvirologicmarkerdetectableinserumwithin1-12weeksQ,
usuallybetween8-12weeks,isHBsAg.Q

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Intypicalcase,HBsAgbecomesundetectable1-2monthsafterthe
onsetofjaundiceandrarelypersistsbeyond6months.AfterHBsAg
disappears,antibodytoHBsAg(anti-HBs)detectableinserumand
remainsdetectableindefinitelythereafter.
TestingforIgManti-HBcmaybeusefultodistinguishbetweenacute

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orrecentinfection(IgManti-HBc-positive)andchronicHBVinfection
(IgManti-HBc-negative,IgGanti-HBc-positive).
Anotherserologicmarkerthatmaybeofvalueinpatientswith
hepatitisBisHBeAg.Itsprincipalclinicalusefulnessisasan
indicatorofrelativeinfectivity.BecauseHBeAgisinvariablypresent

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duringearlyacutehepatitisB,HBeAgtestingisindicatedprimarily
duringfollow-upofchronicinfection.

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Anti-HBsisrarelydetectableinthepresenceofHBsAginpatients
withacutehepatitisB,but10-20%ofpersonswithchronicHBV
infectionmayharborlow-levelanti-HBs

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---

91.WhichofthefollowingvaccineisC/Iin
pregnancy:
a)BCG
b)Oralpoliovaccine
c)Measles

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d)Tetanus
e)HepatitisB
CorrectAnswer-A:B:C
Ans.(A)BCG(B)Oralpoliovaccine(C)Measles
[RefPark23rd/103,216;Ananthanarayan9th/83;Park19th/97-

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98,162,170,179;Harrison17th/779;AsmaRahimcommunity
medicinelst/141]
Pregnancy?isanotherC/I,forlivevaccinesunlesstheriskof
infectionexceedstheriskofharmtothefoetusofsomelive
vaccinesTheonlyabsoluteC/Iforkilledvaccineisseverelocalor

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generalreactiontoapreviousdose.
Unlessspecificallyindicated,BCGshouldnotbegiventopatients
sufferingfromgeneralizedeczema?,infectivedermatitis?,
hypogammaglobulinemia,tothosewithahistoryofdeficient
immunity?(symptomaticHIVinfection,knownorsuspected

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congenitalimmunodeficiency,leukemia,lymphomaorgeneralized
malignantdisease),patientunderimmunosuppressivetreatment
(corticosteroids,alkylatingagents,antimetabolites,radiation)&
pregnancy?
HepatitisBC/I:Individualswithahistoryofallergicreactionstoany

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ofthevaccinescomponents;NeitherpregnancyorlactationisaC/I

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foruseofthisvaccine.
OPVC/I;Immunocompromised,immunedeficiencyQ,HIVdiseaseQ
&activeviralinfection;Acuteinfectiousdiseases,fever,diarrhoea&
dysentery

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92.Whichofthefollowingisnotzoonosis:
a)Gonorrhoea
b)Pertussis
c)Anthrax
d)Brucella

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e)SalmonellaparatyphiB
CorrectAnswer-A:B
Ans:a.Gonorrhoea.&b.Pertussis[RefAnanthanarayan
9th/684;Ananthanarayan8th/381,322;MedicalParasitologyby
Paniker6th/214;Park23th/93,276,788

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ThetermentericfeverincludestyphoidfevercausedbyS.typhi&
paratyphoidfevercausedbyS.paratyphiA,B&C.While
SalmonellaparatyphiAoccuronlyinhumanbeings,S.paratyphiB
caninfectanimalssuchasdogsorcows,whichmayactsassource
ofhumandisease"

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Zoonosis:(Infectionofanimalscommunicabletoman)
Zoonosisisdefinedasaninfectionorinfectiousdiseasethatis
transmissibleundernaturalconditionsfromvertebrateanimalsto
manZoonoticdiseasemaybeduetoinfectionswithviruses,
bacteria,protozoa,helminths,fungiorarthropods.

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Zoonosis:4Categories:1.Directzoonosis,2.CycloZoonosis,
3.Metazoonosise.g.,arbovirusinfection,4.`Saprozoonosis.

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93.Whichofthefollowingis/aretrue
regardingreferenceman&womanexcept:
a)Referencemanisagedb/w18-29years&weighs60kg

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b)Referencemanisagedb/w18-29years&weighs55kg
c)Referenceman:heisengagedin8hoursofoccupationwhich
usuallyinvolvesmoderateactivity
d)Referencewomanisagedb/w18-29years&weighs50kg
e)Referencewoman:heightof1.61meter&aBMIof21.2

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CorrectAnswer-B:D
Ans:b.Referencemanisagedb/w18-29years&weighs55
kg,&d.Referencewomanisagedb/w18-29years&weighs50
kg,[RefPark23rd/632]
ReferenceIndianAdultMan:

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Referencemanisagedb/w18-29years&weighs60kgwithaheight
of1.73meter&aBMIof20.3;isfreefromdisease&physicallyfit
foractivework,Oneachworkingday,heisengagedin8hoursof
occupationwhichusuallyinvolvesmoderateactivity;whilewhennot
atworkhespends8hoursinbed,4-6hoursinsitting&moving

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about,2hoursinwalking&inactiverecreationorhouseholdduties.
ReferenceIndianAdultWoman:Referencewomanisagedb/w18-
29years,nonpregnantnon-lactating(NPNL)&weighs55kgwitha
heightof1.61meter&aBMIof21.2,isfreefromdisease&
physicallyfitforactivework.?Oneachworkingdaysheisengaged

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in8hourofoccupation,whichusuallyinvolvesmoderateactivity,
whilewhennotatworkshespends8hoursinbed,4-6hoursin
sitting&movingabout,2hoursinwalking&inactiverecreationor

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householdduties.

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94.Allofthefollowingaretrueregarding

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watersupplyexcept:
a)Earlierrecommendedtargetofsupplynormforruralareawas
401pcd
b)150-200literspercapitaisconsideredasanadequatesupply
tomeettheneedsforallurbandomesticpurpose

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c)In8th5-yrplantargetsetwas2001pcd&accessibilityof
sourceofwater<200meterforruralareas
d)Formetrocitieswithpopulation>10lakh,targetis1501pcd
e)Formunicipalitywithpopulationb/w1-10lakh,targetis100-135
1pcd

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CorrectAnswer-C
Ans:c.In8th5-yrplantargetsetwas2001pcd&accessibility
ofsourceofwater<200meterforruralareas,
[RefPark23rd/706;NationalHealthProgrammesofIndiaby
JugalKishore7th/457-63;http://www.nih.ernet.

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in/rbis/india_information/drinking.Htm]
WaterRequirement:Theconsumptionofwaterdependsupon
climateconditions,standardofliving&habitsofpeople;Adaily
supplyof150-200literspercapitaisconsideredasanadequate
supplytomeettheneedsforallurbandomesticpurpose.

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Recommendedwater
PopulationLessthan20,000 supplynorm(Ipcd)
a.Populationservedbystand
40
posts

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b.Populationprovidedwithpipe 70
connections

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connections
20,000tolessthan100,000
100

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100(withnosewerage
system)
100,000tolessthan1,000,00 135(withsewerage
system)
1,000,000andabove

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150
40oronehand-pumpfor
Ruralandhills(perelevation
250personswithina
differenceof100m)

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Walkingdistanceof1.6
km
Rural?additionalwaterfor
cattleinDesertevelopment
30

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Programme(DDP)areas.

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95.Deprivationindexincludes:
a)Education
b)Income
c)Workingchild

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d)Dropoutofchildfromschool
e)Physicaldisability
CorrectAnswer-A:E
Ans:a.Education&BIncome&E,Physicaldisability
DeprivationIndex:TheNationalKnowledgeCommission(NKC)has

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proposedaDeprivationIndexformulatoassessthebackwardness
ofstudents.
TheDeprivationIndexproposestolookatthe"socialbackground,
caste,religionandgender,familyeducationhistory,familyincome,
typeofschool,placeofresidence(distinguishingbetweenurbanand

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ruralareas,andaccountingforregionaldeprivation)andphysical
disability.

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96.MostcommoncancerinfemalesinIndia?
a)Breast
b)Cervix

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c)Ovary
d)Uterus
e)Oralcavity
CorrectAnswer-A
Ans.is'a'i.e.,Breast[RefPark24th/ep.401]

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Overallcancersinworld:Breast>Prostate>Colorectal>Lung>
Cervix
Cancersinmalesinworld:Prostate>Colorectum>Lung>
Stomach>Urinarybladder
Cancersinfemalesinworld:Breast>Colorectum>Cervix>Uterus

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>Thyroid
OverallcancersinIndia:Breast>Cervix>Lip/oralcavity>
Colorectum>Prostate
CancersinmalesinIndia:Lip/oralcavity>Prostate>Colorectum
>Pharynx(otherthannasopharynx)>Larynx

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CancerinfemalesinIndia:Breast>Cervix>Ovary>Uterus>
Colorectum

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97.Whichofthefollowingdyadsarecorrects:
a)Childsexratiois914accordingto2011census
b)CBR-21.3in2012

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c)Generalfertilityrate-88.6in2012
d)CDR-7in2012
e)18yr-Legalageofmarriageforfemale
CorrectAnswer-A:D:E
Ans:(A)Childsexratiois914accordingto2011census,

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(D)CDR-7in2012,&(E)18yr-Legalageofmarriageforfemale,
[RefPark23rd/490;Ananthanarayan9th/;IndianYearBook
2015/9;IndianEconomybyRameshSingh6th/Census2011;
Reddy27th/73;Parikh6th/2.131]
Generalfertilityrate-80.3(2012)(Park23rd/490),Totalfertilityrate-

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2.4(2012)(Park23rd/490),Generalmaritalfertilityrate-114.9
(2012)(Park23rd/490)Totalmaritalfertilityrate-4.4(2012)(Park
23rd/490),Crudebirthrate-22.1per1000(2010);21.6per1000
(2012)(Park23rd/490),Crudedeathrate-7.2per1000(2010);7.0
per1000(2012)(Park23rd/490)

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Grossreproductiverate-1.1(2012)(Park23rd/490,"TheCrude
BirthRate(CBR)atthenationallevelduring2013standsat21.4,a
declineof0.2pointsover2012.ThemaximumCBRhasbeen
reportedinBihar(27.6)andtheminimuminKerala(14.7):'(Sample
RegistrationSystem(SRS)survey)

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---

98.Positivepredictivevalue:
a)Numeratorcontainspositiveresultbyscreeningtest
b)Denominatorcontainspositiveresultbyscreeningtest
c)Numeratorcontainspositiveresultbydiagnostictest
d)Denominatorcontainspositiveresultbydiagnostictest

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e)Numeratorcontainspositiveresultbyscreeningtest&
diagnostictestboth
CorrectAnswer-B:E
Ans:(b)Denominatorcontainspositiveresultbyscreening
test&(e)Numeratorcontainspositiveresultbyscreeningtest

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&diagnostictestboth[RefPark23rd/139;BiostatisticsbyRao
2nd/70-71,418;https://onlinecourses.science.psu.
edu/stat507/node/71;http://en.wikipedia.
org/wiki/Positive_and_negative_predictive]
Thepositiveandnegativepredictivevalues(PPVandNPV

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respectively)aretheproportionsofpositiveandnegativeresultsin
statisticsanddiagnosticteststhataretruepositiveandtruenegative
results.ThePPVandNPVdescribetheperformanceofadiagnostic
testorotherstatisticalmeasure.Ahighresultcanbeinterpretedas
indicatingtheaccuracyofsuchastatistic.ThePPVandNPVarenot

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intrinsictothetest;theydependalsoontheprevalence.ThePPV
canbederivedusingBayes'theorem.
Note:InPPV,numeratorcontainsonlytruepositive(notallpositive)
&denominatorcontainsallpositive.
positiveandnegativepredictivevaluesareinfluencedbythe

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prevalenceofdiseaseinthepopulationthatisbeingtested.Ifwe
testinahighprevalencesetting,itismorelikelythatpersonswho

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testpositivetrulyhavediseasethanifthetestisperformedina
populationwithlowprevalence...
Usingthesametestinapopulationwithhigherprevalence

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increasespositivepredictivevalue.Conversely,increased
prevalenceresultsindecreasednegativepredictivevalue

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99.Incubatorycarriersare:
a)Polio
b)Diphtheria

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c)Anthrax
d)Pertussis
e)HepatitisB
CorrectAnswer-A:B:C:E
Ans:a.Polio,b.Diphtheria.,c.Anthrax&e.HepatitisB[Ref

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Park23rd/95-96;Ananthanarayan9th/72]
Incubatorycarriers:Measles,mumps,polio,pertussis,influenza,
diphtheriaandhepatitisB,Convalescentcarriers:Typhoidfever,
dysentery(bacillaryandamoebic),cholera,diphtheriaandwhooping
cough.

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Healthycatiers:Poliomyelitis,cholera,meningococcal,meningitis,
salmonellosis,anddiphtheria
Temporarycarriers:Maybeincludedtheincubatory
convalescentandhealthycarries.
Chroniccarriers:Typhoidfever,hepatitisB,dysentery,cerebro-

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spinalmeningitis,malaria&gonorrhoea

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100.Whichofthefollowingdiseasehave
carrierstage:
a)Staph.aureus
b)GroupBStreptococcus

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c)HepatitisB
d)Typhoid
e)Haemophilusinfluenzae
CorrectAnswer-A:C:D:E
Ans:a.Staph.aureusc.HepatitisBd.Typhoid.&

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EHaemophilusinfluenzae[Ref,Park23ril/95-96;
Ananthanarayan9th/72,203-05,3i0,216,296]
Staphylococcuscarriagestartsearlyinlife,colonizationofumbilical
stumpbeingverycommoninbabiesborninhospitals.Some
carriers,called'shedders'disseminateverylargenumberofcoccifor

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prolongedperiods"(Ananthanarayan9th/203-04)
Haemophilusinfluenzae:Carriageinupperrespiratorytractis
common,particularlyinyoungchildren,butsuchstrainsareusually
non-capsulated&notresponsibleforacuteinvasiveinfection.
Rifampicinisgiventoeradicatethecarrierstate.

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101.TrueaboutSilicosis:
a)Birefringentparticlesareseenunderpolarizedlightinlung
nodule
b)Fibrosisoflung
c)Stoppingtheexposurereversetheprogression

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d)Impairmentoftotallungcapacity
e)Notifiabledisease
CorrectAnswer-A:B:D:E
Ans:a.Birefringentparticlesareseenunderpolarizedlightin
lungnoduleb.Fibrosisoflungd.Impairmentoftotallung

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capacity&e.Notifiabledisease[RefPark23rd/806;Harrison
19th/1688]
Thelongerthedurationofexposure,thegreatertheriskof
developingsilicosisItisfoundthattheincubationperiodmayvary
fromafewmonthsupto6yearsofexposure,dependinguponthe

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abovefactors
Pathologically,silicosisischaracterizedbyadensenodularfibrosis,
thenodulerangingfrom3to4mmindiameter,Someoftheearly
manifestationsareirritantcough,dyspneaonexertion&painin
chest

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Withmoreadvanceddisease,impairmentoftotallungcapacity
(TLC)iscommonlypresent,AX-rayofchestshows"snowstorm"
appearanceinthelungfields,Silicosisisprogressive&whatismore
importantisthatsilicoticsarepronetopulmonarytuberculosis,a
conditionalcalled"silico-tuberculosis"

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Thereisnoeffectivetreatmentforsilicosis.Fibroticchangethat
havealreadytakenplacecannotbereversed,Itwasmade

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notifiablediseaseundertheFactoriesAct1948&Minesact1952
"Characteristicslungtissuepathologyinnodularsilicosisconsistsof
fibroticnoduleswithconcentric`onion-skinned"arrangementof

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collagenfibers,centralhyalinization,andacellularperipheralzone,
withlightlybirefringentparticlesseenunderpolarizedlight.

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102.Trueaboutgrommetinsertion:
a)Smallplastictubeaeratingmiddleear
b)Maximumdurationofgrommetinsertionis5month

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c)Healingoccursmorequicklyafterextrusionthanafterremoval
d)Itisplacedanteriorlyontympanicmembrane
e)Surgeryisalwaysneededtoremoveit
CorrectAnswer-A:C:D
Answer-(A)Smallplastictubeaeratingmiddleear(C)Healing

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occursmorequicklyafterextrusionthanafterremoval(D)Itis
placedanteriorlyontympanicmembrane
Ifagrommetisinserteditmaybeplacedposteriorlyoranteriorly
dependinguponthepreferenceofthesurgeon.
Thegrommetiseitherrejectedspontaneouslyormayberemoved,

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preferablyunderananaatheticbecausethisismomentarilyPainful.
Atthesecondorcertainlyatthethirdmyringotomy,mostsurgeon
willinsertagrommet.
Tympanoscelerosisisseenmuchmorefrequentlyinchildren.
Extrusionofthetube,themajorityofiatrogenicTMperforationswill

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heal.

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103.TrueaboutVasomotorrhinitis:
a)Itisatypeofallergicreaction
b)Clinicallysimulatenasalallergy
c)Nasalmucosagenerallycongested&hypertrophic

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d)Hypertrophyofinferiorturbinateiscommonlypresent
e)Anti-histaminics&oralnasaldecongestantareusedin
treatment
CorrectAnswer-B:C:D:E
Answer-(B)Clinicallysimulatenasalallergy(C)Nasalmucosa

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generallycongested&hypertrophic(D)Hypertrophyofinferior
turbinateiscommonlypresent(E)Anti-histaminics&oral
nasaldecongestantareusedintreatment
Itisnonallergicrhinitisbutclinicallysimulatingnasalallergywith
symptomofnasalobstruction,rhinorrhoea(sneezing).

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Allthetestsofnasalallergyarenegative
"VMR:Swelling(orhypertrophy)ofinferiorturbinateisfrequently
seen
Clinicfeatures-
Paroxysmalsneezingexcessiverhinorrhoea,nasalobstruction&

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postnasaldrip
Nasalmucosaovertheturbinatesisgenerallycongested&
hypertrophic
Treatment-
anti-histaminics,oralnasaldecongestant;systemicsteroidSurgical

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treatment:Relievingofnasalobstruction&vidianneurectomy.

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104.

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Structurespreservedinradicalneck
dissection-
a)Internaljugularvein

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b)CarotidArtery
c)Accessorynerve
d)Brachialplexus
e)Sternocleidomastiodmuscle
CorrectAnswer-B:D

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Answer-(B)CarotidArtery(D)Brachialplexus
Cervicallymphaticsandlymphnode
Internaljugularvein
Accessorynerve
Submandibulargland

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Sternocleidomastiodmuscle
Tailofparotid
Omohyoidmuscle

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105.FeatureofGranulomatosiswith
polyangiitis:

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a)Nasalpolyp
b)PerforatedNasalseptum
c)Persistantsinus
d)Crustingofnasalmucosa
e)Collapseofnasalbridge

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CorrectAnswer-B:C:D
Answer-(B)PerforatedNasalseptum(C)Persistantsinus
(D)Crustingofnasalmucosa
Granulomatosiswithpolyangiitis(Wegener)isadistinct
clinicopathologicentitycharacterizedbygranulomatousvasculitisof

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theupperandlowerrespiratorytractstogetherwith
glomerulonephritis.
Disseminatedvasculitisinvolvingbothsmallarteriesandveinsmay
occur.
Nasalfindingsincludecrustinggranulations,septalperforation&a

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saddlenose
Destructionoftheseptumwithacharacteristicimplosionofthenasal
bridge.

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106.Trueaboutvestibularschwanomma:
a)U/1hearinglossiscommonpresentation

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b)Mostlymalignant
c)MostcommontumourofCPangle
d)Sensorineuraldeafness
e)Uncapsulated
CorrectAnswer-A:C:D

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Answer-(A)U/1hearinglossiscommonpresentation(C)Most
commontumourofCPangle(D)Sensorineuraldeafness
Benignencapsulated,extremelyslowgrowingtumors.
80%ofallCerebello-pontineangletumors.
Earliestsymptoms-Unilateralsensorineuraldeafness.

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Thethreemostcommonpresentingsymptomsincludeinsidious
hearingloss,high-pitchedtinnitus,anddisequilibrium.
Superiordivisionofvestibularnerve?mostcommonsiteofAN.

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107.Tensorofvocalcordincludes:
a)Arytenoid

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b)Thyroarytenoid
c)Interarytenoid
d)Posteriorcricoarytenoid
e)Cricothyroid
CorrectAnswer-E

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Answer-E.Cricothyroid
MuscleofLarynx-
AbductorPosteriorcricoarytenoid
Adductor(3musclegiveninDhingra):Lateralcricoarytenoid,
Interarytenoid(Transversethyroarytenoid)

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TensorCricothyroid&vocalis
AllmuscleoflarynxaresuppliedbyRecurrentLaryngealnerves.
ThelatterreceiveitsinnervationfromExternalLaryngealnerve.
Sensory-
Abovevocalcords-InternalLaryngealnerveabranchofSuperior

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Laryngealnerve.
Belowvocalcords-RecurrentLaryngealnerve

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108.Allaretrueaboutvocalcordnodule
except:
a)Causedbyphonotrauma

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b)CommonlyoccuratJunctionofmiddle&posterior1/3
c)CommonatjunctionofA1/3withP2/3
d)Commoninteachers
e)Treatmentisspeechtherapy
CorrectAnswer-B

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Answer-B.CommonlyoccuratJunctionofmiddle&posterior
1/3
Vocaltraumawhenpersonspeaksinunnaturallowtonesfor
prolongedperiodsorathighintensities.
Patientscomplainsofhoarseness.

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Vocalfatigue&painintheneckonprolongedphonationareother
commonsymptoms.
Theymostlyaffectteachers,actors,vendorsorpopsingers
Surgeryisrequiredforlargenodulesornodulesoflongstandingin
adults.

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Speechtherapy&re-educationinvoiceproductionareessentialto
preventtheirrecurrence.
Theyappearsymmetricallyonthefreeedgeofvocalcord,atthe
junctionofanteriorone-third,withtheposteriortwo-third.

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109.Trueaboutallergicfungalsinusitis:

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a)Fungalhyphaeispresentinallergicmucinwhichispathological
hallmark
b)Invasionofthesinusmucosawithfungus
c)Allergicreactiontofungus
d)Antifungaltreatmentleadtoimprovementofsymptom

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e)Surgicalclearanceismainstayoftreatment
CorrectAnswer-A:C:E
Answer-(A)Fungalhyphaeispresentinallergicmucinwhichis
pathologicalhallmark(C)Allergicreactiontofungus
(E)Surgicalclearanceismainstayoftreatment

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Itisanallergicreactiontothecausativefungus&presentswith
sinunasalpolyposis&mucin.
Thereisnoinvasionofthesinusmucosawithfungus.
Usuallymorethanonesinusareinvolvedononeorbothsides.
Featuresofrefractorysinusitisandnasalpolyposisarepresent.

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aGellandCoombstypeI(lgE-mediated)immuneresponseto
fungalantigens.TypeIIIandIVimmuneresponsesmayalsobe
involved.
Itconsistofconsistingofeosinophils,Charcot-Leydencrystals,and
scatteredfungalhyphae.

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Diagnosis
CTscanshowsmucosalthickeningwithhyperdenseareas
ThediagnosisofAFSisconfrmedbydemonstrationofallergic
mucinandcultureofthefungus.
Treatment-

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Surgicaldebridementandaerationoftheinvolvedsinusfollowedby
theuseofsystemicandtopicalintranasalcorticosteroids.

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theuseofsystemicandtopicalintranasalcorticosteroids.

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110.Trueaboutconductivehearingloss:
a)Presbycusis

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b)Cholestetoma
c)Acousticneuroma
d)Perforationoftympanicmembrane
e)Serousotitismedia
CorrectAnswer-B:D:E

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Answer-(B)Cholestetoma(D)Perforationoftympanic
membrane(E)Serousotitismedia
Causedbyanydiseaseprocessinterferingwithconductionofsound
fromtheexternaleartothestapedio-vestibularjoint.
CommonestcauseofhearinglossinchildrenisChronicsecretory

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otitismedia.
Perforationoftympanicmembrane.
Disruptionofossicles-traumatoossicularchain,CSOM,
cholesteatoma
Fixationofossicles-otosclerosis,tympanosclerosis

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Eustachiantubeblockage

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111.TrueaboutAndyGumpdeformity:
a)Occursduedefectsoftheanteriormandibulararch
b)Hemimandibulectomycancause
c)Marginalmandibulectomycancause

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d)Treatmentisadequatereconstructionofanteriormandibular
archwithplate&graft
e)None
CorrectAnswer-A:B:D
Answer-(A)Occursduedefectsoftheanteriormandibulararch

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(B)Hemimandibulectomycancause(D)Treatmentisadequate
reconstructionofanteriormandibulararchwithplate&graft
Analteredfacialprofileduetoamisinglowerjawbone,ormandible
Resectionoftheanteriormandibulararchproducesthe"Andy
Gump"deformity.

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Causes
Marginalmandibulectomy
Segmentalmandibulectomy
Archpreservingmandibulectomy
Hemimandibulectomy

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112.Foreignbodyintrachea&bronchuscan
cause:
a)Bronchiectasis
b)Atelectasis
c)Subcutaneousemphysema

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d)Pneumothorax
e)All
CorrectAnswer-A:B:C:D
Answer-(A)Bronchiectasis(B)Atelectasis(C)Subcutaneous
emphysema(D)Pneumothorax

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Trachea-
Choking,stridor,wheeze,cough,palpatorythud,audibleslap.
Bronchi-
Cough,wheeze&diminishedairentrytolungformsatriad
Respiratorydistresswithswellingofforeignbody

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Lungcollapse,emphysemo,pneumonitis,bronchiectosisorlung
obscessarelatefeature.

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113.Periosteumoforbitisstronglyattached
to:
a)Medialwalloforbit

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b)Lateralwalloforbit
c)Flooroforbit
d)Roofoforbit
e)Sutureslines
CorrectAnswer-E

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Answer-(E)Sutureslines
Periorbita:Itistheperiostealliningoforbitalwalls.Theperiorbitais
attachedtothesuturelines,fissuresandforaminaoftheorbit.
Posteriorlytheperiorbitaiscontinuouswiththeopticnervesheath.

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114.Poorprognosticfactorfor

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retinoblastomaincludes:
a)>4mmsizeoftumour
b)>2mmsizeoftumor
c)Associatedglaucoma
d)Undifferentiatedtumourcells

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e)Sclerainvolvement
CorrectAnswer-A:C:D:E
Answer-(A)>4mmsizeoftumour(C)Associatedglaucoma
(D)Undifferentiatedtumourcells(E)Sclerainvolvement
(>4mmsizeoftumor)mighthavepoorprognosis

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Childrenwithretinoblastomawhodevelopglaucomatendtohavea
worseprognosis.
Opticnerveinvolvement,undifferentiatedtumourcellsandmassive
choroidalinvasion.

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115.TrueaboutA-Vpatternheterotropia

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squint:
a)ThetermsAor'V'patternsquintarelabelledwhentheamount
ofdeviationinsquintingeyevariesbymorethan10?and15?,
respectively,betweenupwardanddownwardgaze.
b)ThetermsA!or'V'patternsquintarelabelledwhentheamount

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ofdeviationinsquintingeyevariesbymorethan20?and25?,
respectively,betweenupwardanddownwardgaze.
c)Usually,overactionoftheinferiorobliqueorweaknessof
superiorobliqueleadstoaApattern&overactionofthe
superiorobliqueorweaknessofinferiorobliquetoanVpattern

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d)Usually,overactionoftheinferiorobliqueorweaknessof
superiorobliqueleadstoaVpattern&overactionofthe
superiorobliqueorweaknessofinferiorobliquetoanApattern
e)ObliquemuscledysfunctionisthecommonestcauseofAV
pattern

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CorrectAnswer-A:D:E
Answer-(A)ThetermsAor'V'patternsquintarelabelledwhen
theamountofdeviationinsquintingeyevariesbymorethan
10?and15?,respectively,betweenupwardanddownwardgaze.
(D)Usually,overactionoftheinferiorobliqueorweaknessof

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superiorobliqueleadstoaVpattern&overactionofthe
superiorobliqueorweaknessofinferiorobliquetoanApattern
(E)ObliquemuscledysfunctionisthecommonestcauseofAV
pattern
ThetermsKor'V'patternsquintarelabelledwhentheamountof

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deviationinsquintingeyevariesbymorethan

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deviationinsquintingeyevariesbymorethan
l0and15,respectively,betweenupwardanddownwardgaze.
Aand'V'esotropia:InAesotropiatheamountofdeviationincreases
inupwardgaznand,decreasesindownwardgaze.

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Thereverseoccursin'V'esotropia.
'Aand'V'exotropia:ln"A"exotropiatheamountofdeviation
decreasesinupwardgazearad,increasesindownwardgaze.
Thereverseoccursin'V'exotropia.

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116.Trueaboutcongenitalesotropia:

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a)Onsetisonlyafter1yearofage
b)Amblyopiamaydevelop
c)Angleofdeviationisusuallyfixed&large
d)Surgeryshoulddoneafter2years
e)None

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CorrectAnswer-B:C
Answer-(B)Amblyopiamaydevelop(C)Angleofdeviationis
usuallyfixed&large
Asarule,thedeviationisequaltoorlargerthan35prismdiopters
(17.5?)Qandiscomitant,measuringroughlythesameinallgaze

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positions,distanceandnear(i.e.large&stableangleofdeviation)
Amblyopiadevelopsin25-40%ofcases
Treatment:Surgeryistreatmentofchoice
Timeofsurgery:Surgeryshotldbedoneb/w6monthsto2years
(preferablybefore1yrofage)

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117.Trueaboutlensofeye:
a)Avascular
b)Growthtakesplacethroughoutlife
c)Deriveitsnutritionfromaqueoushumour
d)Transparent

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e)Ectodermalinorigin
CorrectAnswer-A:B:D:E
Answer-(A)Avascular(B)Growthtakesplacethroughoutlife
(D)Transparent(E)Ectodermalinorigin
Lensisatransparent,bi-convex,crystallinestructure.

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Lenscapsule:Thickestatpre-equatorregion&thinnestatthe
posteriorpole.
"Thelensgrowinsizecontinuouslythroughoutlife.
Thelensoftheeyeisdevelopedfromathickenedareaofsurface
ectoderm,thelensplacode.

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Sourceofnutrientsupply:Thecrystallinelens,beinganavascular
structure.

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118.Featuresofocularischemicsyndrome
includesallexcept:
a)Microaneurysm

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b)Dot&blothaemorrhage
c)Morecommoninelderlywomenthanmen
d)Discedema
e)Amaurosisfugax
CorrectAnswer-C:D

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Answer-(C)Morecommoninelderlywomenthanmen(D)Disc
edema
Ocularischaemicsyndromereferstoarareconditionresultingfrom
chronicocularhypoperfusionsecondarytocarotidarterystenosis.
Riskfactors-malegender,oldage(60-90years)smoking,for

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carotidstanceshypertension,
Clinicalfeatures-
Amaurosisfugax
Retinalarteryocclusion
Transientcerebralischaemicattacks

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Usuallyunilateral
Pain-ocularorperiorbital
Fundusexaminationmayreveal:
Retinashowmidperipheraldotandblothaemorrhages,
microaneurysmsandcottonwoolspots.

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119.Allareocularemergencyexcept:
a)Eyeinjury
b)Sympatheticophthalmitis
c)Retinalarteryocclusion
d)CRVO

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e)Bacterialendophthalmitis
CorrectAnswer-D
Answer-(D)CRVO
Comonophthalmicemergenciesare:-
Acutecongestiveglaucoma

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Rupturedglobe
Ulcerativeortraumaticcornealdiseases
Opticneuritis
Hyphema
Endophthalmitis

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Acuteblindness
Orbitalcellulitis
Eyelidorconjunctivallaceration
Centralretinalarterialocclusion(CRAG)
Anteriorlenssubluxation

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Retinaldetachment

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120.Allaretrueregardingcorneaexcept:
a)Endotheliumhelpinmaintainingdehydratedstate
b)Oxygenismostlyderivedbyepitheliumdirectlyfromtheair
throughtearfilm

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c)Glucosesupplyforcornealmetabolismismainlyderivedfrom
theaqueous
d)Cornealthicknessismoreatcenterthanperiphery
e)Richlyvascular
CorrectAnswer-D:E

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Answer-(D)Cornealthicknessismoreatcenterthanperiphery
(E)Richlyvascular
Outer&fibrouscoatofEYEBALL.
Transparent,anterior1/6thsegmentofeyeball.
Non-vascular

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Mostoftherefractionineyeoccuratanteriorsurfaceofcornea(air-
tearinterface),i.e.,Anteriorsurfaceofcorneaisthemostimportant
refractivestructureofeye.
Themostactivelymetabolisinglayersofthecorneaareepithelium&
endothelium.

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121.Pulmonarybloodflowincreasedinall
except:
a)ASD
b)VSD
c)TOF

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d)Transpositionofgreatarteries(TGA)
e)PDA
CorrectAnswer-C
Answer-(C)TOF
TruncusArteriosus,completeTGAandTAPVCareassociatedwith

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increasedpulmonarybloodflow.
TOF-WhentheRVoutllowobstructionissevere,pulmonaryblood
llowisreducedmarked.

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122.Caudaequinaisdifferentiatedfrom
conusmedullarisbypresenceof:

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a)Anklejerkmaylost
b)Kneejerkmaylost
c)Motorchanges
d)Bladder&bowelinvolvementasinitialpresentation
e)Rootpain

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CorrectAnswer-B:C:E
Answer-(B)Kneejerkmaylost(C)Motorchanges(E)Rootpain
ConusMedullarisvs.CaudaEquinaSyndromes
Conusmedullaris
Caudaequinasyndrome

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syndrome
Vertebral
L1-L2
L2-sacrum
level

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Sacralcordsegmentand
Spinallevel
Lumbosacralnerveroots
roots
Presentation Suddenandbilateral

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Gradualandunilateral
Radicular
Lesssevere
Moresevere
pain

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Lowback
More
Less
pain
Symmetrical,lessmarked

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Moremarkedasymmetric
Motor
hyperreflexicdistalparesis areflexicparaplegia,
strength
ofLL,fasciculation

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atrophymorecommon
Bothkneeandanklejerks
Reflexes
Anklejerksaffected
affected

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Localizednumbnessto
Localizednumbnessat
Sensory
perianalarea,
saddlearea,asymmetrical,

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symmetricalandbilateral
unilateral
Sphincter
Earlyurinaryandfecal
Tendtopresentlate

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dysfunction incontinence
Impotence
Frequent
Lessfrequent

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123.Whichofthefollowingis/arethefeature

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(s)ofheadacheduetoincreasein
intracranialpressure:
a)Increaseonsupineposition
b)Mostcommonlypresentsassevereacuteheadache
c)Pulsatileinnature

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d)Throbbingcharacter
e)Analgesicsarenotveryhelpful
CorrectAnswer-A:E
Answer-(A)Increaseonsupineposition(E)Analgesicsarenot
veryhelpful

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"Headacheduetointracranialpathologrorraisedintracranialtension
worsensduringcoughingstrainingoradoptingtheheadinlow
posture.
Generalizedheadachethatispresentonwakingandimprovesas
thedaygoeson.

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Headacheonrisinginthemorningornocturnalheadacheisako
characteristicofobstructivesleepapneaorpoorlycontrolled
hypertension.
Corticosteroidarerecommendedinacuteheadacheduetoraised
ICP.

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124.Earlydiastolicmurmurisseeninwhich
condition(s)-
a)Mitralstenosis
b)Tricuspidstenosis
c)Aorticregurgitation

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d)Pulmonaryregurgitation
e)Atrialmyxoma
CorrectAnswer-C:D
Answer-(C)Aorticregurgitation(D)Pulmonaryregurgitation
Aorticregurgitation-Themurmurislowintensity,high-pitched,best

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heardovertheleftsternalborderorovertherightsecondintercostal
space.
AnAustinFlintmurmurisusuallyassociatedwithsignificantaortic
regurgitation.
Pulmonaryregurgitation-Pulmonaryregurgitationismostcommonly

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duetopulmonaryhypertension(Graham-Steellmurmur)
Leftanteriordescendingarterystenosis-Thismurmur,alsoknown
asDock'smurmur.

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125.Allaretrueaboutuseoftriptansin
migraineexcept:

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a)Usedinprophylaxisofmigraine
b)Efficacyincreasedwithconcomitantuseofergot
c)CanbegivenforlongtermwhereNSAIDSisnoteffective
d)GivenwhenNSAIDSisnoteffective
e)None

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CorrectAnswer-A:B:C
Answer-(A)Usedinprophylaxisofmigraine(B)Efficacy
increasedwithconcomitantuseofergot(C)Canbegivenfor
longtermwhereNSAIDSisnoteffective
TriPtansarerapidlyeffectiveagentforabortingattacks.

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OralStimulationofS-HT1B/1Dreceptorscanstopanacutemigraine
attack.
Triptansareselective5-HT1B/lDreceptoragonists.

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126.Allaretrueaboutrenalarterystenosis
except:

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a)ACEinhibitorscanbeusedinbilateralrenalarterystenosis
b)ACEinhibitorscanbeusedinunilateralrenalarterystenosis
c)ACEinhibitorsarebestdrugtocontrolDMassociated
hypertension
d)Excision&Graftingistreatmentofchoice

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e)Angioplastywithorwithoutstenting,andsurgicalbypassused
onlyinrefractorycases
CorrectAnswer-A:D
Answer-(A)ACEinhibitorscanbeusedinbilateralrenalartery
stenosis(D)Excision&Graftingistreatmentofchoice

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ACEinhibitorsarecontraindicatedinbilateralrenalarterystenosis.
ACEinhibitorsareusefulinrenovascularhypertension.
ARFisprecipitatedbyACEinhibitorsinpatientswithb/lrenal
stenosis
Atheroscleroticischemicrenaldiseaseaccountsfornearlyallcases

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ofrenalarterystenosis.
Renalangiographyisthegoldstandardfordiagnosis.

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127.Whichofthefollowingcauses
glomerularproteinuria:
a)DM

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b)Amyloidosis
c)Multiplemyeloma
d)ACEinhibitorsdecreasesproteinuria
e)All
CorrectAnswer-A:B:D

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Answer-(A)DM(B)Amyloidosis(D)ACEinhibitorsdecreases
proteinuria
Nephroticsyndrome
Membranoproliferativeglomerulonephritis,membranous
nephropathy

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HepatitisBandCnephropathy,HIVnephropathy
Refluxnephropathy
Amyloidosis
Postinfectiousglomerulonephritis,lgA,nephropathy,Henoch-
Schonleinnephritis,lupusnephritis,Alport,syndrome

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128.AllaretrueaboutChylouspleural
effusionexcept:
a)StainpositivewithsudanIII
b)Cutoffleveloftriglycerideforchylouseffusionis>150mg/dl
c)Cutoffleveloftriglycerideforchylouseffusionis>50mg/dl

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d)Milkycolourdisappearswithalkali
e)Milkycolourdisappearswithether
CorrectAnswer-B:C
Answer-(B)Cutoffleveloftriglycerideforchylouseffusionis>
150mg/dl(C)Cutoffleveloftriglycerideforchylouseffusionis

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>50mg/dl
Pleuralfluid-milkywhite,triglyceridelevels>ll0mgldL
Chylomicronsisalsodiagnosticofachylothorax&canbeusedasa
confirmatorytestifthetriglyceridelevelsareequivocal.
Onmicroscopy,fatglobulewiIIclearwithalkaliorether&willstain

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withSudanIII.
Themostcommoncauseofchylothoraxistrauma.

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129.Chylouspleuraleffusionoccurin:
a)T.B
b)Malignancy

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c)SLE
d)Thoracicductinjury
e)Congestiveheartfailure
CorrectAnswer-A:B:D
Answer-(A)T.B(B)Malignancy(D)Thoracicductinjury

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TB
Malignancy
Lymphoma
Filariaisis
Myxoedema

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Trauma

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130.Featuresofparkinsonismincludeall
except-
a)Intentiontremors
b)Flaccidity

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c)Maskface
d)Rigidity
e)Restingtremors
CorrectAnswer-A:B
Answer-A,B,Intentiontremors,Flaccidity

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FourcardinalfeaturesofPDthatcanbegroupedundertheacronym
TRAP-
Tremoratrest,Rigidity,Akinesia(orbradykinesia)andPostural
instability.

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131.Whichofthefollowingcausesmassive

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splenomegaly:
a)CLL
b)Multiplemyeloma
c)Follicularlymphangitis
d)Gaucher'sdisease

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e)Sjogren'ssyndrome
CorrectAnswer-A:D
Answer-(A)CLL(D)Gaucher'sdisease
Thecausesofmassivesplenomegalyinclude:
Thalassemia

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Visceralleishmaniasis(KalaAzar)
Schistosomiasis
Chronicmyelogenousleukemia
Chroniclymphocyticleukemia
Lymphomas

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Hairycellleukemia
Myelofibrosis
Polycythemiavera
Gauchersdisease
NiemannPickdisease

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Sarcoidosis
Autoimmunehemolyticanemia
Malaria
Syphilis

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132.ACTHdependentcushingsyndrome

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is/arecausedby:
a)Pituitaryadenoma
b)Adrenaladenoma
c)Adrenocorticalcarcinoma
d)Pheochromocytoma

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e)All
CorrectAnswer-A:D
Answer-(A)Pituitaryadenoma(D)Pheochromocytoma
CushingsyndromeiscausedtoACTH-producingadenoma.
ETIOLOGY

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Pituitarycorticotropeadenomas
Iatrogenichypercortisolism(mostcommon)
EctopictumourACTHproduction
Cortisol-producingadrenaladenomas
Adrenalcarcinoma

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Adrenalhyperplasia
Pheochromocytoma

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133.HyperglycemicHyperosmolarstate
(HHS)ischaracterizedby:
a)Hyperglycemia

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b)Acidosis
c)Dehydration
d)Coma
e)None
CorrectAnswer-A:C:D

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Answer-(A)Hyperglycemia(C)Dehydration(D)Coma
Thisisalifethreateningcomplicationofdiabetesmellitus
characterizedbymarkedhyperglycemia,dehydration,comaand
hyperosmolaritywithorwithoutmentalobtundationintheabsenceof
significantketoacidosis

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134.Whichofthefollowingistrueabout
Pheochromocytoma:
a)Sestabimiscanisdonebeforesurgery
b)Mostlyaremalignant
c)Surgeryismainstayoftreatment

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d)Priorablockerisgiven
e)Priorpblockerisgiven
CorrectAnswer-C:D:E
Answer-(C)Surgeryismainstayoftreatment(D)Priorablocker
isgiven(E)Priorpblockerisgiven

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Sestambiscanningisthepreferredwayinwhichtolocalizediseased
parathyroidglandspriortooperation.
Pheochromocytoma&paragangliomaarecatecholaminesproducing
tumoursderivedfromsympatheticandparasympatheticnervous
system.

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TheyarederivedfromChromaffincells.
Treatment-
Laproscopicresection
Alphaadrenoreceptorblocker(phenoxybenzamine)-block
catecholamineexcess

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Betablockade-tachycardiaorarrhythmias
Centralvenouscatheter&invasivearterialmonitoringused.
AdultDoseofClonidineforClonidineSuppressiontestis0.3mg
(0.3mg/70kg)administeredorally.ClonidineSuppressionTest
Completetumorremovalistheuhimatetherapeuticgoal,,canbe

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achievedbypartialortotaladrenalectomy.

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135.Treatmentofcrohn'sdiseaseincludes:
a)Steroid
b)5-Aminosalicylicacidagents
c)Azathioprine

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d)Daclizumab
e)Adalimumab
CorrectAnswer-A:B:C:E
Answer-(A)Steroid(B)5-Aminosalicylicacidagents
(C)Azathioprine(E)Adalimumab

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Treatment-
5-ASAagents(mesalamine)notusednow
Mildtomoderatediseaseinvolvingterminialileumorascending
colon?Budesonide
Severediseaseinvolvingproximalsmallintestineordistalcolon?

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Prednisone
Immunomodulators(Azathioprine,mercaptopurine,methotrexate)
andformaintenanceofremissionor
inductionofremissionalongwithsteroidsinseveredisease
Anti-TNFtherapy(Infliximab,adalimumab,certolizumab)-first-line

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agentstoinduceremissioninmoderatetoseverediseaseandto
maintainremission
Anti-integrins:Natalizumab(anti-a4integrin)?ifnoresponsetoanti-
TNFagents

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136.EnergyselectioninCPRaccordingto

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AHA2010guidelineis/are:
a)Monophasic120-200J,Biphasic360J
b)Monophasic200J,Biphasic360J
c)Monophasic120J,Biphasic200J
d)Monophasic360J,Biphasic120-200J

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e)Monophasic360J,Biphasic220J
CorrectAnswer-D
Answer-(D)Monophasic360J,Biphasic120-200J
2010AIIAguidelineforCPRContrarytopreviousrecommendation
of3succesiveshocks(200,300,360J)nowadayslst&all

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subsequentshocksareof360Jouleswithmonophasic&120-200
louleswithbiphasic.

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137.Whichofthefollowinglesionrepresent
tertiarysyphilis:
a)Condylomatalata

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b)Mattedlymphnode
c)Condylomataacuminata
d)Tabesdorsalis
e)Gummaformation
CorrectAnswer-D:E

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Answer-(D)Tabesdorsalis(E)Gummaformation
Gumma,neurosyphilis/tabesdorsalis
Ostitis,periostitis
Aortitis,aorticinsufficiency,coronarystenosisandnocturnalangina

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138.Whichofthefollowingstatement(s)

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is/arecorrectregardingsyphilisin
pregnancy&congenitalsyphilis:
a)Foetushasmorechanceofinfectionin3rdT.M
b)Syphiliscanbepreventedbygivingpenicillininneonate
c)Ifinfantshowingsignsofsyphilis,he/sheshouldbegivensingle

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doseofcrystallinepenicillin
d)Ifinfantdoesnothaveanysignsofsyphilis,he/sheshouldbe
givenbenzathinepenicillin
e)Foetusismostlikelyaffectedifmotherissufferingfromprimary
orsecondarysyphilisthanlatesyphilis

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CorrectAnswer-A:B:D:E
Answer-(A)Foetushasmorechanceofinfectionin3rdT.M
(B)Syphiliscanbepreventedbygivingpenicillininneonate
(D)Ifinfantdoesnothaveanysignsofsyphilis,he/sheshould
begivenbenzathinepenicillin(E)Foetusismostlikelyaffected

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ifmotherissufferingfromprimaryorsecondarysyphilisthan
latesyphilis
CongenitalSyphilis
(a)EarlyCongenitalSyphilis:
Snuffles(rhinitis)istheearliestfeature.

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Lesionsarevesiculobullousandsnailtrackulcersonthemucosa
(b)LateCongenitalSyphilis:
CharacterizedbyHutchinson'striadinterstitialkeratitis
8thnervedeafness
Hutchinson'steethi.e.peggedcentralupperincisors

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Saddlenose,sabretibia,mulberrymolars
Bulldog'sjaw(protrusionofjaw)
Rhagades(linearfissureatmouth,nares)
Frontalbossing,hotcrossbundeformityofskull
Clutton'sjoint(painlessswellingofjoints,mostcommonlybothknee)

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Syphilisinpregnancy-
Allpregnantwomenshouldhaveanontreponemalserologictestfor
syphilisatthetimeofthefirstprenatalvisit.
Theonlyacceptabletreatmentforsyphilisinpregnancyispenicillin
indosageschedulesappropriateforthestageofdisease.

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Penicillinpreventscongenitalsyphilisin90%ofcases,evenwhen
treatmentisgivenlateinpregnancy.
Syphiliticwomentoherfoetusmayoccuratanystageofpregnancy.

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139.AsciticfluidwithTSAAG&Talbumin
is/arefoundin:

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a)T.B
b)CHF
c)Cirrhosis
d)Pancreatitis
e)Nephroticsyndrome

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CorrectAnswer-B
Answer-B.CHF
Serum-ascitesalbumingradient(SAAG)isusefulfordistinguishing
ascitescausedbyportalhlpertensionfromnonportalhypertensive
ascites.

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ASAAG>1.1g/dl-reflectsthepresenceofportalhypertension
ASAAG<1.1g/dl-tuberculousperitonitis,peritoneal
carcinomatosis,orpancreaticascites.
Forhigh-SAAG(>1.1)ascites-
Anasciticproteinlevelof>2.5g/dlindicatesthatthehepatic

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sinusoidsoccursincardiacascites,sinusoidalobstruction
syndrome,orearlyBudd-Chiarisyndrome.
Anasciticproteinlevel<2.5g/dl,indicatescirrhosis,lateBudd-
Chiarisyndrome,ormassivelivermetastases.

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140.Forcancerpain,ladder2stepinWHO's

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painstepladderincludes:
a)Oralmorphine
b)Injectablemorphine
c)Codeine
d)Fentanyl

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e)Tramadol
CorrectAnswer-C:E
Answer-(C)Codeine(E)Tramadol
Secondstep:Intermediatestrengthopioids:codeine,tramadolor
dextropropoxyphene.

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141.Trueaboutpepticulcer:
a)H.pyloricausespepticulcer
b)EradcationtherapybetterthanPPItherapy
c)EradicationtherapyalsocontainPPI
d)DuodenumulcerismorecommonlyassociatedwithH.pylori

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thangastriculcer
e)GastriculcerismorecommonlyassociatedwithH.pylorithan
duodenalulcer
CorrectAnswer-A:B:C:D
Answer-(A)H.pyloricausespepticulcer(B)Eradcation

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therapybetterthanPPItherapy(C)Eradicationtherapyalso
containPPI(D)Duodenumulcerismorecommonlyassociated
withH.pylorithangastriculcer
Hpyloriinfection.
Medicaltreatment:ProtonpumpinhibitorsorH2blockers;H.pylori

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eradication
EradicationofH.pyloriandtherapy/preventionofNSAID-induced
diseaseisthemainstayoftreatment.
Combinationregimensthatusetwoorthreeantibioticswithaproton
pumpinhibitor.

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142.FeaturesofConstrictivepericarditis
whichdifferentiatewithrestrictive
cardiomyopathy:
a)Prominentydescentmorecommon
b)Pericardialknock

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c)Thirdheartsound
d)Thickenedpericardium
e)Rightventricularhypertrophy
CorrectAnswer-A:B:D
Answer-(A)Prominentydescentmorecommon(B)Pericardial

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knock(D)Thickenedpericardium
Diastolicpressureareequalizedinconstrictivepericarditisbutnotin
RestrictivecardiomyopathyThickennedpericardiumisseenin
constrictivepericarditisbutnotinRestrictivecardiomyopathy
Rightventricularsizeisusuallynormalinbothandpericardial

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effusionisusuallyabsentinboth,RVsizeandpericardialeffusion,
thereforecannotdistinguishbetweenconstrictivepericarditisand
Restrictivecardiomyopathy.

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143.CURB-65criteriaforseverepneumonia
includes:

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a)Confusion
b)Uremia
c)Respiratoryrate30/min
d)SystolicBloodpressure80mmHg
e)Diastolicbloodpressure,systolic50mmHg

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CorrectAnswer-A:B:C
Answer-(A)Confusion(B)Uremia(C)Respiratoryrate30/min
TheCURB-65assessesfive-
Confusion
Uremia

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Respiratoryrate
Bloodpressure
Age>65

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144.Whichofthefollowingfeaturefavours
emphysemaratherthaninterstitial

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fibrosis:
a)TFEV1
b)LFEV1/FEV6
c)TRV
d)TTLC

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e)4,Peakexpiratoryflow
CorrectAnswer-B:C:D:E
Answer-(B)LFEV1/FEV6(C)TRV(D)TTLC(E)4,Peakexpiratory
flow
Interstitiallungdiseaselikeinterstiulfibrosisarecharacterizedbya

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normalorelevatedFEVIFVCratiowhichischaracteristically>0.7.
PFTresultscomparingobstructiveandrestrictivedisease(maynot
beapplicableforallformsoflung(disease)
FEVI=forcedexpiratoryvolumeinonesecond;FVC=ForcedVital
Capacity;FEF25_75=ForcedExpiratoryFlowat25%=75%vital

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capacity;TLC=TotalLungCapacity;DLCO=DiffusionCapacityof
theLungforCarbonmonoxide.

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145.Nottrueaboutkaposisarcoma-
a)CausedbyHHV-8
b)ClassicalformisassociatedwithHIV

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c)Isanangioproliferativedisorder
d)Monocentrictumor
e)MayinvolveGIT
CorrectAnswer-B:D
Answer-(B)ClassicalformisassociatedwithHIV

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(D)Monocentrictumor
KaPosisarcomaismulticentricvasculartumorcausedbyHuman
herpesvirus-8(HHV-8)alsocalledKaposisarcomaassociated
herpesvirus(KSHV).
TherearefourformsofKaposisarcoma-

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l)Classicalform(EuropeanorMediterraneanKS)
ThereisnoassociationwithHIV.Thereareskinplaquesand
nodules.
2)Africanform(EndemicformorEquatorialform)
ThereisnoassociationwithHIV.Thereislymphadenopathy

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3)Transplantassociated(immunosuppressionassociated)KS
4)AIDScssociated(Epidemic)KS
ItisassociatedwithHIVinfecfion

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146.Whichofthefollowingis/arefeature(s)of
hypomagnesemia

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a)Tremors
b)Improvementseenwithcalciumsupplementation
c)Atheroidmovements
d)Seizure
e)Bradycardia

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CorrectAnswer-A:B:C:D
Answer-(A)Tremors(B)Improvementseenwithcalcium
supplementation(C)Atheroidmovements(D)Seizure
Clinicalfeaturesaremostly:
1. Neuromuscular&CNShyperirritability:Tetany,Seizura,tremer,

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muscleweakness,ataxia,nystagmus,vertigo,atheroidmovement,
depression,irritability,deliriumandpsychosis.
2. Cardiacarrhythmias:Sinustachycardia,othersupraventricular
tachycardia,andventriculararrhythmias.

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147.Featureofunstableangina:

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a)TTroponin
b)TransientelevationofSTsegment
c)DepressionofSTsegment
d)Qwave
e)Twaveinversion

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CorrectAnswer-B:C:E
Answer-(B)TransientelevationofSTsegment(C)Depression
ofSTsegment(E)Twaveinversion
InUA,ST-segmentdepression,transientST-segmentelevation,
and/orT-waveinversionoccurin30to50%ofpatients.

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ThePresenceofnewST-segmentdeviation.
T-wavechangesaresensitiveforischemiadeepT-waveinversions.

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148.Allaretrueaboutrheumatoidfactor
except:
a)AlsofoundinSjogrensyndrome

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b)Mayalsopresentnormally
c)ItisbasicallyIgM
d)Itspresenceisdiagnosticofrheumatoidarthritis
e)None
CorrectAnswer-A:B:C

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Answer-(A)AlsofoundinSjogrensyndrome(B)Mayalso
presentnormally(C)ItisbasicallyIgM
-IgM,IgG,andIgAisotypesofRFoccurinserafrompatientswith
RA.
SerumIgMRFhasbeenfoundin75-80%ofpatientswithRA.

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Foundinotherconnectivetissuediseases,suchasprimary
Sjogren'ssyndrome,systemiclupuserythematosus,andtypeII
mixedessentialcryoglobulinemia.
Anti-CCPantibodiesarethemostspecificbloodtestforrheumatoid
arthritis

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149.Whichofthefollowingisthefeature(s)
ofposteriorcranialfossafracture:
a)Bleedingfromear
b)Discolourationofskin&collectionofbloodoccurintheregion
ofmastoidprocess

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c)Boggyswellinginthenapeoftheneck
d)Bleedingfromnose
e)CSFrhinorrhoea
CorrectAnswer-B:C
Answer-(B)Discolourationofskin&collectionofbloodoccur

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intheregionofmastoidprocess(C)Boggyswellinginthenape
oftheneck
Extravasationofbloodinthesuboccipitalregioncausingboggy
swellinginthenepeoftheneck.
9th,10th&llthcranialnervesmaybeinyolved

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Battlesign:Discolourationofsiin&collectionofbloodoccurinthe
regionofmastoidprocess.

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150.Symptomofoveractivebladderare:
a)Increaseddaytimefrequency
b)Nocturia

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c)Hesitancy
d)Dysuria
e)Urgency
CorrectAnswer-B:E
Answer-(B)Nocturia(E)Urgency

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Symptomsofoveractivebladder(OAB)resultfromsuddenand
involuntarycontractionsofthebladdermuscles,leadingto-
Suddenneedtourinate(urinaryurgency)and/or
Urinaryincontinence(leakageofurine)
urinaryfrequency(havingtourinateoften)&

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Nocturia(urinatingfrequentlyatnight)

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151.Trueaboutundescendedtestis
a)U/LmorecommonthanB/L
b)Missingtestisonpalpationmaybeduetoagenesis
c)10%bilateral

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d)Undescendedtestismaybeassociatedwithabsentkidney
e)Stephenfowlertechniqueinvolvesrenalarteryligation
CorrectAnswer-A:B:C:D
Answer-A,U/LmorecommonthanB/LB,Missingtestison
palpationmaybeduetoagenesisC,10%

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bilateralD,Undescendedtestismaybeassociatedwithabsent
kidney
Cryptorchidismisthemostcommoncongenitalabnormalityofthe
genitourinarytract.
Cryptorchidismmeanshiddentestis.

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Anabsenttestismaybeduetoagenesisoratrophysecondaryto
intrauterinevascularcompromisealsoknownasthe"vanishing
testissyndrome".
Bilaterallyabsenttestesisanorchiawhichis10%cases.
MorecommononRightSide.

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Complicationsofundescendedtestes
Torsioncanbeseeninincompletetesticulardescent
Sterilityisseeninbilateralcases(especiallyintra-abdominaltestes)
Incompletetesticulardescentpredisposestomalignantdisease;
cancerismorecommoninanincompletelydescendedtestes-

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orchidopexymayormaynotdiminishtherisk.
Atrophyofaninguinaltestesbeforepubertymaypossiblybecaused
byrecurrentminortrauma.

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152.TrueaboutPsoasabscess:
a)Hipextensionincreasespain

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b)Staphylococcusismostcommoncause
c)Presentedwithbackpain
d)TBcancause
e)Causesreferredpaintothehip&groin
CorrectAnswer-A:C:D:E

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Answer-(A)Hipextensionincreasespain(C)Presentedwith
backpain(D)TBcancause(E)Causesreferredpaintothehip
&groin
Psoasabscessesmaybeprimaryorsecondary
Primarypsoasabscesses,whichoccurwithoutassociateddisease

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ofotherorgans,arecausedbyhematogenousspreadof
Staphylococcusaureus.
ThemostcommoncauseisCrohn'sdisease.
Mycobacteriumtuberculosisasthemajorcausativeorganism.

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153.AllaretrueaboutAbdominalaneurysm

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except:
a)Atherosclerosisisthecommonestcause
b)Mostcommonlyarisesfromabovethelevelofrenalartery
c)Forasymptomaticaneurysms,repairisindicatedifthediameter
is>5.5cm

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d)Endovascularplacementofanaorticstentisuseforrepair
e)Mostlyasymptomatic
CorrectAnswer-B
Answer-B.Mostcommonlyarisesfromabovethelevelofrenal
artery

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90%ofabdominalaorticaneurysm(AAA)ofsize>4cmindiameter
isduetoatherosclerosis.
Malearemorefrequentlyaffectedthanfemale.
Theaneurysmmostcommonlyarisesbelowthelevelofrenalartery.

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154.Trueaboutincisionalhernia:

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a)Incidenceisabout10-15%ofallabdominalwallhernia
b)Lesschanceinobeseperson
c)Morecommoninwoman
d)Commonlycausedbylowerabdominalsurgery
e)Mayoccurduetoimproperhealingofabdominalincision

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CorrectAnswer-A:C:D:E
Answer-(A)Incidenceisabout10-15%ofallabdominalwall
hernia(C)Morecommoninwoman(D)Commonlycausedby
lowerabdominalsurgery(E)Mayoccurduetoimproperhealing
ofabdominalincision

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Thesearisethroughadefectinthemusculofasciallayersofthe
abdominalwallintheregionofapostoperativescar.
Incisionalherniasaretwiceasconnnoninwomenasinmen.
"Incisionalherniasaccountforl5%to20%ofallabdominalwall
hernias.

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Etiology-
Poorsurgicaltechnique.Inadequatefascialbites,tensiononthe
fascialedges.
Age
Obesity

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ascites,
pregnancy,

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155.Whichoffollowingis/aretruein
accordancetorevisedgastriccarcinoma
staging:

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a)Allgastrictumourswhoseepicentreiswithin5cmofthe
gastrooesophagealjunctionandextendintotheoesophagus
arenowclassifiedaccordingtotherevisedgastricstaging
b)5Nodeinvolvement-N2
c)T1N2M0-StageII

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d)PeritonealspreadisMO
e)AnytumourthatperforatestheserosaisnowclassifiedasT4
disease
CorrectAnswer-B:C:E
Answer-(B)5Nodeinvolvement-N2(C)T1N2M0-StageII

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(E)Anytumourthatperforatestheserosaisnowclassifiedas
T4disease
Stage TNM
Features
0

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Ti,NOMO Nodenegative;limitedtomucosa
Nodenegative;invasionoflamina
IA
T1NOMO propriaorsubmucosa
T2NOMO Nodenegative;invasionofmuscularispropria

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IB
T1N1M0
T1N2M0
Nodepositive;invasionbeyondmucosabutwithin
II

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T2N1M0
wall
T3NOMO Nodenegative;extensionthroughwall
T2N2M0
Nodepositive;invasionofmuscularispropriaor

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IIIA
T3N1-2M0 throughwall

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T3N1-2M0 throughwall
IIIB
T4N0-1M0 Nodenegative;adherencetosurroundingtissue

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IIIC
T4N2M0
Nodepositive;adherencetosurroundingtissue
T1-4N0-2
Distantmetastases

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M1

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156.Dumpingsyndromeischaracterizedby
allofthefollowingexcept:
a)Colic
b)Tremorsandgiddiness

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c)Hyperglycemia
d)Epigastricfullness
e)None
CorrectAnswer-C
Answer-C.Hyperglycemia

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Dumpingsyndromeisarelativelyraredisorderinwhichthestomach
contentsaredeliveredtooquicklytothesmallintestine.
Itoccursasaphysiologicalreactiontotheconsumptionoftoomuch
simpleorrefinedsugarinsomepersons,whensimplesugarexits
thestomachtoorapidlyitattractsfluidintotheupperintestine,and

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thebloodvolumedecreasesasitattemptstoabsorbthesugar.
Thevasomotorsymptomscomprisegeneralweakness,pallor,
sweating,palpitationandlightheadedness.
symptomsofgastrointestinaldisturbancesuchasepigastric
discomfort,nausea,vomitingandpossiblyanepisodeofdiarrheais

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observed.
Thebiochemicalchangesthatoccurindumpingsyndromeare
hyperinsulinaemiafollowedbyhypoglycaemia

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157.Whichofthefollowingis/aretrue
Boerhaavesyndrome:

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a)Occurduetoincreaseinthoracicesophagealpressure
b)Morecommononleftlateralwalloftheesophagus
c)Causedbyseverevomiting
d)Causeshudro-pnemothoraxascomplication
e)Maybemisdiagnosedasmyocardialinfarction

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CorrectAnswer-A:B:C:D:E
Answer-(A)Occurduetoincreaseinthoracicesophageal
pressure(B)Morecommononleftlateralwalloftheesophagus
(C)Causedbyseverevomiting(D)Causeshudro-pnemothorax
ascomplication(E)Maybemisdiagnosedasmyocardial

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infarction
Boerhaave'ssyndromeiswhenapersonvomitsagainstaclosed
glottiscausingfullthicknessoesophagealrupture.
Pressureinoesophagusresultsinburstinginthelowerthirdwhichis
commonestsite.

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Clinicalfeatures-
Severechestpain
Abdominalpain
Subcutaneousemphysema
Shock

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Hanmann'ssign-crunchingeffectofchest
Mackel'striad-vomiting,chestpain&subcutaneousemphysema
MostperforationsarefoundabovetheGEJontheleftlateralwallof
theesophagus.

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Thepressureintheesophagusrapidlyincreases&itburstsatits

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weakcstpointinthelowerthird
MCsiteofperforationisatthemidthoracicesophagusontheright
sideattheleveloftheazygosvein.
Maybemisdiagnosedasmyocardialinfarctionorasperforated
Pepticulcerorpancreatitis.

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158.FeaturesofReidelthyroiditisare:
a)Presentsasagoitre
b)Painful
c)AssociatedwithIgG4relatedsystemicdiseases
d)Fibrosisofinterstitialthyroidstroma

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e)Presentwithhypothyroidism
CorrectAnswer-A:C:D
Answer-(A)Presentsasagoitre(C)AssociatedwithIgG4
relatedsystemicdiseases(D)Fibrosisofinterstitialthyroid
stroma

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Itisararedisorderthattypicallyoccursinmiddle-agedwomen.
Itpresentswithaninsidious,painlessgoiterwilhlocalsymptomsdue
tocompressionoftheesophagus,trachea,neckveins,orrecurrent
laryngealnerves.
Densefibrosisdisruptsnormalglandarchitecture.

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Thyroiddysfunctionisuncommon.
Treatmentisdirectedtosurgicalreliefofcompressivesymptoms.
Tamoxifenmayalsobebeneficial

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159.TrueaboutSickeuthyroidsyndrome:
a)NormalTSH

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b)T4toT3conversionimpaired
c)HighTSH
d)T4high
e)IncreasedreverseT3
CorrectAnswer-A:B:E

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Answer-(A)NormalTSH(B)T4toT3conversionimpaired
(E)IncreasedreverseT3
Themostcommonhormonepatterninsickeuthyroidsyndrome
(SES)isadecreaseintotalendunboundT3levekl(lowT3
syndtome)withnormallevelsofT4aadTSH.

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160.Allaretrueaboutsalivaryglandtumor
except:
a)Parotidglandismostcommonsiteofinvolvement
b)Warthintumouralmostalwaysfoundintheparotidgland
c)Minorglandtumoursaremostlymalignant

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d)Parotidtumoursaremostlymalignant
e)Superficialparotidectomyisdoneinpleomorphicadenoma
CorrectAnswer-D
Answer-D.Parotidtumoursaremostlymalignant
"Warthin'stumorarisesalmostexclusivelyintheparotidgland(the

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onlytumorvirtuallyrestrictedtotheparotid)"
Theparotidglandisthemostcommonsiteforsalivarytumours.
Tumoursinvolvingfhesublingualglandareextremelyrareandare
usually.
Tumoursofthesubmandibularglandareuncommonandusually

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presentasaslow-growingpainlessswellingwithinthe
submandibulartriangle

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161.Trueaboutcleftlip:
a)Occursd/tdefectinfusionoffrontal&nasalprocess
b)Onlybilateralcasesareassociatedwithcleftpalate

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c)Repairedinneonatalperiod
d)Unilateralcasesaremorecommoninleftside
e)All
CorrectAnswer-D
Answer-D.Unilateralcasesaremorecommoninleftside

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Amidlinecleftlipispresentwhenthereisfailureoffusionbetween
Medialnasalprocesses.
Leftsideunilateralcleftiscommon.
CommonesttypeofcleftlipisCombinedwithcleftpalate.
Cleftingofthelipand/orpalateisfelttooccuraroundtheeighth

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weekofembryogenesis,eitherbyfailureoffusionofthemedial
nasalprocessandthemaxillaryprominenceorbyfailureof
mesodermalmigrationandpenetrationbetweentheepithelialbilayer
oftheface.
Repair-

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Ruleoftens:Forincreasedanestheticsafety,aninfantshould
1. Be10weeksold.
2. Weigh10pounds.
3. Haveahemoglobinlevelofatleast10mg/dL

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162.Preferredshuntprocedureinpatientwith

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portalhypertensionhavingacceptable
operativeriskandadequateliver
functionis-
a)Endtosideportocavalshunt
b)Endtoendportocavalshunt

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c)Mesocavalshunt
d)Distalsplenorenalshunt
e)None
CorrectAnswer-D
Answer-D.Distalsplenorenalshunt

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Portosystemicshuntproceduressuchassplenorenalshuntand
mesocavalshunt,maybeindicatedinpatientswithcomplicationof
portalhypertension.
Giventheearlyocclusionrateandtheneedforconstant
surveillance,itisgenerallyadvisedthatTIPSshouldbereservedfor

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ChildCclassificationofcirrhosis,whereasadistalsplenorenalshunt
issafe,durable,preferredandeffectivetreatmentinpatientswith
acceptableoperativeriskandstillgoodliverfunction.

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163.Whichofthefollowingis/aretrue
regardingmanagementofatrauma

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presentingwithshock:
a)TransfusionofPCV:FPP:Plateletshouldbein1:1:1ratio
b)Firsthemodynamicstabilizethepatient,thengoforCTscan
c)FirstgoforCTscan,thenstabilizethepatient
d)CVPlineshouldbeplaced

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e)None
CorrectAnswer-B:D
Answer-(B)Firsthemodynamicstabilizethepatient,thengofor
CTscan(D)CVPlineshouldbeplaced
Hypovolemicshockisthemostcommontypeofshockseenin

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traumapatient&occurssecondarytoacutebloodloss.
Thesubclaviantbinternaljugularveinshouldbereservedforthose
patientsinwhommajorvenousintra-abdominalinjuriesorpelvic
fracturespreventeffectiveuseoffemoralapproach.
Resuscitationconsistsofaninitialbolusof2Lofcrystalloidsolution.

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164.Allaretrueaboutacuteappendicitis
except:
a)ClinicallyindifferentfromMeckeldiverticuluminchildren
b)Lymphoidhyperplasiamaycausesacuteappendicitis
c)Painshifttorightiliacfossa

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d)UltrasoundismorediagnosticthanCTscan
e)None
CorrectAnswer-D
Answer-D.UltrasoundismorediagnosticthanCTscan
Painistheearliestfeature,whichisfrequentlyfirstnoticedatthe

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periumbilicalregion
SoonthepainshiftstotheRIFandchangesincharacter
E.coliisthemostcommonorganism;enterococciismostcommon.
Riskfactorsforperforationofappendix
Immunosuppression

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Diabetesmellitus
Fecolithobstruction
Pelvicappendix
Previousabdominalsurgery
Contrast-EnhancedCT(CECT)?investigationofchoicespeciallyin

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unclassicalcases
UltrasoundismorediagnosticthanCTscan

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165.Whichofthefollowingistrueabout
esophagealadenocarcinoma:
a)Obesityisariskfactor

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b)Mostcommoninmiddle&lower1/3
c)IncidenceinBarrett'soesophagus
d)Squamousmetaplasiaisariskfactor
e)Chronicgastroesophagealrefluxanetiologyofadenocar-
cinoma

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CorrectAnswer-A:C:E
Answer-(A)Obesityisariskfactor(C)IncidenceinBarrett's
oesophagus(E)Chronicgastroesophagealrefluxanetiologyof
adenocar-cinoma
Riskfactorsforesophagealadenocarcinoma(Current

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Gastroenterology)
Barretsesophagus
GastroesophagealRefluxDisease(GERD)
Scleroderma
Smoking

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Alcohol
Historyofcoloncancer
MedicationsLongtermuse(>5years)ofTheophylline&agonists.
Themostcommonsiteofadenocarcinomaesophagusisthelower
1/3rdofesophagus

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166.Trueaboutintestinalpseudoobstruction:
a)Maybecausedbyhypokalemia
b)Bezoarscancausepseudo-obstruction
c)Neostigmineusedintreatment
d)Maybeassociatedwithdiverticulosis

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e)Colonoscopyiscontraindicated
CorrectAnswer-A:C
Answer-(A)Maybecausedbyhypokalemia(C)Neostigmine
usedintreatment
Intestinalpseudoobstructioniscausedbythefollowing

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1. Disordersofthenervoussystem(Familialautonomicdysfunction,
Hirschsprungdisease,Chagasdisease)
2. Diseasesaffectingmusclesandnerves(Musculardystrophy,SLE,
Ehlers-Danlossyndrome,hypokalemia)
3. Disordersoftheendocrinesystem(DM,Hypothyroidism,

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Hyperparathyroidism),and
4. Medication(Narcotics,Laxatives,Tricyclicantidepressants,
Phenothiazines).Ogilive'ssyndromeisacuteintestinalpseudo
obstruction.

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167.Trueaboutsigmoidvolvulus:

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a)Mostcommonspontaneoustypeinadult
b)Lessfiberdietisariskfactor
c)Treatmentincluderesuscitation&decompression
d)Mostcommontypeofcolonicvolvulus
e)Lowrecurrenceafterconservativemanagement

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CorrectAnswer-A:C:D
Answer-(A)Mostcommonspontaneoustypeinadult
(C)Treatmentincluderesuscitation&decompression(D)Most
commontypeofcolonicvolvulus
Mostcommonsiteofvolvulus

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Rotationinsigmoidvolvulusnearlyalwaysoccurinanticlockwise
direction
PREDISPOSINGFACTOR:
Age
Institutionalizedorneurologicallyimpairedorpsychiatricpatients

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Bandofadhesion
LongpelvicmesocolonwithNarrowattachment
Theinitialmanagementisresuscitationfollowedbyendoscopic
decompressionanddetorsion.

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168.Trueaboutdiverticulardiseaseofcolon:

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a)Rightsidemorecommon
b)Sign&symptomsindistinguishablefromirritablebowel
syndrome
c)Profuse&painlessbleeding
d)Sigmoidismostcommonsite

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e)None
CorrectAnswer-B:C:D
Answer-(B)Sign&symptomsindistinguishablefromirritable
bowelsyndrome(C)Profuse&painlessbleeding(D)Sigmoidis
mostcommonsite

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Diverticulamostcommonlyaffectthesigmoidcolon.
Diverticulaaremostoftenasymptomatic(diverticulosis).
Presentclinicallywithsepsisorhaemorrhage.
ComplicationsofDiverticularDisease-
Painandinflammation(Diverticulitis).

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Perforation
Intestinalobstruction
Haemorrhage
Fistulaformation
Hemorhagefromcolonicdiverticulaistypicallypainless&profuse.

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169.Whichofthefollowingistrueabout
primarylymphoedema:
a)Maybecongenital
b)Lymphoedemacongenitamorecommonlyoccurbilaterally
c)Conditionimproveswithmassage

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d)Lymphatichyperplasia
e)All
CorrectAnswer-A:B:C
Answer-(A)Maybecongenital(B)Lymphoedemacongenita
morecommonlyoccurbilaterally(C)Conditionimproveswith

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massage
Itisduetoaninheritedabnormalityofthelymphaticsystem,
sometimestermed'congenitallymphaticdysplasia'.
Primarylymphoedemaismuchmorecommoninthelegsthanthe
arms.

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Lymphoedemacongenitaismorecommoninmales.
Lymphoedemapraecox(onsetfrom2to35years)isthreetimes
morecommoninfemales

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170.Allaretrueaboutthymomaexcept:
a)MCtumorinanteriormediastinum

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b)Treatmentisthymectomy
c)Symptomaticcasespresentasendocrineabnormalities
d)Maybeassociatedwithmyastheniagravis
e)Associatedwiththyroiditis
CorrectAnswer-C

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Answer-C.Symptomaticcasespresentasendocrine
abnormalities
CharachteristicSyndromes
MyaestheniaGravis(mostcommon)
AcquiredHypogammaglobulinemia(10%)

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PureRedCellAplasiac

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171.Trueaboutinvasivethymoma:
a)Benigninnature
b)MaybeassociatedwithEBV
c)Malignantinnature

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d)Epithelialcellsaremostcommonlyofthecorticalvariety
e)None
CorrectAnswer-A:B:D
Answer-(A)Benigninnature(B)MaybeassociatedwithEBV
(D)Epithelialcellsaremostcommonlyofthecorticalvariety

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Invasivethymomareferstoatumorthatiscytologically,benignbut
locallyinvasive.
Thesetumorsaremuchmotelileclytometastasize.
Theepithelialcellsaremostcommonlyofthecorticalvariety,with
abundantcytoplasmandroundedvesicularnuclei,andareusually

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mixedwithnumerousthymocytes.
Bydefinition,invasivethymomasPenetratethroughthecapsuleinto
surroundingstructures.

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172.Trueaboutcystosarcomaphylloides:
a)Usuallybilateral

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b)Usuallyoccurinfemaleoverageof40
c)Notinvolvenipple-areolacomplex
d)Treatmentismastectomyofmalignantlesions
e)Allarebenigninnature
CorrectAnswer-B:C:D

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Answer-(B)Usuallyoccurinfemaleoverageof40(C)Not
involvenipple-areolacomplex(D)Treatmentismastectomyof
malignantlesions
Itisamalignanttumour
Itoftenmetastasisestoaxillarynodes

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Itistreatedbyradicalmastectomy
Usuallyoccurinwomenovertheageold4Oyears.

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173.Trueaboutanorectalabscess:
a)Ischiorectalismostcommontype
b)Primarymodalityoftreatmentisantibioticwithoutdrain

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c)Rupturecancausefistulaformation
d)Commonindiabetics
e)Drainageofpuswithantibioticsismainstayoftreatment
CorrectAnswer-C:D:E
Answer-(C)Rupturecancausefistulaformation(D)Commonin

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diabetics(E)Drainageofpuswithantibioticsismainstayof
treatment
Therearefourtypes-abscess-perianal(mostcommon),ischiorectal,
submucous&pelvirectal.
Anorectalabscesscanruptureinsideaswellasoutsideresultingin

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afistula.
Treatmentisdrainageofpusinfirstinstancetogetherwith
appropriateantibiotics.

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174.Whichofthefollowingindicatepoor
prognosisinbothRanson&Glasgow

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scaleofacutepancreatitis:
a)Albumin
b)Alanineaminotransferase
c)Aspartateaminotransferase
d)Lactatedehydrogenase

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e)Basedeficit
CorrectAnswer-A:B:C:D
Answer-(A)Albumin(B)Alanineaminotransferase(C)Aspart
ateaminotransferase(D)Lactatedehydrogenase
Earlypredictorsofseverityat48hoursincluded3Ranson'ssigns

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andAPACHEIIscore8.
Arecentscoringsystemfortheearlypredictionofmortalitywas
developedinacutepancreatitis.Thisscoringsystemknownasthe
BedsideIndexofSeverityinAcutePancreatitis(BISAP),
incorporatesfiveclinicalandlaboratoryparametersobtainedwithin

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thefirst24hoursofhospitalization.BUN>25,Impairedmental
status,SIRS,Age>60years,Pleuraleffusiononradiography.
Presenceofthreeormoreofthesefactorswasassociatedwith
increasedriskforin-hospitalmortality.
ModifiedGlasgow/PANCREASscore

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PaO2<8kPa(60mmhg)
Age>55years
Neutrophils:WBC>15?109/l

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Calcium<2mmol/l
Renalfunction:(Urea>16mmol/l

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Enzymes:(AST/ALT>200iu/LorLDH>600iu/L)
Albumin<32g/l
Sugar:(Glucose>10mmol/L)

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175.Whichofthefollowingcausesneonatal
jaundice:

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a)Sicklecellanaemia
b)?-Thalassemia
c)Meningitis
d)G6PDdeficiency
e)Rhincompatibility

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CorrectAnswer-B:D:E
Ans.b.?-Thalassemia;d.G6PDdeficiency;e.Rh
incompatibility
ETIOLOGY:
NonConjugated:Haemolytic:

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Intrinsiccauses:
Membraneconditions
Spherocytosis(50%)
Hereditaryelliptocytosis
Systemicconditions

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Sepsis
Arteriovenousmalformation
Enzymeconditions
G6PDdeficiency
Pyruvatekinasedeficiency

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Globinsynthesisdefect
Sicklecelldisease
Alpha-thalassemia,e.g.HbHdisease
Extrinsiccauses:

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Alloimmunity

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Hemolyticdiseaseofthenewborn(ABO)
Rhdisease
Hemolyticdiseaseofthenewborn(anti-Kell)
Hemolyticdiseaseofthenewborn(anti-Rhc)
Otherbloodtypemismatches

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Non-hemolyticcauses:
Breastmilkjaundice
Cephalohematoma
Polycythemia
Urinarytractinfection

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Sepsis
Hypothyroidism
Gilbert'ssyndrome
Crigler-Najjarsyndrome
HighGIobstruction

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Conjugated:Hepaticcauses:
Infections
Sepsis
HepatitisA
HepatitisB

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TORCHinfectionsverticallytransmittedinfections
T?Toxoplasmosis/Toxoplasmagondii
O?Otherinfections
R?Rubella
C?Cytomegalovirus

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H?Herpessimplexvirus-2orneonatalherpessimplex
Metabolic
Galactosemia
Alpha-1-antitrypsindeficiency
Cysticfibrosis

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Dubin-JohnsonSyndrome
Rotorsyndrome
Drugs
Totalparenteralnutrition
Idiopathic

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Post-hepatic:

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Biliaryatresiaorbileductobstruction
Alagillesyndrome
Choledochalcyst

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176.Whichofthefollowingmilestoneis

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developedbychildb/w6to9month:
a)Canpointsomethingwithindexfinger
b)Swapsomeobjectfromonepalmtoanother
c)Canholdobjectwiththumb&indexfinger
d)Canvoluntarydropobject

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e)Canextendarm
CorrectAnswer-B:C:D
Ans.b.Swapsomeobjectfromonepalmtoanother;c.Can
holdobjectwiththumb&indexfinger;d.Canvoluntarydrop
object

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6MONTH:
GrossMotor:
Sitsunsupported.
Putsfeetinmouthinsupineposition
Visual-Motor/Problem-Solving:

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Unilateralreach.
Usesrakinggrasp
Language:
Babbles
Social/Adoptive

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Recognizesstrangers
7MONTH:
GrossMotor:
Creeps
Language:

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Orientstobell((localizedindirectly)
8MONTH:
GrossMotor:
Comestosit.
Crawls

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Visual-Motor/Problem-Solving:
Inspectsobjects
Language:
"Dada"indiscriminately
Social/Adoptive

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Fingerfeeds
9MONTH:
GrossMotor:
Pivotswhensitting.
Pullstostand

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Cruises
Visual-Motor/Problem-Solving:
Usespincergrasp
Probeswithforefinger
Holdsbottle,throwsobjects

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Language:
"Mama"indiscriminately
Gestures,wavesbye-bye
Inhibitsto"no"
Social/Adoptive

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Startstoexploreenvironment
Playsgesturegames(eg,pat-a-cake)

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177.Trueaboutosteumprimumdefect:
a)ItisfoundinASD
b)MorecommonlyassociatedwithASDthanVSD

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c)MaybeassociatedwithDownsyndrome
d)OsteumprimumASDismorecommonthanosteumsecondum
ASD
e)Alltheabove
CorrectAnswer-A:B:C

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Ans.a.ItisfoundinASDb.Morecommonlyassociatedwith
ASDthanVSDc.MaybeassociatedwithDownsyndrome
Themostcommontypeofatrialseptaldefectistheostium
secundumtype.
ChildrenwithDownsyndrome,however,arefrequentlyafflicted

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withtheostiumprimumtypeofatrialseptaldefects,whichmaybe
accompaniedbytricuspidandmitralvalvemalformations.
Morecomplexatrioventricularseptaldefectsmayalsooccurinthis
disorder.
Childrenexhibitingtheselesionsshouldbespecificallyevaluatedfor

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chromosomalabnormalities.
Clinically,thelesionsproduceleft-to-rightshuntswithlatecyanosis
(aftertherightventriclehypertrophiesinresponsetodevelopinglung
diseasefromtheincreasedbloodflowinthepulmonarysystem).
NeithercysticfibrosisnorGaucherdiseaseisspecifically

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associatedwithcardiovasculardefects.
DissectingaorticaneurysmisassociatedwithMarfansyndrome.

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178.Trueaboutminimalchangedisease-
a)Hypertensioniscommonlypresent
b)Mostcommoncauseofnephroticsyndromeinadults

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c)Highdosesteroidsresultsinremissioninmostcases
d)Commonlyprogresstochronicrenalfailure
e)Reversiblelossofpodocytefunction
CorrectAnswer-C:E
Answer-(C)Highdosesteroidsresultsinremissioninmost

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cases(E)Reversiblelossofpodocytefunction
Minimalchangedisease:
Alsok/alipoidnephrosa,footprocessdisease&Nildepositdisease
Thediseasesometimesfollowsarespiratoryinfectionorroutine
prophylacticimmunization'

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Theonsetmaybeprecededbyanupperrespiratoryinfection,atopic
allergyorimmunisation.
Thediseasecharacteristicallyrespondtosteroidtherapy
Thebenigndisorderischaracterizedbydiffuseeffacementoffoot
processesofvisceralepithelialcell(podocytes).

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mostfrequentcauseofnephroticsyndromeinchildren
Thevisceralepithelialchangesarecompletelyreversibleafrer
corticosteroidtherapy,concomitantwithremissionoftheproteinuria.
Thereiscommonlynohypertensionorhematuria.
Theappearanceofacuterenalfailureinadults.

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179.Vesico-uretericreflexiscommonly
diagnosedby:
a)Micturatingcystography
b)Radioisotoperenography
c)IVU

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d)CTscan
e)All
CorrectAnswer-A:B
Ans.a.Micturatingcystography;b.Radioisotoperenography
TherecommendedradiographicevaluationforVURincludesa

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VCUG,renal-bladderultrasonographyandnuclearrenalscan
(DMSA).
PerformVCUGandrenal-bladderultrasonographyinanychildwith
documentedUTIbeforeage5years,anychildwithpyelonephritis,
andanymalechildwithasymptomaticUTI.

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Arenal-bladderultrasonographymaybeusedtoscreenolder
childrenwithUTI.Ifultrasonographicfindingsareabnormal,conduct
furtherworkupstudieswithVCUGtoruleoutVUR.
Duringtheinitialworkupinapatientwithsuspectedreflux,perform
thestandardVCUG,whichprovidesclearanatomicdetailandallows

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accurategradingoftherefluxdegree.Byfillingandemptyingthe
bladderseveraltimes(cycling)withthecatheterstillinthebladder,
asdescribedbyLebowitz,theyieldofidentifyingVURisclearly
enhanced.
Theconventionalcystographyprovidesmoreanatomicalaccuracy

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thannuclearcystography;however,nuclearcystographyis

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advantageous(usedwidelytomonitorVUR)becauseoflower
radiationexposureandincreasedsensitivity.

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180.TrueaboutTannerstageII:
a)Penisincreasesinlength

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b)Penisincreasesinwidth
c)Scantyhairatbaseofpenis
d)Darkeningofscrotum
e)Moregrowthoccurinboysthangirls
CorrectAnswer-A:C

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Ans.a.Penisincreasesinlength;c.Scantyhairatbaseof
penis
DEVELOPMENT:
Genitals(male):

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IllustrationoftheTannerscaleformales.
TannerI
testicularvolumelessthan1.5ml;smallpenis(prepubertal;typically
agenineandyounger)
TannerII

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testicularvolumebetween1.6and6ml;skinonscrotumthins,
reddensandenlarges;penislengthunchanged(9?11)
TannerIII
testicularvolumebetween6and12ml;scrotumenlargesfurther;
penisbeginstolengthen(11?12.5)

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TannerIV
testicularvolumebetween12and20ml;scrotumenlargesfurther
anddarkens;penisincreasesinlength(12.5?14)
TannerV
testicularvolumegreaterthan20ml;adultscrotumandpenis(14+)

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Pubichair(bothmaleandfemale)
TannerI
nopubichairatall(prepubertal)(typicallyage10andyounger)
TannerII
smallamountoflong,downyhairwithslightpigmentationatthe

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baseofthepenisandscrotum(males)oronthelabia
majora(females)(10?11.5)
TannerIII
hairbecomesmorecoarseandcurly,andbeginstoextendlaterally
(11.5?13)

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TannerIV
adult-likehairquality,extendingacrosspubisbutsparingmedial
thighs(13?15)
TannerV
hairextendstomedialsurfaceofthethighs(15+

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181.TrueaboutLockingcompressionplate:
a)Insteoporoticpatients,itshouldnotbeused
b)Canbeusedasbuttressplate
c)Usuallycauseperostealinjury
d)Mechanicallysuperiortoaconventionalplate

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e)Cannotbeusedascompressionplate
CorrectAnswer-B:D
Ans.b.Canbeusedasbuttressplate;d.Mechanicallysuperior
toaconventionalplate
LockingCompressionPlate:

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Thelatestdevelopmentinplatingtechniqueislockingcompression
plate(LCP).
Ithasrigidplate,Screwconstruct,whichhasbeenfoundtobe
mechanicallysuperiortoconventionalplate.
LCPcanbeusedascompressionplate,asneutralizationplate,asa

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buttressplate,asabridgingplate&asalockedplate.
ItisParticularlysuitableforperiarticularfractures&fracturesin
osteoporoticbones

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182.Osteoscleroticmetastasesis/are
commonincancerof:

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a)Prostate
b)Breast
c)Lung
d)Malignantmelanoma
e)Renalcellcarcinoma

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CorrectAnswer-A:B
Ans.a.Prostate;b.Breast
Metastasesaremostcommonlyseeninthepelvis,ribs,vertebral
bodies,andproximallimbs.
Theselesionstypicallyhavealyticappearanceonplain

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radiographs,althoughbreastandprostatemetastasescanbe
scleroticormixedwithlyticandscleroticfeatures.
Overall,metastasesarethemostcommontumorofbones.
Adults:Approximately75%ofmetastasestothebonearederived
fromprostate,breast,kidney,andlungcarcinomas.

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Children:Neuroblastoma,Wilmstumor,osteosarcoma,andEwing
sarcoma.
Kidneyandthyroidneoplasmsareknownforproducingasolitary
metastasis.
Metastasestohandandfootbonesareuncommonand,ifpresent,

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thesourceisusuallyalung,colon,orrenalneoplasm.

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183.Followingareimmediatecomplications
offracture:
a)Vascularischemia
b)Neuronalinjury

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c)Malunion
d)Compartmentsyndrome
e)Avascularnecrosis
CorrectAnswer-A:B
Ans.a.Vascularischemia;b.Neuronalinjury

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ImmediateComplications:
Systemic:
Hypovolaemicshock
Local
Injurytomajorvessels

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Injurytomuscles&tendon
Injurytojoints
Injurytoviscera
Earlycomplications:
Systemic:

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Hypovolaemicshock
ARDS:Fatembolismsyndrome
DVT&Pulmonaryembolism;
Aseptictraumaticfever;
Septicaemia;

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Crushsyndrome
Local

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Infection
Compartmentsyndrome
Latecomplications:

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Imperfectunionoffracture:
Delayedunion;Non-union;Malunion;Crossunion
Others:
Avascularnecrosis;Shortening;Jointstiffness;Sudeck'sdystrophy;
Osteomyelitis;ischaemiccontracture;Myositisossificans;

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Osteoarthritis

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184.Whichofthefollowingcausemalunion
except:
a)Open#
b)Infection

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c)Bonegrafting
d)Softtissueinterposition
e)Properalignmentoffracture
CorrectAnswer-C:E
Ans.c.Bonegrafting;e.Properalignmentoffracture

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Bonegraftingisusedintreatmentofmalunion
Infection:Bothbiology&stabilityofbonehealingarehamperedby
activeinfection

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185.TrueaboutatypicalCTEV
a)Footisflexeddownward

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b)Solecreasearenotfound
c)Difficulttotreatthantypicalvariety
d)Mayoccurduetoneurologicaldisorder
e)MaybeassociatedwithMeningomyelocele
CorrectAnswer-A:C:D:E

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Ans.a.Footisflexeddownward;c.Difficulttotreatthantypical
variety;d.Mayoccurduetoneurologicaldisorder;e.Maybe
associatedwithMeningomyelocele
AtypicalIdiopathicClubfoot:
Ashortandfatorswollenfoot.

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Thebigtoeisshortandpointsupward
Acreaserunsacrossthebottom(sole)ofthefootfromsidetoside.
Thereisadeepcreaseintheskinabovetheheel.
Theheelareaisrigidlytiltedinward.
Thefootisrigidlyflexeddownwardand,theheelcordisverytight,

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wide,andlong.
Thecalfmuscleisverysmallandbunchedupunderthebackofthe
knee.
CausesofCTEV
CTEVmaybeeitherprimaryorsecondary

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1.PrimaryorIdiopathic
ItisthemostcommontypeofCTEV
Footdeformity(CTEV)istheonlymanifestation,otherwise
musculoskeletalsystemisnormal.
2.Secondary

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CTEVisalocalmanifestationofasystemicsyndrome.
Causesare:-
1. Neurologicaldisorders&neuraltubedefectsegmyelomeningocele,
&spinaldysraphism
2. Paralyticdisorder(duetomuscularimbalance)aspolio,spinabifida,

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myelodysplasia,&Fredreich'sataxia
3. Arthrogiyposismultiplexa
4. Larsensyndrome
5. Freeman-Sheldonsyndrome
6. Diastrophicdwarfism

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7. Sacralagenesis,tibialdeficiency,constrictionrings&amniotic
bands

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186.Inyoungpersonmostcommoncancer
amongfollowingis:
a)Giantcell

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b)Osteosarcoma
c)Chondrosarcoma
d)Ewingsarcoma
e)All
CorrectAnswer-B

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Ans.b.Osteosarcoma
Osteosarcomaisthesecondmostcommontumour.
Thesetumoursoccurb/wtheagesof15-25years,constitutingthe
commonestmusculo-skeletaltumouratthatage

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187.Allaretrueaboutsepticarthritisexcept:

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a)Staph.Aureusismostcommoncausativeorganism
b)Commoninchildren
c)Affectgrowthplate
d)E.coliisthecommonestcausativeorganism
e)Aspirationofjointfluidisusedfordiagnosis

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CorrectAnswer-D
Ans.d.E.coliisthecommonestcausativeorganism
Itismorecommoninchildren&males
Staphylococcusaureusisthecommonestcausativeorganism,other
organismarestrepto-pneumo&Gonococcus.

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Aspiratethejoint&examinethefluid.AWBC&gramstainshould
becarriedoutimmediately.Sampleoffluidarealsosentforfull
microbiologicalexamination&testsforantibioticsensitivity.

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188.Featuresoffatembolism:
a)Bradycardia

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b)Hypoxia
c)Hypotension
d)Tachypnoea
e)Petechialrash
CorrectAnswer-B:D:E

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Ans.b.Hypoxia;d.Tachypnoea;e.Petechialrash
Fatembolismsyndrome:
Tachycardia
Slightriseoftemperature
Breathlessness

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Hypoxiafrominvolvementoflung
Tachypnoea
Petechialrash
Respiratoryfailure
Drowsy

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Restless
Coma

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189.Straightlegraisingtestis/arepositive
in:
a)Spinalstenosis

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b)Spinalabscess
c)AlsocalledasTrendelenburgtest
d)Prolapsedintervertebraldisc
e)Sciatica
CorrectAnswer-D:E

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Ans.d.Prolapsedintervertebraldisc;e.Sciatica
Pain&limitationofStraightlegraising(SLR)isafeatureof
prolapsedintervertebraldiscwhenthereisirritationorcompression
ofoneoftherootsofthesciaticnerve.
Straightlegraisingtest:Thisisatesttodetectnerveroot

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compression.

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190.Whichofthefollowingis/aretrueabout
thegaitinsensorydeficit
a)Antalgicgait
b)Apraxia

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c)Trendelenburg
d)PositiveRombergsign
e)Apraxiagait
CorrectAnswer-D
Ans.d.PositiveRombergsign

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Insensoryataxiathepatientisabletomaintaintheupright
positionwhiletheeyesareopen,butwhentheeyesareclosed
hesways.ThisisapositiveRombergsign.
ABNORMALGAIT:
Antalgicgait:occursinpainfulconditionsofthelowerlimb.

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Charlie-Chaplingait:Occursintibialtorsion.
Circumductiongait:Occursinhemiplegia
Waddlinggait:Occursinbilateralcongenitalhipdislocation
Highsteppinggait:Occursinfootdrop
Scissoringgait:Occursincerebralpalsy

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Stiffhipgait:Occursinankylosisofthehip
Trendelenburggait:Occursinunstablehipduetocongenital
dislocationofhip,gluteusmediusmuscleweakness

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191.Whichofthefollowingislowersegment
verticalincision:

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a)Simon
b)Selheim
c)Kronig
d)Kerr
e)None

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CorrectAnswer-B:C
Ans.b.Selheimc.Kronig
Lowcervicalincisionmaybealowcervicaltransverse(LCT)incision
(Monroe/Kerr)oralowcervicalvertical(LCV)incision(Kronig/
Selheim)

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192.AppropriatetimeofIUCDinsertionis/are:
a)Immediatelyafterdelivery
b)1weekafterdelivery
c)Post-puerperalPeriod
d)Beforemenstruation

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e)Anytimeduringlactationperiod
CorrectAnswer-A:B:C:E
Ans.a.Immediatelyafterdelivery;b.1weekafterdelivery;c.
Post-puerperalPeriod;e.Anytimeduringlactationperiod
ItisadvisabletoinsertIUCDduringorsoonaftermenstruation&

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afterabortionorMTP
Lately,immediatepostpartuminsertionwithinl0minofplacental
expulsionorwithin24hrofdeliveryispracticed&isfoundeffective.
Thissavethewomansecondvisittotheclinic.
IUCDinsertioncanalsobetakenupduringthefirstweekafter

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deliverybeforethewomenleavesthehospital(immediate
postpartuminsertion),butcarriesriskofperforation&highexpulsion
Aconvenienttimeforinsertionis6-gweeksafterdelivery(post-
puerperalinsertion).

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193.Whichofthefollowingis/aretrueabout

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combinedoralcontraceptivepills:
a)Reducesriskofvenousthromboembolism
b)Reducesriskofbenignbreastdisease
c)Protectsagainstendometrialcancer
d)DecreasedBonedensity

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e)None
CorrectAnswer-B:C
Ans.(b)Reducesriskofbenignbreastdisease,(c)Protects
againstendometrialcancer
OCPS

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ADVANTAGES:
Controlsfertility
TreatsMenorrhagia&polymenorrhoea.
Relievedysmenorrhoeaandpremenstrualtension
Preventsanaemia

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Lowerschancesof
Fibrocysticdisease
Ovariancyst
Ovarian,uterine&anorectalmalignancy
PID

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Ectopicpregnancy
Usefulinacne,PCODandendometriosis
PreventRA
NoncontraceptivebenefitsofOCPs:
Cyclestabilization

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Cureofmenstrualdisorder-usefulinmenorrhagia&polymenorrhea
Preventsanemia.
Reducestheincidenceofectopicpregnancy.
Protectionagainstcancer?Ovarian,Endometrial
Benigntumour-Benignbreastdisease,Ovarianfunctionalcyst,

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Fibromyomauterus
Protects-PID,Anemia,Endometriosis,PCOD,Acne,hirsutism,
Rheumatoidarthritis,Osteoporosis

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194.Trueaboutimplanon:
a)Releases>67?g/dayofdrug

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b)PreventSTD
c)Lifespanis3Years
d)ContainsLNG
e)Has6implants
CorrectAnswer-C

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Ans.c.Lifespanis3Years
Implanonisasinglerodsubdermalimplantwith68mgofthe
progestinetonogestrel(ENG),andanethylenevinylacetate
copolymercover.
Itcanbeusedascontraceptionfor3yearsandthenreplacedatthe

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samesiteoroppositearm.
Itisplacedinthemedialsurfaceoftheupperarm6to8cmfromthe
elbowinthebicepsgroovewithin5daysofonsetofmenses.
Prolongedandfrequentbleedingisthemostcommonadverse
effect.

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195.TrueaboutProgestogenonlypill:
a)Itistakendailyonthesametime
b)HigherfailureratethanCOC
c)Fertilityreturntonormalafterdiscontinuationwithoutanydelay
d)Suitedforlactatingwomenlactatingwomen

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e)EctopicpregnancyriskaresameasCOC
CorrectAnswer-A:B:D
Ans.a.Itistakendailyonthesametime;b.Higherfailurerate
thanCOC;d.Suitedforlactatingwomenlactatingwomen
ProgestogenonlyPill(POP)/Minipil

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Doesnothavesomemajorsideeffectsofcombinedpills&well
suitedforlactatingwomen;someprogestogens,infact,increase
milksecretion.
Side-effect:weightgain,irregularmenstrualbleeding,depression,
breastcancer,thromboembolism.

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Advantage:Lactatingwomen,womenover35years,thosewith
focalmigraine,thoseintoleranttoestrogenoroestrogen
contraindicated,diabetic,hypertensive,sicklecellanaemia
Asregardstoreturnoffertility,fasterthanCOCusers
Contraindication:C/ItoPOParepreviousarepreviousectopic

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pregnancy,ovariancyst,breast&genitalcancer,abnormalvaginal
bleedingactiveliver&arterialdisease,porphyria,livertumour.

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196.TrueaboutDysgerminoma:
a)Raretumorinpregnancy
b)Alwaysb/l

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c)Totalabdominalhysterectomyisusuallydone
d)Unilateralsalpingo-oophorectomyisgenerallydone
e)Constitute30%ofallmalignantgermcelltumour
CorrectAnswer-D:E
Ans.d.Unilateralsalpingo-oophorectomyisgenerallydone;e.

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Constitute30%ofallmalignantgermcelltumour
Dysgerminomaisthemostmalignantgermcelltumour(nota
virilisingtumour).
SeeninyoungfemaleslikeotherGCT(notinpostmenopausal
women).

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Itisunilateral.
Itscutsectionissoftduetodegeneration(grittycutsectionisseen
inBrenner'stumour).
TumourmarkersforDysgerminomaare:
LDH

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Alphafetoproteinisnormalindysgerminoma.
Placentalalkalinephosphatase.
BetaHCG
ManagementofDysgerminoma:
Surgical--includingresectionoftheprimarylesion(unilateral

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oophorectomy)andpropersurgicaldissection
MetastaticDisease--ChemotherapyorRadiationtherapy

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197.Trueaboutplacentalabruption:
a)Pre-eclampsiaisariskfactor
b)Commoninmultigravida

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c)Commoninprimigravida
d)Prematureseparationofnormalimplantedplacentae
e)Characterofbleedingisbrightredblood
CorrectAnswer-A:B:D
Ans.a.Pre-eclampsiaisariskfactor;b.Commonin

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multigravida;d.Prematureseparationofnormalimplanted
placentae
Abruptioplacentae:
Itisaformofantepartumhemorrhagewherebleedingoccursdueto
prematureseparationofnormallysituatedplacenta.

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Hypertensioninthepregnancyisimportantpredisposingfactor
ETIOLOGY:
PrimarycauseofAPisuncertain
Severalassociatedconditionsidentified:
Increaseinage&parity:1.3-1.5%

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Pre-eclamsia:2.1-4%
Chronichypertension:1.8-3%
Pretermrupturedmembranes:2.4-4.9%
Multifetalgestation:2.1%
Cigarettesmoking:1.4-1.9%

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Cocaineabuse:NA
Folicaciddeficiency
Priorabruption:10-25%
Uterineleiomyoma:NA

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Hydromnios:2%

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Symptoms
VaginalBleeding(78%)
AbdominalPain(66%)-Maybesevereandconstant,posterior
placentamaypresentwithbackpainSigns
Vitalsignssuggestiveofcardiovascularcompromise-Tachycardia,

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orthostaticchangesinBloodPressureandpulse
Evaluateforexternalsignsoftrauma
Uterushypertonicortense(CouvelaireUterus)-Fundustenderto
palpation

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198.Truestatementregardinginvestigationin

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endometrialcancer:
a)MRIissuperiortoCTindetectingmyometrialinvolvement
b)CTissuperiortoMRIindetectingomentalmetastasis
c)USGisinitialinvestigationtobeperformed
d)USGisthebestinvestigation

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e)None
CorrectAnswer-A:B:C
Ans.a.MRIissuperiortoCTindetectingmyometrial
involvement;b.CTissuperiortoMRIindetectingomental
metastasisandc.USGisinitialinvestigationtobeperformed

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DiagnosisofEndometrialCarcinoma
CTscanofpelvisandabdomenmaybeusedtodetectlymphnode
metastases".
MRIcandetectMyocardialinvasion
SensitivityofPETindetectingpelvicnodemetastasesis80%

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comparedtoMRI(70%)andCT(48%)"
"CTisusefulinthediagnosisoflymphnodemetastasisanddepthof
myometrialinvasioninendometrialcancer"
"MRIissuperiortoCTorultrasoundindiagnosingadenomyosis,
myomasandendometrialcancer(includingmyometrialinvasion)

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199.TrueaboutKlinefeltersyndrome:
a)Legaremoreinlengththantrunk
b)IntrauterinefertilizationcannotbesuccessfulevenwithTESA
&ICSI
c)Gynaecomastia

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d)FSHandluteinizinghormone(LH)aredecreased
e)All
CorrectAnswer-A:C
Ans.a.Legaremoreinlengththantrunk;c.Gynaecomastia
Klinefeltersyndrome:?

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Klinefeltersyndromeisthemostcommonchromosomaldisorder
associatedwithmalehypogonadismandinfertility.
Itisdefinedclassicallybya47,XXYkaryotypewithvariants
demonstratingadditionalXandYchromosomes.(Othervariantscan
have48XXXY,rarely49XXXXYormosaicscanbetherewithsome

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cellscontainingnormal46,XYandothers47,XXY).Classically,it
resultsfrommeioticnon-dysjunctionofsexchromosomes(40%
duringspermatogenesisand60%duringoogenesis).Mostly,non-
dysjunctionoccurduring1"meioticdivision.
Thepatienthasmalephenotypewithfeminizingfeaturesdueto

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extraX-chromosome(note:presenceofoneYchromosomeis
sufficientformalephenotype.ThusXY,XXY,XXXYallaremales).
ExtrainactivechromosomeappearsasBarrbody.
Importantclinicalfeaturesincludemicroorchidismwithnormal
externalgenitalia,mentalretardation,gynecomastia,lackof

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secondarysexualcharacteristicswitheunuchoidbodyhabits,
disproportionatelylongarmsandlegs,hypogonadism,increased

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incidenceoftumors(breastcarcinoma,germcelltumors),increased
incidenceofautoimmunedisorders(e.g.SLE),andcardiac
problems(mostcommonismitralvalveprolapse).Testosterone

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levelsaredecreased,whereaslevelsofgonadotropins(FSH/LH)are
elevated.

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200.Allaretrueaboutpolycysticovarian
disease(PCOD)except:
a)Testosterone>2ng/ml

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b)Infertility
c)HighFSH/LHratio
d)Insulinlevel
e)E2/oestrone(E1)ratio
CorrectAnswer-C:E

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Ans.c.HighFSH/LHratio;e.E2/oestrone(E1)ratio
HormonelevelsinPCOD
Raised:
E2(oestradiol),LH,androgens,testosterone,epiandrostenedione,
fastinginsulin,prolactin.

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Decreased:
FSH,FSH/LHratio,sexhormonebindingglobulin,osetradiol(E2)/
oestrone(El)ratio

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201.Trueaboutendometriosis:
a)Laparoscopyisgoldstandardfordiagnosis

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b)COCisusedtorelievemildPain
c)GnRHantagonistisusedtorelieveseverepain
d)Canbemanagedexpectantlyinasymptomaticcases
e)Noneoftheabove
CorrectAnswer-A:B:D

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Ans.(A)Laparoscopyisgoldstandardfordiagnosis;(B).COCis
usedtorelievemildPain;(D)Canbemanagedexpectantlyin
asymptomaticcases
Friendsthisisthemostoftenaskedquestiononendometriosis.Itis
worthwhiletoknowafewdetailsonthistopic.

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Empiricaltreatment:isforpainpresumedtobedueto
endometriosis.(inabsenceofdefinitivediagnosis)andincludes:--
Counselling
1. Analgesia
2. Nutritionaltherapy

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3. ProgestinorOCP's
Analgesia:StudieshaveshownNSAID'sexceptniflumicacidare
moreeffectiveinchronicpainreliefduetoendometriosisor
dysmenorrheasuspectedtobeduetoendometriosis.
Hormonalmedicaltreatment:

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Basisofmanagement:Sinceestrogenisknowntostimulatethe
growthofendometriosis,hormonaltherapyhasbeendesignedto
suppressestrogensynthesis,therebyinducingatrophyofectopic
endometrialimplantsorinterruptingthecycleofstimulationand
bleeding.

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Indication:--Mildpelvicendometriosisinyoungwomen.?
Treatmentofresidualandrecurrentdiseasefollowingconservative
surgery.

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202.Ayoungladycanbecounselledfor
sterilizationoperationinallexcept:

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a)Awomanhavingnoorfewchildrenmayundergosterilization
b)WomanwithHIVeithertakingornottakingARTcangofor
sterilization
c)HusbandconsentisPresent
d)Younglactatingwomenmorethan25yearscangofor

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sterilization
e)Ifthecouplehas3ormorelivingchildren,thelowerlimitofage
ofthehusbandorwifemayberelaxedatthediscretionofthe
operatingsurgeon
CorrectAnswer-A

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Ans.a.Awomanhavingnoorfewchildrenmayundergo
sterilization
Guidelinesforsterilization:
Ageofhusbandnotlessthan25yearsandshouldnotbeover50
years

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Ageofwife:notlessthan20yearsornotmorethan45years
Shouldbehaving2livingchildren
Ifcouplehasthreeormorelivingchildrenthelowerlimitofagemay
berelaxed
Iftheacceptordeclareshavingobtainedtheconsentofhis/her

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spousetoundergosterilizationoperationwithoutoutsidepressure,
inducementorcoercion,andthathe/sheknowsthatforallpractical
purposes,theoperationisirreversibleandalsothatthespousehas
notbeensterilizedearlier.

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203.Nulliparouswomenhavehighriskof

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followingcancer:
a)Cervicalcancer
b)Vaginalcancer
c)Breastcancer
d)Ovariancancer

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e)EndometrialCa
CorrectAnswer-C:D:E
Ans.c.Breastcancer;d.Ovariancancer;e.EndometrialCa
Nulliparityistheriskfactorfor:
Breastcancer

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Ovariancancer
EndometrialCa
Vaginalcancerisseenafter70yearsofage
Cervicalcanceraremorecommonlyseeninmultipara

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204.Screeningtestusedinfirsttrimesterfor

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aneuploidy?
a)PAPP-A&estradiol
b)PAPP-A&AFP
c)PAPP-A&betaHCG
d)BetaHCG&inhibin

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e)Estradiol&AFP
CorrectAnswer-C
Ans.is'c'i.e.,PAPP-A&betaHCG
1sttrimesteraneuploidyscreening:
Humanchorionicgonadotropin(eitherintactorfree(-hCG).

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Pregnancy-associatedplasmaproteinA(PAPP-A).
FetalDownsyndromein1sttrimester:
Higherserumfreebeta-hCGlevel.
LowerPAPP-Alevels.
Trisomy18&13:

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LoweredlevelsofbothHCGPAPPP-A.
2ndtrimesteranalytes:
Serumintegratedscreening.
Accuracyofaneuploidydetection:
Greateroncombinationwith,

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SonographicNTmeasurement.

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205.Trueabouttestosteroneinfemale:
a)>50%testosteronesecretedfromovary
b)>80%testosteronesecretedfromovary
c)0.5ng/mlisplasmaconcentration

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d)Slightdecreaseinthesecretionattimeofovulation
e)Dailyproductionoftestosteroneis0.2-0.3%mg
CorrectAnswer-A:C:E
Ans.a.>50%testosteronesecretedfromovary;c.0.5ng/mlis
plasmaconcentration;e.Dailyproductionoftestosteroneis0.

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2-0.3%mg
Testosteroneinfemales
Itissecretedbytheovary(50%)andalsoderivedfromthe
peripheralconversionofandrostenidione(40%),whichissecretedin
equalamountsbytheovaryandadrenals.

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Totaldailyproductionoftestosteroneis0.2-0.3%mg&theplasma
levelis0.2-0.8ng/ml
Thenormalincreaseinstromaltissueatovulationcausesaslight
increaseinthesecretionofthesehormone
Afterthemenopause,theincreasedovarianstromaisresponsible

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fortheriseinthesehormones&thedevelopmentofhirsutismin
somepostmenopausalwomen

---

206.TrueaboutNonoxynol-9:
a)DecreaseriskofHIV
b)PreventSTDinfection

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c)Remaineffectivefor1-2hrafterapplication
d)Spermicidalaction
e)Causesitchingofvaginainfemale&itchingofpenisinmale
CorrectAnswer-C:D:E
Ans.c.Remaineffectivefor1-2hrafterapplicationd.

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Spermicidalactione.Causesitchingofvaginainfemale&
itchingofpenisinmale
TODAY:
Itismushroomshapedpolyurethanedisposablesponge.
ItiscontainslgmofNONOXYNOL-9andisprovidedwithaloopfor

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easyremoval.
Itisabarriercontraceptivewhichpreventsentryofspermintothe
cervicalcanalandcontainsaspermicidalagent.
Itshouldbeplacedhighupinthevaginawithconcavesidecovering
thecervix.

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Itremainseffectivefor24hoursregardlessofthefrequencyof
coitus.
Itistobeusedonlyonce.
Itshouldbeleftinvaginaandremoved6hrsaftersexual
intercourse.

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Failurerate=9-30/HWY
Sideeffects:
Allergicreactions
Vaginaldryness,sorenessoritching

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Itcanleadtogenitallesionswhichmaydamagethevaginalmucosa

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andenhanceHIVtransmission.
Note:
Differentbookshaveadifferentsayonroleoftodayinpreventing
STD'sandtoxicshocksyndrome.ButLeonSperoffisthemost
authenticbookforthisissue.Itsays?

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Thereisnoriskoftoxicshocksyndrome,intactnonoxynol9retards
staphylococcalreplicationandtoxinproduction.
Itdecreasestheriskofinfectionwithgonorrheatrichomonasand
chlamydia.

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207.Featureoffalselabor:

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a)SteadyintensityofPain
b)Cervicaldilation
c)Discomfortisinthebackandabdomen
d)Intervalsremainlong
e)Discomfortusuallyisrelievedbysedation

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CorrectAnswer-A:D
Ans.a.SteadyintensityofPain;d.Intervalsremainlong
Painintensity:
Intensity:Intrauterinepressure:190-300Montevideounits
40?50mmHginfirststage

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100?120mmHginsecondstage
Duration:
Firststage:30seconds
Frequency:
Firststage:atintervalsof10?15minutes

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Insecondstage:every2?3minutes.
Painofuterinecontractionsisdistributedalongcutaneousnerve
distributionofT10toL1
Painofcervicaldilatationandstretchingisreferredtobackthrough
thesacralplexus

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Effectsofretractiononlabor:
Dilatationandeffacementofthecervix
Expulsionofthefetus
Maintainthedescentproducedbyuterinecontraction
Reducesurfaceareaofuterusfavouringseparationofplacenta.

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Hemostasisafterseparationofplacenta

---

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208.Whichofthefollowingistrueabout
Partialmole:
a)Karyotypeis69XXYor69XYY
b)HighmalignantPotential

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c)?HCGlevelis<50000
d)Thecanluteincystscommon
e)Immunostaining(p57KIP2)positive
CorrectAnswer-A:C:E
Ans.a.Karyotypeis69XXYor69XYY;c.?HCGlevelis<50000;

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e.Immunostaining(p57KIP2)positive
Partialmoles
Partialmolesorincompletemolarpregnancymeansthatalongwith
thehydatidiformchangessomeelementoffetaltissueispresent
Theyhaveatriploidkaryotype(69chromosomes),theextra

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haploidsetofchromosomesusuallyisderivedfromthefather.
Characteristicpathologicalfeaturesofpartialmole
1. Chorionicvilliofvaryingsizeswithfocalhydatiformswelling,
cavitationandtrophoblastichyperplasia
2. Markedvillousscalloping

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3. Prominentstromaltrophoblasticinclusions
4. Identifiableembryonicorfetaltissue.
5. Featureslikehyperemesis,hyperthyroidismandThecaluteincysts
arerareinpartialmole.
Diagnosis

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TheUSGcriteriafordiagnosisofpartialmoleis
?hcglevels>200mIU/rni,afterevacuationofpartialmoleinthe

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thirdthroughtheeighthweekareassociatedwitha35%riskof
persistenttrophoblasticdisease.
Themostsignificantrecentdevelopmentinthepathologicalanalysis

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ofH.moleistheuseofP57KIP2immunostainingtomakea
definitivediagnosisofandrogeneticcompleteH.Moleasopposedto
anhydropicabortionorapartialmole.Stainingisnegativein
completemoleincontrasttopartialmoles,hydropicabortion&
normalplacenta

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1. Presenceoffocalcysticareasintheplacentaltissues.
2. Increaseintransversediameterofgestationalsac.

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209.Trueaboutacuteparonychia:
a)Pusundernailbed
b)Pusmayextendtobaseofnail

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c)Swellingofnailfold
d)Candidaismostcommoncausativeorganism
e)None
CorrectAnswer-A:B:C
Ans.A,PusundernailbedB,Pusmayextendtobaseofnail&

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C,Swellingofnailfold
AcuteParonychia:
Paronychia:Inflammationofnailfolds.
Etiology:StaphyLococcusenterthenailfold
Clinicalfeature:Nailfoldisswollen,redandtender.Pusvisible

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undernailfold/nailbed.

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210.TrueaboutCampbelldeMorganspots:
a)Benign
b)Malignant
c)Proliferationofbloodvessel

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d)Verypainful
e)Cherryredincolor
CorrectAnswer-A:C:E
Ans.(A)Benign(C)Proliferationofbloodvessel(E)Cherryred
incolor

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[RefL&B26th/599;http:l/www.dermhealth.com/campbell-de-
morgan-spots.html;http://ww14,.pcds.org.uAtechnical-
guidance/cherry-angioma-syn.-campbell-de-morgan-sPot]
CampbellDeMorganspots:
Alsoknownascampbelldemorganangiomas,cherryangiomas,

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cherryspotsandsenileangiomas,arebenign(non-cancerous)skin
growthsmadeofbloodvessels.
Growthsarebrightred,oftendescribedas"cherry-ret'.
Hencetheyareoftenreferredtoascherryangiomas.
Theycanappearanywhereonthebody,butmostoftenappearon

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thctorso
Causes:
Hereditary
Hormonalchangesduringpregnancy.
Appearmostcommonlyinadultsovertheageof30butpeopleof

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anyagecangetthem.

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211.
Whichofthefollowingdiseaseis
associatedwithhepatitisCinfection:
a)Lichenplanus

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b)Psoariasis
c)Sjogren'ssyndrome
d)HUS
e)HSP
CorrectAnswer-A:C

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Ans.(A)Lichenplanus(C)Sjogren'ssyndrome
[Ref:NeenaKhanna4th/56;Ilarrison19th/2041;Roxburg16th/;
HepatologybyKuntz2nd/443]
HepatitisCAssociateddisease:
Attentionhasbeendrawnaswelltoassociationsbetweenhepatitis

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CandsuchcutaneousdisordersasPorphyriacutaneatardaand
lichenplanus.
ExtrahepaticmanifestationsinViralHepatitisC:
Agranulocytosis
Aplasticanaemia

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Cornealulceration
CryoglobulinaemiaQ
Diabetesmellitus(typeI)
Erythemaexsudativummultiforme
GlomerulonephritisQ

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Guillain-Barresyndrome
Hyperlipasaemia
LichenPlanus

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Non-Hodgkinlymphoma
Polyarteritisnodosa

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Polyarthritis
Polyneuritis
PorphyriacutaneatardaQ
Sialadenitis
Sjogrensyndrome/Siccasyndrome

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Thrombocytopenia
Thyroiditis

---

212.Whichofthefollowingstatementis/are
correctaboutScabies:
a)Numberoflesioncorrespondenttonumberofmite

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b)Ivermectinnotusedfortreatment
c)Itchingworsenatnight
d)Notinvolvefaceinchildren
e)None
CorrectAnswer-C

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Ans.C.Itchingworsenatnight
[Ref:NeenaKhanna4th/341-<14,3rd/297;Harrison19th/27t14-45;
KDT6th/863-64]
Thenumberofmitesnormallypresentinanindividualpatientvaries,
beinglessthan7-8inanadult.

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Mostlesionsinscabiesareduetohypersensitivity.
Scabies(sarcoptesscabieivar.hominis)
Morphology:
Pruritic,erythematouspapules,burrows,andvesiclesinweb
spaces,tolarwrtsk,waist,genitalsandaxillae.

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Scalp,face,Palm&solesarecharacteristicallyinvolvedin
infants/children
Scabicidesusedare:
PermethrincreamQ(5%),Gammabenzenehexachloride(G-
BHCI%),Crotamiton(10%o)'Benzylbenzoate(25%)6ivermectin

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(singleoraldose200mg/kg)

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213.ThefollowingstatementisTRUEforPityriasisRosea:
a)Selflimiting
b)Chronicrelapsing
c)Lifethreateninginfection

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d)Causedbydermatophytes
e)None
CorrectAnswer-A
Ans.A.Selflimiting
Pityriasisroseaisanacuteexanthematouspapulosquamous

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

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Morphology:
Heraldpatch,FirtreeorChristmastreeappearance
Site:
Trunkalonglineofcleavage;sometimes(20%)lesionsoccur
predominantlyonextremities&neck(inversepattern)

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Ref:Harrison'sPrinciplesofInternalMedicine16thEditionPage
292;Roxburgh's-CommonSkindisease17thEditionPage17;
Fitzpatrick'sDermatology5thEditionPage7369;Illustrated
TextbookofDermatology:Pasricha3rdEditionPage7134;
IllustratedSynopsisofDermatology&STDs,NeenaKhanna1st

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EditionPage742-44
Accordigntoananthanarayanmicrobiologybook9thed/p.595:

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Causatiyeagent:yeastlikefungusmalasseziafurfur(formelyPityro
sporumorbiculare).
Site:Uppertrunk,neck6upperarm.

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Thisachronic,usuallyasytnptomatic,invohtementofthestartum
corneum.
Theoldnametineaversicolorshouldbediscardedaspityrtasis
eersicolorisnotcausedbydermatophytes.

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214.

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Whichofthefollowingis/aretrue
regardinganaestheticgas:
a)N20-increasesefficacyofotherinhalationalagents
b)Halothane-agentofchoiceinchildren
c)Sevofluraneisagentofchoiceinchildren

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d)Isoflurane-smoothinduction
e)None
CorrectAnswer-A:C
Ans.(A)N20-increasesefficacyofotherinhalationalagents
(C)Sevofluraneisagentofchoiceinchildren

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NitrousOxide:
Goodanalgesia
Itisnotcompleteanaesthesia(usedasasupplementtoanesthesia)
Whengivenalongwithotherinhalationalagentitincreasesthe
alveolarconcentrationofthatagent(secondgaseffect)

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Notamusclerelaxant
Sevoflurane:
Odourissweetsoinductionissmooth
Faster,pleasant&smoothinductionwithnosignificantsystemic
toxicitymakessevofluraneistheagentofchoiceforinductionin

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children

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215.Whichoneofthefollowinganaesthetic
agentsdoesnottriggermalignant
hyperthermia?
a)Halothane

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b)Isotlurane
c)Suxamethonium
d)Thiopentone
e)None
CorrectAnswer-D

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Ans.is'd'i.e.,Thiopentone
DrugscausingMalignanthyperthermia
Succinylcholine
Enflurane
Methoxyflurane

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Phenothiazines
Halothane
Sevoflurane
MAOinhibitors
Lignocaine

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Isoflurane
Destlurane
TCA
SuccinylcholineisthemostcommoncauseofMH.
Amongstanaesthetics,halothaneismostcommoncause.

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CombinationofSchandHalothanehasamuchhigherincidence.

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216.TrueaboutEndotrachealtube:
a)Mostcommonusedsizeforadultmaleis8-8.5
b)Mostcommonusedsizeforadultfemaleis7-7.5
c)PVCtubeisreusablebycleaning

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d)Inchildrencuffedtubeisnotused
e)Cuffisforaspirationofsecretions
CorrectAnswer-A:B:D
Ans.(A)Mostcommonusedsizeforadultmaleis8-8.5
(B)Mostcommonusedsizeforadultfemaleis7-7.5(D)In

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childrencuffedtubeisnotused
[RefAjayYadav5th/43-46;Lee13th/209;Miller7th/Chap10;
Morgansclinicalanesthesia5th/321]
Thesizeofthetrachealtubeisnormallydescribedastheinternal
diameter(ID)inmillimeters.

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Trachealtubesizeof8mm(ID)formolesand7.5mm(ID)for
femalesareoftenused.
Twotypes-redrubber(reusable,costlier,non-transParent)&PVC
(disposable,cheap,transparent).
CuffpreventleakagebetweentheETT&thetrachea-bothleakage

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ofgasoutwardsduringIPPV&ofgastriccontents,blood&mucus
intothelungs.
Inchildrenlessthan10yearsofageuncuffedtubeshouldbeused
&-thereshouldbeslightleaktoavoidbarotraumasifinspiratory
pressureexceedsabove30cmH2O.

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217.Trueaboutsubarachnoidblock(spinal
anesthesia):
a)Cannotbeusedininfant&children
b)Canbegivenbyunskilleddoctor
c)MaybeusedwhenI.Vaccessisnotpossibleforintravenous

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drugs
d)Hypotensionismostcommonside-effect
e)None
CorrectAnswer-D
Ans.D.Hypotensionismostcommonside-effect

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[RefAjayYailav5th/155-61;Lee13th/479;OxfordHandbookof
Anesthesia3rd/832]
Subarachnoidblock:
Mostcommonlyusedanaesthetictechnique
AdultlevelisusuallyL3-4

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Indications:
Orthopaedicssurgerygeneralsurgery(pelvic&perineal),
gynecological&obstetricalsurgery'urologicalsurgeriesetc.,
MostcommonlydrugsusedinIndiaare-xylocaine(lignocaine)&
Sensoricaine(bupivacaine)

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Hypotensionismostcommonside-effect:
Managedbypreloading&intraoperativefluidsvasopressors.For
thisgoodi.VaccessisveryimPortant.

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218.IndicationofCVPlineis/are:
a)CVPmonitoringinshockpatient

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b)Priortomajorsurgery
c)ForadministeringinotropicsthroughCVPlineinshockpatients
d)Ineverycaseofcaesareansection
e)Forgivingbloodinpatientwithseverehaemorrhage
CorrectAnswer-A:B:C:E

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Ans.(A)CVPmonitoringinshockpatient(B)Priortomajor
surgery(C)ForadministeringinotropicsthroughCVPlinein
shockpatients(E)Forgivingbloodinpatientwithsevere
haemorrhage
[RefAjayYadav5th/59;Morgan'sclinicalanesthesia5th/100]

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IndicationofCVP:
Majorsurgerieswherelargefluctuationsinhaemodynamicsare
expected
Openheartsurgeries
Fluidmanagementinshock

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Asvenousaccessinpatientswithpoorperipheralveins
Parenteralnutrition
Aspirationofairembolism
Cardiacpacing

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219.Waterlilysignisseenin:

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a)Hydatidcystoflung
b)Aspergillomalung
c)T.B
d)Silicosis
e)Hemartomalung

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CorrectAnswer-A
Ans.(A)Hydatidcystoflung
[RefReviewofRadiologybySumerSethi6th/59;DahnertRadiology
manual5th/493]
HydatidLung

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Noorrarecalcificationinlung
WaterlilysignorCamalotesign(inchestX-ray)
LungEchinococcosis:
Waterlilysign:
Completelycollapsedcrumpledcystmembranefloatingonthecyst

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fluid
SignofCamelot
Serpentsign
Cumbosign
Meniscussign

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Crescentsign
Hamartomalung.
Carney'striad&calcification
Silicosis:Eggshellcalcification.

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220.Whichofthefollowingdonotuse

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radiation:
a)MRI
b)CT
c)USG
d)SPECT

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e)PET
CorrectAnswer-A:C
Ans.(A)MRI(C)USG
[R4L6B26th/174;ReviewofRadiologybySumerSethi6th/5'9;
DahnertRadiologymanuatsth/1070-71]

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Ultrasound:
Secondcommonestmethodofimaging.
Itreliesonhigh-frequencysoundwavesgeneratedbyatransducer
containingpiezoelectricmaterial.
MRI:

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MRIreliesonthefactthatnucleicontaininganoddnumberof
protonsorelectronshaveacharacteristicmotioninamagneticfield
(precession)andproduceamagneticmomentasaresultofthis
motion.
Abriefradiofrequencypulseisthenappliedtoalterthemotionofthe

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nuclei.

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221.Whichofthefollowingisnon-ionising
radiation:
a)X-ray
b)13-rays

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c)a-rays
d)Microwave
e)yrays
CorrectAnswer-D
Ans.(D)Microwave

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[RefRobbins9th/428;ReviewofRadiologybySumerSethi6th/166;
L6.826th/172]
TheenergyofnonionizingradiationsuchasUVandinfraredlight,
microwave&soundwaves,canmoveatomsinamoleculeorcause
themtovibrate.

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222.Onx-ray,smallbowelcanbe
differentiatedbylargebowelbyhaving:
a)Stringofbeadssign
b)Haustarions
c)Peripherallyplacedconcavecoilofintestine

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d)Airfluidlevel
e)Valvulaeconniventes
CorrectAnswer-A:D:E
Ans.(A)Stringofbeadssign(D)Airfluidlevel(E)Valvulae
conniventes

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[Ref.BDC6th/Vol.II438;ReviewRadiologybySumerSethi
6th/123;Grainger&AllisoniDiagnosticRadiology6th/598,602;
DahnertRadiologymanual5th/767;L6B26th/I143-44]
Dilatedloopsofsmallintestinearereadilyidentifiediftheyaregas
filledonsupineradiographs.

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Thestringsofbeadssign,causedbyalineofgasbubblestrapped
b/wthevalvulascontents,isseenonlywhenverydilatedsmall
bowelisalmostcomPletelyfilledwithfluid&isvirtuallydiagnosticof
smallbowelobstruction.

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223.Forradiotherapyanisotopeispacedin

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oraroundcanecrsite.Itiscalledas:
a)Brachytherapy
b)Teletherapy
c)Externalbeamtherapy
d)IntensityMedulatedradiotherapy

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e)None
CorrectAnswer-A
Ans.(A)Brachytherapy
[Ref.RadiologybySumerSethi6th/176;Grainger&Allison\
DiagnosticRadiology6th/1737]

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Brachytherapy:
Itreferstosituationsinwhicharadioisotopeisplacedontoorinside
thepatient.
Thesourcecanbeplacedintothetargettissuesortumouritself
suchasprostateorbreast(interstitialbrachytherapy,intoabody

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cavitysuchastheuterinecavity,oesophagusorbronchus
(intracavity/intraluminalbrachytherapy)otontotheskinsurfaceto
treatacutaneousmalignancy

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224.Normalbraincalcificationis/arepresent
in:

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a)Pinealgland
b)Choroidsplexus
c)Thalamus
d)Duramater
e)Hypothalamus

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CorrectAnswer-A:B:D
Ans.(A)Pinealgland(B)Choroidsplexus(D)Duramater
[ReviewofRadiologybySumerSethi6th/137]
NormalIntracranialCalcification:
Pineal,habenulae

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ChoroidPlexus
Dura(falx,tentorium,overvault)
Ligaments(petroclinoid&interclinoid)
Pacchionianbodies
BasalGangliadentatenucleus

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Pituitary
Lens

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225.Exposure&responseprevention
techniqueis/areusedin:
a)Schizophrenia

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b)OCD
c)Phobia
d)Mania
e)Depression
CorrectAnswer-B:C

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Ans.(B)OCD(C)Phobia
[RefAhuja7th/94,214-15,80;Kaplan&Sadockltth/42s,1266-67]
InOCD:
TheprincipalbehavioralapproachesinOCDareexposureand
responseprevention.Desensitization,thoughtstopping,flooding,

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implosiontherapy,andaversiveconditioninghavealsobeenusedin
patientswithOCD.
Inbehaviortherapy,patientsmustbetrulycommittedto
improvement.
InPhobia:

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Ifproperlyplanned,behaviortherapy(flooding,systematic
desensitization;exposure&responseprevention(relaxation
technique)isusuallysuccessful.

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226.Mostcommondisorder(s)aftertrauma
is:

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a)Majordepression
b)Mania
c)Schizophrenia
d)PTSD
e)Acutestressreaction

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CorrectAnswer-D:E
Ans.(D)PTSD(E)Acutestressreaction
[Ref:Ahuja7th/111-12;Kaplan6Sadock11th/437-40,449]
Posttraumaticstressdisorder(PTSD):
Startsasadelayed&protractedresponsetoanexceptionally

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stressfulorcatastrophiclifeeventorsituation,whichislikelyto
causepervasivedistressinalmostanyperson(e.gdisasters,war,
rapeortorture,seriousaccident.
Symptomsmaydevelop,afteraperiodoflatency,withinsixmonths
afterthestressormaybedelayedbeyondthisperiod.

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Acutestressreaction:
Immediate&cleartemporalrelationshipb/wanexceptionalstressor
(suchasdeathofalovedone,naturalcatastrophe,accident,rape)&
theonsetofsymptoms.
Symptomsrangefromadazedcondition,anxiety,depression,

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anger,despair,overactivityorwithdrawalconstrictionoffieldof
consciousness.
Resolverapidly(withinafewhoursusually),ifremovalfromthe
stressfulenvironmentispossible.

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Ifstresscontinuesorcannotbereversed,resolutionofsymptoms

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beginafterl-2days&isusuallyminimalafterabout3days.

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227.Awomanhasmilddepressionafterfew
daysofdelivery&disappearedafter2
weekinpostpartumperiod.Itmaybedue
to:

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a)Post-partumblue
b)Mania
c)Post-partumdepression
d)Milddepression
e)Postpartumpsychosis

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CorrectAnswer-A
Ans.(A)Post-partumblue
Normallyaround25-50%ofallwomencandeveloppsychological
symptomsinthepuerperalperiod.
Commonesttypeofpresentationismilddepression&irritability,

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oftenknownaspostnatalblues.
Passoffwithinafewdays.
SeverepsychiatricsymPtomsincludeddepressiveepisodewith
psychoticsymPtoms(mostcommon),schizophrenialikesymptoms,
manicepisode&delirium(leastcommon).

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invalidquestionid

---