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This post was last modified on 11 August 2021

1.Trueaboutinferiorobliquemuscle:
a)Suppliedbyinferiordivisionof3rdCN
b)Primaryeyeaction-Extorsion,abduction&depression
c)Themusclepassbelowinferiorrectus
d)Originfromlacrimalbone

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e)Nerveentersthemusclefromocularsurface
CorrectAnswer-A:C
Ans.(A)Suppliedbyinferiordivisionof3rdCN(C)Themuscle
passbelowinferiorrectus
Itoriginatesfromorbitalplateofmaxillalateraltotheorificeof

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nasolacrimalduct.
Itistheonlymuscletotakeoriginfromfrontoftheorbit.Otherrecti
muscletakeoriginfromannulusofzinn.
Occulomotornerveinorbit:Thelarger,lowerdivisiondividesinto3
branchesforthemedialrectus,theinferiorrectus6theinferior

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oblique.Allbranchesenterthemuscleontheirocularsurfaces
exceptthatfortheIOwhichentersitsposteriorborder'

2.TrueaboutSubmandibularglandduct
obstructionbystone:
a)Presentsasamassbelowbodyofmandible

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b)StoneinWhartonductcanbepalpatedbelowmucous
membraneoffloorofmouth
c)Startspainjustafterstartingameal
d)Paincarriedbyglossopharyngealnerve
e)Alltheabove

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CorrectAnswer-E
Ans.e.Alltheabove
Thesubmandibularsalivaryglandisacommonsiteofcalculus
formation.
Thepresenceofatenseswellingbelowthebodyofthemandible,

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whichisgreatestbeforeorduringamealandisreducedinsizeor
absentbetweenmeals,isdiagnosticofthecondition.
Examinationofthefloorofthemouthwillrevealabsenceofejection
ofsalivafromtheorificeoftheductoftheaffectedgland.
Frequently,thestonecanbepalpatedintheduct,whichliesbelow

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themucousmembraneofthefloorofthemouth'
Allthe3pairsofsalivaryglandsaresuppliedbyefferent
(Parasympathetic&sympathetic)&afferentnerves(chordatympani-
br.ofVIInerve&IXnerw).Afferentfiberscarrypainimpulsefrom
salivarygland

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3.Trueaboutpalatinetonsil:
a)Cryptsislinedbysquamousepithelium
b)SuppliedbyIXCN
c)Tonguedepressorisusedforexamination
d)Arterialsupplyisbytonsillarascendingbranchofgrater

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

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Presentinoropharynx
Palatinetonsil
ThePalatinetonsilsaretwoprominentmassessituatedoneon
eithersidebetweentheglossopalatineandpharyngopalatine
arches.

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Eachtonsilconsistsfundamentallyofanaggregationoflymphoid
tissueunderlyingthemucousmembranebetweenthepalatine
arches.
Inthechildthetonsilsarerelatively(andfrequentlyabsolutely)
largerthanintheadult

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Thefolliclesofthetonsilarelinedbyacontinuationofthemucous
membraneofthepharynx,coveredwithstratifiedsquamous
epithelium
Arteriessupplyingthetonsilarethe:
Dorsalislinguaefromthelingual

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Theascendingpalatineandtonsillarfromtheexternalmaxillary
Theascendingpharyngealfromtheexternalcarotid

Thedescendingpalatinebranchoftheinternalmaxillary
Atwigfromthesmallmeningeal.
Theveinsendinthetonsillarplexus,onthelateralsideofthetonsil

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Thenervesarederivedfromthesphenopalatineganglion,andfrom
theglossopharyngeal.

4.Trueaboutarticularcartilage:
a)Inzonelchondrocytesaresmaller
b)Zone2containsarticularcartilageprogenitorcells

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c)Zone3containscalcifiedcartilage
d)Zone4containcalcifiedcartilage
e)Chondrocytesareactivecell
CorrectAnswer-A:C:E
Ans.(A)Inzonelchondrocytesaresmaller;(C)Zone3contains

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calcifiedcartilage;(E)Chondrocytesareactivecell
Therearefourzones(layers)ofarticularcartilagefromthearticular
surfacetosubchondralbone.
1.Superficialzone(Zone-1)
Itisthethinnestzone.

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Itconsistsoftwolayers:(i)Asheetofdenslypackedcollagenwith
littlepolysaccharideandtocells,coversthejointsurface,and(ii)
flattenedelipsoid-shapedchondrocytes,withtheirmajoraxis
paralleltojointsurface.
2.Transitionzone(Zone2)

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Compositionisintermediatebetweensuperficialzoneandmiddle
zone.
3.Middlezoneorradialzoneordeepzone(Zone-3)
Thechondrocytesarespheroidalinshapewiththeirmajoraxis
perpendiculartojointsurface.

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Chondrocytesaremostactivesyntheticallyinthiszone.
Thiszonecontainsthelargestdiametercollagenfibrils,thehighest
concentrationofproteoglycansandthelowestconcentrationof
water.

4.Calcifiedcartilagezone(Zone-4)

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Itseparatesthemiddlezonefromsubchondralbone.
Thecellsaresmallwithsmallamountofendoplasmicreticulumand
golgiapparatuswithverylittlemetabolic

5.Trueaboutinnervationofparotidgland:
a)Postganglionicparasympatheticfibresecretomotor

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b)PreganglionicparasympatheticfibrerelayinOticganglion
c)Preganglionicparasympatheticnervebeginininferiorpetrosal
nucleus
d)Sympatheticnervearevasomotor
e)Postganglionicparasympatheticfibrespassthroughthe

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glossopharyngealnerve
CorrectAnswer-A:B:D
Ans:a.Postganglionicparasympatheticfibresecretomotor.b.
PreganglionicparasympatheticfibrerelayinOticganglion.d.
Sympatheticnervearevasomotor.

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Development:
Parotidglandisthefirstsalivaryglandtoappear,inearly6'week.
Itisectodermalinoriginanddevelopsfromthebuccalepithelium
justlateraltotheangleofmouth
Structuresemergingfromparotid

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Thefollowingstructuresemergefromtheparotidgland:
Anteriorborder:
Parotidduct
3Terminalbranchesoffacialnerve:
Thezygomaticandbuccalbranches:towardthetemporalregion,

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eyelidsandcheek,respectively.
Mandibularbranch:Runalongthebodyofthemandibletowardsthe
mouth
Apex:
5thterminalbranchoffacialnerve:Cervicalbranchcontinuesinto

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theneck(toplatysma).
Anterior&posteriordivisionsofretromandibularvein
Posteriorborder:
Posteriorauricularnerve
Posteriorauricularartery

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Posteriorauricularvein
Alongbase:
superficialtemporalartery
temporalbranchoffacialnerve
Auriculotemporalnerve

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STRUCTURESWITHINGLAND:
Arteries:
Externalcarotidarteryentersthroughposteromedialsurface
Maxillaryartery
Superficialtemporalvessel

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Posteriorauricularartery
Veins:
Theretromandibularveins
FacialNerve
ParotidDuct(Stenson'sduct)

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Theductturnsopensintothevestibuleofthemouth(gingivo-buccal
vestibule)oppositethecrownoftheupper2ndmolartooth
Nervesupply:
PARASYMPATHETIC:auriculotemporalnerve
SYMPTHETICSUPPLY-
plexusaroundtheexternalcarotidartery.

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SENSORYNERVES:auriculotemporalnerve,exceptforparotid
fascia&overlyingskinwhichareinnervatedbyGreatauricular
nerve(C2,C3).


6.Whichofthefollowingmuscleissupplied
bymediannerve:

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a)Oppenenspollocis
b)Adductorpollicis
c)LateralhalfoftheFlexordigitorumprofundus
d)Superficialheadofflexorpollicisbrevis
e)Deeppartofflexorpollicisbrevis

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CorrectAnswer-A:C:D
Ans.a.Oppenenspollocis;c.LateralhalfoftheFlexor
digitorumprofundus;d.Superficialheadofflexorpollicis
brevis
Therearefourshortmusclesofthumb(pollex),theyareabductor

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pollicisbrevis,opponenspollicis,flexorpollicisbrevisandadductor
pollicis.Thefirstthreeofthesemusclesformthethenareminence.
Allthesemusclesaresuppliedbymediannerveexceptforadductor
polliciswhichisinnervatedbyulnarnerve.

7.Trueaboutabductionatshoulderjoint:

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a)Supraspinatusinitiatesabduction
b)Serratusanterior&trapeziusalsohelpinabduction
c)Multipennatedeltoidclavicularfiberismainabductor
d)Axillarynerveinjuryhasnoeffectonabduction
e)Musculotendinouscuffstabilizesshoulderjoint

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CorrectAnswer-A:B:E
Ans.(a)Supraspinatusinitiatesabduction(b)Serratusanterior
&trapeziusalsohelpinabduction(e)Musculotendinouscuff
stabilizesshoulderjoint.
MOVEMENTSOFSHOULDERJOINT

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Movementineverydirection(Flexion,extension,abduction,
adduction,rotation,circumduction)
SpinalCordregulatingShouldermovements(C5,C6,C7&C8)
Flexion,Abduction,&lateralrotation(C5,C6,).
Extension,Adduction,&Medialrotationis(C6,C7,C8)

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Movementsthattakeplaceduringabductionofshoulderare
axialrotationofhumerusatacroclavicularjoint,elevationof
humerus&movementatclavicularendofsternoclavicularjoint.

PLANE
HUMERAL RANGE

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TYPEOF
AXISOF MUSCLES
FACTOR
OF
HEAD

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OF
MOVEMENT
MOTION INVOLVED
LIMITING
MOTION

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GLIDING MOTION
Total-0-
165?or
-Inferior
175?

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glenohumeral
Full
ligament
internal
-Tightnessof

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internal
-Tightnessof
Inferiorly
rotationof
Frontal

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Saggital Deltoid,
theinferior
Abduction
inglenoid humerus0-
plane

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axis
Supraspinatus
joint
cavity
60?

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capsuleof
Full
the
external
gleno-

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rotationof humeraljoint
humerus0-
90?

8.Organwhichhavenolymphaticsupply:
a)Eyeball

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b)Brain
c)Liver
d)Kidney
e)Spinalcord
CorrectAnswer-A:B:E

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Ans.a.Eyeball;b.Brain&e.Spinalcord
Lymphcapillariesareabsentfromthecellularstructureslikebrain,
spinalcord,splenicpulp,bonemorrow,articulatecartilage,
epidermis,hair,nail&cornea.
Lymphaticvesselarefoundinalltissue&organofbodyexceptthe

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centralnervoussystem,eyeball,internalear,epidermisoftheskin,
cartilage&bone.

9.Whichofthefollowingstatement(s)is/are
trueaboutsphinctersofbody:
a)Lower5cmofoesophagealactasoesophagealsphincter&itis

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notmorphologicallydifferentfromotherportionofoesophagus
b)Oesophageal&pyloricsphincterremainsintopicallycontracted
state
c)Pre-capillarysphincterispresentinb/wmetarteriole&capillary
d)Pudendalnervesuppliesthesphincterurethrae

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e)Sphincterofoddiliesatjunctionofduodenum&CBD
CorrectAnswer-B:C:D:E
Ans.b.Oesophageal&pyloricsphincterremainsintopically
contractedstate;c.Pre-capillarysphincterispresentinb/w
metarteriole&capillary;d.Pudendalnervesuppliesthe

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sphincterurethrae;e.Sphincterofoddiliesatjunctionof
duodenum&CBD
Thecommonbileductenterstheduodenumatduodenumpapilla.
ItsorificeissurroundedbythesphincterofOddi6itusuallyunites
withthemainpancreaticductjustbeforeenteringtheduodenum

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Atthelowerendoftheesophagus,extendingupwardabout3cm
aboveitsjunctionwithstomach,itisbroadloweresophageal
sphincter.
Loweroesophagealsphincter,aspecializezoneofcircularsmooth
musclesurroundingtheoesophagusatitstransitthroughthe

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diaphragmandformuchofitsshortabdominalfloor
Atthepointwhereeachtruecapillaryoriginatesfromametarteriole,
asmoothmusclefiberusuallyencirclesthecapillary.Thisiscalled,

theprecapillarysphincter.Thissphinctercanopen&closethe
entrancetothecapillary

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Pyloricsphincterremainslightlytonicallycontractedalmostallthe
time.Despitenormaltoniccontractionofthepyloricsphincter,the
pylorususuallyisopenenoughforwater&otherfluidstoemptyfrom
thestomachintotheduodenumwithease.

10.Muscle(s),whichformthefloorofpelvic

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floor:
a)Obturatorinternus
b)Piriformis
c)Puborectalis
d)Pubococcygeus

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e)Ischiococcygeus
CorrectAnswer-C:D:E
Ans.c.Puborectalis;d.Pubococcygeus;e.Ischiococcygeus
Thepelvicfloorisformedbythelargelevatorani(withparts
includingthepubococcygeus,puborectalis,andiliococcygeus)and

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themuchsmallercoccygeus.

11.TrueaboutAtlanto-axialjoint:
a)Vertebralarterypassthroughgroveonarchofatlasvertebrae
toforamenmagnum
b)Permitsflexion&extension

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c)Permitsidetosidemovementofhead
d)Permitsflexiononly
e)Permitsrotation
CorrectAnswer-A:C:E
Ans.a.Vertebralarterypassthroughgroveonarchofatlas

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vertebraetoforamenmagnum;c.Permitsidetosidemovement
ofhead;e.Permitsrotation
Thereare3atlantoaxialarticulations-twolateralatlantoaxialjoints
b/wthelateralmassesofCl&C2vertebrae&onemedian
atlantoaxialjointb/wthedensofC2&theanteriorarchtransverse

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ligamentoftheatlas
Movement(mainlyrotation)atallthreeatlantoaxialjointspermitsthe
headtobeturnedfromsidetoside,asoccurswhenrotatingthe
headtoindicatedisapproval(the'NO'movement)
Themostimportantfactorsmaintainingstabilityaretheligaments,of

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whichthetransverseatlantalligamentisthestrongest.
Thealarligamentsareweaker

12.AllaretrueaboutCSFexcept:
a)Totalvolumeis250ml
b)Pressureis60-180mmofH2O

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c)Formedfromchoroidplexusof3rdventricle
d)Formedfromchoroidplexusoflateralventricle
e)Noneoftheabove
CorrectAnswer-A
Ans.a.Totalvolumeis250ml

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ThemajorsourceofCSFisthechoroidalplexusofall4ventricles,
mainlyintwolateralventricles.
OthersourcesofCSFareependymalcellsoftheventriclesandthe
brainitself,viaperivascularspaces.
ThetotalvolumeofCSFinanadultisabout125-150ml.

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TherateofformationofCSFisabout500-550ml/day.ThustheCSF
isreplaced3-4timeseveryday.
CSFpHis7.33
112mmH20istheaveragenormalCSFpressure

13.

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Whichofthefollowingplaymost
importantroleinmemory:
a)Synapticnetwork
b)Electricconductionnetwork
c)Conductivitycircuit

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d)Conductivitynetwork
e)None
CorrectAnswer-A
Ans:a.SynapticNet.
[Ref:Ganong25th/283-88;Guyton12th/67;AKJain6th/1039-40]

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Synapticnetworkssinglebestanswer"Long-termmemoryinvolves
changesinthestructureofneuronsincludinggrowthofnew
processesandsynapses.
So,totheextentthatyourememberanythingaboutthismaterialon
memorytomorrow,ornextweek,ornextyear,itwillbebecause

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structuralchangesinsynapsesarebeginninginyourbrains.

14.CyanidepoisoningblockKinflux&Na
efflux.ButATPreversethiseffect.Sotrue
statement(s)relatedtomechanismof
actionofcyanideis/are:

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a)Kinflux&NaeffluxisregulatedbyNa-KATPaseenzyme
b)Kinflux&NaeffluxisregulatedbyNa-Kpump
c)ATPprovideenergyforthischannel
d)Na-KATPasechannelisATPindependent
e)None

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CorrectAnswer-A:B:C
Ans:a.Kinflux&NaEffluxIsRegulatedByNa-K-ATpase
Enzymeb.Kinflux&NaEffluxIsRegulatedByNa-Kpumpc.
ATPprovidesenergyforthischannel.
[Ref:Reddy32nd/595;Katzung13th/1010;Guyton12th/357;AK

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Jain6th/459;Harrison19th/262e-7]
Cyanide:
Directlypoisonsthelaststepinthemitochondrialelectrontransport
chain,cytochromea3,whichresultsinashutdownofcellularenergy
production.

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Thispoisoningresultsfromcyanidehighaffinityforcertainmetals,
notablyCoandFe+++.Cytochromea3containsFe+++,towhich
CN-binds.
CyanidePoisoning:
Itinhibitstheactionofcytochromeoxidase,carbonicanhydrase&

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probablyofotherenzymesystem.
Itblocksthefinalstepofoxidativephosphorylation&preventsthe

formationofATP&itsuseasanenergysource.

15.TrueaboutCarbonmonoxidepoisoning:
a)COhas100timesmoreaffinitythan02forHb

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b)Causerightsideshiftingof02dissociationcurve
c)Oxygen-haemoglobinsaturationcurvebecomeshyperbolic
shape
d)PulseoximetrycanaccuratelydetectlevelofCO
e)10-15%levelofCOnormallymayoccurinhealthynonsmoker

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CorrectAnswer-C
Ans:c.Orygen-haemoglobinsaturationsaturationCurve
BecomesHyperbolicShape
[RefGanong25th/650-51;Guyton12th/352;AKJain6th/431;
httpst/pedclerk.bsd.uchicago.edu/page/(www.nebi.Nlm.nih.

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gov)
Carbon-monoxide-poisoning:
Carbonmonoxideshiftstheoxygen-haemoglobinsaturationcurveto
theleftandchangesittoamorehyperbolicshape.
Lessoxygenisavailableforthetissues.

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plasmalevelofcarboxyhemoglobinisnormallyquitelow.
Atbaseline,levelsupto3percent,naybeseeninnonsmokers,
whilesmokersmayhavelevelsupto10-15%percent.
LeftshiftofO2-Hbdissociationcurveoccurin-COpoisoningHbF,
myoglobinebdecreaseinbodytemperature.

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COhasabout240timestheaffinityofO2forHb;thismeansthatCO
willcombinewiththesameamountofHbas02whentheCOpartial
pressureis240timeslower.

16.Deadspaceisincreasedin:
a)Positivepressureventilation

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b)Extensionofneck
c)Anticholinergicdrug
d)Endotrachealtubeintubation
e)Emphysema
CorrectAnswer-A:B:C:E

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Ans:a.Positivepressureventilationb.Extensionofneckc.
AntiCholinergicdruge.Emphysema
RefAjayYadav5th/4-5;Ganong25th/632-33;Guyton323;AKlain
6th/421
AnatomicalDeadSpaceIncreasedin:

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OIdage
Neckextension
jawprotrusion
Bronchodilators
Increasinglungvolume(moreininspiration)

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Atropine(causebronchodilation)
Anaesthesiamask,circuits
Intermittentpositivepressureventilation(IppV)&positiveend
expiratorypressure(PEEP)
AlveolarDeadSpaceincreasedby:

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Lungpathologiesaffectingdiffusionatcapillarymembranelike
interstitiallungdisease,pulmonaryembolism,pulmonaryedema&
ARDS
Generalanaesthesia
IPPV

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PEEP
HYPotension

17.Whichofthefollowingistrueabout
cardiacinnervation:
a)T1-T5issympatheticsupply

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b)Inferior&superiorcervicalganglianotinvolveininnervation
c)Parasympatheticsupplyisfromvagusnerve
d)Greatcardiacnervearisefromsuperiorcervicalganglia
e)InferiorcervicalgangliagivesoffInferiorcardiacnerve
CorrectAnswer-A:E

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Ans:a.T1-T5issympathetice.Inferiorcervicalgangliagives
offinferiorcardiacnerve
[Ref:BDC6th/Vol.I267;Grayb40th/982;Guyton12th/178;AKlain
6th/324]
CardiacInnervation

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Thecervicalgangliaareparavertebralgangliaofthesympathetic
nervoussystem.
Thecervicalganglionhasthreeparavertebralganglia.
Superiorcervicalganglion(largest)-adjacenttoC2&C3
Middlecervicalganglion(thesmallest)-adjacenttoC6;target:

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heart,neck.
Inferiorcervicalganglion.Theinferiorganglionmaybefusedwith
thefirstthoracicgangliontoformasinglestructure,thestellate
ganglionadjacenttoC7.
Themiddlecardiacnerve(greatcardiacnerve),thelargestofthe

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threecardiacnerves,arisesfromthemiddlecervicalganglion.
Nervesemergingfromchemicalsympatheticgangliacontributeto
thecardiacplexus.

SymPatheticsupply:T1toT5spinalsegments.
SympatheticpreganglionicfibrespassintothesymPathetictrunkto

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superionmiddle&inferiorcardiacganglion
Sympatheticpostganglionicfibrespassesviasuperiormiddle&
inferiorcardiacsympatheticnerves
Parasympatheticsupplytoheartisviatwovagusnerveswiththeir
cellbodieslocatedinthemedullainthenucleusambiguus.

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18.Trueaboutcortisollevelinbloodplasma:
a)Morningconcentrationis17-18nmol/d1
b)Morningconcentrationis5-23pg/dL
c)Eveningconcentrationisalmosthalfofmorningconcentration
d)Eveningconcentrationis5-23i.ig/dL

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e)None
CorrectAnswer-B:C
Ans:b.Morningconcentrationis5-23microg/dLc.Evening
concentrationisalmostHalfOfMorningConcentration
Eveningconcentrationisalmosthalfofmorningconcentration(a/c

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belowreferencevalues).
Cortisolconcentrationat8.00aminmorning5-20mcg/dL(140-550
nmol/L).

19.Saccadicceyemovementiscontrolledby:
a)Parietallobe

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b)Prefrontallobe
c)Temporallobe
d)Frontalcortex
e)Occipitallobe
CorrectAnswer-D

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Ans:d.Frontalcortex
[RefGanong25th/189,195-96;Guyton12tlt/786;AKJain1115-16]
Normallysaccadicmovementsarevoluntarybutcanbearousedby
peripheralvisualorauditorystimulibystimulationoffrontaleye
fields(area8).

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Thusthesemovementsareprogrammedinthefrontalcortex.
Thebilateralfrontaleyefieldsinthispartofthecortexareconcerned
withthecontrolofsaccades,andanareajustanteriortothesefields
isconcernedwithvergenceandthenearresponse.

20.TrueaboutnormalECG:

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a)NormalPRintervalis0.12-0.20s
b)PRinternalcorrespondenceinitiationofPwavetoinitiationofR
wave
c)QTinternalcorrespondenceinitiationofQwavetoinitiationofT
wave

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d)NormalQRSinterval<0.12s
e)NormalQTcinterval
CorrectAnswer-A:D
Ans:a.NormalPRintervalis0.12-0.20sd.NormalQRSinterval
[Ref:Ganong25th/524;Guyton12th/179-80;ECGmadeEasyby

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Hamptot4th/6-71]
ThePRintervalismeasuredfromthebeginningofPwavetothe
beginningofQRScomplex.
AQTcintervallongerthan0.45sislikelytobeabnormal.
NormalQRSintervaldurationisnogreaterthan0.12s.

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QTintervalisameasureofthetimebetweenthestartoftheQwave
andtheendoftheTwaveintheheart'selectricalcycle.



21.Whichofthefollowingis/aretrueabout
SIADH:

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a)Desmopressinisusedfortreatment
b)Vasopressinlevelisinappropriatelyhigh
c)Plasmaosmolalityishigherthanurineosmolality
d)TedOsmolalityofurine
e)TedOsmolalityofplasma

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CorrectAnswer-B:D
Ans:b.VasopressinlevelisinappropriatelyHighd.Ted
Osmolalityofurine
[RefHarrison19th/2280;Ganong25th/698;AKJain6th/673-74]
Desmopressinisveryusefulinthemanagementofdiabetes

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insipidus.
SyndromeofInappropriateAntidiureticHormone
Thesyndromeof"inappropriate'hypersecretionofantidiuretic
hormone(SIADH)occurswhenvasopressinisinappropriatelyhigh
relativetoserumosmolality.

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Vasopressinisresponsiblenotonlyfordilutionalhyponatremia
(serumsodium<135mmol/L)butalsoforlossofsaltintheurine
whenwaterretentionissufficienttoexpandtheECFvolume,
reducingaldosteronesecretion
Features:

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Hyposmolality
Increasedurineosmolality
Urineosmolalitybecomeshigherthanplasmaosmolality
UrinaryNa+exceeds20mEq/L


22.Whichofthefollowingfeature(s)is/are

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suggestiveofnehogrnicDIincomparison
tocentralDI:

a)Desmopressinnasalsprayrestoreurineoutputtonormallevel
b)Basalvasopressinlevel>1pg/ml
c)NormalposteriorpituitarybrightspotisnotvisibleonMRIscan

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d)Changeinwaterlossduringfluiddeprivationtest
e)None
CorrectAnswer-B
Ans:b.Basalvasopressinlevel>1pg/ml
[RefGanong25th/698;Guyton12th/488-89;AKJain6th/674]

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FailuretoProduceADH:"Central"DiabetesInsipidus.
Thetreatmentforcentraldiabetesinsipidusisadministrationofa
syntheticanalogofADH,desmopressin,whichactsselectivelyon
V2receptorstoincreasewaterpermeabilityinthelatedistaland
collectingtubules.

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Desmopressincanbegivenbyinjection,asanasalspray,ororally,
anditrapidlyrestoresurineoutputtowardnormal.
ThepolyuriaanilpolydipsiaofnephrogenicDIarenotaffectedby
treatment*ithstandarddosesofDDAVP.


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23.AllareUreacycleenzymesexcept:
a)Ornithinetranscarbamylase
b)Carbamoyl-phosphatesynthetaseI
c)Argininosuccinase
d)Citrullinesynthase

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e)Argininosuccinicacidsynthetase
CorrectAnswer-D
Answer:(D)Citrullinesynthase[RefHarper30th/290-96,
29th/274-88;Lippincott


24.Non-polaraminoacidsare:

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a)Proline
b)Lysine
c)Isoleucine
d)Arginine
e)Asparginine

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CorrectAnswer-A:C
Ans:a.Prolinec.Isoleucine[RefHarper30th/16-22;Lippincott
6th/1-9;Satyanarayan4th/48]
AcidicandPolarsidechainsAsparticAcidGlutamicAcid
BasicandPolarsidechainsArginine,Lysine,Histidine

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Uncharged&PolarsidechainsAsparginine,Glutamine,Serine,
Threonine,Tyrosine
NonPolarAminoAcidswithNonPolarsidechainsGlycine,
Alanine,Valine,Leucine,Isoleucine,Proline.

25.Trueaboutsqualene:

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a)Presentinsubhumanprimateonly
b)Itisoneofthemajorcarbohydratesofbody
c)Itinvolvesinthesynthesisofcholesterol
d)Itinvolvesinthesynthesisofsteroids
e)None

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CorrectAnswer-C:D
Ans:(C)Itinvolvesinsynthesisofcholesterol,(D)Itinvolvesin
synthesisofsteroids
Squaleneisahydrocarbonandatriterpene,andisanaturaland
vitalpartofthesynthesisofallplantandanimalsterols,including

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cholesterol,steroidhormones,andvitaminDinthehumanbody.
Squaleneisusedincosmetics,andmorerecentlyasan
immunologicadjuvantinvaccines.
Itisanatural30-carbonorganiccompoundoriginallyobtainedfor
commercialpurposesprimarilyfromsharkliveroil(henceitsname),

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althoughplantsources(primarilyvegetableoils)arenowusedas
well,includingamaranthseed,ricebran,wheatgerm,andolives.
Squaleneandomega2fattyacidhasunlikeomega3fishoilsmore
completeandeffectivechemicalgroups.

26.Molecularweightofproteincanbe

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determined/estimatedby:
a)SDS-PAGE
b)Gelfiltrationchromatography
c)Agarosegelelectrophoresis
d)Ultracentrifugation

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e)FRETmicroscopy
CorrectAnswer-A:B:D
Ans:(A)SDS-PAGE(B)Gelfiltrationchromatography(D)
Ultracentrifugation[RefHarper30th/28;Shinde7th/772-74;
Satyanarayan4th/725,60;Vasudevan5th/482-851

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"SDS-PAGEiscommonlyusedformolecularweightdetermination
ofproteins"(Vasudevan5th/482)
"SDS-PAGEisapopulartechniquefordeterminationofmolecular
weightofproteins"(Satyanarayan4th/725)
"Sodiumdodecylsulfate-polyacrylamidegelelectrophoresis(SDS-

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PAGE)isareliablemethodfordeterminingthemolecular
weight(MW)ofanunknownprotein".
"Thegelfiltrationchromatographytechniqueisusedfor"Separation
ofproteinmolecules,purificationofproteins&molecularweight
determinations"Ultracentrifugationisanindispensabletoolforthe

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isolationofsubcellularorganelles,proteins,&nucleicacids.In
addition,thistechniqueisalsoemployedindeterminationof
molecularweightofmacromolecules\

27.GelusedinRNAelectrophoresis:
a)Agarosegel

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b)Polyacrylamideplaingel
c)PolyacrylamideSDS(Sodiumdodecylsulphate)impregnated
Polyacrylamidegel
d)A&C
e)None

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CorrectAnswer-A
Ans:a.Agarosegel
SeparationofRNAinagarosegelsisusedforanumberofdifferent
purposes,includingNorthernblotstomonitorRNAexpression
levels,checkingRNAintegrityandsizeselectionofRNAforcloning

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experiments.
SeparationofRNAbasedonfragmentlengthrequiresconditions
thataredifferentfromDNAanalysis.
ThemostfrequentlyuseddenaturantsforRNAagarosegel
electrophoresisareformaldehyde,formaldehyde/formamide,and

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glyoxalplusDMSO.
ThemostefficientRNAdenaturantismethylmercuryhydroxide.
Becauseofthehazardsassociatedwiththisdenaturant,itisthe
leastusedsystemforRNA

28.Whichoffollowingreleases/provide

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energy:
a)ConversionofADPtoATP
b)Breakingofhighenergybondtolowenergybond
c)Conversionofpyruvatetolactate
d)Electricalgradientacrossinner&outersideofmitochondria]

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membrane
e)Passageofe-throughFADinelectrontransportchain
CorrectAnswer-B:D:E
Ans:(B)Breakingofhigh...(D)Electricalgradientacross...(E)
Passageofe-throughFAD...
.

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Inabsenceof0xygenpyruvateisreducedtolacticacid(without
producingATP).Inanaerobicglycolysis,pyruvateactsasa
temporaryH-store.
Itdehydrogenation(oxidizes),thereducedNADH+H+backto
oxidizedNAD+,sothatglycolysiscancontinueevenintheabsence

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of02.Inpresenceof02,lacticacidcanbeoxidizedintopyruvicacid
again.
ElectrontransportiscoupledtothephosphorylationofADPbythe
transport("pumping")ofprotons(H+)acrosstheinnermitochondrial
membranefromthematrixtotheintermembranespaceat

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ComplexesI,III,andIV.
Thisprocesscreatesanelectricalgradient(withmorepositive
chargesontheoutsideofthemembranethanontheinside)anda
pHgradient(theoutsideofthemembraneisatalowerpHthanthe
inside).

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Theenergygeneratedbythisprotongradientissufficienttodrive
ATPsynthesis.Thus,theprotongradientservesasthecommon
intermediatethatcouplesoxidationtophosphorylation.

29.Whichofthefollowingisfeature(s)of
diabeticketoacidosis:

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a)Decreasedtriglyceridelevel
b)Increasedfattyacidlevel
c)TLipoprotein
d)Decreasedketonebodies
e)HighAniongapacidosis

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CorrectAnswer-B:C:E
Ans:(B)Increasedfattyacidlevel(C)TLipoprotein(E)High
Aniongapacidosis[RefHarper30th/231;Lippincott6th/339,
345;Satyanarayan4th/481,682;Harrison19th/2417-18]
DKAischaracterizedbyhyperglycemia,ketosis,andmetabolic

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acidosis(increasedaniongap)alongwithanumberofsecondary
metabolicderangements,Leukocytosis,hypertriglyceridemia,and
hyperlipoproteinemiaarecommonlyfoundaswell
Increasedlacticacidproductionalsocontributestotheacidosis.The
increasedfreefattyacidsincreasetriglycerideandVLDLproduction.

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VLDLclearanceisalsoreducedbecausetheactivityofinsulin-
sensitivelipoproteinlipaseinmuscleandfatisdecreased.
Hypertriglyceridemiamaybesevereenoughtocausepancreatitis.
Reducedinsulinlevels,incombinationwithelevationsin
catecholaminesandgrowthhormone,increaselipolysisandthe

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releaseoffreefattyacids.Normally,thesefreefattyacidsare
convertedtotriglyceridesorvery-low-densitylipoprotein(VLDL)in
theliver.

30.Whichofthefollowingis/aretrueabout
pHofsolution:

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a)Absoluteconcentrationofacid&salt
b)Relativeconcentrationofacid&saltinsolution
c)IncreaseoftemperatureincreasespH
d)AriseinH+concentrationdecreasespH
e)None

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CorrectAnswer-B:D
Ans:(B)Relativeconcentration...,(D)AriseinH*concentra
tion....
"WhenpHmeasuredatroomtemperaturethereisnodirect
correlationbetweenpHandtemperature.

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AriseinH+concentrationdecreasespHwhileafallinH+
concentrationincreasespH.ThereverseistrueforOH-
concentration
Theratioofsalttoacidconcentration-Actualconcentrationsofsalta
acidinabuffersolutionmaybevaryingwidely,withnochangein

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pH,solongastheratiooftheconcentrationsremainsthesame

31.Truestatement(s)aboutMagnetic-
activatedcellsorting:
a)Itisamethodtoseparatespecificcellfromcomplexmixture
b)Fluorescentdyesareuses

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c)Antibody-coatedmagneticnanoparticlesareused
d)Antibodiesusedarespecificforcertaincellsurfacemarkers
e)Magneticfieldisapplied
CorrectAnswer-A:C:D:E
Ans:(A)Itisamethod...,(C)Antibody-coatedmagnetic...,(D)

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Antibodiesusedare...,(E)Magneticfieldisappli...
MACS,isaproceduredevelopedbyMiltenyiBiotectoseparatecells
fromcomplexmixturesusingantibody-coatedmagneticnano
particles.
Theantibodiesarespecificforcertaincellsurfacemarkers,either

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expressedonyourpopulationofinterest(positiveselection),or
expressedonundesiredcelltypes(negativeselection).
Afteraddingtheantibody-coatedbeadstothecellmixtureand
incubating,thesuspensionisaddedtoaspecialsingle-use
separationcolumnaffixedtoamagnet,towhichthebeadsstick,

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whileunlabeledcellsflowthrough.

32.Silverstainingisdonefor:
a)DNA
b)RNA
c)Karyotypinganalysis

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d)Protein
e)Collagen
CorrectAnswer-A:B:C:D:E
Answer-(A)DNA(B)RNA(C)Karyotypinganalysis(D)Protein
(E)Collagen

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Silverstainingisahighlysensitivemethodfordetectingproteinsand
nucleicacids(dsDNA&RNA)inpolyacrylamideslabgels.
Silverstainingistheuseofsilvertoselectivelyaltertheappearance
ofatargetinmicroscopyofhistologicalsections;intemperature
gradientgelelectrophoresis;andinpolyacrylamidegels.

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Silverstainingisthemostsensitivemethodforpermanentstaining
ofproteinsornucleicacidsinpolyacrylamidegels.
Histologicalcharacterization:Silverstainingaidsthevisualizationof
targetsofinterest,namelyintracellularandextracellularcellular
componentssuchasDNAandproteins,suchastypeIIIcollagen

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andreticulinfibresbythedepositionofmetallicsilverparticlesonthe
targetsofinterest.

33.Non-codingRNAis/are:
a)miRNA
b)SiRNA

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c)tRNA
d)mRNA
e)rRNA
CorrectAnswer-A:B:C:E
Ans:a.miRN...,b.SiRNA...,c.tRNA...,e.rRNA...,[RefHarper

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30th/394-95,368;en.wikipedia.org;Lippincott6th/417]
AlleukaryoticcellshavetwomajorclassesofRNA,theprotein
codingRNAs,ormessengerRNAs(mRNAs),andtwoformsof
abundantnon-proteincodingRNAsdelineatedonthebasisofsize:
thelargeribosomalRNAs(rRNA)andlongnoncodingRNAs

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(lncRNAs)andsmallnoncodingRNAstransferRNAs(tRNA),the
smallnuclearRNAs(snRNAs)andthemicroandsilencingRNAs
(miRNAsandsiRNAs).
ThemRNAs,rRNAsandtRNAsaredirectlyinvolvedinprotein
synthesiswhiletheotherRNAsareparticipateineithermRNA

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splicing(SnRNAs)ormodulationofgeneexpressionbyaltering
mRNAfunction(mi/SiRNAs)and/orexpression(lncRNAs).These
RNAdifferintheirdiversity,stability,andabundanceincells

34.PolymeraseIIIsynthesizes:
a)Fragment28SofrRNA

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b)Fragment23SofrRNA
c)Fragment5SofrRNA
d)tRNA
e)mRNA
CorrectAnswer-C:D

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Ans:c.andd[RefHarper30th/395-98;Lippincott428]
"RNApolymeraseIIIsynthesizestRNA,5SrRNA,andsomesnRNA
andsnoRNA"(Lippincott428)

35.TwostrandsofDNAis/areheldby:
a)Glycosidicbond

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b)Hydrogenbond
c)Covalentbond
d)Ionicbond
e)Vanderwaalforce
CorrectAnswer-B

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Answer(b)hydrogenbond[RefHarper30th/359;Lippincott
6th/396-97;Satyanarayan4th/75]
Thetwostrandsareheldtogetherbyhydrogenbondformed
bycomplementarybasepairs"(Satyanarayan4th/75)
"Thebasepairsareheldtogetherbyhydrogenbonds:twobetween

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AandTandthreebetweenGandC.Thesehydrogenbonds,plus
thehydrophobicinteractionsbetweenthestackedbases,stabilize
thestructureofthedoublehelix.


36.Whichofthefollowingis/aretrueabout
Translation:

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a)N-formylmethionineisfirstaminoacidinprokaryotes
b)UsesenergyinformofGMP
c)ElongationfactorEF-1&EF-2usedinprokaryotes
d)ElongationfactorPisusedineukaryoticorganism
e)Threeinitiationfactorsarerequiredinprokaryotes

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CorrectAnswer-A:E
Ans:a.N-formylmethionine...,e.Threeinitiation[RefHarper
30th/419-23;Lippincott6th/438-42;Satyanarayan4th/554-60]
Ineukaryotes,thefirstaminoacidincorporatedismethionine(AUG
codon).Butinprokaryotes,thesamecodonattractsN-formyl

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methionine,whichisthefirstaminoacid"(Vasudevan5th/432)
"ElongationfactorPisaprokaryoticproteintranslation
factor
requiredforefficientpeptidebondsynthesison70S
ribosomesfromfMet-tRNAfMet.Itprobablyfunctionsindirectlyby
alteringtheaffinityoftheribosomeforaminoacyl-tRNA,thus

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increasingtheirreactivityasacceptorsforpeptidylStepsinProtein
Synthesis
Inprokaryotes,threeinitiationfactorsareknown(IF-1,IF-2,andIF-
3),
whereasineukaryotes,thereareoverten(designatedeIFto
indicateeukaryoticorigin).
EukaryotesalsorequireATPforinitiation.

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37.Nucleicacidamplificationtechniquesare:
a)PCR
b)RealtimePCR
c)DNACloning
d)NextgenerationDNAsequencing

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e)None
CorrectAnswer-A:B
Ans:a.PCR...,b.Realtime....[RefHarper30th/458;Robbins
9th/180;Lippincott6th/479;Harrison19th/150e-7;http://link.
springer.corn]

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Real-timePCRautomatesthelaboriousprocessofamplificationby
quantitatingreactionproductsforeachsampleinevery
Cycle.
Thereareseveralmethodsforamplification(copying)ofsmall
numbersofmoleculesofnucleicacidtoreadilydetectablelevels.

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TheseNAATsincludePCR,LCR,stranddisplacementamplification,
andself-sustainingsequencereplication.
Theamplifiednucleicacidcanbedetectedafterthereactionis
completeor(inreal-timedetection)asamplificationproceeds.The
sensitivityofNAATsisfargreaterthanthatoftraditionalassay

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methodssuchasculture.

38.Secondmessengeris/are:
a)Ca2+
b)DNA
c)Histone

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d)cDNA
e)None
CorrectAnswer-A
Ans:a.Ca2+[RefHarper30th/501,91-92,179,343;Lippincott
6th/94-951

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Nucleotides,suchascyclicadenosinemono-phosphate(cAMP)and
cyclicguanosinemonophosphate(cGMP),serveassecond
messengersinsignaltransductionpathways.
Twoofthemostwidelyrecognizedsecondmessengersystemsare
thecalciumlphosphatidylinositolsystem,andtheadenylylcyclase

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system,whichisparticularlyimportantinregulatingthepathwaysof
intermediarymetabolism.

39.Trueaboutgeneticcode:
a)FollowMendelianlaw
b)Itistotalnumberofchromosomeinthebody

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c)Itisnucleotidesequencewhichcodesforaminoacids
d)ItcodesforDNA
e)None
CorrectAnswer-C
Ans:c.Itisnucleotidesequencewhichcodesforaminoacids

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M
endelianGeneticsiswidelyregardedasthecornerstoneof
classicalgenetics.Itisasetofprimarybeliefsrelatingtothe
transmissionofhereditarycharacteristicsfromparentorganismsto
theiroffspring
Thegeneticcodeisadictionarythatidentifiesthecorrespondence

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betweenasequenceofnucleotidebasesandasequenceofamino
acids.
TheNucleotideSequenceofanmRNAMoleculeConsistsofa
SeriesofCodonsThatSpecifytheAminoAcidSequenceofthe
EncodedProtein

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40.Restrictionendonucleasecleaves:
a)dsDNA
b)RNA
c)Histone
d)Protein

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e)ssDNA
CorrectAnswer-A
Ans:a.dsDNA
Restrictionendonucleases(restrictionenzymes),which
cleavedouble-stranded(ds)DNAintosmaller,moremanageable

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fragments,hasopenedthewayforDNAanalysis"
Restrictionenzyme(REorRestrictionEndonuclease)isanenzyme
thatcleavedouble-strandedDNAQatspecificrecognitionnucleotide
knownasrestrictionsitesQ
ThecutDNAfragmentsbyREmayhavestickyends(cohesive

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ends)?
orbluntsends?dependingonthemechanismusedby
enzyme
DNAfragmentswithstickyendsareparticularlyusefulfor
recombinantDNAexperiments(hybridorchimericDNAmolecules)
Restrictionenzymeisnamedaccordingtotheorganismfromwhich

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itwasisolated


41.PhospholipaseA2acton:
a)Phosphoglycericacid
b)Phosphate
c)Ca+

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d)Phosphatidyl-inositol
e)None
CorrectAnswer-D
Ans:d.Phosphatidyl-inositol
Phospholipaseshydrolyzethephosphodiesterbondsof

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phosphoglycerides,witheachenzymecleavingthephospholipidata
specificsite.
Phospholipasesreleasemoleculesthatcanserveasmessengers
(forexample,DAGandIP3),orthatarethesubstratesforsynthesis
ofmessengers(forexample,arachidonicacid.

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Phospholipasesareresponsiblenotonlyfordegrading
phospholipids,butalsofor"remodeling"them.Forexample,
phospholipasesAlandA2removespecificfattyacidsfrom
membrane-boundphospholipids;thesecanbereplacedwith
alternativefattyacidsusingfattyacylCoAtransferase.

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42.EnzymeusedinDNArepairis/are:
a)DNAgyrase
b)DNApolymerase
c)Restrictionendonuclease
d)DNAligase

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e)None
CorrectAnswer-B:D
Ans:b.DNApoly...,d.DNA(RefHarper30th/382,389-92;
Lippincott6th/411-131
Whenthestrandcontainingthemismatchisidentified,an

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endonucleasenicksthestrandandthemismatchednucleotide(s)
is/areremovedbyanexonuclease.
Additionalnucleotidesatthe5'-and3'-endsofthemismatchare
alsoremoved.Thegapleftbyremovalofthenucleotidesisfilled,
usingthesisterstrandasatemplate,byaDNApolymerase.

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The3'-hydroxylofthenewlysynthesizedDNAisjoinedtothe5'-
phosphateoftheremainingstretchoftheoriginalDNAstrandby
DNAligase

43.Nucleosomecontains:
a)DNA

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b)RNA
c)Chromatin
d)Histone
e)None
CorrectAnswer-A:D

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Ans:a.DNAd.Histone[RefHarper30th/371-72;Lippincott6th/
409]
Histonesarehighlyalkalineproteinsfoundineukaryoticcellnuclei
thatpackageandordertheDNAintostructuralunitscalled
nucleosomes.

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Theyarethechiefproteincomponentsofchromatin,actingas
spoolsaroundwhichDNAwinds,andplayingaroleingene
regulation.
WhenthehistoneoctamerismixedwithpurifieddsDNAunder
appropriateionicconditions,thesamex-raydiffractionpatternis

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formedasthatobservedinfreshlyisolatedchromatin.Biochemical
andelectronmicroscopicstudiesconfirmtheexistenceof
reconstitutednucleosomes.
Inthenucleosome,theDNAissupercoiledinalefthandedhelix
overthesurfaceofthedisk-shapedhistoneoctamer

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44.Serotonin,amediatorofinflammationin
ourbody,issecreted/releasedby:
a)Leukocytes
b)Endothelialcell
c)Mastcell

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d)Platelet
e)Macrophage
CorrectAnswer-D
Answer-D.Platelet
Serotonin:Itisfoundintheintestinalmucosa,braintissue&

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platelets.
Releaseofserotonin(andhistamine)fromplateletsisstimulated
whenplateletsaggregateaftercontactwithcollagen,thrombin,
adenosinediphosphate(ADP),andantigen-antibodycomplexes.

45.Autosomalrecessivedisease(s)is/are:

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a)Sicklecellanaemia
b)Phenylketonuria
c)Tuberousscelerosis
d)Familialpolyposiscoli
e)Marfansyndrome

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CorrectAnswer-A:B
Answer-(A)Sicklecellanaemia(B)Phenylketonuria
1.Metabolic-
Cysticfibrosis
Phenylketonuria

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Galactosemia
Homocystinuria
Wilsondisease
Hemochromatosis
2.Hematopoietic

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Sicklecellanemia
Thalassemias
3.Endocrine
Congenitaladrenalhyperplasia
4.Skeletal

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Ehlers-Danlossyndrome
5.Nervous
Friedreichataxia
Spinalmuscularatrophy

46.Whichofthefollowingis/arefeatures(s)of

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lewybodydementia:
a)Plaquecontainingbeta-amyloidpeptide
b)Depositionofa-synucleinprotein
c)Oftenresistanttostandardtreatment
d)Commoninelderly

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e)Riskoffallingmaypresent
CorrectAnswer-B:C:D:E
Answer-(B)Depositionofa-synucleinprotein(C)Often
resistanttostandardtreatment(D)Commoninelderly(E)Risk
offallingmaypresent

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Alpha-synucleincontainingLewybodiesoccurinthebrainstem,
midbrain,olfactorybulb,andneocortex.
Thisisaneurodegenerativedisorderclinicallycharacterizedby
dementiaandsignsofParkinson'sdisease.
Commoninelderly.

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TheDLBclinicalsyndromeischaracterizedbyvisualhallucinations,
parkinsonism,fluctuatingalertness,falls.

47.TrueaboutAlzheimer'sdisease:
a)Morecommoninolderage
b)Impairmentoftheabilitytoremembernewinformation

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c)Mainlyaffectslongtermmemory
d)Generalcognitivebehaviorimpairedinprodromalphase
e)Atrophyoffrontal&parietallobe
CorrectAnswer-A:B:D:E
Answer-(A)Morecommoninolderage(B)Impairmentofthe

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abilitytoremembernewinformation(D)Generalcognitive
behaviorimpairedinprodromalphase(E)Atrophyoffrontal&
parietallobe
Alzheimer'sdisease(AD)isaslowlyprogressivediseaseofthe
brainthatischaracterizedbyimpairmentofmemory.

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Alzheimer'sdiseaseisCommonin5thand6thdecade.
EarlyStage-
Thisisconsideredasamild/earlystageandthedurationperiodis2-
4years.
Frequentrecentmemoryloss.

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Writingandusingobjectsbecomedifficultanddepressionand
apathycanoccur.
Secondstage-
Thisisconsideredasamiddle/moderatestageandthedurationis2-
10years.

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DementiaofAlzheimer'stypeisassociatedwithDepressive
symptoms,Delusions,Apraxiaandaphasia.
Pervasiveandpersistentmemorylossimpactslifeacrosssettings.
Moderatestage-

Increasedmemorylossandconfusion.

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Laststage-
Thisisconsideredastheseverestageandthedurationis1-3years.
Extremeproblemswithmood,behavioralproblems,hallucinations,
anddelirium.

48.TrueaboutHypersensitivitypneumonitis:

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a)Occursduetoinorganicantigen
b)IncreasedCD8+Tcellsinbronchoalveolarlavage
c)Manifestsmainlyasanoccupationalandenvironmentdisease
d)Forsevereacutecases,oralsteroidsisgivenfor3-4weeks
e)Interstitialinflammatoryinfiltrateisseeninlung

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CorrectAnswer-B:C:D:E
Answer-(B)IncreasedCD8+Tcellsinbronchoalveolarlavage
(C)Manifestsmainlyasanoccupationalandenvironment
disease(D)Forsevereacutecases,oralsteroidsisgivenfor3-
4weeks(E)Interstitialinflammatoryinfiltrateisseeninlung

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Itismanifestedmainlyasanoccupationaldisease,inwhich
exposuretoinhaledorganicagentsleadstoacuteandeventually
chronicpulmonarydisease.
Bronchoalveolarlavagespecimensalsoconsistentlydemonstrate
increasednumbersofbothCD4+andCDB+Tlymphocytes.

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HistologyshowsevidenceofaninterstitialinflammatoryinfiItratein
thelung.
Inacutecases,prednisoloneshouldbegivenfor3-4weeks,starting
withanoraldoseof40mgperday.

49.RScellhavingsameimmunophenotyping

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arepresentinwhichsubtypesof
Hodgkin'slymphoma:

a)Nodularsclerosis
b)Lymphocytepredominant
c)Lymphocyterich

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d)Mixedcellularity
e)Lymphocytedepletion
CorrectAnswer-A:C:D:E
Answer-(A)Nodularsclerosis(C)Lymphocyterich(D)Mixed
cellularity(E)Lymphocytedepletion

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Inthefirstfoursubtypes-nodularsclerosis,mixedcellularity,
lymphocyte-rich,andlymphocytecells.

50.TrueaboutLyonisationofXchromosome:
a)InactivationofXchromosomeonlyinsomaticcell
b)InactivationofXchromosomeonlyingermcell

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c)InactivationofXchromosomeinsomatic&germcellboth
d)MaximunnumberofBarrbodyisequaltoXchromosome
e)All
CorrectAnswer-A
Answer-A.InactivationofXchromosomeonlyinsomaticcell

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Infemale,oneoftwoX-chromosome(eitherpaternalormaternal)is
inactivatedduringembryogenesisasstatedinLyonhypothesis.
Thisinactivationispassedtoallthesomaticcellwhilethegermcells
inthefemaleremainunaffected.

51.TwomostcommoncancerinIndian

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womanis:
a)Carcinomabreast
b)Carcinomacervix
c)Carcinomacolon
d)Carcinomastomach

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e)Carcinomalung
CorrectAnswer-A:B
Answer-(A)Carcinomabreast(B)Carcinomacervix
Inwomen,cancerbreast,cervixuteri,colorectum,ovary,lip&oral
cavity.

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52.Whichofthefollowingisparaganglioma:
a)AdrenalPheochromocytoma
b)Extra-adrenalPheochromocytoma
c)Carotidbodytumour
d)Carcinoidtumour

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e)Glomustympanicum
CorrectAnswer-B:C:E
Answer-(B)Extra-adrenalPheochromocytoma(C)Carotidbody
tumour(E)Glomustympanicum
Pheochromocytornaisachromaffin-cellneoplasmthatcanarisean

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adrenal(adrenalmedulla)orextraadrenaltumor.
Extraadrenalpheochromocytomaisalsoreferredtoas
paraganglioma.
Thecarotidbodytumorisaprototypeofaparasympathetic
paraganglioma.

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Glomustympanicum:Mostcommontumourinmiddleear.

53.Feature(s)ofXIIIfactordeficiencyis/are:
a)Delayedwoundclosure
b)Clotsolubilitytestsareabnormal
c)TaPTT

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d)TPT
e)TBT
CorrectAnswer-A:B
Answer-A,DelayedwoundclosureB,Clotsolubilitytestsare
abnormal

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Itcharacteristicallyleadstodelayedbleedingthatoccurshoursto
daysafterahemostaticchallenge.
Clotsolubilitytestsareabnormal.

54.Whichofthefollowingstatement(s)is/are
correctexcept:

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a)IncreasedPTinextrinsicpathways
b)IncreasedaPTTininstrinsicpathways
c)Ifplateletcountis>1.5lac/microL,thennormalhomeo-stasis
present
d)BTisdecreasedinplateletabnormality

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e)None
CorrectAnswer-D
Aswer-D.BTisdecreasedinplateletabnormality
Hemostasisisspontaneousarrestofbleedingbyphysiological
Process.

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Prothrombintime(PT):
Thisassayteststheextrinsicandcommoncoagulationpathways.
Partialthromboplastintime(PTT):
Thisassayteststheintrinsicandcommonclottingpathway.
Prolongationgenerallyindicatesadefectinplateletnumbersor

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function.

55.TrueaboutDentigerouscyst:
a)Arisesinrelationtouneruptedteeth
b)Itmostcommonlyencroachesmaxillaryantrum
c)Mandibularthirdmolariscommonsite

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d)Commoninmandible
e)All
CorrectAnswer-A:C:D
Answer-A,ArisesinrelationtouneruptedteethC,Mandibular
thirdmolariscommonsiteD,Commoninmandible

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Commoninlowerjaw(mandible)inwomen30-40years.
Itoccursinrelationtounerupted,permanent,molartooth,most
commonlytheupperorlowerthirdmolar.

56.Prognosticfactorsforcarcinoma
esophagusis/are:

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a)Depthofinvasion
b)Lymphnodestatus
c)Tumourgrading
d)Stageofthedisease
e)All

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CorrectAnswer-E
Answer-E,All
StageThemostreliableprognosticfacforforesophagealcanceris
thestageofthetumouratthetimeofdiagnosis.
Tumoursize

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Lymphnodesstatus
Cancerhasspreadtodistantorgans
Cancerthatremainsaftersurgery
Tumourgrade

57.Trueaboutsurgicaljaundice:

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a)Increaseofserumbilirubin
b)Increaseacidphosphatase
c)Increasealkalinephosphatase
d)Urinebilirubinisabsent
e)Stoolsterocobilinogenabsent

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CorrectAnswer-A:C:E
Answer-A,IncreaseofserumbilirubinC,Increasealkaline
phosphataseE,Stoolsterocobilinogenabsent
Obstructivejaundice-
1.Biluribin

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Direct&Indirect-increased
2.Urinebilirubin-increased
3.Serumalbumin-generallyunchanged
4.Alkalinephosphatase-Increased
5.Sterocobilinogen-absent

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58.Whichofthefollowingmarkerfavours
diagnosisofpreinvasive&invasive
cervicalcancer:

a)Ki67
b)OncoproteinE6

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c)p16INK4,cyclinE,andKi-67
d)OncoproteinE8
e)None
CorrectAnswer-A:B:C
Answer-A,Ki67B,OncoproteinE6C,p16INK4,cyclinE,andKi-

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67
TheexpressionofE7determinestheinactivationofpRbwitha
consequentincreaseoffreeE2Finthecell,leadingtobothan
increaseofcyclin-dependentkinaseinhibitorpl6(p16INK4a)and
aberrantproliferation(markedbyincreasedlevelsofKi-67

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expression).

59.Whichofthefollowingmarker/mutation
is/areseeninpapillarycarcinomaof
thyroid:

a)Synaptophysin

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b)RET/PTC
c)P53
d)NTRK1
e)RAS
CorrectAnswer-B:D:E

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Answer-B,RET/PTCD,NTRK1E,RAS
GeneticAlterationsinThyroidNeoplasia-
RET/PTC
BRAF
TRK

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RAS

60.Whichofthefollowingis/aretrueabout
pregabalin:
a)Approveddrugfordiabeticneuropathy
b)Approvedfortreatmentofgeneralizedtonicclonicseizure

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c)Peripheraledemaissideeffect
d)Somnolenceissideeffect
e)ApprovedforuseinPartialseizure
CorrectAnswer-A:C:D:E
Ans.a.ApproveddrugForDiabeticneuropathy;c.Peripheral

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edemaissideeffect;d.Somnolenceissideeffect;e.Approved
foruseinpartialseizures.
[RefKDT7th/419;Katzung13th/4M,419;Harrisontgth/2682;
PharmacologybySatoskar24th139)
Pregabalinside-effectincludes:Cognitivechanges,sedation&

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peripheraledema.
GABAanalog.
Antiseizureactivityandforitsanalgesicproperty.
Approvedforuseinneuropathicpain,includingpainfuldiabetic
peripheralneuropathy,postherpeticneuralgia&complexregional

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painsyndrome.
Toxicityincluded-Somnolence,dizziness,ataxia

61.Drug(s)usedforoveractivebladder:
a)Oxybutinin
b)Tolterodine

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c)Mirabegron
d)OnabotulinumtoxinA
e)Pirenzepine
CorrectAnswer-A:B:C:D
Ans.a.Oxybutynin;b.Tolterodine;c.Mirabegron;D.

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OnabotulinumtoxinA
[R4KDf7th/117-18;Katzung13th/127-28;Rang&Date8th/366;
PharmacologybySatoskar24th/3OS-07]
OveractiveBladder:
AntimuscarinicdrugssuchasOxybutynin,Flavoxate,tolterodine&

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trospiumareusedforbothneurogenic&non-neurogenicoveractive
bladder.
Sollfenacin&darifenacinarethenewdrugs(M3antagonist)foruse
inoveractivebladder.
Mirabegronisbeta-3adrenergicagonistusedforoveractivebladder.

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OnabotulinumtoxinAisusedassingleintradetrusorinjection,to
treatoveractivebladder.

62.Allaretrueaboutwarfarinexcept:
a)ActthroughinhibitionofcoagulationfactorIX
b)Protaminesulphatereversesitsaction

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c)MonitoringisdonethroughINR
d)TargetofINRwithwarfarinisgenerally2-3
e)Skinnecrosisisusuallyoccurin3-10daysofinitiationof
warfarin
CorrectAnswer-B

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Ans:b.Protaminesulphatereversesitsaction.
[RefKDT7th/620-24;Katzung13th/590-92;Rang&DaleSth/30q
PharmacologybySatoskar24th/jN-301]
Warfarininducedskinnecrosisisararecomplicationcharacterized
bytheappearanceofskinlesion3-10daysafterinitiationof

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treatment.
DoseofwarfarinadjustedtogiveanINRof2-4,theprecisetarget
dependingontheclinicalsituation.
Thereferencerangeforprothrombintimeisusuallyaround12-13
secondsandtheINninabsenceofanticoagulationtherapyis0.8-1.

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2
Warfarin:Doseregulationisdonebyprothrombintime&INR
(Heparin/aPTT/clottingtime.
AntagonistisVitK(c.fHeparin-Protaminesulphate).

63.TrueaboutM/Aofdoxorubicin:

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a)Intercalateb/wDNAstrands
b)InhibitionofDNApolymerase
c)InhibitionofRNApolymerase
d)InhibitionoftopoisomeraseII
e)Inhibitionofproteinsynthesis

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CorrectAnswer-A:D
Ans.A.Intercalateb/wDNAstrands;D.InhibitionOf
TopoisomeraseII
[Ref:KDT7th/867;Katzung13th/932'j5;G6G1lth/1358;
PharmacologybySatoskar24th/835)

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Doxorubicin:Itactsasanon-specificinhibitoroftopoisomerase-II,
thusinterferingwithDNAreplication.

64.Anticholinergicdrugside-effectincludes:
a)Constipation
b)Urinaryretention

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c)Mydriasis
d)Hypothermia
e)Blurringofvision
CorrectAnswer-A:B:C:E
Ans:A.Constipation.B.UrinaryretentionC.MydriasisE.

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Blurringofvision
[Ref:KDT7th/120;GdzG11th/194;Katzung13th/129;Rang&
Dale\th/164-65;PharmacologybySatoskar24th/301).
Bodytemperatureisfrequentlyelevated.
Unfortunately,children,especiallyinfants,areverysensitiveto

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hyperthermiceffectsofatropine.
Constipation&urinaryretention(precipitationespeciallyinelderly)
canoccurwithatropine
Difficultyinswallowing,drymouth,ferer,dry-flushed&hotskin,
difficultyinmicturition,Mydriasis,photophobia,blurringofnear

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vision,palpitations,dreadfulvisualhallucination,ataxia,delirium,
psychoticbehavior,weak&rapidpulse,hypotension,
cardiovascularcollapsewithrespiratorydepression,convulsion&
coma.

65.Whichofthefollowingis/aretrueabout

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benefitsofSustainedreleaseformulation
ofdrugs:

a)Decreasedincidenceand/orintensityofundesiredeffects
b)Increasespotencyofthedrug
c)ReleaseofdrugislessinfluencedbypH

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d)Prolongdrugeffect
e)Decreasedfrequencyofadministration
CorrectAnswer-A:C:D:E
AnsA.DecreasedIncidenceand/orIntensityofundesired
effects;c.ReleaseOfDrugIsLessInfluencedBypH;D.

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Prolongdrugeffect;E.DecreasedFrequencyofadministration.
[Ref:KDf7th/35;G6'G11th/5;PharmacologybySatoskar24th/7;
http://www.pharmatutor.org/articles/review-sustained-release-
dosage'forms).
Sustainedreleaseimpliesslowreleaseofthedrugoveratime

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period.
Itmayormaynotbecontrolledrelease
Advantagesofsustainedreleasedosageforms:
Controlofdrugtherapyisachieved.
Rateandextentofdrugabsorptioncanbemodified

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Frequencyofdrugadministrationisreduced.
Patientcompliancecanbeimproved.
Drugadministrationcanbemadeconvenient
Maximizingtheavailabilityofdrugwithminimumdose.
Thesafetymarginofhighpotencydrugcanbeincreased.

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66.Trueaboutdrug-responsecurve(DRC):
a)SteepestinmiddleportionoftheDRC
b)InvertedUshapedcurvemaybeforsomedrug
c)Rectangularhyperbola-whenplottedinlogarithmicscale
d)Sigmoidshape-whenplottedinlogarithmisused

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e)Enablescomparisonofpotencyofdrugs
CorrectAnswer-A:B:C:E
Ans.(A)SteepestinmiddleportionoftheDRC(B)InvertedU
shapedcurvemaybeforsomedrug(C)Rectangularhyperbola-
whenplottedinlogarithmicscale(E)Enablescomparisonof

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potencyofdrugs
Dose-ResponseRelationship:
Rectangularhyperbola.
Sigmoidalcurveindose-responserelationship:thesteepestportion
inthemiddle-wiki.

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DRCisusedtomeasure-drugpotency,drugefficacy&drugsafety-
slideshare.
Somedrugscauselow-dosestimulationandhigh-doseinhibitionof
response.
TheseU-shapedrelationshipsforsomereceptorsystemsaresaidto

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displayhormesis.
Severaldrug-receptorsystemscandisplaythispropertye.g.,
prostaglandins,endothelin,andpurinergicandserotonergic
agonists,amongothers),whichislikelytobeattherootofdrug
toxicity.

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67.Trueaboutorganophosphoruspoisoning:
a)Atropineisbestforearlytreatment&maintenance
b)Pralidoximeisimportantforrestoringneuromuscular
transmission
c)Phenytoinistheprimarydrugusedforseizurecontrol

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d)Mydriasispresent
e)Pralidoxime&atropineworkssynergistically
CorrectAnswer-A:B:E
Ans.(A)Atropineisbestforearlytreatment&maintenance
(B)Pralidoximeisimportantforrestoringneuromuscular

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transmission(E)Pralidoxime&atropineworkssynergistically
[RefReddy32nd/495-97;G&Gltth/21};KDT7th/111:13th/979-80;
PharmacologybySatoskar24th/297]
OrganophosPhorusPoisoning:
AIIcaseofAnti-ChEpoisoningmustbepromptlygivenatropine2

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mgi.Vrepeatedevery10mintilldryness&othersignsof
atropinizationappear.
Continuedtreatmentwithmaintenancedosesmayberequiredfor1-
2weeks
Theuseofoximesinorganophosphatepoisoningissecondaryto

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thatofatropine.Moreventheclinicalbenefitofoximesishighly
variable.
Controlofconvulsionswithjudicioususeofdiazepam.
Ocularmanifestationsincludemarkedmiosis'ocularpain'
conjunctivalcongestion,diminishedvision,ciliaryspasm,Andbrow

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ache.
Atropineinsufficientdosageeffectivelyantagonizestheactionsat

muscarinicreceptorsites,andtoamoderateextentatperipheral
ganglionicandcentralsites

68.Whichofthefollowingdrug(s)actby

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inhibitingproteinsynthesisbyattaching
to50Sribosome:

a)Tetracycline
b)Ampicillin
c)Isoniazid

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d)Imipramine
e)Ethionamide
CorrectAnswer-B:C
Ans.(B)Ampicillin(C)Isoniazid
[KDT7th/734,768;Katzung13th/789]

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Tetracyclinesbindto30Sribosome&inhibitaminoacylRNA
attachmenttotheAsite
Erythromycin&clindamycinbindto50Sribosome&hinder
translocationoftheelongatedpeptidechainbackfromAsitetoP
site.PeptidesynthesismaybeprematurelyTerminated.

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ChloramPhenicolbindsto50Ssubunit'Itinterferewithpeptidebond
formation&transferofpeptidechainfromPsite
Aminoglycosidesbindtoseveralsitesat30S&50Ssubunits-freeze
initiation,interferewithpolysomeformation&causemisreadingof
mRNAcode

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69.OCPefficacydecreaseswithconcurrent
administrationofwhichofthefollowing
drug(s):

a)Phenytoin
b)Ampicillin

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c)Isoniazid
d)Imipramine
e)Ethionamide
CorrectAnswer-A:B
Ans.(A)Phenytoin(B)Ampicillin

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[RefKDT7th/326;Katzung13th/712;Rang&DaIe9th/434:
PharmacologybySatoskar24th/967).
Contraceptivefailuremayoccurwithconcurrentadministration
of:
Enzymeinducer:Phenytoin,phenobarbital,primidone,

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carbamazepine,rifampin,ritonavir-Metabolismofestrogenic&
progestationalcomponentisincreased.
Tetracyclines-ampicillin.
Deconjugationofestrogenssecretedinbilefailstooccurtheir
enterohepaticcirculationisinterruptedbloodlevelfal

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70.Allaretrueabouttamoxifeneexcept:
a)Usedasadjuvanttherapyinestrogenreceptorpositivebreast
cancer
b)Approvedfortheprimaryprophylaxisofbreastcancerinhigh
riskwoman

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c)Noeffectonuterus
d)Pro-estrogeneffectonbone
e)CauseendometrialCa
CorrectAnswer-A:C:D:E
Ans.(A)Usedasadjuvanttherapyinestrogenreceptorpositive

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breastcancer(C)Noeffectonuterus(D)Pro-estrogeneffecton
bone(E)CauseendometrialCa
[Ref;KDT7th/101'02;Katzung13th/106]
NMislocatedinneuromuscularjunction6causedepolarizationof
muscleendPlate

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NNlocatedonautonomicganglia,adrenalmedulla&CNS
Mostsmoothmuscles&glandshaveM26M3subtypes;M3
Predominates.
Achisamajorneurotransmitteratautonomic,somaticaswellas
centralsites.ReleaseofAchfromnerveterminalhelpinsynaptic

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transmission

71.
Whichoffollowingtrueregarding
acetylcholinereceptors:
a)M2receptor-heart

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b)MIreceptor-smoothmuscle
c)NMreceptorispresentonneuromuscularjunction
d)Synapticjunction-Achistransmitter
e)NNlocatedonadrenalmedulla
CorrectAnswer-A:C:D:E

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Ans.(A)M2receptor-heart(C)NMreceptorispresenton
neuromuscularjunction(D)Synapticjunction-Achis
transmitter(E)NNlocatedonadrenalmedulla
[Ref;KDT7th/101'02;Katzung13th/106]
NMislocatedinneuromuscularjunction6causedepolarizationof

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muscleendPlate
NNlocatedonautonomicganglia,adrenalmedulla&CNS
Mostsmoothmuscles&glandshaveM26M3subtypes;M3
Predominates.
Achisamajorneurotransmitteratautonomic,somaticaswellas

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centralsites.ReleaseofAchfromnerveterminalhelpinsynaptic
transmission

72.Whichofthefollowingdrug(s)comesin
riskcategoryBofFDAteratogenicrisk
categoriesforpregnancy:

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a)Phenytoin
b)Resperidone
c)Olanazapine
d)Clozapine
e)Arpirazole

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CorrectAnswer-D
Ans.D.Clozapine
[Ref:KDT7th/90;Katzung13th/1018;Rang6Dale8th/700;
PharmacologybySatoskar24th/1122;http://schizophreniabulletin-
oxfordjournal]

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CategoryA:
Norisktofetusinhumanstudies
Levothyroxine
Potassium
Supplementation

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MgSO4
CategoryB
Animalstudiesshownorisk
Humanstudiesarelacking
Penicillins

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Cephalosporins
Macrolides
Brimonidine

CategoryC
AnimalstudiesshowPositiveteratogenicrisk

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Humanstudiesarenotavailable
Albuterol
Zidovudine
CCB
Morphine

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Atropine
CategoryD
Humanandanimalstudiesshowpositiveteratogenicrisk
Canbeusedinpregnancybecauseofbenefitsgreaterthanrisk
mightbeacceptable.

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Corticosteroids
Azathioprine
Carbamazepine
Valproate
Methotrexate

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Lithium
CategoryX
Humanandanimalstudiesshowpositiveteratogenicrisk
Absolutelycontraindicatedinpregnancybecauseofriskgreaterthan
benefits.

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Thalidomide
isotretinoin
Fluoroquinolones
Tetracyclines
Chloramphenicol

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Warfarin
ACEinhibitors

73.Whichofthefollowingistrueregarding
ropinirolewrtL-dopa:
a)Cognitivesymptomimproves

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b)Lowerincidenceofhallucination
c)Causeexcessivesleepiness
d)Moreeffectiveinthetreatmentofpatientswhohavedeveloped
on/offphenomena
e)Provideneuroprotectiveeffect

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CorrectAnswer-C:D:E
Ans.C,CauseexcessivesleepinessD,Moreeffectiveinthe
treatmentofpatientswhohavedevelopedon/offphenomena
E,Provideneuroprotectiveeffect
[Ref:KDT7th/430-31;G&G535-j8;Katzung13th/478;Rang6Date

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8th/494-95;PharmacologybySatoskar24th/237
Allthedopamineagonistsinlargerdosescancoutetevere
neuropsychiatricadverseeffects.
Ropinirole&Pramipexole
SelectiveD2/D1receptoragonists

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Bettertolerateddtdonotshowthefluctuationsinefficacyassociated
withlevodopa.
Theydo,however,causesomnolence6sometimeshallucinations
(recentevidencesuggeststhattheymaypredisposetocompulsive
behaviours,suchasexcessivegambling,overeating6sexual

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excess,relatedtotherewardfunctionsofdopamine
Adisadvantageofcurrentdopamineagonistsistheirshortplasma
halfLife(6-8hr),requiring3timesdailydosagethoughslowrelease

oncedailyformulationsarenowavailable
Trialhavefoundthemtoaffordsymptomreliefcomparableto

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levodopa.
Sometrialshavenotedlowerincidenceofdyskinesias6motor
fluctuationsamongPatientstreatedwiththesedrugsthandose
treatedwithlevodopa
Itislongeractingthanlevodopa.

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Highincidenceofhallucination&sleepiness

74.Trueaboutmethanolpoisoning:
a)Gastricdecontaminationishelpful
b)Formate&formaldehydeareactivemetabolite
c)TakingwithEthanolcausemoretoxicity

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d)Fomipezoleaspecificantagonist,isgivenfortreatment
e)Causehighaniongapacidosis
CorrectAnswer-A:B:D:E
Ans.A,GastricdecontaminationishelpfuB,Formate&
formaldehydeareactivemetaboliteD,Fomipezoleaspecific

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antagonist,isgivenfortreatmentE,Causehighaniongap
acidosis
[Ref:KDT7th/394-96;Katzung13th/393;Pharmacologyby
Satoskar24th/9s-96).
TreatmentofMethylAlcohol

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Fomepizole,analcoholdehydrogenaseinhibitor,isapprovedforthe
treatmentofethyleneglycolpoisoningandmethanolpoisoning.
Ethanolusedintravenouslyastreatmentformethanolpoisoning.
Methanolconcentrationshigherthan50mg/dlarethoughttobean
absoluteindicationforhemodialysisandtreatmentwithfomepizole

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orethanol,althoughformatebloodlevelsareabetterindicationof
clinicalpathology.
Hospitalisation,nursingcare
Gastriclavage,activatedcharcoal
Treatmentofacidosis/hypoglycemia

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Inhibitionofmethanolmetabolism-Givingethylalcoholdtfomepizole
(aspecificinhibitorofalcoholdehydrogenase&drugofchoicefor
methanolpoisoning)

Promotemetabolicdegradationofformate:folinicacidtogetherwith
folicacid

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Diuretics,urinealkalinisation
Hemodialysisinseverecase
Maintenanceofnutrition

75.S/EofBevacizumabincludes:
a)Hypertension

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b)Hemoptysis
c)Malena
d)Cerebellarstroke
e)Notcausegastrointestinalperforation
CorrectAnswer-A:B:C:D

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Ans.A,HypertensionB,HemoptysisC,MalenaD,Cerebellar
stroke
[Ref:KDT7th/871:Katzung13th/937-38;Rang&Dale8th/;
PharmacologybySatoskar24th/840).
S/EofBevacizumab:

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Hypertension
Arterialthromboembolism-heartattack6stroke
Vesselinjury6haemorrhages
Heartfailure
Proteinuria

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Gastrointestinalperforation
Healingdefect

76.TNF-aInhibitorsareusedfor:
a)Ulcerativecolitis
b)Crohn'sdisease

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c)Rheumatoidarthritis
d)Psoariasis
e)Lichenplanus
CorrectAnswer-A:B:C:D
Ans.A,UlcerativecolitisB,Crohn'sdiseaseC,Rheumatoid

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arthritisD,Psoariasis
[RefHanison19th/1961;NeenaKhanna5th/58,68;CMDT2016/641;
KDT7th/883-84).
TNF-alphaInhibitors:Use
Etanercept-Rheumatoidarthritis,severe/refractoryankylosing

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spondylitis,plaquepsoriasis,polyarticularidiopathicjuvenilearthritis.
Infliximab-refractoryrheumatoidarthritis,ankylosingspondylitis,
psoriasis,fistulatingCrohn'sdisease,ulcerativecolitis
Adalimumab-Useaslikeinfliximab
Certolizumab-Crohn'sdisease

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Golimumab-ulcerativecolitisPsoriasis:TreatmentincludesTNF
blockerslikeetanercept,infliximab.

77.Antibioticofchoicefor
Stenotrophomonasmaltophiliainfection
is:

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a)Ampicillin
b)Trimethoprim-sulfamethoxazole(TMP-SMX)
c)Penicillin
d)Ciprofloxacin
e)None

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CorrectAnswer-B
Ans:b.Trimethoprim-sulfamethoxazole(TMP-SMX)

78.Whichofthefollowingis/areparaphilia:
a)Pedophilia
b)Sodomy

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c)Frotteurism
d)Voyeurism
e)Exhibitionism
CorrectAnswer-A:C:D:E
Ans:A.PedophiliaC.FrotteurismD.VoyeurismE.Exhibitionism

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[RefSynopsisofPsychiatrybyKaplondrSaddockllth/593-97;
Reddy32nd/411;NeerajAhuja7th/124-26;Parikh7th/411-12J
Paraphiliasorperversionsaresexualstimulioractsthatare
deviationsfromnormalsexualbehaviors,butarenecessaryfor
somepersonstoexperiencearousalandorgasm.

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AccordingtotheDiagnosticandStatisticalManualofMental
Disorders,fifthedition(DSM-5),thetermparaphilicdisorderis
reservedforthosecasesinwhichasexuallydeviantfantasyor
impulsehasbeenexpressedbehaviorally.
Individualswithparaphilicinterestscanexperiencesexualpleasure,

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buttheyareinhibitedfromrespondingtostimulithatarenormally
considerederotic.Theparaphiliacperson'ssexualityismainly
restrictedtospecificdeviantstimulioracts.
DSM-5listspedophilia,frotteurism,voyeurism,exhibitionism,sexual
sadism,sexualmasochism,fetishism,andtransvestismwithexplicit

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diagnosticcriteriabecauseoftheirthreattoothersand/orbecause
theyarerelativelycommonparaphilias.Therearemanyother
paraphiliasthatmaybediagnosed

79.Whichofthefollowingjointisbest
predictorofageof16-17yearbyX-ray:

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a)Knee
b)Elbow
c)Hip
d)Wrist
e)Ankle

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CorrectAnswer-D:E
Ans:(D)Wrist(E)Ankle[RefReddy32nd/78,77,74;Parikh7th/
61-63]
Forestimationofage:TakeX-ray
6-12years
Elbowjoint,Wristjoint,6yr-centerforlowerendof

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ulna(A);medialepicondyleofthehumerus(A)
9years:Olecranon(A)
9to11years:Trochelaofhumerus(A)
10thto11thyear:Pisiform(A)
11thyear:Lateralepicondyleofhumerus(A)

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13to16years:X-rayofpelviselbowjoint&pelvis(13thyr-separate
centersintriradiatecartilageofacetabulum(A)
12to14years:Lessertrochanteroffemur(A)
14thyear:Crestofilium(A),fusionofmedialepicondyleof
humerus,lateralepicondylewithtrochlea

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15thyear:fusionoftriradiatecartilageofacetabulum
16-17year:wrist
Crestofilium:18-19.
Ischealtuberostty,clavicle(innerend):21-22(F),23-24(M)


80.Whichofthefollowingis/arefeature(s)of

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humanhair:
a)Medullaryindex:<0.3
b)Cortexisthin
c)Cortexisthick
d)Medulla-narrow

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e)Medulla-wider
CorrectAnswer-A:C:D
Ans:a.Medullaryindex...,c.Cortexisthick...,d.Medullanar....
[RefReddy32nd/91;Parikh7th/499]
Trait

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HumanHair
Animalhair
Character
Fine&thin
Coarse&thick

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Cuticularscalesare
Cuticle
Cuticularscalesare
very
large&havestep-

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short,broad,thin&
likeor
irregularlyannular
wavyprojections
Thin,rarelymore

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Cortex
Thick,well-striated
than
&4to10timesas
twiceasbroadas

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broadasmedulla
medulla
Variesconsiderably,
Medulla
usuallynarrow,discontinuous, Continuous&wider

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fragmentedorentirelyabsent
Mostlypresentinthe
Pigment
Evenlydistributed
medulla

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medulla
Specificfordifferent
Precipitin
Specificforhuman
animals

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Medullaryindex
(Diameterof
Below0.3
Above0.5
medulla/

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Diameterof
shaft)

81.Whichofthefollowingistrue
statement(s)aboutexhumation?
a)Policecanorderforexhumation

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b)Executivemagistratecanorderforexhumation
c)Postmortemcannotbedoneonexhumatedbody
d)CrPC176(4)isrelatedtoenquiryofexhumatedbody
e)CrPC174isrelatedtoenquiryofexhumatedbody
CorrectAnswer-B:D

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Ans:b.Executivemagistrate...,d.CrPC176(4)isrelated...
[RefReddy32nd/128-29;Parikh7th/133-34]
I
tisdiggingoutofanalreadyburiedbodylegallyfromthegrave
ThereisnotimelimitforexhumationinIndia
Autopsiesareperformedonexhumedbodies:

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(1)Incriminalcases,suchashomicide,suspectedhomicide
disguisedassuicideorothertypesofdeath,suspiciouspoisoning,
deathasaresultofcriminalabortion&criminalnegligence;
(2)Incivilcases,suchasaccidentaldeathclaim,insurance,
workmen'scompensationclaim,liabilityforprofessionalnegligence,

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survivorship&inheritanceclaimsordisputedidentity
Authorisation:Thebodyisexhumatedonlywhen,thereisawritten
orderfromtheexecutivemagistrate.Thebodycanheexhumatedby
anygovernmentdoctor
Thebodyisexhumatedunderthesupervisionofamedicalofficer&

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magistrateinthepresenceofapoliceofficer
Wheneverpracticable,themagistrateshouldinformtherelativesof
thedeceased&allowthemtoremainpresentattheenquiry(176(4)

Cr.P.C)

82.Trueaboutcadavericspasm:

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a)Samemechanismasrigormortis
b)Mechanismisunknown
c)Alsok/ainstantaneousrigor
d)Occuronlyincoldenvironment
e)Canbeseeninsomedrowningcase

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CorrectAnswer-B:C:E
Ans:b.Mechanism...,c.Also1c/a...,e.Canbeseen....
CadavericSpasm(CatalepticRigidityorInstantaneousRigor)isa
rarecondition.Inthis,themusclesthatwerecontractedduringlife
becomestiffandrigidimmediatelyafterdeathwithoutpassinginto

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thestageofprimaryrelaxation,anditsMechanismisunknown
Itoccursespeciallyincasesofsuddendeath,excitement,fear,
severepain,exhaustion,cerebralhaemorrhage,injurytothe
nervoussystem,firearmwoundofthehead,drowning,convulsant
poisons(suchasstrychnine).

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83.Cause(s)ofOpisthotonusis/are:
a)Cocaine
b)StrychnosNuxVomicaseed
c)Strychnine
d)Codeine

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e)Curare
CorrectAnswer-B:C
Ans:B.StrychnosNuxVomicaseedC.Strychnine
Strychnine
(alkaloidfromseedsofstrychnosnux-vomica)cause
opisthotonus(Parikh7th/639-40)

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"Strychnine:Theconvulsionsaremostmarkedinantigravity
muscles,sothatthebodytypicallyarchesinhyperextension
(opisthotonus)"(Reddy32nd/581)
CausesofOpisthotonus:Arnold-Chiarisyndrome,Meningitis,
Braintumor,Gaucherdisease,Growthhormonedeficiency

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(occasionally),Glutaricaciduriaandorganicacidemias(formsof
chemicalpoisoning).

84.WhichofthefollowingisNOTrape:
a)Sexualintercoursewithwife,ofagebelow15year,with
consent

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b)Sexualintercoursewithwife,ofage16year,withconsent
c)Sexualintercoursewithagirlbelow18yearsofage,with
consent
d)Sexualintercoursewithagirlof18yearwithconsent
e)Sexualintercoursewithwifewhoislivingseparatelyfrom

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himunderadecreeofseparation,oranycustomorusage
withherconsent
CorrectAnswer-B:D:E
Ans:b.Sexualintercoursewith...,d.Sexualintercoursewitha
girl...,e.Sexualintercoursewithwifewhoisliving......[Ref

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Reddy32nd/392-95;Parikh7th/389-911
Rape:TheCriminalLaw(Amendment)Bill,2013(5.375,I.P.C)
AcctoGazetteNotificationofGOIregardingCriminalLaw
(amendendment)Act,2013releasedon2april,2013,1tisage15
year.

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ExceptiontoS.375,I.P.C:Sexualintercourseorsexualactsby
amanwithhisownwife,thewifenotbeingunder15years.
Thereiscontroversialreferenceregardingageofwife,either16or
15yearinReddy(old&newed.)&Parikh.
Withherconsent,whenthemanknowsthatheisnotherhusband

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andthatherconsentisgivenbecauseshebelievesthatheis
anothermantowhomsheisorbelievesherselftobelawfully
married.
Withherconsentwhen,atthetimeofgivingsuchconsent,by


reasonofunsoundnessofmindorintoxicationortheadministration

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byhimpersonallyorthroughanotherofanystupefyingor
unwholesomeSubstance,sheisunabletounderstandthenature
andconsequencesofthattowhichshegivesconsent.
Withorwithoutherconsent,whensheisundereighteenyearsof
age.

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Whensheisunabletocommunicateconsent


85.Inwhichofthefollowingcondition(s),
childrenarepronetofungal&viral
infection:

a)Thymicaplasia

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b)Agammaglobulinemia
c)Lymphocytopenia
d)Severecombinedimmunedeficiencies(SCID)
e)Chediak-Higashisyndrome
CorrectAnswer-A:C:D

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Ans:(A)Thymicaplasia(C)Lymphocytopenia(D)Severe
combinedimmunedeficiencies(SCID)
[RefHarrison19th/2104-08;Ananthanarayan9th/171-76;Jawetz
27th/146-47;Greenwood16th/148J
Tcelldisordersaffectbothcell-mediatedandhumoralimmunity

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makingthepatientsusceptibletoviral,protozoalandfungal
infections.Viralinfectionssuchasthosebycytomegalovirusand
attenuatedmeaslesinthevaccinecanbefatalinthesepatients.
LymphocytopeniaismostoftenduetoAIDSorundernutrition,butit
alsomaybeinheritedorcausedbyvariousinfections,drugs,or

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autoimmunedisorders.Patientshaverecurrentviral,fungal,or
parasiticinfections.
Hypogammaglobulinemialeadstorecurrentbacterialinfections.
Viral&fungalinfectionsarecontrolledbycell-mediatedimmunity,
whichisnormalinhypogammaglobulinemicindividual.

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86.Whichofthefollowingistype3
hypersensitivityreaction(immune
complexdisease):

a)SLE
b)DiabetesMellitusI

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c)Goodpasteursyndrome
d)Multiplesclerosis
e)Bronchialasthma
CorrectAnswer-A
Ans:a.SLE

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[RefAnanthanarayan9th/162-67;Robbins9th/201;lawetz27th/145
46;Greenwood16th/144]
Type3Hypersensitivityreaction(Immunecomplexdisease)
Ananthanarayan9th/162,Itistwotypes-arthusreaction&serum
sickness.

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thedamageiscausedbyantigen-antibodycomplexes.Thesemay
precipitatein&aroundsmallbloodvesselscausingdamagetocells
secondarily,oronmembranes,interferingwiththeirfunction.

87.Whichofthefollowinginfectionhas
incubationperiod

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a)Brucella
b)Gonorrhoea
c)Syphilis
d)HBV
e)Leishmaniasis

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CorrectAnswer-A:B:C
Ans:(A)Bruce...,(B)Gonorrho...,(C)Syphilis
[RefHarrison19th/1134,194e-2,1005;Ananthanarayan9th/341.1]
Brucella:Theincubationperiodisusuallyabout10-30days,but
maybesometimesbeveryprolonged"(Ananthanarayan9th/341)

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"Brucella:Theincubationperiodvariesfrom1weektoseveral
months,andtheonsetoffeverandothersymptomsmaybeabrupt
orinsidious"(Harrison19th/194e-2)
Syphilis:Clinicaldiseasesetsinafteranincubationperiodofabout
amonth(range10-90days)"(Ananthanarayan9th/372)

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"Syphilis:Themedianincubationperiodinhumans(-21days)
suggestsanaverageinoculumof500-1000infectiousorganismsfor
naturallyacquireddisease;theincubationperiodrarelyexceeds6
weeks.
Gonococcalinfectioninmen:Acuteurethritisisthemostcommon

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clinicalmanifestationofgonorrheainmalepatients.Theusual
incubationperiodafterexposureis2-7days,althoughtheinterval
canbelonger&somemenremainasymptomatic(Harrison
19th/1005)


88.StainusedforMycobacterium

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tuberculosisis/are:
a)Ziehl-Neelsentechniqueofstaining
b)Auramine-rhodaminestain
c)Gomorimethenaminesilverstain
d)Kinyounstain

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e)Gramstaining
CorrectAnswer-A:B:D
Ans:a.Ziehl-Neelsentechni...,b.Auramine-rhodaminesta...,d.
Kinyounstain
[RefHarrison19th/1113;Ananthanarayan9th/346-48;Lippincott

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Microbiology3rd/21;Jawetz27th/38;TextBookofDiagnostic
microbiologybyConnieR.Mohan3rd/691;Greenwood16th/15]
WhenstainedwithcarbolfuchsinbyZiehl-Neelsenmethodorby
fluorescentdyes(Auramine0,Rhodamine),mycobacterium
tuberculosisreistdecolourisationby20%sulphuricacid&are

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thereforecalledacidfast.
Ziehl-Neelsenmethoddphenol-auramineproceduresaremethods
ofgreatpracticalimportanceinthediagnosisofmycobacterial
diseases".
TheKinyounmethod,orKinyounstain,isanacid-fastprocedure

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usedtostainanyspeciesofthegenusMycobacteriumandNocardia
species.Itinvolvestheapplicationofaprimarystain(carbol
fuchsin),adecolorizer(acid-alcohol),andacounterstain(methylene
blue)"

89.Foodbornediseasesare:

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a)Japaneseencephalitis
b)Hemophilia
c)HBV
d)Botulism
e)Typhoidfever

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CorrectAnswer-D:E
Ans:d.Botuli...,e.Typhoid...,[RefPark23rd/657]
Theterm"food-bornedisease"isdefinedas:"Adisease,usually
eitherinfectiousortoxicinnature,causedbyagentsthatenterthe
bodythroughtheingestionoffood."Withthecateringsystems,food-

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bornediseasesareontheincreasethroughouttheworld.
DuetotoxinsproducedbycertainbacteriaLIKEBotulism,
StaphylococcuspoisonS
Bacterialdiseases:-Typhoid,fever,Paratyphoidfever,
salmonellosis,staphylococcalintoxication,C.perfringens,

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Shigellosisbrucellosisetc.

90.WhichofthefollowingisNOTlysine
positivenon-fermentor:
a)Burkholderiapseudomallei
b)Burkhomeliamallei

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c)Burkholderiacepacia
d)Stenotrophomonasmaltophilia
e)Pseudomonasaeruginosa
CorrectAnswer-A:B:E
Ans:a.Burkholderia...,b.Burkhomelia...,e.PseudomonasAeru

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......
TheBurkholderiacepaciacomplex(BCC)andStenotrophomonas
maltophiliaarecloselyrelatedgroupsofnonfermentinggram-
negativebacilli(NFGNBs)havingasimilarspectrumofinfections
rangingfromsuperficialtodeep-seatedanddisseminatedinfections.

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Identificationoftheselysinedecarboxylase-positiveNFGNBslags
behindinmostIndianlaboratories.Asimplifiedidentificationscheme
wasdevisedforthesetwopathogensthatallowedustoisolatethem
withanincreasingfrequencyatourtertiarycareinstitute.

91.Apersonissufferingfromacquired

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immunodeficiencydisease(AIDS)&visited
thezoo.Aftersomedays,heiscom
plainingofheadache&cough.Hehas
alsohavesomeneurologicalsymptoms.
OnstainingofCSFsample,itshowscap

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sulatedyeast.Likelyinfectionis:

a)Histoplasma
b)Aspergillus
c)Cryptococcus
d)Blastomycosis

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e)Coccidioidomycosis
CorrectAnswer-C
Ans:C,Cryptococcus
LikeCNSdisease,pulmonarycryptococcosiscanfollowanindolent
course,andthemajorityofcasesprobablydonotcometoclinical

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attention.
Pulmonarycryptococcosiscanbeassociatedwithantecedent
diseasessuchasmalignancy,diabetes,andtuberculosis.
CryptococcusInfectioncanbeacquiredbyinhalationof
desiccatedyeasts(orbasidiospores)fromfecesofpigeonorother

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birds
DirectmicroscopicexaminationofIndiaink-stainedwetfilmsof
materialfromlesionsrevealscapsulated,buddingyeastcells;the

capsuleareprominentintheIndiainkpreparatio

92.NormalfloraofOralcavityis/areexcept:

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a)Veillonella
b)Anerobicmicrococci
c)Geotrichum
d)Gemella
e)Yersinia

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CorrectAnswer-A:B:C:D
Ans:a.Veillone...,b.Anerobicmicroc...,c.Geotrich...,d.
Gemell.
Morethan700bacterialspeciesorphylotypes,ofwhichover50%
havenotbeencultivated,havebeendetectedintheoralcavity.

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Themouthcontainsaplethoraoforganisms-pigmented&non-
pigmentedmicrococci;someofwhichareaerobic,grampositive,
aerobic,sporebearingbacilli,coliforms,proteus&lactobacilli
Thegumpocketb/wtheteeths,&thecryptsofthenostrilshavea
widespectrumofanaerobicflora-anerobicmicro-cocci,

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microaerophilic&anaerobicstreptococci,vibrios,fusiformbacilli,
corynebactriumspecies,actinomyces,leptothrix,mycoplasma,
Neisseriaeb?bacteriodesareallfoundinvaryingextents.Among
fungi,candidaergeotrichumhavebeenreported.

93.Goldstandarddiagnostictestfor

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babeiosisis:
a)Peripheralbloodsmearexamination
b)BloodCulture
c)PCR
d)ELISA

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e)Indirectfluorescentantibody(IFA)test
CorrectAnswer-A
Ans:a.Peripheralbloodsmear...,
[RefHarrison19th/1385-86;PanikerParasitology7th/85;Chatterjee
Parasitology13th/137;LippincottMicrobiology3rd/225;Jawetz

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27th/708;Greenwood16th/599]
Microscopicexaminationofstainedbloodsmearisgoldstandard
testforbabesiosis"
Aspecificdiagnosisusuallyisestablishedbymicroscopic
examinationofGiemsa-stainedthinbloodsmears.Babesia

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trophozoitesappearround,pear-shaped,orameboid.
Theringformismostcommonandlacksthecentralbrownish
deposit(hemozoin)typicalofPlasmodiumfalciparumtrophozoites.
Otherdistinguishingfeaturesaretheabsenceofschizontsand
gametocytesandtheoccasionalpresenceoftetrads("Maltese

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cross").
Ifparasitescannotbeidentifiedbymicroscopyandthediseaseis
stillsuspected,amplificationofthebabesial18SrRNAgeneby
polymerasechainreaction(PCR)isrecommended.Quantitative
PCRhasgreatlyloweredthethresholdfordetectionofB.microti

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DNA

94.Trueaboutlisteriamonocytogens
infection:
a)Commoninpregnantwomen
b)Commoninelderly

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c)Commoninchildren
d)Commoninnewborns
e)Ampicillinisdrugofchoice
CorrectAnswer-A:B:D:E
Ans:a.Commoninpregnant...,b.Commoninelderly...,d.

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Commoninnewborns...,e.Ampicillin.
[RefHarrison19th/982-84;Ananthanarayan9th/395-96;
LippincottMicrobiology3rd/98;Jawetz27th/197-98;
Greenwood16th/195-96]
Listeriainfectionsaremostcommoninpregnantwomen,fetuses

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andnewborns,andinimmunocompromisedindividuals,suchas
olderadultsandpatientsreceivingcorticosteroids"(Lippincott
Microbiology3rd/98).
Thediseaseaffectspregnantwomen,newborns,adultswith
weakenedimmunesystems,andtheelderly,

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Listeriamonocytogenesisafood-bornepathogenthatcancause
seriousinfections.
Meningitisinolderadults(especiallywithparenchymalbrain
involvementorsubcorticalbrainabscess)shouldtrigger
considerationofL.monocytogenesinfection.

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95.TrueaboutJapaneseencephalitis:
a)Mostsevereepidemicspreadoccuredin2006
b)MainvectorinIndiaisculextritaeniorhynchus
c)Spreadbyaedesmosquito
d)Indiastillnotabletodevelopvaccineindigenously

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e)Pigsareamplifierhost
CorrectAnswer-B:E
Ans:(B)MainvectorinIndiaisculextritaeniorhynchus(E)Pigs
areamplifierhost
[RefPark23rd/284-87;Harrison19th/1315;Ananthanarayan

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9th/52022,519]
During2006,therewasalargeoutbreakofchikungunyainIndia,
with1.39millionofficiallyreportedcasesspreadover16states;
attackrateswereestimatedat45%insomeareas"
Thevirusisparticularlycommoninareaswhereirrigatedricefields

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attractthenaturalavianvertebratehostsandprovideabundant
breedingsitesformosquitoessuchasCulextritaeniorhynchus,
whichtransmitthevirustohumans.
Additionalamplificationbypigs,whichsufferabortion,andhorses,
whichdevelopencephalitis,maybesignificantaswell.Vaccination

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oftheseadditionalamplifyinghostsmayreducethetransmissionof
thevirus.

96.NotAIDSdefiningcancer:
a)Analcarcioma
b)Hodgkin'slymphoma

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c)Cervialcancer
d)Non-Hodgkinslymphoma
e)Kaposicarcinoma
CorrectAnswer-A:B
Ans:(A)Analcarcioma(B)Hodgkin'slymphoma

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[RefHarrison19th/1268;Ananthanarayan9th/576-77;Lippincott
Microbiology3rd/302]
T
heneoplasticdiseasesconsideredtobeAIDSdefiningconditions
areKaposi'ssarcoma,non-Hodgkin'slymphoma,andinvasive
cervicalcarcinoma.

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Inaddition,thereisalsoanincreaseintheincidenceofavarietyof
non-AIDS-definingmalignanciesincludingHodgkin'sdisease;
multiplemyelotna;leukemia;melanotna;andcervical,brain,
testicular,oral,lung,gastric,liver,renal,andanalcancers.

97.TrueaboutPlasmodiumfalciparum:

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a)IncreasedsizeofinfectedRBC
b)Crescentricshapedgametocyte
c)Delicateringpresent
d)Small&multipleringscommon
e)Erythrocytepreference-oldcells

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CorrectAnswer-B:C:D
Ans:(B)Crescentricshapedgametocyte(C)Delicatering
present(D)Small&multipleringscommon
[RefHarrison19th/1369;ParasitologybyChatterjee13th/103;
ParasitolgybyPaniker7th/75]

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Ringstage-delicate,small,doublechromatin,multiplerings
common,Accoleformsfound
Macrogametocyte-Crescentric,deepbluecytoplasm,largediffuse
nucleus
Thematuregametocytesareroundinshape,exceptinP,

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falciparum,inwhichtheyarecrescent-shaped
Schizont:Fillstwo-thirdofredbloodcellwhichisnotenlarged-
Chatterjee13th/103
Infectederythrocyte-Normalsize,Maurer'scleft,sometimes
basophilicstippling

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Erythrocytepreference-youngerythrocyte,butcaninfectallstages

98.Whichofthefollowingstatementis/are
trueaboutGiardia:
a)Causebloodydiarrhorea
b)InvasivetoGImucosa

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c)Morecommoninhypogammaglobulinemicperson
d)Lesscommoninachlorohydria
e)Metronidazoleiseffectiveintreatment
CorrectAnswer-C:E
Ans:(C)Morecommoninhypogammaglobulinemicperson(E)

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Metronidazoleiseffectiveintreatment[RefParasitologyby
Chatterjee13th/47-48;ParasitolgybyPaniker7th/32-33;Harrison
19th/1406]
Metronidazole,trimidazole,furazoilidonehavebeenfoundtobe
effectiveforgiardiasis

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G.lambliaistypicallyseenwithinthecryptsofduodenal&jejunal
mucosa.Itdoesnotinvadethetissue,butremainstightlyadheredto
intestinalepitheliumbymeansofthesuckingdisc
Tepersonhavingagammaglobulinemia,malnourishedpersonsare
moresusceptibletogiardiasis

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99.Inwhichorganismcanbeisolated:
a)CSFspecimenoftetanusinfection
b)CSFspecimenoflisteriamonocytogenes
c)Fromvalvesinrheumaticvalvulitis
d)Frommyocardiumindiphthericmyocarditis

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e)Meningococcalrash
CorrectAnswer-B:E
Ans:(B)CSFspecimenoflisteria
monocytogenes(E)Meningococcalrash
L.
monocytogenes:Thediagnosisistypicallymadebycultureof

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blood,cerebrospinalfluid(CSF),oramnioticfluid.L.monocytogenes
maybeconfusedwith"diphtheroids"orpneumococciingram-
stainedCSFormaybegram-variableandconfusedwith
Haemophilusspp.
Petechiallesion:Meningococcimaysometimesbedemonstratedin

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petechiallesionsbymicroscopy&culture.

100.Trueaboutcytomegalovirus-
a)Characteristicowleyeappearance
b)Type5Humanherpesvirustype
c)Lymphocyteenlargement

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d)Causecongenitalinfection
e)Lymphoproliferative
CorrectAnswer-A:B:D
Ans:a.Characteristic...,b.Type5Human...,d.Cause
congenital....

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[RefHarrison19th/1190-91;Ananthanarayan9th/473-74;Jawetz
27th/470-74]

Itiscytomegalic(notlymphoproliferative,whichoccurinHHV4,6&
7)
Characterizedbyenlargementofinfectedcells

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Congenitalinfection-Intrauterineinfectionleadstofetaldeathor
cytomegalicinclusiondiseaseofnewbornwhichisoftenfatal

101.Whichofthefollowingis/aretrueabout
Mycoplasmapneumoniainfection
except:

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a)Causesmanyextrapulmonarymanifestations
b)Coldagglutinintiterisnotincreased
c)Causeatypicalpneumonia
d)Paucityofrespiratorysignsonphysicalexamination
e)Coughistypicallyproductive

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CorrectAnswer-B:E
Ans:b.Coldagglutinin...,e.Coughistypically
Coldhemagglutininsforgroup0humanerythrocyteappearinabout
50%ofuntreatedpatients,inrisingtiter,withthemaximumreached
inthethirdorfourthweekafteronset.

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Atiterof1:64ormoresupportsthediagnosisofM.pneumoniae
infection.
Thecoughistypicallynonproductive,butsomepatientsproduce
sputum.Headache,malaise,chills,andfeverarenotedinthe
majorityofpatients.

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102.Trueaboutenteroviruses:
a)In1999,wildpoliovirus2waseradicatedfromworld
b)Vaccineassociatedparalyticpoliomyelitis(VAPP)most
frequentlycausedbyserotype1vaccine
c)BivalentOPVcontainstype1&type3strain

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d)PrimarycourseofOPVconsistsofonly1dose
e)CoxasackieA7&enterovirustype71causesasepticmeningitis
CorrectAnswer-A:C:D:E
Ans:(A)In1999,wildpoliovirus2waseradicatedfromworld
(C)BivalentOPVcontainstype1&type3strain(D)Primary

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courseofOPVconsistsofonly1dose(E)CoxasackieA7&
enterovirustype71causesasepticmeningitis
[RefPark23rd/202-09;Harrison19th/1289-91;Ananthanarayan
9th/485]
Ofthe3strainsofwildpoliovirus,wildpoliovirustype2was

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eradicatedin1999&casenumbersoftype3aredowntothe
lowest-everlevelswiththelastcasereportedinNov2012from
Nigeria.
TheWHOprogrammeonimmunization(EPI)&thenational
immunizationprogrammeinIndiarecommendedaprimarycourseof

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3dosesofOPVatone-monthintervals,commencingthefirstdose
wheninfantis6weeksold.
Poliovirustype1isresponsibleformostepidemicsofparalytic
poliomyelitis.Type3alsocausesepidemicstoalesserextent..
Type2usuallycausesinapparentinfectionsinwesterncountriesbut

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inIndiaparalysisduetotype2isquitecommon"

GROUP
SEROTYPE
Poliovirus
1-3

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CoxsackievirusA 1-22AND24
CoxsackievirusB
1-6
s
Echovirus

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1-9,11-27,
29-34
Numbered
(EV)68-78
echovirus

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103.Trueaboutchickengunyafever:
a)CausedbysinglestrandedRNAarbovirus
b)Excruitingarthralgiainperipheraljoints
c)Antiviraltherapyisveryeffective
d)Absolutelymphocytosisispresent

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e)Vectorisaedesmosquitoes
CorrectAnswer-A:B:E
Ans:(A)CausedbysinglestrandedRNA
arbovirus(B)Excruitingarthralgiainperipheral
joints(E)Vectorisaedesmosquitoes.[RefHarrison19th/13j3;

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park23ril/289;Ananthanarayangth/440,519;Jawetz27th/548.
Chickengunya:Bloodcountsmaybenormal,orpatientsmayhave
leukopeniawithrelativelymphocytosis.
ThevectorisAedesaegypti,Itiscausedbyarbovirus(Family-
Togaviridae,Genus-Al?phavirus)(Ananthanarayan9th/517)

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TheChikungunyavirusbysinglestrandedRNAvirus?
Chikungunyaisalocalwordmeaningdoublingupowingto
excruciatingjointpains
Thereisnospecifictreatment&usuallyselflimiting.Analgesics&
antipyreticsalongwithfluidsupplementationarerecommendedto

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manageinfection&relievefever,jointpains&swelling.Drugslike
aspirin&steroidsshouldbeavoided

104.TrueaboutZikavirus:
a)Sexuallytransmitted
b)50%infectedpersondevelopsymptoms

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c)Effectivetherapyavailable
d)TransmittedbyAedesvector
e)Transmissioninutero
CorrectAnswer-A:D:E
Ans:a.Sexuallytransmittedd.TransmittedbyAedesvectore.

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Transmissioninutero[RefHarrison19th/1314;
ItisspreadmostlybythebiteofaninfectedAedesspecies
mosquitoes(A.aegyptiandA.albopictus).Thesemosquitoesare
aggressivedaytimebiters.
Itcanbepassedfromapregnantwomantoherfetus.Infection

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duringpregnancycancausecertainbirthdefects.
ItcanbepassedthroughsexfromapersonwhohasZikatohisor
herpartners.Itcanbepassedthroughsex,eveniftheinfected
persondoesnothavesymptomsatthetime.
ThemajorityofpeopleinfectedwithZikavirusdonotdisplayany

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symptoms

105.Biosafetylevel4infectionincludes:
a)Hantavirus
b)Nilevirus
c)Ebolavirus

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d)Crimean-CongoHF
e)LyssaFever
CorrectAnswer-C:D:E
Ans:c.Ebolavirusd.Crimean-CongoHFe.LyssaFever[Ref
Harrison19th/1323,1328;consteril.corn/biosafety-levels;

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thecerebrallounge.wordpress.corn]
Filoviruses(includesthreegenera:Cuevavirus,Ebolavirus,and
Marburgvirus)arecategorizedasWorldHealthOrganization(WHO)
RiskGroup4Pathogens.
BiosafetyLevel4-Hemorrhagicfevers,Marburgvirus,Ebola

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virus,Lassavirus,Smallpox

106.Serologicaltestis/areusefulindiagnosis
ofwhichofthefollowingdisease:
a)Typhoid
b)Qfever

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c)Acanthamoebainfection
d)Scrubtyphus
e)Brucellosis
CorrectAnswer-A:B:D
Ans:a.Typhoidb.Qfeverd.Scrubtyphus

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ThediagnosisofQfeverisbasedmainlyonserologicaltests,such
asmicroagglutination,complementfixation,immunofluorescence&
ELISA.
Serologicaltests:Therearenotusedforearlydiagnosisofrickettsia!
diseases(includingQfever,scrubtyphus),fromatreatment

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perspective,buttoconfirmthediagnosisforepidemiological
investigations.
Scrubtyphus:Serologicalassay(indirectfluorescentantibody,
indirectimmunoperoxidae&enzymeimmunoassays),aremainstays
oflaboratorydiagnosis.

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Tubeagglutinationisroutinelyusedforserologicaldiagnosisof
typhoid,brucellosis&typhusfever.

107.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"

108.WhicharetransmittedbyDog:
a)Echinococcusgranulosus
b)ToxocaraCanis
c)Echinococcusmultiocularis

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d)ToxoplasmaGondii
e)None
CorrectAnswer-A:C
Ans:A.EchinococcusgranulosusC.Echinococcus
multiocularis"[RefPark23rd/3}4;Hanison19th/1432,167

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e-1:ChatterjeeParasitology13th/159;CMDT2016/
12801.
Alveolarechinococcosis(AE)
iscausedbyinfectionwiththelarval
stageofEchinococcusmultilocularis.Theadulttapewormis
normallyfoundinfoxes,coyotes,anddogs.Infectionwiththelarval

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stagesistransmittedtopeoplethroughingestionoffoodorwater
contaminatedwithtapewormeggs.
Toxocaracanis:Humaninfectionisbyingestionofeggs,whichare
shedinfecesofdog.
Toxoplasmagondii:Manacquiresinfectionbyingestionof

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contaminatedfoodandwatercontainingsporulatedoocyst(fromcat)
orbyingestionofundercookedmeatcontainingtissuecysts"

109.Followupisnotrequiredinwhichof
thefollowingstudy:
a)Prospectivestudy

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b)Retrospectivestudy
c)Cross-sectionalstudy
d)Longitudinalstudy
e)Cohortstudy
CorrectAnswer-B:C

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Ans:b.Retrospectivestudy,c.Cross-sectionalstudy.[RefPark
23rd/62,69;Community
Cohort(Knownbyavarietyofnames-prospectivestudy,
longitudinalstudy,incidencestudy&forwardlookingstudy)isfollow
upstudywithindividualasunitofstudy(Park23rd/62,75)Case

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controlstudies,oftencalledretrospectivestudies:
Noattritionproblems,becausecasecontrolstudiesdonotrequire
follow-upofindividualintothefuture.
Cross-sectionalstudies(Alsok/aprevalencestudy)issingle
examination(sonofollowup)ofacross-sectionofpopulationatone

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pointintime-theresultsofwhichcanbeprojectedonthewhole
population.
Longitudinalstudies:Observationsarerepeatedinthesame
populationoveraprolongedperiodoftimebymeansoffollow-up
examinations.

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110.Specialprotectionincludes:
a)Personalitydevelopment
b)lmmunizationagainstspecificdisease
c)Specificnutritionaldiet
d)Protectionfromoccupationalhazard

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e)Environmentalmodification
CorrectAnswer-B:C:D
Ans:b.Immunizationagainst...,c.Specificnutritionaldiet...,d.
Protectionfromoccupational
SpecificProtection

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Immunization
Useofspecificnutrients
Chemoprophylaxis
Protectionagainstoccupationalhazards
Protectionagainstaccident

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Protectionfromcarcinogens
Avoidanceofallergens
Thecontrolofspecifichazardsinthegeneralenvironmente.g.,air
pollution,noisecontrol
Controlofconsumerproductquality&safetyoffoods,drugs,

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cosmeticsetc

111.TrueaboutCivilregistrationsystemin
India:
a)Dualrecordsystem
b)Deficient

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c)Headofinstitutionorofficer-inchargeisresponsiblefor
registration
d)Birth&Deathbothareregistered
e)Causeofdeathisrecorded
CorrectAnswer-B:C:D:E

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Ans:b.Deficie...,c.Headofinstitution...,d.Birth&Death
both...,e.Causeofdeath
TheregistrationsysteminIndiatendedtobeveryunreliable,the
databeinggrosslydeficientinregardstoaccuracy,timeliness,
completeness&coverage.Thisisbecauseofilliteracy,ignorance,

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lackofconcern,&motivation
Thecentralbirths&DeathRegistrationAct,1969fixesthe
responsibilityforreportingbirths&deaths.Whilethepublic(e.g,
parents,relatives)aretoreporteventsoccurringintheirhouseholds,
theheadsofhospital,nursinghomes,hotels,jailsordharmashalas

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aretoreporteventsoccurringinsuchinstitutionstobeconcerning
registrar
Thetimelimitforregisteringtheeventsofbirth&thatofdeathsis21
daysuniformlyalloverIndia.Incaseofdefaultalatefeecanbe
imposed.

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112.Trueaboutsilicosisallexcept:
a)Causedbyexposureofsilicaoxide
b)Severeexposure-wholelunglavagemayhelpfulin
alleviat_ingsymptoms
c)Fibrosisofupperlung

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d)Fibroticchangecanbereversedafterstoppingexposure
e)MoreriskofTB&lungcancer.
CorrectAnswer-D
Ans:d-Fibroticchangecanbereversedafterstopping
exposure

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Silicosisisprogressive&whatismoreimportantisthatsilicoticsare
pronetotuberculosis
Thereisnoeffectivetreatmentforsilicosis.Fibroticchangesthat
havealreadytakenplacecannotbereversed
Nodularfibrosis,morefrequentinapex&posteriorborder(upper

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partoflung)(c.finasbestosisfibrosisinlowerhalfoflung)
Silicoticsaremorepronetodeveloppulmonarytuberculosis(butin
recentyearthereisdoubtwhethersilicoticsreallydevelopT.B.)
Foracutesilicosis,bronchoalveolarlavagemayalleviatesymptoms,
butdoesnotdecreaseoverallmortality.

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113.Whichofthefollowingis/aretrue
aboutuseofBardiagram:
a)Comparisonof2categorialdatawhicharenot-additive
b)Comparisonof2categorialdatawhichareproportional
percentagecontributionofcategories

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c)Piechartisusedforcomparisonof2categorialdatawhichare
proportionalpercentagecontributionofcategories
d)Comparisonofmagnitudeofdifferentfrequenciesindiscrete
data
e)Comparisonofcontinuousdata

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CorrectAnswer-A:C:D
Ans:a.Comparison...,c.Piechartis...,d.Comparisonof
magnitude
BarDiagram
Lengthofbarrepresentsfrequencyofacharacter

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Popularereasymethod
Usedforcomparisonofmagnitudeofdifferentfrequenciesin
discretedata
Spacingb/wanytwobarsshouldbenearlyequaltohalfofthewidth
ofthebar

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3Type-simple,proportionate&multiple.
Categories Quantitytobe
Appropriatediagram
onx-axis representedony-axis*
Continuous Additive

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Pieifproportionalcontribution
(frequencyor
ofthecategoriesistobe
percentage),
represented,otherwise

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histogram


histogram
Linefordepictionoftrend,
otherwisebar

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Addictive(frequencyor
Discreteor
Pieifproportionalpercentage
percentage),
categorical

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contributionofthecategories
istoberepresented,
(number,rateorratio)
otherwisebar
bar

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114.Benefitofverticalhealthprogramme
includes:
a)MorefocusonefficiencY
b)Morerapidresults
c)Dedicatedworkeralwaysavailable

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d)Manyprogramscanrunatonetime
e)Effectivewayofmaximizingtheimpactoftheavailable
resources
CorrectAnswer-A:B:C:E
Ans:a.Morefocus...,b.Morerapid...,c.Dedicatedworker...,e.

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Effectivewayof.
Verticalprogrammesare"socalledbecausetheyaredirected,
supervised,andexecuted,eitherwhollyortoagreatextent,bya
specializedserviceusingdedicatedhealthworkers"
Incontrast,anintegratedprogrammeis"theprocessofbringing

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togethercommonfunctionswithinandbetweenorganizationsto
solvecommonproblems,developingacommitmenttosharedvision
andgoalsandusingcommontechnologiesandresourcestoachieve
thesegoals"
Verticalprogrammes(alsoknownasstand-alone,categoricalor

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free-standingprogrammesortheverticalapproach)referto
instanceswhere"thesolutionofagivenhealthproblem[is
addressed]throughtheapplicationofspecificmeasuresthrough
single-purposemachinery"


115.TrueaboutReinke'soedema:

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a)Usuallyunilateral
b)Commoninsmoker
c)Corticosteroidismainstayoftreatment
d)Involvewholeofmembranouspartofthevocalcords
e)Patienthaslowpitchvoice

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CorrectAnswer-B:D:E
Answer-B,CommoninsmokerD,Involvewholeofmembranous
partofthevocalcordsE,Patienthaslowpitchvoice
Itisbilateralsymmetricalswellingofthewholeofmembranouspart
ofthevocalcords.

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Thisisduetooedemaofthesubepithelialspace(Reinketspace)
ofthevocalcords.
Etiology-
Heavysmoking,
Chronicsinusitis&

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Laryngopharyngealreflex
C/F-
Patientusesfalsecordsforvoiceproduction&thisgiveshimalow-
pitched&roughvoice.
Treatment-

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Decorticationofthevocalcordsi.e.,removalofstripofepithelium,is
donefirstononeside&3-4weeksalterontheother.

116.Feature(s)ofScheibe'ssyndromeis/are:
a)Semicircularcanalfistula
b)Abnormalityinbonylabyrinth

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c)Dysplasiaofcochlea
d)Middleearanaomaly
e)All
CorrectAnswer-C
Answer-C.Dysplasiaofcochlea

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Itismostcommoninnerearanomaly.
Dysplasiaisseeninthecochlea&saccule;hencealsocalled
cochleosacculardysplasia.
Itisinheritedasanautosomalrecessivenonsyndromictrait.

117.Trueaboutnasopharyngealcarcinoma:

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a)Level4cervicallymphnodenotinvolved
b)Radiotherapyistreatmentofchoice
c)Alsoc/aGuangdongtumour
d)MayassociatedwithU/Lotitismedia
e)AssociatedwithEBV

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CorrectAnswer-A:B:C:D:E
Answer-A,Level4cervicallymphnodenot
involvedB,RadiotherapyistreatmentofchoiceC,Alsoc/a
GuangdongtumourD,MayassociatedwithU/Lotitis
mediaE,AssociatedwithEBV

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Itismostlyseeninfifthtoseventhdecades.
Malesarethreetimesmorepronethanfemale.
Epstein-Barrvirusiscloselyassociatedwithnasopharyngeal
carcinoma.
DuetoobstructionofEustachiantube,thereisconductivehearing

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loss,serousorsuppurativeotitismedia.
Radiotherapy:Itistreatmentofchoicefornasopharyngeal
carcinoma.

118.Trueabouttubercularotitismediaareall
except?

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a)Spreadsthrougheustachiantube
b)Causespainlesseardischarge
c)Maycausemultipleperforations
d)Usuallyaffectsbothears
e)None

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CorrectAnswer-D
Answer-D.Usuallyaffectsbothears
Tuberculosisofmiddleearisacomparativelyrareentityusually
seeninassociationwithorsecondarytopulmonarytuberculosis,
infectionreachesthemiddleearthrougheustachiantube.

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Clinicalfeatures
Generally,tuberculosisofmiddleearisunilateral.
Itischaracterizedbypainlessotorrhoeawhichfailstorespondtothe
usualantimicrobialtreatment.Thereispainlesswateryotorrhea.
Singleormultipleperforationoftympanicmembrane.

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119.EvidencebasedtherapyofBell'spalsy
include(s):
a)Facialnervemassage
b)Facialnervestimulation
c)Steroid

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d)Acyclovir
e)All
CorrectAnswer-C
Answer-C.Steroid
1.Medicaltreatment

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Prednisolone(steroid)isthedrugofchoiceandisstartedatinitial
visit.Initiationoftherapyduringfirst24hoursofsymptomconfersa
higherlikelihoodofrecovery.
Antiviraltherapy(Acyclovir)isaneweradjunctintreatingacute
facialpalsyofviralorigin(bothBell'spalsyandRamsayhunt

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syndrome).
Mostsurgeonsthesedaysadvocatecombinationofsteroidsand
antiviraldrugs.

120.ApersonhasvertigowithoutCNS
involvement.Causesis/are:

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a)Perilymphfistula
b)Otolithiasis
c)Vestibularneuritis
d)Meniere'sdisease
e)Multiplesclerosis

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CorrectAnswer-A:B:C:D
Answer-A,PerilymphfistulaB,OtolithiasisC,Vestibular
neuritisD,Meniere'sdisease
Peripheral(Lesionsofendorgansvestibularnerve)
Meniere'sdisease

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Benignparoxysmalpositional
vertigo
Vestibularneronitis
Labyrinthitis
Vestibulotoxicdrugs

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Headtrauma
Perilymphfistula
Syphilis
Acousticneuroma

121.Cause(s)ofinMydriasis:

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a)Organophosphoruspoisoning
b)Homersyndrome
c)Oculomotornervepalsy
d)Parasympatheticstimulation
e)All

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CorrectAnswer-C
Answer-C.Oculomotornervepalsy
Carbolicacid,Chloralhydrate,Organophosphorus,Morphine
(opiate)and'NewHorn'i.e.neurosyphilis/tabesdorsalis(spinal
miosisorsmall,irregularArgyllRobertsonpupil)andHorner's

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syndrome,Oculomotornervepalsy.
Atropineandcocainecausemydriasis.

122.Trueaboutprimaryopenangle
glaucoma:
a)Alsok/aChronicsimpleglaucoma

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b)Hypermeteropeasaremorepredisposed
c)Polygenicinheritance
d)Laseriridotomyisusedfortreatment
e)Fundusexaminationrevealslargecup
CorrectAnswer-A:C:E

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Answer-(A)Alsok/aChronicsimpleglaucoma(C)Polygenic
inheritance(E)Fundusexaminationrevealslargecup
Alsoknownaschronicsimpleglaucomaofadultonsetandis
typicallycharacterizedbyslowlyprogressiveraisedintraocular
pressure.

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Associatedwithcharacteristicopticdisccuppingandspecificvisual
fielddefects.
Pathogenesis-
Heredity:POAGhasapolygenicinheritance.
Age-elderlybetween5thand7thdecades.

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Myopesaremorepredisposedthanthenormals.
DiabeticshaveahigherprevalenceofPOAG.
POAGismoreinhyPertensives.
C/F
patientsusuallycomplainoffrequentchangesinpresbyopicglasses.

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Patientsdevelopdelayeddarkadaptation.
Fundusexaminationshowlargecup.(0.6ormore)
Laseriridotomyisusedfortreatmentofprimaryangleclosure

glaucoma.

123.Cloudycorneais/areseen:

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a)Klinefeltersyndrome
b)Turnersyndrome
c)Megalocornea
d)Mucopolysaccharidosis
e)All

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CorrectAnswer-D
Answer-D.Mucopolysaccharidosis
S-Sclerocornea
T-Trauma
U-Ulcer

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M-Mucopolysaccharidosis
P-Peteranomaly
ED-Congenitalhereditaryendothelialdystrophy

124.Ectopialentisisassociatedwithall
except-

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a)Homocystinuria
b)Weil-Marchesanisyndrome
c)Marfansyndrome
d)Cockaynesyndrome
e)Osteogenesisimperfecta

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CorrectAnswer-D:E
Answer-(D)Cockaynesyndrome(E)Osteogenesisimperfecta
Morecommon:
Marfansyndrome
Homocystinuria

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Weil-Marchesanisyndrome
Sulfiteoxidasedeficiency
Hyperlysinemia

125.NotfeatureofFuch's
heterochromiciridocyclitis:

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a)Whitenodulesontheanteriorsurfaceoftheiris
b)Koppeprecipitatespresentatbackofcornea
c)Granulomatoustypeoflowgradeanterioruveitis
d)Topicalcorticosteroidsareusedfortreatment
e)All

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CorrectAnswer-C
Answer-C.Granulomatoustypeoflowgradeanterioruveitis
Fuchs'heterochromiciridocyclitisisachronicnongranulornatous
typeoflowgradeanterioruveitis.
Thediseaseischaracterisedby:

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Heterochromiaofiris,
Diffusestromalirisatrophy,
FineKPsatbackofcornea,
Faintaqueousflare,
Absenceofposteriorsynechiae

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Topicalcorticosteroidsareallthatisrequired.

126.Trueaboutiris:
a)Eyecolourisduetorelativenumberofmelanocytes
b)Stromaisresponsibleforpigmentation
c)Sphincterpupillaeissuppliedbyparasympatheticfibres

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d)Dilatorpupillaeissuppliedbysympatheticfibres
e)Stromaiscoveredonitsanteriorsurfacebytwolayersof
pigmentedepithelium
CorrectAnswer-A:B:C:E
Answer-A,Eyecolourisduetorelativenumberof

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melanocytesB,Stromaisresponsiblefor
pigmentationC,Sphincterpupillaeissuppliedby
parasympatheticfibresE,Stromaiscoveredonitsanterior
surfacebytwolayersofpigmentedepithelium
Eyecolorisdeterminedbytherelativenumberofmelanocyteinthe

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stromaandofcoursethedensityofmelaningranulesproduced.
Irisiscomposedofastromacantainingbranchedconnectivetissue
cells,usuallypigmentedbutlargelyunpigmentedinblueirides.
Thestromaiscoveredonitsposteriorsurfacebytwolayersof
pigmentedepithelium.

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Theirisisrichlysuppliedbysensorynervefibresderivedfromthe
trigeminalnerve.
Thesphincterpupillaeissuppliedbyparasympatheticautonomous
secretomotornervefibresderivedfromtheoculomotornerve,while
themotorfibresofthedilatormusclearcdefivedfromthecervical

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sympatheticchain.

127.Whichofthefollowingis/arenotthe
feature(s)ofcornealulcerduetoherpes
virus:

a)RoseBengalstainingofmarginofulcer

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b)Decreasedcornealsensitivity
c)Fluoresceinstainingofflooroftheulcer
d)Ringinfiltration
e)All
CorrectAnswer-A:B:C

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Answer-A,RoseBengalstainingofmarginof
ulcerB,DecreasedcornealsensitivityC,Fluoresceinstainingof
flooroftheulcer
"Dendriticulcerbasestainswithfluorescein&themarginswithrose
Bengal.

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Fluoresceininstallationilluminatedbybluelightshowsupcorneal
ulcerationatanearlystage.
Thecorneaisrelativelyinsensitive.Insevereforms,dendriticulcers
develop.

128.Allaretrueaboutchronicfatigue

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syndromeexcept:
a)Fordiagnosis,durationoffatigueshouldbeatleast6month
b)Impairedmemoryandconcentrationmaypresent
c)Fatiguerelievedbyrest
d)Physicalexaminationshowsnoabnormalities

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e)Cognitivebehavioraltherapyisusefulfortreatment
CorrectAnswer-C
Answer-C.Fatiguerelievedbyrest
Fatiguelastsforatleast6months
Fatigueisofnewordefiniteonset.

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Fatigueisnottheresultofanorganicdiseaseorofcontinuing
exertion
Fatigueisnotalleviatedbyrest.
Fatiguesymptomsaresoarthroat,tendercervicaloraxilarylymph
nodes,musclepain,paininseveraljoints,headaches,malaise

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129.Allaretrueaboutprimaryaldosteronism
except:
a)Oneofthemostcommoncauseofsecondaryhypertension
b)Hyperkalemia
c)Sodiumretention

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d)Ratioofplasmaaldosteronetoplasmareninactivity(PA/PRA)
isausefulscreeningtest
e)Tetanymayoccur
CorrectAnswer-B
Answer-B.Hyperkalemia

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Primaryhyperaldosteronismisoneofthemostcommoncauseof
secondaryhypertension.
Excessivelevelsofaldosteronecausesodiumretentionand
potassiumexcretion,withresultanthypertensionandhypokalemia.
Hypokalemiacancauseweakness,parethesias,visualdisturbances

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andtetany.
Thediagnosisofprimaryhyperaldosteronismisconfirmedbythe
elvatedlevelofaldostetoneanddepressedlevelsofrenininthe
circulation(lowPRA).
Theratioofplasmaaldosteronetoplasmareninactivity(PA/PRA)is

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ausefulscreeningtest.

130.Allaretrueaboutacutepericarditis
except:
a)Painradiatetoleftshoulder&arm
b)WidespreadelevationoftheSTsegments,oftenwithupward

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concavity&thenreturntobaseline
c)Painrelievedbylyingsupine&intensifiedbysittingupand
leaningforward
d)Corticosteroidrelievessymptoms
e)High-pitchedscratchingorcrunchingnoisemayheardin

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auscultation
CorrectAnswer-C
Answer-C.Painrelievedbylyingsupine&intensifiedbysitting
upandleaningforward
Thecharacteristicpainofpericarditisisretrosternal,radiatestothe

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shouldersandneck(retrosternal,andleftprecoridal).
Characteristically,pericaridialpainmayberelievedbysittingupand
leaningforwardandisintensifiedbylyingsupine.
Apericardialfrictionrubisahigh-pitchedsuperficialscratchingor
crunchingnoise,producedbymovementoftheinflamed

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pericardium.
TherearefourstagesofECGchangesintheevolutionofacute
pericarditis.
Instage1,thereiswidespreadelevationoftheSTsegments,often
withupwardconcavity,involvingtwoorthreestandardlimbleads

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andV2toV6,withreciprocaldepressionsonlyinaVRand
sometimesV1,aswellasdepressionofthePRsegmentUsually

therearenosignificantchangesinQRScomplexes.
Instage2,afterseveraldays,theSTsegmentsreturntonormal,
andonlythen,orevenlater,dotheTwavesbecomeinverted(stage

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3).
Ultimately,weeksormonthsaftertheonsetofacutepericarditis,the
ECGreturnstonormalinstage4.
Thepainisusuallyrelievedbyaspirin.

131.Malignancyassociatedwith

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hypercalcemia:
a)Breastcancer
b)Smallcelllungcancer
c)Non-smalllungcancer
d)Prostatecancer

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e)Multiplemyeloma
CorrectAnswer-A:C:D:E
Answer-A,BreastcancerC,Non-smalllungcancerD,Prostate
cancerE,Multiplemyeloma
Lungcarcinoma,breastcarcinoma,andmultlplemyelomaaccount

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formorethan50%ofallcasesofmalignancy-associated
hypercalcemia.
Gastrointestinaltumarsandprostatecarcinomaarelesscommon
causesofhypercalcemia.

132.Whichofthefollowingmarkerssuggest

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likelyprimarycancerincarcinomaof
unknownprimary(CUP):

a)CK7isfoundintumorsofthelung,ovary,endometrium&
breast
b)CK20+/CDX-2+/CK7?,suggestiveoflowergastrointestinal

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cancer
c)Calretin&WT-1formelanoma
d)Chromogranin,synaptophysin&CD56aremarkerof
neuroendocrineprrimary
e)None

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CorrectAnswer-A:B:D
Answer-A,CK7isfoundintumorsofthelung,ovary,
endometrium&breastB,CK20+/CDX-2+/CK7?,suggestiveof
lowergastrointestinalcancerD,Chromogranin,synaptophysin
&CD56aremarkerofneuroendocrineprrimary

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CK7,CK20,thrombomodulin-Urothelial
CK7,CK20,CDX-2,carcinoembryonicantigen(CEA)-intestinal
Calretinin,WT-1-Mesothelioma
Chromogranin,synaptophysin,CD56-Neuroendocrine

133.Whichistrueaboutthrombolysisin

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acuteischemicstroke:
a)Mosteffectiveifusedwithin3hour
b)Contraindicatedinh/opriorintracranialhaemorrahage
c)Useofheparinwithin48hrisnotacontraindication
d)Contraindicatedifplatelets<100,000permicroliter

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e)All
CorrectAnswer-A:B:D
Answer-A,Mosteffectiveifusedwithin3
hourB,Contraindicatedinh/opriorintracranial
haemorrahageD,Contraindicatedifplatelets<100,000per

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microliter
Intravenousthrombolysiswithrecombinanttissueplasminogen
activator(rt-PA)increasestheriskofhaemorrhagictransformationof
thecerebralinfarctwithpotentiallyfatalresults.However,ifitis
givenwithin4.5hoursofsymptomonsettocatefullyselected

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patients,thehaemorrhagicriskisoffsetbyanimprovementin
overalloutcome.

134.Highaniongapmetabolicacidosisis/are
presentin:
a)Asthma

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b)COPDwithCO2retention
c)Poorlycontrolleddiabetes
d)Renaltubularacidosis
e)All
CorrectAnswer-C

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Answer-C.Poorlycontrolleddiabetes
Ketoacidosis
Diabetic
Alcoholic
Starvation

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135.TrueaboutMcCune-Albrightsyndrome:
a)Occurinchildren&duringpuberty
b)Precociouspubertyinfemale
c)Involvelongboneoflimb
d)Associatedwithhypothyroidism

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e)All
CorrectAnswer-A:B:C
Answer-A,Occurinchildren&duringpubertyB,Precocious
pubertyinfemaleC,Involvelongboneoflimb
McCune-Albrightsyndrome(MAS)ischaracterizedbythetriadof

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polyostoticfibrousdysplasia,cafeaulaitskinpigmentation,and
peripheralprecociouspuberty.
Albrightsyndromeisprecocioussexualdevelopment,whichoccurs
mostofteningirls.
Theaverageageatonsetinaffectedgirlsisabout3yrandpuberty.

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136.Increasedportalveinpressure&normal
hepaticveinpressurecanbeseeninall
except:

a)Alcoholiccirhhosis
b)Alcholoichepatitis

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c)BuddChairisyndrome
d)Portalveinthrombosis
e)Inferiorvenacavaobstruction
CorrectAnswer-C:E
Answer-C,BuddChairisyndromeE,Inferiorvenacava

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obstruction
"Budd-Chiarisyndrome(Obstructionofhepaticveinsatanysitefrom
efferentveinofthelobuletotheentryoftheIVCintorightatrium.
Posthepatic-Budd-Chiarisyndrome,Inferiorvenacavalwebs

137.Whichofthefollowingstatement(s)

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is/areregardingAmericanHeart
Association(AHA)Guideline-2015for
cardiopulmonaryresuscitation(CPR)&
Emergencycardiovascularcare(ECC):

a)Chestcompression:ventilationCompressionventilationratio

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withoutadvancedairway?rate30:2irrespectiveofrescuer&
ageofpatient
b)Compressionrate-atleast100/min
c)FailuretoachieveanETCO2of10mmHgbywaveform
capnographyafter20minutesofresuscitationhasbeen

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associatedwithanextremelypoorchanceofreturnof
spontaneouscirculation(ROSC)
d)Limitinterruptionsinchestcompressionstolessthan10
seconds
e)None

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

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compressionstolessthan10seconds
Compressionrateismodifiedtoarangeofl00to120/min.
Compressionventilationratiowithoutadvancedairway-1or2
rescuers30:2

FailuretoachieveanETCO2ofI0mmHgbywaveform

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

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138.Trueaboutmultiplesclerosis:
a)Corticosteroidsareusedinacuteattack
b)IntravenousImmunoglobuliniseffectivemodeoftreat?ment
c)IFNa-usedinrecurrence
d)IFN-P-usedinrecurrence

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e)Plasmapheresismaybeusedinsevererelapses
CorrectAnswer-A:D:E
Answer-(A)Corticosteroidsareusedinacuteattack(D)IFN-P-
usedinrecurrence(E)Plasmapheresismaybeusedinsevere
relapses

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MaindrugsusedfortreatingmultiplesclerosisincludeInterferon-
1a
Frequencyofrelapsesinmultiplesclerosispatientisdecreasedby
beta-interferon/glatiramer.
Newerdrugapprovedforrelapseinmultiplesclerosispatientsis

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Fingolimod.
Glucocorticoidsareusedtomanageeitherfirstattacksoracute
exacerbations.
Natalizumabisamonoclonalantibodyagainst4subunitof41
integrinonlymphocytes,usefulintreatingmultiplesclerosis.

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Itreducestherelapseratewhengivenintravenouslyoncemonthly.

139.Extrathyroidfeatureofhypothyroidism
includes:
a)Pretibialmyxedema
b)Carpaltunnelsyndrome

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c)Bradycardia
d)Thyroidacropathy
e)Peripheraledema
CorrectAnswer-B:C:E
Answer-(B)Carpaltunnelsyndrome(C)Bradycardia

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(E)Peripheraledema
Commonsymptomsare-Weightgain,Fatigue,Dryskinandhair,
Menorrhagia,Hoarseness,coldness
CVS-Bradycardia,Myxoedema,hypertension
Nervoussystem-Carpaltunnelsyndrome,

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Facialfeatures-purplishlips,malarflush,periorbitaloedema
Yellowingofskinoccursduetoaccumulationofincreasecarotene.

140.Whichofthefollowingistrueabout
medicationoveruseheadache:
a)Notassociatedwithtriptanuse

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b)Restrictionofanalgesicsshouldbedone
c)Opioidismainlyresponsible
d)Preventivetherapyshouldbeencouragedafterstopping/
reducinganalgesic
e)None

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CorrectAnswer-B:C:D
Answer-(B)Restrictionofanalgesicsshouldbedone
(C)Opioidismainlyresponsible(D)Preventivetherapyshould
beencouragedafterstopping/reducinganalgesic
medicationsthatarethemostcommonculpritsarecompound

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analgesia(particularlycodeineandotheropiatecontaining
preparations)andtriptans,andMOHisusuallyassociatedwithuse
onmorethan10-15dayspermonth.
Managementisbywithdrawaloftheresponsibleanalgesics
Migraineprophylacticsmaybehelpfulinreducingtherebound

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headaches.

141.Whichofthefollowingis/arefeature(s)of
acuteinterstitialnephritis:
a)Eosinophiluria
b)Peripheraleosinophilia

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c)WBCcast
d)Grosshaematuria
e)Significantproteinuria
CorrectAnswer-A:B:C
Answer-(A)Eosinophiluria(B)Peripheraleosinophilia(C)WBC

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cast
Peripheraleosinophiliacanoccur,especiallywithdruginduced.
Microscopichematuriaisinvariablypresent.
Urinalysiscanrevealwhitebloodcell,granularorhyalinecast.
Thepresenceofurineeosinophilsisneithersensitiveorspecific.

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Proteinuriacanbeafeature,particularlyinNSAIDS-induced
interstitialnephritis.

142.Feature(s)ofBulbarpalsyis/are:
a)Dysphagia
b)Absentjawjerk

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c)Absentgagreflex
d)Tongueatrophy
e)Tonguewasting&fasciculations
CorrectAnswer-A:B:C:D:E
Answer-(A)Dysphagia(B)Absentjawjerk(C)Absentgag

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reflex(D)Tongueatrophy(E)Tonguewasting&fasciculations
Paralysisorlossoffunctionsuppliedbycranialnervearisingfrom
bulb(oldnameofmedullaoblongata).
AffectedCNare9,10,11&l2th.
Tongue-flaccid,wasted,fasciculationmaybepresent.

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InvolvementofIX&XCN:Nasaltwang,nasalregurgitation,hoarse
voice,dysphagia,lossofsensationoverpl/3tongue,
weakcough,absentgagreflex&weakcoughreflex.
Inu/llesion,thereisneveracompleteparalysisofdeglutitionorof
articulation.

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143.Allaretrueabouthepatorenalsyndrome
except:
a)Creatininelevelraised
b)Albumininfusiongiven
c)Livertransplantationimprovesrenalfunctions

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d)Mayoccurincirrhosis
e)Lowdosedopamineinfusionisveryeffective
CorrectAnswer-E
Answer-E.Lowdosedopamineinfusionisveryeffective
Thehepatorenalsyndrome(HRS)isaformoffunctionalrenalfailure

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withoutrenalpathologythatoccursinabout10%ofpatientswith
advancedcirrhosisoracuteliverfailure.
Therearemarkeddisturbancesinthcarterialrenalcirculationin
PatientswithHRS.
TyPeIHRS-asignificantreductionincreatinineclearancewithin1-2

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weeksofpresentation.
Type2HRS-anelevationofserumcreatininelevel.
HRSisoftenseeninpatientswithrefractoryascites.
Treatment-
dopamineorprostaglandinanalogueswereusedasrenal

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vasodilatingmedications.
Patientsaretreatedwithmidodrine,analpha-agonist,alongwith
octreotideandintravenousalbumin.
ThebesttheragyforHRSislivertransplantation.

144.Whichofthefollowingis/areusedfor

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assessmentofcarbohydrate
malabsorption:

a)Schillingtest
b)Steatorrhoea
c)D-xylosetest

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d)Glucosetest
e)Urinetest
CorrectAnswer-C
Answer-C.D-xylosetest
D-xyloseabsorptiontestisthemostcommonlyemployedtestfor

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carbohydrateabsorption-Harrison
Anendoscopicmucosalbiopsyisthemorespecifictestandisnow
consideredessential.
D-xyloseisacarbohydratethatisabsorbedalmostexclusivelyinthe
proximalsmallbowelwithoutthehelpofpancreaticenzymes.A

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positiveD-xylosetestindicatesmalabsorptionduetointestinal
mucosaldiseaseandthusbeusedasatestforassessmentof
mucosalfunction.

145.TrueaboutSwan-Ganzcatheter:
a)Measuresrightatrialpressure

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b)Measuresleftventricularfillingpressure
c)MeasurePCWP
d)Insertedthroughleftsubclavianvein
e)InserteddirectlyinRightatrium
CorrectAnswer-A:B:C:D

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Answer-(A)Measuresrightatrialpressure(B)Measuresleft
ventricularfillingpressure(C)MeasurePCWP(D)Inserted
throughleftsubclavianvein
Continuouscardiacoutputmonitoring.
CentraltemPeraturemonitoring

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Measurementofpulmonaryarterypressure(canalsomeasureRA
andRVpressuresduringinsertion)
Measurementofmixedvenoussaturations
Estimationofdiastolicfillingofleftheart(normalPCWP2-12mmHg)

146.TreatmentofacuteHyperleukocytosis

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includes:
a)Hydroxyurea
b)Isotretinoin
c)Leukapheresis
d)Vincristine

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e)All
CorrectAnswer-A:C:D
Answer-(A)Hydroxyurea(C)Leukapheresis(D)Vincristine
Leukapheresisisthetreatmentofchoice.
InpatientswithAML,hydroxyureashouldbestarted.

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InALLpatients,higherthan200,000/mm3patientsmaybetreated
withvinctistine,steroids,orboth.

147.Feature(s)of3rddegreeburnis/are:
a)Blisterformation
b)Verypainful

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c)Nospontaneoushealing
d)Dryescharformation
e)Thrombosedvesselscanbeseenundertheskin
CorrectAnswer-C:D:E
Answer-C,NospontaneoushealingD,Dryeschar

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formationE,Thrombosedvesselscanbeseenundertheskin
Entirethicknessofskindestroyed(intofat)
Anycolor(white,black,red,brown),dry,lesspainful(dermalplexus
ofnervesdestroyed)
Healbycontractionandscardeposition(noepitheliumleftinmiddle

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ofwound)
Full-thicknessBurns(3degreeBURN)-thrombosedvesselscanbe
seenundertheskin.

148.TrueaboutBabcockforcep:
a)Teethatend

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b)Serrationatend
c)Triangularorificeinblades
d)Usedforsoftdelicatetubularstructure
e)Curvedforcep
CorrectAnswer-C:D

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Answer-C,TriangularorificeinbladesD,Usedforsoftdelicate
tubularstructure
Aninstrumentwitharatchet&atriangularerpansionwith
fenestrationsattheoperatingend
Itdoesnothaveanyteeth

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Thisinstrumentcanbeusedtoholdintestine,thyroidgland,
mesoappendix,uterinetubeetc.

149.Gasusedincreatingpneumoperitonem:
a)Water
b)CO2

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c)02
d)Air
e)CO
CorrectAnswer-B:C:D
Answer-B,CO2C,02D,Air

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Gasesusedforpneumoperitoneumincludecarbondioxide(CO2),
air,oxygen,nitrousoxide(N20),argon,heliumandmixturesofthese
gases.

150.CO2isusedinlaproscopyforcreating
pneumoperitoneuminplaceofair

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because:

a)Lessabsorptionfromperitonealsurface
b)Fastclearancefrombody
c)Lesssolubilityinblood
d)Electrocauteryissafetouse

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e)Lessriskofgasembolism
CorrectAnswer-B:D:E
Answer-B,FastclearancefrombodyD,Electrocauteryissafeto
useE,Lessriskofgasembolism
CO2gasinsufflationispreferredbymostlaparoscopistsbecauseit

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hasahighdiffusioncoefficientandisanormalmetabolicend
productrapidlyclearedfromthebody.
Also,CO2ishighlysolubleinbloodandtissuesanddoesnot
supportcombustion.
TheriskofgasembolismislowestwithCO2.

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CardiacarrhythmiascanoccurwithCO2pneumoperitoneum.

151.Acutehaemorrhagicpancreatitis
producewhichofthefollowingsign:
a)Cullensign
b)Rovsingsign

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c)Psoassign
d)GreyTurnersign
e)Kehrsign
CorrectAnswer-A:D
Answer-A,CullensignD,GreyTurnersign

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Bleedingintothefascialplanescanproducebluishdiscolourationof
theflanks(GreyTurner'ssign)orumbilicus(Cullen'ssign).

152.Trueregardingurinarycatheterization
with16Frenchsize:
a)Itisthesuitablesizetouseinadultfemale

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b)ItcancauseUTIinlongtermuse
c)Usedinmanagementofurethralobstruction
d)Diameteris4mm
e)Steriletechniquemustbeusedforinsertion
CorrectAnswer-A:B:C:E

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Answer-A,ItisthesuitablesizetouseinadultfemaleB,Itcan
causeUTIinlongtermuseC,Usedinmanagementofurethral
obstructionE,Steriletechniquemustbeusedforinsertion
Foley'scatheterissterilizedbygammaradiation.UsuallyFoley's
catheteriskeptfor7days.

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Size:
Adults--16F
Children--8For10F
Obstructionoftheurethrabyananatomicalconditionthat,makesit
dfficultforonetourinate:prostatehypertrophy,

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prostatecancer,ornarrowingoftheurethra.

153.Whichofthefollowingis/aretrueabout
obstructiveuropathy:
a)Strictureinureteriscause
b)Stoneinureteriscause

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c)RTAtype4canoccur
d)AbsenceofhydronephrosisonUSGruleoutobstructive
uropathy
e)Whenobstructionisabovethelevelofthebladder,bilateral
hydroureterandhydronephrosisoccurs

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CorrectAnswer-A:B:C
Answer-A,StrictureinureteriscauseB,Stoneinureteris
causeC,RTAtype4canoccur
Anyobstructionatordistaltothebladderneckmayleadtoback
pressureaffectingbothkidneys.

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Obstructionatorproximaltotheureteralorificeleadstounilateral
damage.
Partialobstructionleadstogradualprogressivemuscular
hypertrophyfollowedbydilation,decompensationand
hydronephroticchanges.

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Acquiredurinarytractobstructionmaybeduetoinflammatoryor
traumaticurethralstrictures,ureteralorpelvicstones.

154.Trueaboutbranchialfistula:
a)Externalopeningneartheanteriorborderof
sternocleido?mastoid

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b)Externalopeningatjunctionofupper&middlethirdof
sternocleidomastoidmuscle
c)Developduetopersistenceof2ndbranchialcleft
d)Openinoropharynx
e)Movewithswallowing

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CorrectAnswer-A:C:D
Answer-A,Externalopeningneartheanteriorborderof
sternocleido?mastoidC,Developduetopersistenceof
2ndbranchialcleftD,Openinoropharynx
Thisisalwayscongenital&occursduetopersistent2ndbranchial

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cleft.
Theexternalorificeisnearlyalwayssituatedinthelowerthirdofthe
neckneartheanteriorborderofthesternocleidomastoid.
Thepatientmaycomplainofadimple,dischargingmucus&the
dimplebecomesmoreobviouswhenthepatientisaskedtoswallow.

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155.Trueabout1stdegreehaemorrhoid:
a)Painlessbleeding
b)Malaenaeoccur
c)Constipationmaybepresent
d)Prolapseondefaecation

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e)Neverprolapse
CorrectAnswer-A:C:E
Answer-A,PainlessbleedingC,Constipationmaybe
presentE,Neverprolapse
FourDegreesofHaemorrhoids

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Firstdegree:bleedonly,noprolapse
Seconddegree:prolapse,butreducespontaneously
Thirddegree:prolapseandhavetobemanuallyreduced
Fourthdegree:permanentlyprolapsed

156.Whichofthefollowingexaminationis

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doneinsupineposition:
a)Tredelenburgposition
b)ReverseTredelenburgposition
c)Simsposition
d)Jackknifeposition

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e)Lloyd-Daviesposition
CorrectAnswer-A:B:E
Answer-A,TredelenburgpositionB,ReverseTredelenburg
positionE,Lloyd-Daviesposition
"Tredelenburgposition:Lithotomywithheaddown

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ReverseTredelenburgposition:Thepatientissupineonthe
operatingtablewiththetabletiltedup15"attheheadendtoreduce
venousengorgement.
"Mostcommonly,thepatientisexaminedintheleftlateral(Sims)
positiorwiththebuttocksoverlyingtheedgeoftheexamination

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couchandwiththeaxisofthetorsocrossing,ratherthanparallel
with,theedgeofthecouch.
Thepronejackknifeorknee-elbowpositionsmaybeused.
Lloyd-DaviesPosition:ItisalsoknownastheTrendelenburg
positionwithlegsapart.

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157.Trueaboutlipcarcinoma:
a)Commoninsmoker
b)Morecommoninlowerlip
c)Morecommoninupperlip
d)Alwayspainfultotouch

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e)Distantmetastasisislate
CorrectAnswer-A:B:E
Answer-A,CommoninsmokerB,Morecommoninlower
lipE,Distantmetastasisislate
Lowerlipismoreofteninvolved

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lncidenceoforalcancerissixtimesmoreinsmokerthannon-
smoker
Siteofpredilectionisb/wthemidline&commissureofthelip
Mostly,itissquamouscellcarcinoma,oftenseeninmalesintheage
groupof40-70years

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L,Nmetastasesdeveloplate.Submental&submandibularnodes
arethefirsttobeinvolved;otherdeepcervicalnodesmayalsoget
involvedlater.

158.Trueaboutmediastinalteratoma:
a)Mostcommontumourofanteriormediastinum

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b)Mostcommongermcelltumourofmediastinum
c)Morecommonlyoccursinanteriormediastinum
d)Containteeth,skin,hair,cartilageandbone
e)Histologicallygradedasdifferentiated&undifferentiated
CorrectAnswer-B:C:D:E

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Answer-B,Mostcommongermcelltumourof
mediastinumC,Morecommonlyoccursinanterior
mediastinumD,Containteeth,skin,hair,cartilageand
boneE,Histologicallygradedasdifferentiated&
undifferentiated

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Mostcommonmalignancyinyoungmenbetweenage15and35
years.
Primarymediastinalgermcelltumors(includingteratomas,
seminomas,andnonseminomatousmalignantgermcelltumors)are
aheterogeneousgroupofbenignandmalignantneoplasms.

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Teratomasarethemostcommontypeofmediastinalgermcell
tumors.
Theycontaintwoorthreeembryoniclayersthatmayincludeteeth,
skin,hair(ectodermal),cartilageandbone(mesodermal),or
bronchial,intestinal,orpancreatictissue(endodermal).

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MediastinalTeratomasmayeitherbe-
Mature:Welldifferentiated
Immature:Poorlydifferentiated
Withmalignanttransformation

159.Trueaboutinguinalherniainchildren:

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a)Occurduetopersistenceofprocessusvaginalis
b)Defectinabdominalmaypresent
c)Mostcommonvarietyisdirecttype
d)Difficulttoreducenon-operatively
e)Morecommoningirls

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CorrectAnswer-A:B:D
Answer-A,Occurduetopersistenceofprocessus
vaginalisB,DefectinabdominalmaypresentD,Difficultto
reducenon-operatively
Inchildren,ifinguinal(indirect)herniaispresentinoneside,then

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processusvaginalisisintactonotherside.
Malesareaffectedaboutsixtimesmoreoftenthanfemales.
Indirectinguinalhernia-Canoccurinanyagefromchildhoodto
adult.
Inguinalherniaresultsfromafailureofclosureoftheprocessus

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vaginalis.

160.Trueregardingtesticulartumour:
a)ForstageIseminoma-orchidectomyaloneusedfortreatment
b)ForstageIseminoma-orchidectomy+radiotherapyusedfor
treatment

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c)StageInon-seminomatousgermcelltumour-orchidectmy
+radiotherapyusedfortreatment
d)Stagingisimportantforplanningmanagement
e)i3HCG&AFPmaybeusedasmarkertheresponseof
treatment

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CorrectAnswer-B:D:E
Answer-B,ForstageIseminoma-orchidectomy+radiotherapy
usedfortreatmentD,Stagingisimportantforplanning
managementE,i3HCG&AFPmaybeusedasmarkerthe
responseoftreatment

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TesticularTumour:Staging
StageI:Thetumourisconfinedtothetestis;
StageII:Nodaldiseaseispresentbutisconfinednodesbelowthe
diaphragm;
StageIII:Nodaldiseaseispresentabovethediaphragm;

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StageIV:Nonlymphaticmetastaticdise
Inconfirmedcases,stagingisanessentialstepinplanning
treatment.
HCG&NSGCTswhenraised,thesemarkersareusedtomonitor
theresponsetotreatment.

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161.Feature(s)ofFournier'sgangrene:
a)Necrotizingfasciitisofthemalegenitaliaandperineum
b)Diabetesisriskfactor
c)Urgentwidesurgicalexcisionofthedeadandinfectedtissueis
essential

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d)Testisneedtoberemovedinallcases
e)None
CorrectAnswer-A:B:C
Answer-A,Necrotizingfasciitisofthemalegenitaliaand
perineumB,DiabetesisriskfactorC,Urgentwidesurgical

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excisionofthedeadandinfectedtissueisessential
Fournier'sgangreneisanecrotizingfasctitisofthemalegenitalia
andperineumthatcanberapidlyprogressingandfatalifnottreated
promptly.
Riskfactors-

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urethral
strictures,
perirectalabscesses,
poorperinealhygiene,
diabetes,

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cancer,
humanimmunodeficiencyvirus(HIV)
Clinicalfeatures-
Clinicalsignsincludefevers,perinealandscrotalpain.
Cellulitis,eschars,necrosis,flakingskin,andcrepitusmayallbe

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observed.
Treatment-

Urgentwidesurgicalexcisionofthedeadandinfectedtissueis
essential.

162.Whichofthefollowingis/arefeature(s)of

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enlargedkidney:
a)Ballotable
b)Upperbordercanbereached
c)Shifttoparacolicgutteroncompression
d)Donotmovewithrespiration

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e)Dullonpercussiononrenalangle
CorrectAnswer-A:E
Answer-A,BallotableE,Dullonpercussiononrenalangle
Itisareniformswelling
ltmovesveryslightlyuithrespirationasitcomesdownalittleatthe

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heightofinspiration.
ltisballottable
Asickeningsensationisoftenfeltduringmanipulation
Ahandcanbeeasilyinsinuctedb/wtheupperpoleofswelling&the
costalmargin

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Percussionwillrewalresonontnoteinfrontofakidneyswellingas
coilsofintestine&colonwillalwaysbeinfrontofthekidney.

163.Hypoparathyroidismcanoccurin:
a)Afterthyroidsurgery
b)Digeorgesyndrome

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c)Radicalresectionofhead&neckcancer
d)MENI
e)All
CorrectAnswer-A:B:C
Answer-A,AfterthyroidsurgeryB,Digeorge

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syndromeC,Radicalresectionofhead&neckcancer
Geneticdisorders(eg:DeGeorgesyndrome)
.Abnormalparathyroidglanddevelopment
.AbnormalPTHsynthesis
oActivatingmutationsofcalciumsensingreceptor(autosomal

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dominanthypocalcemiaorsporadicisolatedhypoparathyroidism)
.Post-surgical(thyroidectomnparathyroidectomnradicalneck
dissection)
oAutoimmunepolyglandularsyndrome

164.Trueaboutbreastcyst:

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a)Mostlyseeninpremenopausalperiod
b)Mostcommoninyoungwoman
c)Usuallyunilateral
d)Yellowish-greenishdischarge
e)Adheretounderlyingskin

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CorrectAnswer-A:C:D
Answer-A,MostlyseeninpremenopausalperiodC,Usually
unilateralD,Yellowish-greenishdischarge
Classicallyseeninperimenopausalwomenmostlyinlastdecadeof
reproductivelife.

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50%ofcystsaremultipleorrecurrent.
Cystfluidcanbestraw,colored,opaque,ordarkgreenandmay
containfleckofdebris.
Diagnosiscanbeconfirmedbyaspirationand/orultrasound.

165.Fibrocysticdiseasedifferfrom

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fibroadenomabyhaving:
a)Painshiftwithcycle
b)Freelymobile
c)Usuallybilateral
d)Firm&rubbery

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e)Welldemarcatedborder
CorrectAnswer-A:C
Answer-A,PainshiftwithcycleC,Usuallybilateral
Painful,oftenmultiple,usuallybilateralmassesinthebreast.
Rapidfructuationinthesizeofthemassesiscommon.

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Frequently,painoccursorincreasesandsizeincreasesduring
premenstrualphaseofcycle.
Theselesionsarealwaysassociatedwithbenignchangesinthe
breastepithelium.
Themicroscopicfindingsoffibrocysticconditionindudecyst(gross

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andmicroscopic),papillomatosis,adenosis,fibrosis,andductal
epithelialhyperplasia.
Clinicalfeatures-
Painortendernessoftencallsattentiontothemass.
Dischargefromthenipple.

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Discomfortoccursorisincreasedduringthepemenstrualphaseof
thecycle.
Fibroadenoma-
Peakageofincidenceisat20year
Presentwithpainlesslump

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Itissmooth,roundbordered,firmtohardinconsistency&freely
mobilewithinthebreast(socalledbreastmouse)

166.Testforincompetentvalvedoneby:
a)Coughimpulsetest
b)Trendelenburg

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c)Percussationwavetravelinretrogradedirectionalongvaricose
vein
d)Percussationwavetravelinorthogradedirectionalongvaricose
vein
e)All

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CorrectAnswer-A:B:C
Answer-A,Coughimpulse
testB,TrendelenburgC,Percussationwavetravelinretrograde
directionalongvaricosevein
Coughimpulsetest:saphenoofemoralincompetence

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TrendelenburgI:saphenofemoralincompetence
TrendelenburgII:Perforatorincompetence
Multipletourniquettest:Siteofperforatorincompetence
Schwartztest:Superficialcolumnofblood


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167.Whichofthefollowingis/aretrueabout
renalcarcinomaofT3astage:
a)InvolveGerotafascia
b)Involveperinephricfat
c)Renalveininvolvement

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d)Inferiorvenacavainvolvement
e)Size>10cm
CorrectAnswer-B:C:E
Answer-B,InvolveperinephricfatC,Renalveininvolvement
E,Size>10cm

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168.Trueaboutextracorporealshockwave
lithotripsy(ECWL):
a)C/Iinpregnancy
b)Lesssatisfactoryforhardstones
c)Stoneisbreakedintosmallpieceswhichcomesoutwithurine

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d)Saferincoagulopathy
e)Endoscopicretrievalissometimesusedforimpactedstone
fragmentproducedbylithotripsy
CorrectAnswer-A:B:C:E
Answer-A,C/IinpregnancyB,Lesssatisfactoryforhard

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stonesC,Stoneisbreakedintosmallpieceswhichcomesout
withurineE,Endoscopicretrievalissometimesusedfor
impactedstonefragmentproducedbylithotripsy
Crystallinestonesdisintegrateundertheimpactofshockwaves
producedbytheESWLmachine.

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UretericcoliciscommonafterESWL.
TheprincipalcomplicationofESWLisinfection.
"Pregnantwomenand.patientswithlargeabdominalaortic
aneurysmsoruncorrectablebleedingdisordersshouldnotbe
treatedwithESWL.

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169.Trueaboutcarcinomagallbladder:
a)Increasedbilirubinleveliscontraindicationforsurgery
b)Palliativetreatmentisforadvanceddisease
c)Metastaticrecurrenceiscommoninliver
d)Whengallbladderwallisinvolved,extendedcholecystectomy

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isdone
e)Surgeryshouldbedoneinallcases
CorrectAnswer-B:C:D
Answer-(B)Palliativetreatmentisforadvanceddisease
(C)Metastaticrecurrenceiscommoninliver(D)Whengall

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bladderwallisinvolved,extendedcholecystectomyisdone
IfGBcancerisfoundatcholecystectomy&ifmucosaaloneis
involved,thencholecystectomyissufficient
IfGBwallisinvolved,thenextendedcholecystectomyisdone
Radiationhasverysmallbenefit.Chemotherapyalsohasbeentried.

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5-FU,mitomycinC,doxorubicinaredrugsused
Prognosisisverypoor.Aggressivesurgery&completeclearance
givebestresults.
Surgeryremainstheonlycurativeoptionforgallbladdercancer.

170.Trueaboutparamedianincision:

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a)Itismadebelowumbilicus
b)Betterinobeseperson
c)Causeabdominalhernia
d)Cutanteriorsurfaceofrectussheath
e)Cutposteriorsurfaceofrectussheath

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CorrectAnswer-C:D:E
Answer-(C)Causeabdominalhernia(D)Cutanteriorsurfaceof
rectussheath(E)Cutposteriorsurfaceofrectussheath
Use:provideslateralitytothemidlineincision,allowinglateral
structuressuchasthekidney,adrenalsandspleentobeaccessed.

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Location:about2-5cmtotheleftorrightofthemidlineincision.
lncisionisoverthemedialaspectofthetransverseconvexityofthe
rectus.
Layersoftheabdominalwallskin,fascia(camper'sandscarpa's)
andtheanteriorrectussheathareincised.

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Incisionsinanteriorandposteriorshectiisseperatedbymuscle
whichactsasabuttress,thereforeclosureandmoresecure.

171.Allaretrueaboutfullthicknessrectal
prolapseexcept:
a)Elderlyareatrisk

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b)Commoninchildren
c)Morecommoninfemale
d)sensationofincompleteevacuation
e)Mayassociatedwithaweakpelvicfloor
CorrectAnswer-B

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Answer-B.Commoninchildren
Commonlnelderlywomenwhoaremultipara
ConstiPationisimportantfeature
Tenesmuscommon
Somedegreeofincontinenceoffaeces&flatusisalwayspresent.

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172.Whichofthefollowingis/arefeature(s)of
Keloid:
a)Collagenfibersarerandomlyarranged
b)TypeIVcollagendominates
c)Lesionwithhealthymarginremoved

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d)Steroidisveryuseful
e)Goesbeyondmarginofwound
CorrectAnswer-B:D:E
Answer-(B)TypeIVcollagendominates(D)Steroidisvery
useful(E)Goesbeyondmarginofwound

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Scarsareoftendescribedasbeingatrophic,hypertrophicand
keloid.
Ahypertrophicscarisdefinedasexcessivescartissuethatdoesnot
extendbeyondtheboundaryoftheoriginalincisionorwound.
Akeloidscarisdefinedasexcessivescartisstethatextendsbeyond

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thebounilariesoftheoriginatincisionorwound.
IgEantibodyisleastcommonlyseeninkeloid.
eloidsgrowonparticularsites,theseare?
1. Centralchests(probablymostcommon,notsure)
2. Back

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3. Shoulder
4. Earlobes
Etiologyofkeloid-
Keyfactors:Surgeryburns,vaccinations
Elevatedlevelsofgrowthfactor(moreoftype.8,collagen)

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Lacerationorabrasion

Overthesternum(incision)
Inheritanceandinjection
Deeppigmentedskin
Histologyofbothhypertrophicandkeloidscars-

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Excesscollagenwithhypervascularity
keloidswherethereismoretypeIIIcollagen.
Hypertrophicscarsimprovespontaneouslywithtime,whereaskeloid
scarsdonot.
keloidscarshavethicker,moreabundantcollagenbundles.

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Treatment-
Intralesionalinjectionofsteroid(Triamcinoloneacetate)isnow
recommendedasthefirstlineoft/tforkeloid.

173.TrueaboutCongenitalhypertrophic
pyloricstenosis:

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

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

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Imagingconfirmationissoughtbymostcliniciantodifferentiatefrom
gastroesophagealreflex
Precaution:Emptystomachvianasogastrictubebeforestudy&
Removecontrastatend
Elongation&narrowingofpyloriccanal

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

174.Incomparisontoulcerativecolitis,which
ofthefollowingis/arefeature(s)of

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crohn'sdisease:

a)Transmuralinflammation
b)Morecommoninsmoker
c)MorepANCApositivity
d)TNF-alphainhibitorroleonlyinCD

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e)All
CorrectAnswer-A:B:D
Answer-(A)Transmuralinflammation(B)Morecommonin
smoker(D)TNF-alphainhibitorroleonlyinCD
CanaffectanypartofGIT,butmesites?terminalileum,ileocecal

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valve,andcaecum.
Etiology-
Smokingisastrongriskfactor
OCPsandAppendicectomyincreaserisk
Morphology-

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Skiplesions
Thickbowelwall
Stricturescommon
Transmuralinflammation
Noncaseatinggranulomas

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Moderatepseudopolyps
Deep,knife-likeulcers
Fibrosis,serositis-Marked
Investigations-

70%ASCA+ve(antiSaccharomycescerevisiaeAb)10%pANCA

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positive
Treatment
Anti-TNFtherapy(Infliximab,adalimumab,certolizumab)-first-line
agentstoinduceremissioninmoderatetoseverediseaseandto
maintainremission

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175.Trueaboutparalyticileus:
a)Postoperativeileusprimarilyaffectsthestomachandcolon
b)Mostlyresolveafter24-72hours
c)Returnoffunctionoccursinthefollowingorder:stomach,large
bowelandsmallbowel.

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d)Ifopioidisusedaspostoperativeanalgesia,thenchance
increases
e)Isananticipatedcomplicationsofabdominaloperations
CorrectAnswer-A:B:D:E
Answer-(A)Postoperativeileusprimarilyaffectsthestomach

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andcolon(B)Mostlyresolveafter24-72hours(D)Ifopioidis
usedaspostoperativeanalgesia,thenchanceincreases(E)Is
ananticipatedcomplicationsofabdominaloperations
Etiology
Postoperative

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Adegreeofileususuallyoccursafteranyabdominalprocedure
Self-limiting(24-72hours)
MaybeprolongedinHypoproteinemiaormetabolicabnormality
Intra-abdominalinflammation(peritonitis,abscess,retroperitoneal
hemorrhage)

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Reflexileus:followingfracturesofspine/ribs,retroperitoneal
hemorrhageorapplicationofaplasterjacket
Metabolic&electrolytederangements(uremia,hypokalemia,
hyponatremia,hypoandhypomagnesemia,diabeticcoma,
hypoparathyroidism,hypothyroidism)

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Drugs(opiates,psychotropicagents,anticholinergicagents,calcium
channelblockers)

Returnoffunctionoftheintestineoccursinthefollowingorder:small
bowel,largebowelandthenstomach
Paralyticileus,alsocalledpseudo-obstruction,isoneofthemajor

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causesofintestinalobstructionininfantsandchildren.

176.Aciniccellcarcinomais/arefoundin:
a)Breast
b)Parotid
c)Lacrimalgland

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d)Pancrease
e)Minorsalivarygland
CorrectAnswer-B:D:E
Answer-(B)Parotid(D)Pancrease(E)Minorsalivarygland
MajorSalivaryGlands(includingparotid)

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MinorSalivaryGlands
Acinarcellcaricinomaaremalignantepithelialneoplasm(of
pancrease)

177.WhichareRadio-opaquestones:
a)Pureuricacid

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b)Cysteine
c)Phosphate
d)Oxalate
e)Impureuricacid
CorrectAnswer-B:D:E

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Answer-(B)Cysteine(D)Oxalate(E)Impureuricacid
RenalCalculus-
Oxalatestones
Phosphatecalculus-struvite
Uricacidanduratecalculi

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Cystinecalculus

178.Trueaboutlymphangiomacircum
scriptum:
a)Compressibleswelling
b)Oftencontainclearfluid

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c)Groupsofvesiclesarefoundonskin
d)Maypresentatbirthorshortlyafterbirth
e)None
CorrectAnswer-B:C:D
Answer-(B)Oftencontainclearfluid(C)Groupsofvesiclesare

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foundonskin(D)Maypresentatbirthorshortlyafterbirth
ThistyPePresentsascircumscribedlesionwhichappearsassmall
vaicleorsmallblisterorslightlyelevatedskinpatch
Thesizevariesfrom0.5to4mmindiameter
Alargeareaofskinmaybeinvolvedontheinnersideofthethigh,

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buttockontheshoulderorintheaxilla
Thewholelesionissoft&sPongY
Fluctuation,fluidthrill&translucencytestarealwayspositive.The
swellingisnotcompressible
Themarginsoftheswellingareindistinct

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Theskinvesiclescontainclearfluid
Itisusuallyprominentatpubertyandmayoftenstartbleeding.

179.Sacral-teratoma/sacrococcygeal
teratomaisaderivativeof-
a)Primitivestreak

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b)Ectoderm
c)Hypoblasts
d)Cranialneuropore
e)None
CorrectAnswer-A

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Answer-A.Primitivestreak
Gastrulation&Hensen'snode:
In2ndweek-GastrulationoccursEstablishes3rdgermlayer
(mesoderm).
Gastrulationbeginswithprimitivestreakformationincaudalregion

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ofepiblast.
PrimitivenodeorHensen'snodeorprimitiveknot:
Thickeningformedatcranialendofprimitivestreak.
Sacrococcygealformation:
FailureofHensen'snodetoregresscanleadtosacrococcygeal

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formation.
Incompleteprimitivestreakregressionleavescaudalremnant
Sacrococcygealteratoma.
Arisefromresidualtototipotentialcellrests(Hensen'snode).
Sacrococcygealteratomademonstratestissuederivedfromallthree

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celllayers.
Containvaryingproportionsofmature&immatureelements.

180.Trueaboutcentralvenous
catheterization:
a)Cathetermaybeplacedthroughsubclavianvein

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b)IftheCVPislowinthepresenceofalowMAPorcardiac
output,thenfluidresuscitationisnecessary
c)Canbeusedforgainingvenousaccessinpatientwithpoor
peripheralveins
d)Subclavianveinrouteissafestintermofcomplications

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e)All
CorrectAnswer-A:B:C
Answer-(A)Cathetermaybeplacedthroughsubclavianvein
(B)IftheCVPislowinthepresenceofalowMAPorcardiac
output,thenfluidresuscitationisnecessary(C)Canbeused

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forgainingvenousaccessinpatientwithpoorperipheralveins
UsedformonitoringofCVEadministrationoffluidtotreat
hypovolemia&shock,infusionofcausticdrug&totalParenteral
nutrition,asPirationofemboli,insertionoftranscutaneouspacing
leads&gainingvenousaccessinpatientwithpoorperipheralveins.

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CVPorrightatrialpressure(RAP)ismonitoredusingacatheter
insertedviaeithertheinternaljugularorthesubclavianvein.
TheCVPmayhelpinassessingtheneedforintravascularfluid
replacemant.

181.Trueaboutcareofpolytraumapatient:

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a)CTscanofwholebodycanbedonetoexcludeinjuries
b)Longspinalcordinjurysupportisgivenifspinalcordinjuryis
suspected
c)Triageofinjurieswithcolourcodinglikered,yellow,green&
blackcanbedoneincaseofmasscasualty

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d)Initialfluidmanagementisdoneasearlyaspossible
e)None
CorrectAnswer-A:B:C:D
Answer-(A)CTscanofwholebodycanbedonetoexclude
injuries(B)Longspinalcordinjurysupportisgivenifspinal

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cordinjuryissuspected(C)Triageofinjurieswithcolour
codinglikered,yellow,green&blackcanbedoneincaseof
masscasualty(D)Initialfluidmanagementisdoneasearlyas
possible
BecauseofCT,anincreasingamountofbothblunt&penetrating

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traumahasbeensafelymanagednonoperatively.
'Theavailabilityofhighresolutionmultislicescanners,promotingthe
developmentofprotocolsinsomecentersthatcallforearly
intergrationofcompletebody(i.e.head,cervicalmspine,chest,
abdomen&pelvis)CTscanningofselectedtraumapatient.

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Intravenouslineiscriticalforintravenousvolumeresuscitation.
Triagesysteminvolvesacolor-codingschemeusingred,yellow,
green,white,andblacktags:Redindicateshighprioritytreatmentor
transfer,yellowsignalsmediumpriority,greenindicatesambulatory
patients&blackfordeadormoribund.

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182.Whichofthefollowingistrueabout
suturetechnique:
a)Subcuticularsutureisusedwherecosmeticappearanceis
important
b)Verticalmattresscausescauseprominentstitchmarkscars

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c)Horizontalmattressisusedforfragileskin
d)Verticalmattressisusedforfragileskin
e)None
CorrectAnswer-A:B:C
Answer-(A)Subcuticularsutureisusedwherecosmetic

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appearanceisimportant(B)Verticalmattresscausescause
prominentstitchmarkscars(C)Horizontalmattressisusedfor
fragileskin
Thehorizontalmattressstitchisasuturetechniqueusedtoclose
wounds.

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Thismakesitidealforholdingtogetherfragileskin.
Verticalmattresssuturearethatitprovidesclosureforbothdeep
andsuperficiallayers,andalsoallowsperfecteversionandvertical
oppositionofthesuperficialskinedges.
Subcuticularsuturetechniqueisusedinskinwhereacosmetic

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appearanceisimportantarrdwheretheskinedgesmaybe
approximatedeasily.

183.Corticosteroidsareusefulinwhichofthe
followingpaediatricsdisease:
a)TBmeningitis

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b)EndobronchialTB
c)Spinaventosa
d)Acutetuberculouspericardialeffusion
e)Severemiliarytuberculosis
CorrectAnswer-A:D:E

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Ans.(A)TBmeningitis;b.EndobronchialTB;(D)Acute
tuberculouspericardialeffusion;(E)Severemiliary
tuberculosis
Corticosteroidsuseinpaediatrics:
Theseareusefulinthetreatmentofsomechildrenwithtuberculosis

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disease.
Corticosteroidsdecreasemortalityratesandlong-termneurologic
sequelaeinsomePatientswithtuberculousmeningitisbyreducing
vasculitis,inflammation,and,ultimately,intracranialpressure.
Shortcoursesofcorticosteroids:Endobronchialtuberculosisthat

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causesrespiratorydistress,localizedemphysema,orsegmental
pulmonarylesions.
Relievesymptomsandconstrictionassociatedwithacute
tuberculouspericardialeffusion.
Dramaticimprovementinsymptomsoftuberculouspleuraleffusion

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andshiftofthemediastinum.
Severemiliarytuberculosishavedramaticimprovementwith
corticosteroidtherapyiftheinflammatoryreactionissoseverethat

alveolocapillaryblockispresent.

184.Eosinophiliainchildrenis/arepresentin:

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a)Allergicrhinitis
b)Echinococcosis
c)Rheumatoidarthritis
d)Infectiousmononucleosis
e)Wiskott-Aldrichsyndrome

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CorrectAnswer-A:B:C:E
Ans.(A)Allergicrhinitis;(B)Echinococcosis;(C)Rheumatoid
arthritis;(E)Wiskott-Aldrichsyndrome

Commoncausesofeosinophilia:
Acute:

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Allergicdisorder:Asthma,atopicdermatitis,urticaria.drug
hypersensitivity,pemphigoid
Parasiticinfestation:Toxocara,ascaris,amebiasis,strongyloidiasis,
filarial,toxoplasmosis,trichinosia,schistosomiasis,malaria,scabies
Fungalinfections:Bronchopulmonaryaspergillosis,coccidiomycosis

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Malignancy:Hodgkinlymphoma,Tcelllymphoma,acute
myelogenousleukaemia,myeloproliferativesyndrome
Hypereosinophilicsyndrome
Chronic:
Allergicdisorders:Pemphigus,dermatitisherpetiformis

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Autoimmunedisorders:Inflammatoryboweldisease,rheumatoid
arthritis,Myeloproliferativesyndrome,hypereosinophilicsyndrome
,Loefflersyndrome.
Immunodeficiencysyndromes:HyperIgE,WiskottAldrichsyndrome;
Omennsyndrome;graftversushostreaction

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Miscellaneous:Thrombocytopeniawithabsentradii;renalallograft

rejection;Addisondisease

185.Syndromenotassociatedwithchildhood
leukaemia:
a)Edwardsyndrome

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b)Fanconisyndrome
c)Diamond-Blackanaemia
d)Patausyndrome
e)Kostmannsyndrome
CorrectAnswer-A:D

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Ans.(A)Edwardsyndrome;(D)Patausyndrome
RiskfactorsforChildhoodLeukemia
Downsyndrome
Shwachman-Diamondsyndrome
Kostmannsyndrome

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Li-Fraumenisyndrome
Fanconisyndrome
Bloomsyndrome.
Klinefeltersyndrome
Turnersyndrome

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NeurofibromatosistypeI
Ataxia-telangiectasia
Severecombinedimmunedeficiency
Paroxysmalnocturnalhaemoglobinuria

186.AchildhasvitaminDdeficiencyrickets.

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Whichofthefollowingis/arecorrect
regardingbiochemicalchanges:

a)Alkalinephosphatase
b)serumcalcium
c)parathyroidhormone

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d)phosphate
e)25-(OH)D3
CorrectAnswer-A:C
Ans.(A)Alkalinephosphatase;(C)parathyroidhormone
BIOCHEMICALREACTIONS:

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Serumcalcium:normalorlow
Serumphosphate:low
Alkalinephosphatase:high
Hypophosphatasiashowslowlevelofalk.phosphatase
PTH:High

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Hypophophatemia

187.Trueaboutfetalalcoholsyndrome:
a)Increasedbirthweight
b)Normalfinemotordevelopment
c)Normalsocialskilldevelopment

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d)Facialabnormalities
e)Intelligencesubnormal
CorrectAnswer-D:E
Ans.(D)Facialabnormalities;(E)Intelligencesubnormal
Fetalalcoholsyndrome

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Highlevelofalcoholingestioninpregnancycancausedamageto
fetus,knownasfetalalcoholsyndrome.
Theharmfuleffectsmaybeduetoalcoholitselforduetooneofits
breakdownproducts.Someevidencesuggeststhatalcohol
mayimpairplacentaltransferofessentialaminoacidsandzinc,both

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necessaryforproteinsynthesis,whichmayaccountforIUGR.
Characteristicsoffetalalcoholsyndromeinclude:?
IUGR(notlargeproportionatebody)
Microcephaly
Congenitalheartdefects(ASD,VSD)

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Mentalretardation
FacialabnormalitiesShortpalpebralfissures,epicanthalfolds,
maxillaryhypoplasia,micrognathia,lowsetears,smoothphiltrum,
thinsmoothupperlip.
Minorjointanomalies

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Hyperkineticmovements

188.Feature(s)ofcongenitalrubella
syndromeinclude:
a)Cataract
b)ASD

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c)Deafness
d)Patentductusarteriosus
e)Alltheabove
CorrectAnswer-A:C:D
Ans.(A)Cataract;(C)Deafness;(D)Patentductusarteriosus

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Congenitalrubellasyndrome(CRS)canoccurinadevelopingfetus
ofapregnantwomanwhohascontractedrubella,usuallyinthefirst
trimester.
Triadshows:PDA,cataractanddeafnes
Ifinfectionoccurs0?28daysbeforeconception,theinfanthasa

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43%riskofbeingaffected.
Infectionin2ndtrimester?maybedeafnessonly.
>6wks?nomajorabnormalities
Diagnosis:Isolationofvirusincellculturesofthroatsamples,urine
orothersecretions.

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DetectionofIgMinsingleserumsampleshortlyafterbirth.
PersistenceofRubellaIgGantibodiesserumbeyond1yearor
risingantibodytitreanytimeduringinfancyinanunvaccinatedchild

189.A4.2kgsbabyborntouncontrolled
diabeticmother.Thefollowingcondition

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willnotoccurinthebaby:

a)Hypercalcemia
b)Hypoglycemia
c)Hyperbilirubinemia
d)Polycythaemia

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e)Cardiovasculardefects
CorrectAnswer-A
Ans.(A)Hypercalcemia
NeonatalComplication:
Hypoglycaemia

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Respiratorydistresssyndrome
Hyperbilirubinemia
Hypocalcemia
Hypomagnesemia.
Polycythemia

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Cardiomyopathy

190.Trueaboutcaputsuccedaneum-
a)Oedematousswellingofscalp
b)Marginsareclearlydefined
c)Swellingresolvespontaneouslyafterfewdaysofbirth

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d)Swellingremainsforthreemonths
e)Maximumsizeatbirth
CorrectAnswer-A:C:E
Ans.(A)Oedematousswellingofscalp;(C)Swellingresolve
spontaneouslyafterfewdaysofbirth;(E)Maximumsizeat

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birth
Caputsuccedaneumisadiffuse,sometimesecchymoticedematous
swellingofthesofttissuesofthescalpinvolvingtheareaPresenting
duringvertexdelivery.
Itmayextendacrossthemidlineandacrosssuturelines.

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Theedemadisappearswithinthelstfewdaysoflife.
Moldingoftheheadandoverridingoftheparietalbonesare
frequentlyassociatedandbecomemoreevidentaftercaputhas
receded;theydisappearduringthelstweeksoflife
Analogousswelling,discoloration,anddistortionofthefaceareseen

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infacePresentations.

191.Achildhasfeverwithrednessofcheek.
Thecausativeorganismforthiscondition
is:

a)Herpesvirus

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b)ParvovirusB-19
c)Adenovirus
d)Rubella
e)Roseola
CorrectAnswer-B

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Ans.(B)ParvovirusB-19
Exanthemainfectiosum:
Thecharacteristicrashfirstappearsaserythematousflushingonthe
faceinaslappedcheekappearance(redcheek).
ThemostcommonmanifestationofparvovirusB19iserythema

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infectiosum,alsoknownasfifthdisease,whichisabenign,self-
limitedexanthematousillnessofchildhood.
Itwasthe5thinaclassificationschemeofcommonchildhood
exanthems.
Thepreceding4exanthemsweremeasles,scarletfever,rubella,

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andFilatov-Dukesdisease(anatypicalscarletfever),withroseola
infantumasthe"sixthdisease

192.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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193.Whichofthefollowingtrueaboutnew-
born&children:
a)Erythropoietinlevelismoreinpretermthanterm
b)Erythropoietingiventopretermonlyinsomespecialcases
c)ErythropoietingiventoPretermcancausecomplication

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d)a&b
e)Noneoftheabove
CorrectAnswer-B:C
Ans.(B)Erythropoietingiventopretermonlyinsomespecial
cases;(C)ErythropoietingiventoPretermcancause

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complication
Mostinfantswithbirthweightof<1KgRBCtransfusions.Akey
reasonwhythenadirhaemoglobinvaluesofprematureinfantsare
lowerthanthoseofterminfantsistheformergroup'srelatively
diminishedplasmaEPOlevelinresponsetoanaemia.

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PreterminfantsexhibitasluggishEPOresponsetofalling
haematocritvalues.
LowplasmaEPOlevelproviderationaletheuseofrecombinant
EPOinthetreatmentofanemiaofprematurity.
ProperdosesofEPOandironeffectivelystimulateneonatal

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erythropoiesis.However,theefficacyofEPOtherapytosubstantially
diminishtheneedfarRBCtransfusionhasnotbeen
convincinglydemonstrate,particularlyfarsick,extremelypremature
neonates,andrecombinantEPOhasnotbeenwidelyacceptedas
treatmentforanemiaofprematurity.

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lnrarecases,somepreparationsofEPOhavebeenassociatedwith

thedevelopmentofanti-EPOantibodiesthatresultinsevereanemia.

194.Inwhichcondition(s),urethralopeningis
neverattipofglanspenis:
a)Epispadias

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b)Hypospadias
c)Urethralstricture
d)Bladderexstrophy
e)Alloftheabove
CorrectAnswer-A:B:D

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Ans.a.Epispadias;b.Hypospadias;d.Bladderexstrophy
Hypospadias

Acongenitaldisorderoftheurethrawheretheurinaryopeningisnot
attheusuallocationontheheadofthepenis.Itisthesecond-most
commonbirthabnormalityofthemalereproductivesystem,affecting

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aboutoneofevery250malesatbirth.
EPISPADIAS
Anepispadiasisararetypeofcongenitalmalformationinwhichthe
urethraopensonthedorsum(theupperaspect)ofthepenis.Itis
oftenpartoftheconditiontermedEpispadias-exstrophyofthe

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bladder.Epispadiasisamildformofbladderexstrophy,andin
severecases,exstrophyandepispadiascoexist.

195.Ingestionofwhichofthefollowing
mimicsscurvyinchild:
a)Magnesium

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b)Potassiumiodide
c)Arsenic
d)Iron
e)Copper
CorrectAnswer-A

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Ans.a.Magnesium
Hypermagnesemiaismostprobableanswerbecauseitalsocause
paralysis
Hypermagnesemiainhibitsacetylcholinereleaseatthe
neuromuscularjunction,producinghypotonia,hyporeflexia,and

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weakness;paralysisoccursathighconcentrations.The
neuromuscular

196.Trueaboutboutonnieredeformity:
a)Flexionofproximalinterphalangealjoint&hyperextensionof
distalinterphalangealjoint

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b)Hyperextensionofproximalinterphalangealjoint&flexionof
distalinterphalangealjoint
c)Flexionatproximalinterphalangeal&extensionat
metacarpophalangealjoint
d)Flexiondeformityoftheproximalinterphalangealjointoccur

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duetotearincentralslipofextensortendon
e)Mayoccurinrheumatoidarthritis
CorrectAnswer-A:D:E
Ans.a.Flexionofproximalinterphalangealjoint&
hyperextensionofdistalinterphalangealjoint;d.Flexion

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deformityoftheproximalinterphalangealjointoccurdueto
tearincentralslipofextensortendon;e.Mayoccurin
rheumatoidarthritis
Boutonnieredeformityisadeformedpositionofthefingersortoes,
inwhichthejointnearesttheknuckle(theproximalinterphalangeal

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joint,orPIP)ispermanentlybenttowardthepalmwhilethefarthest
joint(thedistalinterphalangealjoint,orDIP)isbentbackaway(PIP
flexionwithDIPhyperextension).
Itcanbecausedbyacutonthetopofthefinger,whichcansever
thecentralslip(tendon)fromitsattachmenttothebone.Thetear

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lookslikeabuttonhole("boutonni?re"inFrench).Insomecases,the
boneactuallycanpopthroughtheopening.
Boutonni?redeformitiesmayalsobecausedbyarthritis.



197.Trueaboutankylosingspondylitis:

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a)Romanuslesionmaybefound
b)Ifleftuntreated,spinefusionmayoccur
c)Predilectionofthejointsoftheaxialskeleton
d)Bonyerosionsdonotoccur
e)all

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CorrectAnswer-A:B:C
Ans.a.Romanuslesionmaybefound;b.Ifleftuntreated,spine
fusionmayoccur;c.Predilectionofthejointsoftheaxial
skeleton
Ankylosingspondylitis(marie-strumpelldisease)

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Ankylosingspondylitisisachronicprogressiveinflammatorydisease
ofthesacroiliacjointsandtheaxialskeleton.
rototypeofseronegative(absenceofrheumatoidfactor)
spondyloarthropathies.
Inflammatorydisorderofunknowncause.

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Usuallybeginsinthesecondorthirddecadewithamedianageof
23,in5%symptomsbeginafter40.
Maletofemaleratiois2-3:1
StrongcorrelationwithHLA-B270-95%ofcase
9sarepositiveforHLA-B27.

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Jointsinvolvedinankylosingspondylitis
Ankylosingspondylitisprimarilyaffectsaxialskeleton.
Thediseaseusuallybeginsinthesacro-iliacjointsandusually
extendsupwardstoinvolvethelumbar,thoracic,andoftencervical
spine.

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Intheworstcasesthehipsorshouldersarealsoaffected.Hipjoint

isthemostcommonlyaffectedperipheraljoint.
Rarelyknee(Ebenzar4th/e593)andankle(Apley's9thle67)are
alsoinvolved.Pathology
Enthesitisi.e.inflammationoftheinsertionpointsoftendons,

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ligamentsorjointcapsuleonboneisoneofthehallmarksofthis
entityofdisease.
Primarilyaffectsaxial(spinal)skeletonandsacroiliitisisoftenthe
earliestmanifestationofA.S..
Involvementofcostovertebraljointsfrequentlyoccur,leadingto

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diminishedchestexpansion(normal_5cm)
Peripheraljointse.g.shoulders,andhipsarealsoinvolvedin1/3rd
patients.
Extraarticularmanifestationslikeacuteanterioruveitis(in5%);rarely
aorticvalvedisease,carditisandpulmonaryfibrosisalsooccur.

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Pathologicalchangesproceedinthreestages?
Inflammationwithgranulationtissueformationanderosionof
adjacentbone.
Fibrosisofgranulationtissue
Ossificationofthefibroustissue,leadingtoankylosisofthejoint.

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Radiologicalfeaturesofankylosingspondylitis
Radiographicevidenceofsacroiliacjointisthemostconsistent
findinginankylosingspondylitisandiscrucialfordiagnosis.The
findingsare:-
SclerosisofthearticulatingsurfacesofSIjoints

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Wideningofthesacroiliacjointspace
Bonyankylosisofthesacroiliacjoints
Calcificationofthesacroiliacligamentandsacro-tuberousligaments
Evidenceofenthesopathy-calcificationattheattachmentofthe
muscles,tendonsandligaments,particularlyaroundthepelvisand

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aroundtheheel.
X-rayoflumbarspinemayshow:-
Squaringofvertebrae:Thenormalanteriorconcavityofthe
vertebralbodyislostbecauseofcalcificationoftheanterior
longitudinalligament.

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ftLossofthelumbarlordosis.
Bridging`osteophytes'(syndesmophytes)
Bamboospineappearance


198.Trueaboutgiantcellsarcoma?
a)Mostcommonagegroupaffectedis20-40year

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b)Proximalfemurismostcommonsiteaffected
c)Pulmonarymetastasisoccurin<3%ofcases
d)Alocallyaggressivetumor
e)Mayinvolvesacrum
CorrectAnswer-A:C:D:E

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Ans.a.Mostcommonagegroupaffectedis20-40year;c.
Pulmonarymetastasisoccurin<3%ofcases;d.Alocally
aggressivetumor;e.Mayinvolvesacrum
GCT:
Itperhapsrepresentsthemostaggressivebenigntumorand

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threatensthetruedefinitionofabenigncancerbecausebenign
pulmonarymetastasisdevelopinapproximately1%to2%ofgiant
celltumors.
CLINICALFEATURES
Thetumourisseencommonlyintheagegroupof20-40yearsi.e.,

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afterepiphysealfusion.
Thebonesaffectedcommonlyarethosearoundthekneei.e.,lower-
endofthefemurandupper-endofthetibia.
Lower-endoftheradiusisanothercommonsite.
Thetumourislocatedattheepiphysis.

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Itoftenreachesalmostuptothejointsurface.
Commonpresentingcomplaintsareswellingandvaguepain.
Sometimes,thepatient,unawareofthelesion,presentsforthefirst
timewithapathologicalfracturethroughthelesion.

199.Whichofthefollowingis/aretrueabout

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simplebonecyst:
a)Mostcommonlyoccurinadult
b)Commonestsiteistheupperendofthehumerus
c)Cortexmaybethin
d)Causepathologicalfracture

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e)Noriskofrecurrenceafterremoval
CorrectAnswer-B:C:D
Ans.b.Commonestsiteistheupperendofthehumerusc.
Cortexmaybethind.Causepathologicalfracture
SimpleBoneCyst(Alsok/aSolitaryorUnicameralCyst)

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ltappearduringchildhood,inmetaphysisinoneofthelongbones&
mostcommonlylnproximalhumerusorfemur.
ltisnotatumour,ittendtohealspontaneously.
Itisseldomseeninadult
Thisconditionisusuallydiscoveredafterapathologicalfractureor

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asanincidentalfindingonX-ray.
X-rayshowsawelldemarcatedradiolucentareainthemetaphysis
oftenextendinguptothephysealplate;thecortexnaybethinned&
theboneexpanded
Treatmentdependsonwhetherthecystissymptomatic,actively

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growingorinvolvedinafracture

200.TrueaboutColle'sfracture:
a)Occuratdistalendofradius,about2cmfromdistalarticular
surface
b)Fracturealsoinvolvesradiocarpaljoint

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c)Fracturealsoinvolvesproximalradioulnarjoint
d)Causeulnardeviation
e)Commoninwomen
CorrectAnswer-A:E
Ans.a.Occuratdistalendofradius,about2cmfromdistal

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articularsurface;e.Commoninwomen
Colle'sFracture:
ThisisaFractureatthedistalendoftheradius,atits
corticocancellousjunction(about2cmfromthedistalarticular
surface),inadults,withtypicaldisplacement.

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Itnearlyalwaysresultsfromafallonanout-stretchedhandcItis
commonestfractureinpeopleabovefortyyears
Particularlycommoninwomenbecauseofpostmenopausal
osteoporosis.
Displacement-dorsaldisplacement,dorsaltilt(mostcharacteristic),

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lateraldisplacement,dorsaltilt,supination&impactionoffragments
Complication:Dinnerforkdeformity&Subluxationoftheinferior
radio-ulnarjoint(distalradiocarpaljoint)
Itismostcommonofallfractureinolderpeople.

201.Forassessingtheinjuryofmeniscusof

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kneejoint,whichofthefollowingtest
is/aredone:

a)Apley'stest
b)Lachmanntest
c)McMurray'stest

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d)Thessalytest
e)Hamiltonrulertest
CorrectAnswer-A:C:D
Ans.a.Apley'stest;c.McMurray'stest;d.Thessalytest
TestsforMeniscalInjuries?

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Apley'sgrindingtest:formeniscusinjury
McMurray'stest-Thisclassictestforatornmeniscusisseldomused
nowthatthediagnosiscaneasilybemadebyMRI.Apositivetestis
helpfulbutnotpathognomonicanegativetestdoesnotexcludea
tear.

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Thessalytest:Thistesthasshownahighdiagnosticaccuracyrate
atthelevelof95%indetectingmeniscaltears

202.A70yearoldladygotcompression
fractureofL1vertebra.Thereisno
neurologicaldeficittothispatient.What

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advisewillyougiveforthisPatient:

a)VitaminDsupplementation
b)DoMRIscan
c)GoforscrewfixationofL1vertebra
d)TotakeDexamethasone

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e)TotakeAlendronate
CorrectAnswer-A:E
Ans.a.VitaminDsupplementation;e.TotakeAlendronate
Itisacaseofosteoporoticfractureoflumbarspine
Treatmentcanbedividedintomedical&preventive.

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Medical:
Highproteindiet,androgen,estrogen,VitaminD,fluoride,
alendronate,calcitonin,teripratide,denosumab&strontium(bothare
antiresorptiveagent).
Orthopaedictreatment:Exercise&Bracing(ASHbraceorTaylor

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brace)

203.Whichofthefollowingindicateshigh
riskchoriocarcinoma:
a)InitialserumhCG>40,000mIU/mL
b)Priorchemotherapyfailure

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c)Followingtermpregnancy
d)Metastasislimitedtolungandvagina
e)Longdurationofdisease
CorrectAnswer-A:B:C:E
Ans.a.InitialserumhCG>40,000mIU/mL;b.Prior

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chemotherapyfailure;c.Followingtermpregnancye.Long
durationofdisease
Highriskfactorswhichindicatesthedevelopmentof
choriocarcinomaatthetimeofdiagnosisofahydatidiform
moleare:

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Maternalagemorethan40years
Excessiveuterineenlargement
SerumhCGlevelsmorethan100,000mIU/ml
Thecaluteincystsgreaterthan6cmindiameter
Toxemia,hyperthyroidismandcoagulopathy

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Trophoblasticembolization
Previouslytreatedchoriocarcinoma

204.Trueaboutmatureovarianteratoma:
a)Recurrenceiscommonafterexcision
b)ContainhairTeeth,bone&cartilage

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c)Mostlybenign
d)Maybebilateral
e)Torsioniscommoncomplication
CorrectAnswer-B:C:D:E
Ans.b.ContainhairTeeth,bone&cartilage;c.Mostlybenign;

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d.Maybebilateral;e.Torsioniscommoncomplication
Teratomaaredividedintothreecategories-
Mature(benign)e.g.dermoid
Immature(essentiallymalignant),e.g.solidteratoma&monodermal
orhighlyspecializede.g.stromaovarii"

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DermoidCyst:
Ofallcystictumoursoftheovary5-10%aredermoid.
Itconstitute97%ofallovarianteratoma.
Itcontainssebaceousmaterial&hair&thewallislinedinpartby
squamousepitheliumwhichcontainshairfollicle&sebaceous

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glands
Teeth,bone,cartilage,thyroidtissue&bronchialmucusmembrane
areoftenfoundinthewall
Dermoidcystsareinnocentovariantumoursbutepidermoid
carcinomaoccurinl.7%&sarcomatouschangehavebeen

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described
Dermoidsarebilateralin12-15%
Torsionismostcommon(15-20%)&ruptureisanuncommon(1%)
complication


205.Poorprognosticfactorsforheartdisease

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inpregnancyis/are:
a)EF30mmHgbyechocardiography
b)Priorcardiacfailure,arrhythmiaortransientischemicattack
c)Aorticvalvearea<1.5cm2
d)ClassIIIandClassIVNYHApatients

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e)PeakLVoutflowtractgradient>30mmHgby
echocardiography
CorrectAnswer-B:C:D:E
Ans.b.Priorcardiacfailure,arrhythmiaortransientischemic
attack;c.Aorticvalvearea<1.5cm2;d.ClassIIIandClassIV

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NYHApatients;e.PeakLVoutflowtractgradient>30mmHgby
echocardiography
Heartdiseasesinwhichpregnancywithpoorprognosis:
Marfansyndrome
Aorticdiseasewithdilatationof>50mmwithbicuspidaorticvalve.

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Coarctationofaorta
Eisenmengersyndrome
Severefixedobstructivelesions(aorticstenosis,mitralstenosis,
pulmonicstenosis,hypertrophicobstructivecardiomyopathy)
NYHAclass3&4heartdiseases(severesystemicventricular

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dysfunction/CHF)
Ejectionfraction<30-40%
Previousperipartumcardiomyopathywithanyresidualimpairmentof
LVfunction
Pulmonaryarterialhypertensionofanycause

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Severecyanosis

206.Trueaboutabdominalhysterectomy:
a)Preferredforprolapseinpostmenopausalwoman
b)Ureterinjurycanbeavoidedbyopeningtheretroperitoneum&
identifyingureter

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c)Postoperativecomplicationsarelessthanvaginalhysterectomy
d)Preferredinobesepatient
e)Enableswideexplorationofabdomen
CorrectAnswer-B:E
Ans.b.Ureterinjurycanbeavoidedbyopeningthe

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retroperitoneum&identifyingureter;e.Enableswide
explorationofabdomen
AbdominalHysterectomy(AH)
Requiredforendometriosisandlargefibroids
Resultsingreatestmeanbloodloss

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Injurytoureterisoneofthemostformidablecomplicationof
hysterectomy.Mostureteralinjuriescanbeavoidedbyopeningthe
retroperitoneumtodirectlyidentifyingtheureter
Hasthehighestincidenceoffebrilemorbidity
Posteriorwallofabdominalwoundinfection(obviously)

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Longesthospitalisation
Enableswideexplorationofabdomen
Andslowesttorecover
Factorssuggestingpreferredroute:
Significantuterineenlargement

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Inadequatetransvaginalaccess
Adnexalpathology&fixation
ObliterationofpouchofDouglas(endometriosis)


207.TrueaboutCoppercontainingIUCD:
a)Increasedcopperlevelinmilk

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b)Increasedriskofectopicpregnancy
c)Increasedbleedinginmenstruationwithpain
d)ProvideprotectionagainstPID
e)Irregularmenses
CorrectAnswer-B:C:E

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Ans.b.Increasedriskofectopicpregnancy;c.Increased
bleedinginmenstruationwithpain;e.Irregularmenses
CoppercontainingIUCDactslocallyinuterus,sonoaffecton
Culevelinmilk
ComplicationofIUCD:

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Dysmenorrhoea
Menstrualdysfunction:prolonged&heavybleeding
PID:2-10timesgreateramongIUDusers.
Shouldpregnancyoccurwithadeviceinsitu,thereisriskofectopic
pregnancy(0.02%)

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208.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.

209.Markersofmalignantovariantumour
is/are:
a)Inhibin

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b)Betahumanchorionicgonadotropin
c)Alphafetoprotein(AFP)
d)Pax7
e)NB/70K
CorrectAnswer-A:B:C:E

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Ans.a.Inhibin;b.Betahumanchorionicgonadotropin;c.Alpha
fetoprotein(AFP);e.NB/70K
TumourMarkerinEpithelialOvarianCancer:
CA-125:screeningofepithelialcancerofovary
Macrophagecolonystimulatingfactor(M-CSF)

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OVXI
HER-2/Neu
Inhibin
hCG:ovarianchoriocarcinoma
BRCAI&BRCA2(Serouscarcinoma)

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MLHI,MSH2&MSH6(HNPCCassociatedovariancancer)
AFP,hCG&CEA-Germcelltumour
Tumourmarker-forembryonalcarcinoma(AFBhCG)
Endodermalsinustumour(AFP)
Choriocarcinoma(hCG)

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Germcelltumor-AFP,hCG,NB/70K,placentalalkalinephosphatase
&lactatedehydrogenase.

210.A30-yearladydeliveredababy.Whichof
thefollowingstatement(s)isnottrue
aboutpostpartumcontraception:

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a)OCPisnotgivenbecauseitcancausesvenousthrombosis&
haveadverseimpactonmilkproduction
b)POPiscontraceptiveofchoiceforlactatingwomen
c)POPshouldbestartedafter6week
d)LNG-IUDisgoodinlactatingwomen

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e)Fornon-lactatingwomen,ovulationnotoccursuntil12week
CorrectAnswer-E
Ans.e.Fornon-lactatingwomen,ovulationnotoccursuntil12
week
Non-lactating(Postpartum):Contraceptivepracticeshouldbestarted

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after3week.Pillisgood;IUDisequallyeffectivealternative
POPissafeinlactatingwomen&canbestarted6weeksonwards.
LNGissaferthandesogestrel&gestagenfromthrombosispointof
view.
Intramuscular&progestogenimplantcanbeprescribed6weekafter

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deliver
IUCDinsertionwithin10minofexpulsionofplacentaorwithin24hr
ofdeliveryisprovedsafe&effective
COCarecontraindicatedinthepuerperium,bothbecauseofits
adverseonmilksecretioninalactatingwomen&increasedriskof

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thromboembolicepisode.COCcanbeprescribedtoanonlactating
woman3weeksafterdelivery.

211.Trueaboutplacentaaccreta:
a)Incidenceisabout1in2500Pregnancy
b)Incidenceincreasedinlastdecade

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c)Absenceofdeciduabasalis
d)Fibrinoidlayerdeficient
e)Morecommoninprimi
CorrectAnswer-B:C:D
Ans.b.Incidenceincreasedinlastdecade;c.Absenceof

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deciduabasalis;d.Fibrinoidlayerdeficient
Inplacentaaccretadeciduabasalisisabsentandplacentalvilliare
attachedtothemyometrium.
Riskfactors:
Patientswithahistoryofuterinesurgeryareatgreatestriskof

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developinganaccreta.
Infact,thosewithapriorcesareansectioncarrya25%risk.
placentapreviainthepresenceofauterinescar
Others-prioruterinesurgery,endometrialablation,Asherman
syndrome,uterineleiomyomata,

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212.Trueaboutlowgradesquamous
intraepitheliallesions:
a)Confinedtothelower1/3oftheepitheliumofcervix
b)Allcasesaretreatedbycryotherapy
c)30%progresstoinvasivecancerin10years

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d)ItiskeptunderobservationwithPAPsmearorHPVDNAtests
e)Noneoftheabove
CorrectAnswer-A:D
Ans.(A)Confinedtothelower1/3oftheepitheliumofcervix&
(d)ItiskeptunderobservationwithPAPsmearorHPVDNA

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tests
CIN-I(Lowgradesquamousintraepitheliallesions):Itisoftenseen
withinflammatoryconditionsliketrichomoniasis&HP&isreversible
followingtreatment.
Theundifferentiatedcellsareconfinedtothelower1/3ofthe

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epithelium.
WomenwithCINI,confirmedonbiopsyiskeptunderobservation
withpapsmearfollowupat6monthsorHPVDNAtestsat12
month.Ifbothtestsarenegativeroutinerecall(screening)isdone.If
thesetestsarePersistentthentreatitasHSIL

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213.Trueaboutendometriosis:
a)Laparoscopyisgoldstandardfordiagnosis
b)COCisusedtorelievemildPain
c)GnRHantagonistisusedtorelieveseverepain
d)Canbemanagedexpectantlyinasymptomaticcases

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e)Noneoftheabove
CorrectAnswer-A:B:D
Ans.(A)Laparoscopyisgoldstandardfordiagnosis;(B).COCis
usedtorelievemildPain;(D)Canbemanagedexpectantlyin
asymptomaticcases

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Friendsthisisthemostoftenaskedquestiononendometriosis.Itis
worthwhiletoknowafewdetailsonthistopic.
Empiricaltreatment:isforpainpresumedtobedueto
endometriosis.(inabsenceofdefinitivediagnosis)andincludes:--
Counselling

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1. Analgesia
2. Nutritionaltherapy
3. ProgestinorOCP's
Analgesia:StudieshaveshownNSAID'sexceptniflumicacidare
moreeffectiveinchronicpainreliefduetoendometriosisor

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dysmenorrheasuspectedtobeduetoendometriosis.
Hormonalmedicaltreatment:
Basisofmanagement:Sinceestrogenisknowntostimulatethe
growthofendometriosis,hormonaltherapyhasbeendesignedto
suppressestrogensynthesis,therebyinducingatrophyofectopic

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endometrialimplantsorinterruptingthecycleofstimulationand
bleeding.

Indication:--Mildpelvicendometriosisinyoungwomen.?
Treatmentofresidualandrecurrentdiseasefollowingconservative
surgery.

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214.Whichistrueregardingpremenstrual
dysphoricdisorder(PMDD):
a)Severedepressedmood
b)Painceasesatonsetofmenses
c)Depressionmaycontinueaftermenstrualperiod

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d)Antidepressantisgivenfortreatment
e)Painceasesaftermensesisover
CorrectAnswer-A:D:E
Ans.(A)Severedepressedmood;(D)Antidepressantisgiven
fortreatment;(E)Painceasesaftermensesisover

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Premenstrualsyndrome(PMS)&Premenstrualdysphoricdisorder
(PMDD)
PMSisoftennoticedjustpriortomenstruation(last7-10daysofthe
menstrualcycle)
Itshouldfulfilthefollowingcriteria:

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Norelatedtoanyorganiclesion
Regularlyoccurringduringthelutealphaseofeachcycle.
Symptommustbesevereenoughtodisturbthelifestyleofwomen
orsherequiresmedicalhelp.
Symptomfreeperiodduringrestofthecycle

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Whenthesesymptomsdisruptdailyfunctioningtheyaregrouped
underPMDD
Morecommoninwomenaged30-35yr.
Itmayrelatedtochildbirthoradisturbinglifeevent
Therearenopelvicfindingsexceptfeaturesofpelviccongestion.

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5%sufferfromseveresymptomswhichinfluencedailyactivities

SSRI6NoradrenalineReuptakeinhibitors(SNRI)arefoundtobe
veryeffective

215.Trueaboutdiagnosisofgestational
diabetesmellitus(GDM):

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a)Ifpostprandialsugar>200mg/dl,thenovertdiabetes
b)Iffastingsugaris100-120mg/dl,thenovertdiabetes
c)Iffastingsugaris>126mg/dl,thenovertdiabetes
d)IfPostprandialsugaris<140mg/dl,thenIGT
e)Iffastingsugaris110-125mg/dl,thenIGT

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CorrectAnswer-A:C:E
Ans.(A)Ifpostprandialsugar>200mg/dl,thenovertdiabetes;
(C)Iffastingsugaris>126mg/dl,thenovertdiabetes;(E)If
fastingsugaris110-125mg/dl,thenIGT
OVERTDIABETES:

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Womenwitharandomplasmaglucoselevel>200mg/dL+classic
signsandsymptomssuchaspolydipsia,polyuria,andunexplained
weightlossorafastingglucoseexceeding125mg/dL.
Thediagnosticcutoffvalueforovertdiabetesisafastingplasma
glucoseof126mg/dLorhigher.

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IGT:
Criteriafordiagnosisofimpairedglucosetolerance&diabetes
with75gmoralglucose:
ForfastingItsIGTif>100&<126
For2hourpostglucoseitsIGTif>140&<200

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216.Trueaboutprimaryamenorrhoea:
a)InRokitansky-Kuster-Hausersyndrome,FSHisnormal
b)InTurnersyndrome,FSHisdecreased
c)InKallmansyndrome,FSHisincreased
d)InKallmansyndrome,LHisreduced

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e)None
CorrectAnswer-A:D
Ans.(A)InRokitansky-Kuster-Hausersyndrome,FSHisnormal
and(D)InKallmansyndrome,LHisreduced
ASSOCIATEDCONDITION
:

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Turner'ssyndrome
Congenitaladrenalhyperplasia(CAH)
Androgeninsensitivitysyndrome
Testicularfeminizationsyndrome
PCOS

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M?llerianagenesis/Utero-vaginalAgenesis/Mayer-Rokitansky-
Kuster-Hausersyndrome
DIAGNOSIS:
Buccalsmearandanexaminationofthepolymorphonuclear
leucocytestodetermineifchromatinpositive(probablyXX)or

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chromatinnegative(probablyXOorXY);inothercasesafull
chromosomeanalysismaybeneededtoexcludemosaicismand
AIS.
HormonalinvestigationsshouldincludeLH,FSH,oestradioland
testosteronelevels.

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Ultrasoundwillhelpdeterminethepresence,stateandsizeofthe
ovariesandanyfollicularactivity.


217.Inassistedbreechdelivery,aftercoming
headisdeliveredby:
a)Headdeliveredspontaneously

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b)Pinardmanoeuvre
c)ModifiedMauriceau-Smellie-Veittechnique
d)Specialforcepfordeliveringheadisused
e)Praguemanoeuvre
CorrectAnswer-C:D:E

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Ans.(C)ModifiedMauriceau-Smellie-Veittechnique;(D)Special
forcepfordeliveringheadisused;(E)Praguemanoeuvre
DeliveryoftheAftercomingheadofBreech
Variousmethodofsafedeliveryofaftercominghead
Burns-Marshallmethod:Forcepdelivery(Piperforcep,Dasforcep,

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NevilleBarne'sforcep)
Malarflexion&shouldertraction(modifiedMauriceauSmellie-Veit
technique)
ArrestofafterComingHead
Burns-Marshallmethod

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ModifiedMauriceau-Smellie-Veittechnique
Brachtmaneuver
Wigand-Martinmaneuver
Praguemaneuver
Forcepapplication

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Duhrssen'sincision
Craniotomy

218.Whichofthefollowingis/are
ultrasonographicfindingoftwins:
a)Typeoftwinpregnancycanbediagnosedinfirsttrimester

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b)Lambdasignindicatesdichorionicity
c)Tsignsuggestsmonochorionicdiamnioticpregnancy
d)Monozygotictwinsaremorecommon
e)All
CorrectAnswer-A:B:C

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Ans.a.Typeoftwinpregnancycanbediagnosedinfirst
trimester;b.Lambdasignindicatesdichorionicity;c.Tsign
suggestsmonochorionicdiamnioticpregnancy
Sonography
Separategestationalsacs

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Confirmationofdiagnosisasearlyas10thweekofpregnancy
Variabilityoffetuses,vanishingtwininsecondtrimester
Chorionicity(twinpeaksignorlamdasign)(10?13weeksof
gestation)
Thickseptumindichorionictwinsatbaseofthemembrane

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withtriangularprojectionisknownaslambdaortwinpeaksign
Pregnancydating,Fetalanomalies
Fetalgrowthmonitoring,Presentationandlieoffetuses
Twintransfusionlocalization,Amnioticfluidvolume


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219.Whichofthefollowingis/areusedin
psoriasis:
a)Highdoseoraldexamethasone
b)Methotrexate
c)TNF-alphainhibitor

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d)Acitretin
e)NarrowbandUVB
CorrectAnswer-B:C:D
Ans.B,MethotrexateC,TNF-alphainhibitorD,Acitretin
Ref;.NeenaKhanna5th/54-59;Hartison19th/348;Roxburg

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17th/138-42).
Systemiccorticosteroidsareonlyindicatedforgeneralizedpustular
psoriasisinpregnancy(impetigoherpetiformis).
Biologicalresponsemodifiersusedtotreatpsoriasisinclude:Tcell
inhibitors(alefacept,adalimumab,itolizumab).

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Oralglucocorticoidsshouldnotbeusedinthetreatmentofpsoriasis
duetothepotentialfordevelopinglife-threateningpustularPsoriasis
whentherapyisdiscontinued.

220.Trueaboutskin:
a)Epidermisishighlyvascular

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b)Melanocyteisderivedfromneuralcrest
c)Sebaecousgland-holocrine&absentinpalm
d)Apocrineglandpresentsinaxilla&groin
e)Hiraadenitissuppuritaisinfectionofapocrinegland
CorrectAnswer-B:C:D:E

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Ans:B,MelanocyteisderivedfromneuralcrestC,Sebaecous
gland-holocrine&absentinpalmD,Apocrineglandpresentsin
axilla&groin&E,Hiraadenitissuppuritaisinfectionofapocrine
gland
[RefNeenaKhannaSth/119,451-53;Harrison19th/1099;Roxburgh

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tTth/4-11;GeneralAnatomybyBDChaurasia5th/254-60
Hidradenitissuppurativa(Synonym-apocrineacne):Axillary
apocrinesweatglandinfection
Sebaceousglandsareholocrineinnature,
Thepigmentcells(melanocyte)oftheskinarederivedfromneural

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crest.
Apocrinesweatglandsdrainsdirectlyintohairfolliclesintheaxillae&
groins
Sebaceousglandarelocatedthroughouttheskinexceptonpalms&
soles.

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Glandsmadeupofacinioflipidcontainingcells,whichsecrete
sebumasaholocrinesecretion.
Eccrinesweatglandspresentalloverbody,especiallyonpalms,
soles&inaxillae.Humanhave2-24millioneccrinesweatglands

221.Acneiformeruptionis/aresideeffectof:

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a)Tetracycline
b)Phenytoin
c)Isoniazid
d)Steroid
e)Potassiumiodide

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CorrectAnswer-B:C:D:E
Ans:B,PhenytoinC,IsoniazidD,Steroid&E,Potassiumiodide
[RefNeenaKhanna5th/125;Harrison19th/356;Harrison14th/425;
Roxbug17th/Ea-55
Drug-inducedAcneiformEruptions:

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Steroids(corticosteroids,androgens,anabolicsteroids),oral
antieMEtics,antituberculardrugs,anticonvulsants,halides(iodides.
bromides).
Trunkespeciallyback,facenaybeinvolved.
LesionsaremonomorPhic,consistingofpapulessometimespustule

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222.Cicatricalalopeciais/areseenin:
a)Lichenplanopilaris
b)Discoidlupuserythematous
c)Andogenefflyum
d)Lichenplanus

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e)Trichotillomania
CorrectAnswer-A:B:D
Ans.A.LichenplanopilarisB,Discoidlupuserythematous&
D,Lichenplanus
[RefNeenaKhanna5th/141;Hanison19th/355;Roxburg17th/270]

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Thichotillomania(compulsivehair-pulling)ischaracterizedby
noticeablehairlosscausedbyperson!persistent&recurrentfailure
toresistimpulsetopullouthairs.
Nonscarringalopecia
A.Primarycutaneousdisorders

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l.Telogeneffluvium
Androgeneticalopecia
Alopeciaareata
Tineacapitis
Traumaticalopecia

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B.Drugs
C.Systemicdiseases
Systemiclupuserythematosus
Secondarysyphilis
Hypothyroidism

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Hyperthyroidism
Hypopituitarism

Deficienciesofprotein,iron,biotin,andzinc
ll.Scarringalopecia
A.Primarycutaneousdisorders

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Cutaneouslupus(chronicdiscoidlesions)
Lichenplanus
Centralcentrifugalcicatricialalopecia
Folliculitisdecalvans
Linearscleroderma(morphea)

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B.Systemicdiseases
Discoidlesionsinthesettingofsystemiclupuserythematosus
Sarcoidosis
Cutaneousmetastases

223.WavelengthofUVBis:

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a)250-280nm
b)280-320nm
c)320-400nm
d)400-700nm
e)100-200nm

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CorrectAnswer-B
Ans.B.280-320nm
Thewavelengthfoundmosteffectiveintreatingskindiseasewith
phototherapyisUVBwithwardengfhof311(+-2nm)(narrowband
UVB,NBUVB).

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Thewavelengthsbetween4(Nand7AOnmarevisibletothehuman
eye.

224.Whichofthefollowingstatement(s)
is/aretrueaboutphysicalurticaria
a)Cholinergicurticarialisprecipitatedbycold

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b)Solarurticariaisskinsignoferythropoieticprotoporphyria
c)Dermatographismisanexample
d)Coldurticariaisprecipitatedbyemotion
e)None
CorrectAnswer-B:C

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Ans.B,Solarurticariaisskinsignoferythropoietic
protoporphyria&C,Dermatographismisanexample
[RefNeenaKhannaSth/189;Harrison19th/i6i;Roxburg17th/74-74
).
PhysicalUrticarias:

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Patientswithdermatographismexhibitlinearwhealsfollowingminor
pressureorscratchingoftheskin.
Solarurticariacharacteristicallyoccurswithinminutesofsun
exposureandisaskinsignofonesystemicdisease.
Coldurticariaisprecipitatedbyexposuretothecold,andtherefore

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exposedareasareusuallyaffected.
Cholinergicurticariaisprecipitatedbyheat,exercise,emotionandis
characterizedbysmallwhealswithrelativelylargeflares.

225.Trueabouttracheostomy:
a)Tracheostomytubemayclosedbymucoussecretion&crust

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formation
b)Copioussecretionfromtubeisalwaysduepulmonaryinfection
c)X-raychestshouldbedoneforconfirmationineverycase
d)Improperpositioningmayleadtofatalhaemorrhage
e)Displacingoftubeafter2weekismedicalemergency

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CorrectAnswer-A:D
Ans.A,Tracheostomytubemayclosedbymucoussecretion&
crustformationD,Improperpositioningmayleadtofatal
haemorrhage
RefSchwartz9th/59-Iqhttp://www.nurses.com/;pL.Dhingra6th/

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3I6-20;AjayYadav5th/48-49;MilloAnaesthaiaZth/232&IBit-72
Reintubationinthefirst36hoursaftertracheostomyIson
emergency.
TracheostomytubeshouldnotbedisturbedForthefirst48-72hr,
butthereafterthetubeischangeddaily&cleanedatregularinterval.

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Recentstudydonotsupportobtainingaroutineposttracheostomy
chestX-ray.
Themostdramaticcomplicationistracheo-innominatearteryfistula
(TIAF).
Palpabletubepulsationsuggestimpendingerosionofanartery,

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Trachealdeviationmaysignalabdomenbleeding

226.Trueaboutdesflurane:
a)Boilingpointis<230C
b)ChemicallyitisFlourinatedmethylethylether
c)Itincreasestheeffectofmusclerelaxant

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d)Canbegivensafelytopatientsusceptibletomalignant
hyperthermia
e)Morepotentthanisoflurane
CorrectAnswer-A:B:C
Ans.A,Boilingpointis<230CB,ChemicallyitisFlourinated

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methylethyletherC,Itincreasestheeffectofmusclerelaxant
[RefAjeyYadavSth/82;MorganSth/170&71)
Desflurane:
Fluorinatedmethylethylether
Boilingpointislessthan20C.

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Producesmaximummusclerelaxationamongtheagents.
5timeslesspotentthanisoflurane.
Lossofpotency(theMACofdesfluraneis5timeshigherthan
isoflurane)
Immunemediatedhepatitisarareoccurrence.

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hasthelowestblood:gassolubilityofthepotentvolatileanesthetics

227.Drug(s)notgivenastransdermalpatch:
a)Fentanyl
b)Diclofenac
c)Morphine

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d)Clonidine
e)Buprenorphine
CorrectAnswer-B:C
Ans.B,Diclofenac&C,Morphine
[Ref:KDT7th/476

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Transdermalfentanyl(Durogesic)hasbecomeavailableforusein
cancer/terminalillness.
Butransskinpatchescontainbuprenorphineanopioidpain
medication.
Clonidinetransdermaldelivery(patch)systemshavebeenavailable

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sincethe1980

228.Endotrachealintubationis/areassessed
by:
a)Mallampatigrading
b)ASAphysicalstatusgrading

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c)Thyromentaldistance
d)Teetharrangement
e)None
CorrectAnswer-A:C:D
Ans.A,MallampatigradingC,Thyromentaldistance&D,Teeth

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arrangement
Ref:ManipalSurgery4th/1072-73;AjayYadav5th/53'124;Morgan
5th/312-13
ASAphysicalstatusgradingisforgeneralhealthstatusofpatient
(notforassessingintubation)

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AssessmentofDifficultIntubation:
Mallampatigrading:ItisdonetoassessmouthoPening
Thyromentaldistance(distanceb/wthyroidnotchtomental
prominencewithfullyextendedneck)
Mentohyoiddistance:normal>5cm

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AssessmentofTMjointfunction:Interincisorgap(mouthopening)
shouldbeatleast5cm(2fingerbreadth)
NeckMovement

229.Trueaboutphotodynamictherapyof
head&neckcancer:

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a)Tumoursensitizerisused
b)Singletoxygenisproducedintumourcell
c)Aftertherapy,radiosensitizermayremainwithtumourcell
d)Hemoporphyringivenasradiosensitizer
e)Photosensitivityisaside-effectaftertherapy

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CorrectAnswer-A:B:C:E
Ans.A,TumoursensitizerisusedB,Singletoxygenisproduced
intumourcellC,Aftertherapy,radiosensitizermayremainwith
tumourcell&E,Photosensitivityisaside-effectaftertherapy
RefSabiston236;Ballenger\Otorhinolaryngology16th/1324

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Photodynamictherapyisanewtreatmentthatallowsdestruction
ofcancercellsandhasrecentlybeenexpandedtotheeradicationof
metaplasticcells,
Itbeginswiththeadministrationofatargetspecificphotosensitizer
thatiseventuallyconcentratedinthetargettissue.

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Thephotosensitizingagentisthenactivatedwithawavelength-
specificlightenergysource,whichleadstogenerationoffree
radicalscytotoxictothetargettissue.
Applicationsreportedintheliteratureincludetreatingearly
radiographicallydetected,non-smallcelllungcancer,pancreatic

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cancersquamouscellandbasalcellcarcinomaoftheskin,recurrent
superficialbladdercancer,Chestwallinvolvementfrombreast
cancerandevenchestwallrecurrenceofbreastcancer.
Givensystemically,thesedrugsarepreferentiallytakenupintumor

cells,renderingthemmoresensitivetolight-mediatedcellkilling

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thantheirsurroundingtissues.

230.Whichofthefollowingcell(s)areless
radiosensitive:
a)Osteocyte
b)Erythroblasts

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c)Chondrocyte
d)Spermatogonia
e)Lymphocyte
CorrectAnswer-A:C
Ans.A,Osteocyte&C,Chondrocyte

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Ref:SumerSethi6th/174;Radiology&ImagingbyThayalanIst/310
Mostradiosensitivebloodcell-Lymphocyte
Leastradiosensitivebloodcell-platelet
Mostradiosensitivetissueofbody-Bonemarrow
Leastradiosensitivetissttcofbody-Nervoustissue/brain

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HighRadiosensitive-Lymphoidorgans,bonemarrowblood,testes,
ovaries,intestines
LowRadiosensitive-Muscle,brain,spinalcord

231.Allaretrueaboutgammaknifeexcept:
a)Focussedradiationisdeliveredtotumor

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b)Provideequalexposuretosurroundinghealthytissue
c)Itisatypeofstereotacticsurgery
d)Primarilyusedforsmallbraintumours
e)UsesCo-60assourceofradiation
CorrectAnswer-B

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Ans.B.Provideequalexposuretosurroundinghealthytissue
Ref:SumerSethi6th/196-97
StereotacticRadiosurgerY:
Goalofstereotacticradiosurgeryistodeliverenoughradiationto
destroyorstopthegtorvfhofalesionpreviouslydefinedby

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specializedimagingtechniqueswithoutadverselyaffecting
surroundingtissue.
GammaKnifeRadiosurgery:
Gammakniferadiosurgerykatypeofradiationtherapyusedtotreat
tumorsandotherabnormalitiesinthebrain.

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Closeto200tinybearnsofradiationonatumor.
Gammaknife:
TheGammaKnifeisanadvancedradiationtreatmentforadultsand
childrenwithsmalltomediumbraintumors,abnormalbloodvessel
formationscalledartetiotenotrsmalformations,epilepsy,trigeminal

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neuralgia,anerve.ott-ditiottthatcauseschronicpain,andother
neurologicalconditions.
The'blades"oftheGammaKnife"arethebeamsofgammaradiation
programmedtotargetthelesionatthepointwheretheyintersect.
GammaKnifeenablespatientstoundergoanon-invasiveformof

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brainsurgerywithoutsurgicalrisks,alonghospitalstayor
subsequentrehabilitation.

232.Gammaradiationis/areproducedby:
a)Co-60
b)Caesium-137

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c)P-32
d)Iridium-192
e)Strontium-90
CorrectAnswer-A:B:D
Ans.A,Co-60B,Caesium-137&D,Iridium-192

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[Ref:SumerSethi6th/177,184;Radiology6ImagingbyThayalan
lst/17,278
Radiationemitted-Radionuclide
Gammarays-
Radium-226

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Caesium-137
Cobalt-60
iridium-192
Gold-198
Samarium-153

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Betarays:
Strontium-90
Yttrium-90
Phosphorus-32
Rhenium-188

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Combinationofgammaandbetarays:
Rhenium-186
iodine-131

233.PreciseFNACcanbeobtainedbyusing:
a)USG

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b)CT
c)EndoscopicUSG
d)MRI
e)Plain-Xray
CorrectAnswer-A

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Ans.A.USG
RefDahnertRadiologyManual7th/368;Harshmohan7th/902-
l3;Robbins9th/333
RadiologicalimagingAidsforFNAC:
Non-palpablelesionrequiresomeformoflocalizationbyradiological

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aidsforFNACtobecarriedout.
PlainX-rayfilmsareusuallyadequateforlesionswithinbones&for
somelesionswithinthechest
FNACofchestmayalsobeattemptedunderimageamplified
fluoroscopywhichallowsvisualizationofneedleplacementonthe

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televisionmonitor
CTguidanceisalsousedforlesionswithinthechestdyAbdomen.
Themostversatileradiologicalaidisultrasonographicguidance
(USG)whichallowdirectvisualizationoFneedleplacementinreal
time&isfreefromradiationhazards.

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ItisanextremelyvaluableaidforFNACofthyroidnodules,soft
tissuemasses,intra-abdominallesionsdtforintrathoracicwhich
aboutthechestwall,butnohelpindeepintrathoraciclesionsorin
bonylesions
PrecisionofUSGandCTscaniscomparableforguidanceinFNAC

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fromthoracicmasslesions

234.TrueaboutsignalcharacteristicofCSF
onMRI&FLAIR:
a)HyperintenseonT1WI
b)HypointenseonTIWI

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c)HyperintenseonT2WI
d)FLAIRreducesCSFsignal
e)FLAIRincreasesCSFsignal
CorrectAnswer-B:C:D
Ans.B,HypointenseonTIWIC,HyperintenseonT2WI&

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D,FLAIRreducesCSFsignal
Ref:SumerSethi6th/15;Radiology6ImagingbyThayalanIst/386-
89]
MRISignalCharacteristic
CSF:HypointenseonTIWI,hyperintenseonT2W1.

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Grey/Whitematter:Greymatterisgrey&whitematterswhiten
T1W1&relationshipisreversedonT2W1.
Thefluid,-attenuatedinversion-recovery(FLAIR)useslongerT1
(2400ms)&TR(7000ms)toreducethesignallevelofCSF&other
tissuewithlongTlrelaxationconstant.

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ItreducesCSFsignal&otherwater-boundanatomyinMRimage
byusingaTldetectedatornearthebouncepointofCSF.
FLAIRMRItechniquesconsistofaninversionrecoverypulsetonull
thesignalfromCSFandalongechotimetoproduceaheavilyT2-
weightedsequence.

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235.ContrastagentwhicharenotusedforCT
scan:
a)Water
b)CO2
c)Bariumcompounds

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d)Iodinatedhigh-osmolalitycontrastmedia
e)Polyethyleneglycol
CorrectAnswer-B
Ans.B.CO2
RefSumerSethi6th/20;Radiology6ImagingbyThayalan159;

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DahnertRadiologyManual7th/1147-48
Radiocontrastagentsareatypeofmedicalcontrastmediumusedto
improvethevisibilityofinternalbodilystructuresinX-ray-based
imagingtechniquessuchascomputedtomography(CT),
radiography&fluoroscopy.

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Radiocontrastagentsaretypicallyiodineorbariumcompounds.
Whenanagentimprovesvisibilityofanarea,itiscalled"contrast
enhancing
Gadoliniumisakeycomponentofthecontrastmaterialmostoften
usedinmagneticresonance(MR)exams.

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Saline(saltwater)andairarealsousedascontrastmaterialsin
imagingexams.
Bariumsulfatecontrastmediacontinuetobethepreferredagents
foropacificationofthegastrointestinaltractforconventional
fluoroscopicexaminations

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Thecurrentuseofiodinatedwater-solublecontrastmediais

primarilylimitedtoselectsituations
Twocommercidwater-solubleiodinatedhigh-osmolalitycontrast
media(HOCMs)specificallydesignedforentericopacificationarein
commonuse.Gastrografinand,Gastroview

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236.TrueaboutUSG:
a)Usesmostcommonlyfrequencyof20-50MHzfordiagnostic
ultrasound
b)Workonprincipleofpiezoelectriceffect
c)Ultrasonicwavesonlypenetratesgas,notliquid

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d)Gasfilledmicrobubblesareusedascontrastmedia
e)None
CorrectAnswer-B:D
Ans.B.Workonprincipleofpiezoelectriceffect&D.Gasfilled
microbubblesareusedascontrastmedia

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RefSumerSethi6th/9-10;Radiology&ImagingbyThayalan334-
40
Contrast-enhancedUltrasound(CEUS):
Applicationofultrasoundcontrastmediumtotraditionalmedical
sonography.

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Commerciallyavailablecontrastmediaaregx-filled(airor
perfluorocarbon)microbubblesthatareadministeredintravenously
tothesysferniccirculation.
Microbubbleshaveahighdegreeofechogenicity(theabilityofan
objecttoreflectultrasoundwaves)

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237.Trueaboutfindingofpleuraleffusion:
a)CTscancandistinguishbetweenapleuraleffusionanda
pleuralempyema
b)USGcandetectverysmallamountoffluid
c)X-ray-homogenousopacitywithobliterationofCPangle

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d)MRIcannotdifferentiatemalignantfrombenignpleuraldisease
e)MRIcandifferentiatemalignantfrombenignpleuraldisease
CorrectAnswer-A:B:C:E
Ans.,A,CTscancandistinguishbetweenapleuraleffusionand
apleuralempyemaB,USGcandetectverysmallamountof

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fluidCX-ray-homogenousopacitywithobliterationofCP
angle&EMRIcandifferentiatemalignantfrombenignpleural
disease
Ref:SumerSethi6th/49;DahnertRadiologyManual7th/446;WHO
ManualofRadiographicInterpretation2002/4I_42

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Imagingcriteriaare:
Homogenousdensity
Densityindependentportion
Upright:CostophrenicangleinpAview
Lateralyiew:Anteriorandposteriorportionsofgutter

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Lateraldecubitusposition:Alongsides
Supineposition:Alongposteriorly,givingdiffusehazinessonthe
sideofeffusion
Silhouetteofupperlimitofdensity
UppermarginhighinaxillainpAview(yellowarrows)

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Uppermarginhighanteriorlyandposteriorlyinlateralview
Thisisjustanillusion

Lossofsilhouette:Intheimagesbelownotelackofidentifiableleft
diaphragmbeforeandvisiblediaphragmafterclearanceoffluid
(Silhouettesignprinciple)

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Mediastinalshift
PleuralEffusion-X-Ray
First300mlnotvisualizedonPAyiew
Lateraldecubitusviewsmaydetectaslittleas25ml
PleuraleffusiononCTscan:

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CTscanningisexcellentatdetectingsmallamountsoffluidandis
alsooftenabletoidentifyunderlyingintrathoraciccauses(e.9.
malignantpleuraldepositsorprimarylungneoplasms)aswellas
subdiaphragmaticdiseases1e.g.subdiaphragmaticabscess).

238.Trueaboutschizophrenia:

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a)Q-EEGfindingisoneofdiagnosticcriteriaforschizophrenia
b)Psychosurgerycanbedoneforsomeresistantcases
c)Familyhistoryofschizophreniaispoorprognosis
d)Depressionmaybefound
e)Onsetonlyafter40yearofage

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CorrectAnswer-B:C:D
Ans.B,Psychosurgerycanbedoneforsomeresistant
casesC,Familyhistoryofschizophreniaispoorprognosis&
D,Depressionmaybefound
[Ref:Ahuja7th/54-68;SynopsisofPsychiatrybyKaplan&Sadock

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11th/300-32s
Schizophrenia:
Equallyprevalentinmales&females.
Onset-Before25yrs.Peakage-10to20yrs(males)&25to35
yrs.(Females)

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EEGrecordingshowsdecreasedalphaactivity,increasedtheta&
deltaactivity.
QuantitativeEEG(qEEG)istheanalysisofthedigitizedEEG,andin
laytermsthissometimesisalsocalled'BrainMapping'.
Psychosurgeryisnotroutinelyindicated.

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Whenused,thetreatmentofchoiceislimbicleucotomyinsome
caseswithseyere&veryprominentdepression,anxietyor
obsessionalsymptoms

239.Whichofthefollowingis/arenotside-
effectoflithium:

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a)Seizure
b)Hyporeflexia
c)Nephrogenicdiabetesinsipidus
d)Alopecia
e)Tremor

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CorrectAnswer-B
Ans.B.Hyporeflexia
Ref:SynopsisofpsychiatrybyKaplan6Sadock11th/985-88;KDT
7th/449;pharmacologybySatoskar2ith/225
Lithium:

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Mildtoxicity:GIdisturbances,drowsiness,muscularweakness,
alopecia,allergicreaction,blurredvision,glycosuria,polyuria&
weightgain.
Chronicadministration:goiterformation,hypothyroidism&ECG
changes

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Embryotoxicity:Liisembryotoxic&increasestheriskofEbstein's
anomaly
Hyper-reflexia
invalidquestionid

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