Download PGIMER (Post Graduate Institute of Medical Education & Research, Chandigarh) PGI 2016 May Solved Question Paper
a)Suppliedbyinferiordivisionof3rdCN
b)Primaryeyeaction-Extorsion,abduction&depression
c)Themusclepassbelowinferiorrectus
d)Originfromlacrimalbone
e)Nerveentersthemusclefromocularsurface
CorrectAnswer-A:C
Ans.(A)Suppliedbyinferiordivisionof3rdCN(C)Themuscle
passbelowinferiorrectus
Itoriginatesfromorbitalplateofmaxillalateraltotheorificeof
nasolacrimalduct.
Itistheonlymuscletotakeoriginfromfrontoftheorbit.Otherrecti
muscletakeoriginfromannulusofzinn.
Occulomotornerveinorbit:Thelarger,lowerdivisiondividesinto3
branchesforthemedialrectus,theinferiorrectus6theinferior
oblique.Allbranchesenterthemuscleontheirocularsurfaces
exceptthatfortheIOwhichentersitsposteriorborder'
2.TrueaboutSubmandibularglandduct
obstructionbystone:
a)Presentsasamassbelowbodyofmandible
b)StoneinWhartonductcanbepalpatedbelowmucous
membraneoffloorofmouth
c)Startspainjustafterstartingameal
d)Paincarriedbyglossopharyngealnerve
e)Alltheabove
CorrectAnswer-E
Ans.e.Alltheabove
Thesubmandibularsalivaryglandisacommonsiteofcalculus
formation.
Thepresenceofatenseswellingbelowthebodyofthemandible,
whichisgreatestbeforeorduringamealandisreducedinsizeor
absentbetweenmeals,isdiagnosticofthecondition.
Examinationofthefloorofthemouthwillrevealabsenceofejection
ofsalivafromtheorificeoftheductoftheaffectedgland.
Frequently,thestonecanbepalpatedintheduct,whichliesbelow
themucousmembraneofthefloorofthemouth'
Allthe3pairsofsalivaryglandsaresuppliedbyefferent
(Parasympathetic&sympathetic)&afferentnerves(chordatympani-
br.ofVIInerve&IXnerw).Afferentfiberscarrypainimpulsefrom
salivarygland
3.Trueaboutpalatinetonsil:
a)Cryptsislinedbysquamousepithelium
b)SuppliedbyIXCN
c)Tonguedepressorisusedforexamination
d)Arterialsupplyisbytonsillarascendingbranchofgrater
palatineartery
e)Presentinoropharynx
CorrectAnswer-A:B:C:E
Ans.(A)Cryptsislinedbysquamousepithelium;(B)Supplied
byIXCN;(C)Tonguedepressorisusedforexamination;(E)
Presentinoropharynx
Palatinetonsil
ThePalatinetonsilsaretwoprominentmassessituatedoneon
eithersidebetweentheglossopalatineandpharyngopalatine
arches.
Eachtonsilconsistsfundamentallyofanaggregationoflymphoid
tissueunderlyingthemucousmembranebetweenthepalatine
arches.
Inthechildthetonsilsarerelatively(andfrequentlyabsolutely)
largerthanintheadult
Thefolliclesofthetonsilarelinedbyacontinuationofthemucous
membraneofthepharynx,coveredwithstratifiedsquamous
epithelium
Arteriessupplyingthetonsilarethe:
Dorsalislinguaefromthelingual
Theascendingpalatineandtonsillarfromtheexternalmaxillary
Theascendingpharyngealfromtheexternalcarotid
Thedescendingpalatinebranchoftheinternalmaxillary
Atwigfromthesmallmeningeal.
Theveinsendinthetonsillarplexus,onthelateralsideofthetonsil
Thenervesarederivedfromthesphenopalatineganglion,andfrom
theglossopharyngeal.
4.Trueaboutarticularcartilage:
a)Inzonelchondrocytesaresmaller
b)Zone2containsarticularcartilageprogenitorcells
c)Zone3containscalcifiedcartilage
d)Zone4containcalcifiedcartilage
e)Chondrocytesareactivecell
CorrectAnswer-A:C:E
Ans.(A)Inzonelchondrocytesaresmaller;(C)Zone3contains
calcifiedcartilage;(E)Chondrocytesareactivecell
Therearefourzones(layers)ofarticularcartilagefromthearticular
surfacetosubchondralbone.
1.Superficialzone(Zone-1)
Itisthethinnestzone.
Itconsistsoftwolayers:(i)Asheetofdenslypackedcollagenwith
littlepolysaccharideandtocells,coversthejointsurface,and(ii)
flattenedelipsoid-shapedchondrocytes,withtheirmajoraxis
paralleltojointsurface.
2.Transitionzone(Zone2)
Compositionisintermediatebetweensuperficialzoneandmiddle
zone.
3.Middlezoneorradialzoneordeepzone(Zone-3)
Thechondrocytesarespheroidalinshapewiththeirmajoraxis
perpendiculartojointsurface.
Chondrocytesaremostactivesyntheticallyinthiszone.
Thiszonecontainsthelargestdiametercollagenfibrils,thehighest
concentrationofproteoglycansandthelowestconcentrationof
water.
4.Calcifiedcartilagezone(Zone-4)
Itseparatesthemiddlezonefromsubchondralbone.
Thecellsaresmallwithsmallamountofendoplasmicreticulumand
golgiapparatuswithverylittlemetabolic
5.Trueaboutinnervationofparotidgland:
a)Postganglionicparasympatheticfibresecretomotor
b)PreganglionicparasympatheticfibrerelayinOticganglion
c)Preganglionicparasympatheticnervebeginininferiorpetrosal
nucleus
d)Sympatheticnervearevasomotor
e)Postganglionicparasympatheticfibrespassthroughthe
glossopharyngealnerve
CorrectAnswer-A:B:D
Ans:a.Postganglionicparasympatheticfibresecretomotor.b.
PreganglionicparasympatheticfibrerelayinOticganglion.d.
Sympatheticnervearevasomotor.
Development:
Parotidglandisthefirstsalivaryglandtoappear,inearly6'week.
Itisectodermalinoriginanddevelopsfromthebuccalepithelium
justlateraltotheangleofmouth
Structuresemergingfromparotid
Thefollowingstructuresemergefromtheparotidgland:
Anteriorborder:
Parotidduct
3Terminalbranchesoffacialnerve:
Thezygomaticandbuccalbranches:towardthetemporalregion,
eyelidsandcheek,respectively.
Mandibularbranch:Runalongthebodyofthemandibletowardsthe
mouth
Apex:
5thterminalbranchoffacialnerve:Cervicalbranchcontinuesinto
theneck(toplatysma).
Anterior&posteriordivisionsofretromandibularvein
Posteriorborder:
Posteriorauricularnerve
Posteriorauricularartery
Posteriorauricularvein
Alongbase:
superficialtemporalartery
temporalbranchoffacialnerve
Auriculotemporalnerve
STRUCTURESWITHINGLAND:
Arteries:
Externalcarotidarteryentersthroughposteromedialsurface
Maxillaryartery
Superficialtemporalvessel
Posteriorauricularartery
Veins:
Theretromandibularveins
FacialNerve
ParotidDuct(Stenson'sduct)
Theductturnsopensintothevestibuleofthemouth(gingivo-buccal
vestibule)oppositethecrownoftheupper2ndmolartooth
Nervesupply:
PARASYMPATHETIC:auriculotemporalnerve
SYMPTHETICSUPPLY-plexusaroundtheexternalcarotidartery.
SENSORYNERVES:auriculotemporalnerve,exceptforparotid
fascia&overlyingskinwhichareinnervatedbyGreatauricular
nerve(C2,C3).
6.Whichofthefollowingmuscleissupplied
bymediannerve:
a)Oppenenspollocis
b)Adductorpollicis
c)LateralhalfoftheFlexordigitorumprofundus
d)Superficialheadofflexorpollicisbrevis
e)Deeppartofflexorpollicisbrevis
CorrectAnswer-A:C:D
Ans.a.Oppenenspollocis;c.LateralhalfoftheFlexor
digitorumprofundus;d.Superficialheadofflexorpollicis
brevis
Therearefourshortmusclesofthumb(pollex),theyareabductor
pollicisbrevis,opponenspollicis,flexorpollicisbrevisandadductor
pollicis.Thefirstthreeofthesemusclesformthethenareminence.
Allthesemusclesaresuppliedbymediannerveexceptforadductor
polliciswhichisinnervatedbyulnarnerve.
7.Trueaboutabductionatshoulderjoint:
a)Supraspinatusinitiatesabduction
b)Serratusanterior&trapeziusalsohelpinabduction
c)Multipennatedeltoidclavicularfiberismainabductor
d)Axillarynerveinjuryhasnoeffectonabduction
e)Musculotendinouscuffstabilizesshoulderjoint
CorrectAnswer-A:B:E
Ans.(a)Supraspinatusinitiatesabduction(b)Serratusanterior
&trapeziusalsohelpinabduction(e)Musculotendinouscuff
stabilizesshoulderjoint.
MOVEMENTSOFSHOULDERJOINT
Movementineverydirection(Flexion,extension,abduction,
adduction,rotation,circumduction)
SpinalCordregulatingShouldermovements(C5,C6,C7&C8)
Flexion,Abduction,&lateralrotation(C5,C6,).
Extension,Adduction,&Medialrotationis(C6,C7,C8)
Movementsthattakeplaceduringabductionofshoulderare
axialrotationofhumerusatacroclavicularjoint,elevationof
humerus&movementatclavicularendofsternoclavicularjoint.
PLANE
HUMERAL RANGE
TYPEOF
AXISOF MUSCLES
FACTOR
OF
HEAD
OF
MOVEMENT
MOTION INVOLVED
LIMITING
MOTION
GLIDING MOTION
Total-0-
165?or
-Inferior
175?
glenohumeral
Full
ligament
internal
-Tightnessof
internal
-Tightnessof
Inferiorly
rotationof
Frontal
Saggital Deltoid,
theinferior
Abduction
inglenoid humerus0-
plane
axis
Supraspinatus
joint
cavity
60?
capsuleof
Full
the
external
gleno-
rotationof humeraljoint
humerus0-
90?
8.Organwhichhavenolymphaticsupply:
a)Eyeball
b)Brain
c)Liver
d)Kidney
e)Spinalcord
CorrectAnswer-A:B:E
Ans.a.Eyeball;b.Brain&e.Spinalcord
Lymphcapillariesareabsentfromthecellularstructureslikebrain,
spinalcord,splenicpulp,bonemorrow,articulatecartilage,
epidermis,hair,nail&cornea.
Lymphaticvesselarefoundinalltissue&organofbodyexceptthe
centralnervoussystem,eyeball,internalear,epidermisoftheskin,
cartilage&bone.
9.Whichofthefollowingstatement(s)is/are
trueaboutsphinctersofbody:
a)Lower5cmofoesophagealactasoesophagealsphincter&itis
notmorphologicallydifferentfromotherportionofoesophagus
b)Oesophageal&pyloricsphincterremainsintopicallycontracted
state
c)Pre-capillarysphincterispresentinb/wmetarteriole&capillary
d)Pudendalnervesuppliesthesphincterurethrae
e)Sphincterofoddiliesatjunctionofduodenum&CBD
CorrectAnswer-B:C:D:E
Ans.b.Oesophageal&pyloricsphincterremainsintopically
contractedstate;c.Pre-capillarysphincterispresentinb/w
metarteriole&capillary;d.Pudendalnervesuppliesthe
sphincterurethrae;e.Sphincterofoddiliesatjunctionof
duodenum&CBD
Thecommonbileductenterstheduodenumatduodenumpapilla.
ItsorificeissurroundedbythesphincterofOddi6itusuallyunites
withthemainpancreaticductjustbeforeenteringtheduodenum
Atthelowerendoftheesophagus,extendingupwardabout3cm
aboveitsjunctionwithstomach,itisbroadloweresophageal
sphincter.
Loweroesophagealsphincter,aspecializezoneofcircularsmooth
musclesurroundingtheoesophagusatitstransitthroughthe
diaphragmandformuchofitsshortabdominalfloor
Atthepointwhereeachtruecapillaryoriginatesfromametarteriole,
asmoothmusclefiberusuallyencirclesthecapillary.Thisiscalled,
theprecapillarysphincter.Thissphinctercanopen&closethe
entrancetothecapillary
Pyloricsphincterremainslightlytonicallycontractedalmostallthe
time.Despitenormaltoniccontractionofthepyloricsphincter,the
pylorususuallyisopenenoughforwater&otherfluidstoemptyfrom
thestomachintotheduodenumwithease.
10.Muscle(s),whichformthefloorofpelvic
floor:
a)Obturatorinternus
b)Piriformis
c)Puborectalis
d)Pubococcygeus
e)Ischiococcygeus
CorrectAnswer-C:D:E
Ans.c.Puborectalis;d.Pubococcygeus;e.Ischiococcygeus
Thepelvicfloorisformedbythelargelevatorani(withparts
includingthepubococcygeus,puborectalis,andiliococcygeus)and
themuchsmallercoccygeus.
11.TrueaboutAtlanto-axialjoint:
a)Vertebralarterypassthroughgroveonarchofatlasvertebrae
toforamenmagnum
b)Permitsflexion&extension
c)Permitsidetosidemovementofhead
d)Permitsflexiononly
e)Permitsrotation
CorrectAnswer-A:C:E
Ans.a.Vertebralarterypassthroughgroveonarchofatlas
vertebraetoforamenmagnum;c.Permitsidetosidemovement
ofhead;e.Permitsrotation
Thereare3atlantoaxialarticulations-twolateralatlantoaxialjoints
b/wthelateralmassesofCl&C2vertebrae&onemedian
atlantoaxialjointb/wthedensofC2&theanteriorarchtransverse
ligamentoftheatlas
Movement(mainlyrotation)atallthreeatlantoaxialjointspermitsthe
headtobeturnedfromsidetoside,asoccurswhenrotatingthe
headtoindicatedisapproval(the'NO'movement)
Themostimportantfactorsmaintainingstabilityaretheligaments,of
whichthetransverseatlantalligamentisthestrongest.
Thealarligamentsareweaker
12.AllaretrueaboutCSFexcept:
a)Totalvolumeis250ml
b)Pressureis60-180mmofH2O
c)Formedfromchoroidplexusof3rdventricle
d)Formedfromchoroidplexusoflateralventricle
e)Noneoftheabove
CorrectAnswer-A
Ans.a.Totalvolumeis250ml
ThemajorsourceofCSFisthechoroidalplexusofall4ventricles,
mainlyintwolateralventricles.
OthersourcesofCSFareependymalcellsoftheventriclesandthe
brainitself,viaperivascularspaces.
ThetotalvolumeofCSFinanadultisabout125-150ml.
TherateofformationofCSFisabout500-550ml/day.ThustheCSF
isreplaced3-4timeseveryday.
CSFpHis7.33
112mmH20istheaveragenormalCSFpressure
13.
Whichofthefollowingplaymost
importantroleinmemory:
a)Synapticnetwork
b)Electricconductionnetwork
c)Conductivitycircuit
d)Conductivitynetwork
e)None
CorrectAnswer-A
Ans:a.SynapticNet.
[Ref:Ganong25th/283-88;Guyton12th/67;AKJain6th/1039-40]
Synapticnetworkssinglebestanswer"Long-termmemoryinvolves
changesinthestructureofneuronsincludinggrowthofnew
processesandsynapses.
So,totheextentthatyourememberanythingaboutthismaterialon
memorytomorrow,ornextweek,ornextyear,itwillbebecause
structuralchangesinsynapsesarebeginninginyourbrains.
14.CyanidepoisoningblockKinflux&Na
efflux.ButATPreversethiseffect.Sotrue
statement(s)relatedtomechanismof
actionofcyanideis/are:
a)Kinflux&NaeffluxisregulatedbyNa-KATPaseenzyme
b)Kinflux&NaeffluxisregulatedbyNa-Kpump
c)ATPprovideenergyforthischannel
d)Na-KATPasechannelisATPindependent
e)None
CorrectAnswer-A:B:C
Ans:a.Kinflux&NaEffluxIsRegulatedByNa-K-ATpase
Enzymeb.Kinflux&NaEffluxIsRegulatedByNa-Kpumpc.
ATPprovidesenergyforthischannel.
[Ref:Reddy32nd/595;Katzung13th/1010;Guyton12th/357;AK
Jain6th/459;Harrison19th/262e-7]
Cyanide:
Directlypoisonsthelaststepinthemitochondrialelectrontransport
chain,cytochromea3,whichresultsinashutdownofcellularenergy
production.
Thispoisoningresultsfromcyanidehighaffinityforcertainmetals,
notablyCoandFe+++.Cytochromea3containsFe+++,towhich
CN-binds.
CyanidePoisoning:
Itinhibitstheactionofcytochromeoxidase,carbonicanhydrase&
probablyofotherenzymesystem.
Itblocksthefinalstepofoxidativephosphorylation&preventsthe
formationofATP&itsuseasanenergysource.
15.TrueaboutCarbonmonoxidepoisoning:
a)COhas100timesmoreaffinitythan02forHb
b)Causerightsideshiftingof02dissociationcurve
c)Oxygen-haemoglobinsaturationcurvebecomeshyperbolic
shape
d)PulseoximetrycanaccuratelydetectlevelofCO
e)10-15%levelofCOnormallymayoccurinhealthynonsmoker
CorrectAnswer-C
Ans:c.Orygen-haemoglobinsaturationsaturationCurve
BecomesHyperbolicShape
[RefGanong25th/650-51;Guyton12th/352;AKJain6th/431;
httpst/pedclerk.bsd.uchicago.edu/page/(www.nebi.Nlm.nih.
gov)
Carbon-monoxide-poisoning:
Carbonmonoxideshiftstheoxygen-haemoglobinsaturationcurveto
theleftandchangesittoamorehyperbolicshape.
Lessoxygenisavailableforthetissues.
plasmalevelofcarboxyhemoglobinisnormallyquitelow.
Atbaseline,levelsupto3percent,naybeseeninnonsmokers,
whilesmokersmayhavelevelsupto10-15%percent.
LeftshiftofO2-Hbdissociationcurveoccurin-COpoisoningHbF,
myoglobinebdecreaseinbodytemperature.
COhasabout240timestheaffinityofO2forHb;thismeansthatCO
willcombinewiththesameamountofHbas02whentheCOpartial
pressureis240timeslower.
16.Deadspaceisincreasedin:
a)Positivepressureventilation
b)Extensionofneck
c)Anticholinergicdrug
d)Endotrachealtubeintubation
e)Emphysema
CorrectAnswer-A:B:C:E
Ans:a.Positivepressureventilationb.Extensionofneckc.
AntiCholinergicdruge.Emphysema
RefAjayYadav5th/4-5;Ganong25th/632-33;Guyton323;AKlain
6th/421
AnatomicalDeadSpaceIncreasedin:
OIdage
Neckextension
jawprotrusion
Bronchodilators
Increasinglungvolume(moreininspiration)
Atropine(causebronchodilation)
Anaesthesiamask,circuits
Intermittentpositivepressureventilation(IppV)&positiveend
expiratorypressure(PEEP)
AlveolarDeadSpaceincreasedby:
Lungpathologiesaffectingdiffusionatcapillarymembranelike
interstitiallungdisease,pulmonaryembolism,pulmonaryedema&
ARDS
Generalanaesthesia
IPPV
PEEP
HYPotension
17.Whichofthefollowingistrueabout
cardiacinnervation:
a)T1-T5issympatheticsupply
b)Inferior&superiorcervicalganglianotinvolveininnervation
c)Parasympatheticsupplyisfromvagusnerve
d)Greatcardiacnervearisefromsuperiorcervicalganglia
e)InferiorcervicalgangliagivesoffInferiorcardiacnerve
CorrectAnswer-A:E
Ans:a.T1-T5issympathetice.Inferiorcervicalgangliagives
offinferiorcardiacnerve
[Ref:BDC6th/Vol.I267;Grayb40th/982;Guyton12th/178;AKlain
6th/324]
CardiacInnervation
Thecervicalgangliaareparavertebralgangliaofthesympathetic
nervoussystem.
Thecervicalganglionhasthreeparavertebralganglia.
Superiorcervicalganglion(largest)-adjacenttoC2&C3
Middlecervicalganglion(thesmallest)-adjacenttoC6;target:
heart,neck.
Inferiorcervicalganglion.Theinferiorganglionmaybefusedwith
thefirstthoracicgangliontoformasinglestructure,thestellate
ganglionadjacenttoC7.
Themiddlecardiacnerve(greatcardiacnerve),thelargestofthe
threecardiacnerves,arisesfromthemiddlecervicalganglion.
Nervesemergingfromchemicalsympatheticgangliacontributeto
thecardiacplexus.
SymPatheticsupply:T1toT5spinalsegments.
SympatheticpreganglionicfibrespassintothesymPathetictrunkto
superionmiddle&inferiorcardiacganglion
Sympatheticpostganglionicfibrespassesviasuperiormiddle&
inferiorcardiacsympatheticnerves
Parasympatheticsupplytoheartisviatwovagusnerveswiththeir
cellbodieslocatedinthemedullainthenucleusambiguus.
18.Trueaboutcortisollevelinbloodplasma:
a)Morningconcentrationis17-18nmol/d1
b)Morningconcentrationis5-23pg/dL
c)Eveningconcentrationisalmosthalfofmorningconcentration
d)Eveningconcentrationis5-23i.ig/dL
e)None
CorrectAnswer-B:C
Ans:b.Morningconcentrationis5-23microg/dLc.Evening
concentrationisalmostHalfOfMorningConcentration
Eveningconcentrationisalmosthalfofmorningconcentration(a/c
belowreferencevalues).
Cortisolconcentrationat8.00aminmorning5-20mcg/dL(140-550
nmol/L).
19.Saccadicceyemovementiscontrolledby:
a)Parietallobe
b)Prefrontallobe
c)Temporallobe
d)Frontalcortex
e)Occipitallobe
CorrectAnswer-D
Ans:d.Frontalcortex
[RefGanong25th/189,195-96;Guyton12tlt/786;AKJain1115-16]
Normallysaccadicmovementsarevoluntarybutcanbearousedby
peripheralvisualorauditorystimulibystimulationoffrontaleye
fields(area8).
Thusthesemovementsareprogrammedinthefrontalcortex.
Thebilateralfrontaleyefieldsinthispartofthecortexareconcerned
withthecontrolofsaccades,andanareajustanteriortothesefields
isconcernedwithvergenceandthenearresponse.
20.TrueaboutnormalECG:
a)NormalPRintervalis0.12-0.20s
b)PRinternalcorrespondenceinitiationofPwavetoinitiationofR
wave
c)QTinternalcorrespondenceinitiationofQwavetoinitiationofT
wave
d)NormalQRSinterval<0.12s
e)NormalQTcinterval
CorrectAnswer-A:D
Ans:a.NormalPRintervalis0.12-0.20sd.NormalQRSinterval
[Ref:Ganong25th/524;Guyton12th/179-80;ECGmadeEasyby
Hamptot4th/6-71]
ThePRintervalismeasuredfromthebeginningofPwavetothe
beginningofQRScomplex.
AQTcintervallongerthan0.45sislikelytobeabnormal.
NormalQRSintervaldurationisnogreaterthan0.12s.
QTintervalisameasureofthetimebetweenthestartoftheQwave
andtheendoftheTwaveintheheart'selectricalcycle.
21.Whichofthefollowingis/aretrueabout
SIADH:
a)Desmopressinisusedfortreatment
b)Vasopressinlevelisinappropriatelyhigh
c)Plasmaosmolalityishigherthanurineosmolality
d)TedOsmolalityofurine
e)TedOsmolalityofplasma
CorrectAnswer-B:D
Ans:b.VasopressinlevelisinappropriatelyHighd.Ted
Osmolalityofurine
[RefHarrison19th/2280;Ganong25th/698;AKJain6th/673-74]
Desmopressinisveryusefulinthemanagementofdiabetes
insipidus.
SyndromeofInappropriateAntidiureticHormone
Thesyndromeof"inappropriate'hypersecretionofantidiuretic
hormone(SIADH)occurswhenvasopressinisinappropriatelyhigh
relativetoserumosmolality.
Vasopressinisresponsiblenotonlyfordilutionalhyponatremia
(serumsodium<135mmol/L)butalsoforlossofsaltintheurine
whenwaterretentionissufficienttoexpandtheECFvolume,
reducingaldosteronesecretion
Features:
Hyposmolality
Increasedurineosmolality
Urineosmolalitybecomeshigherthanplasmaosmolality
UrinaryNa+exceeds20mEq/L
22.Whichofthefollowingfeature(s)is/are
suggestiveofnehogrnicDIincomparison
tocentralDI:
a)Desmopressinnasalsprayrestoreurineoutputtonormallevel
b)Basalvasopressinlevel>1pg/ml
c)NormalposteriorpituitarybrightspotisnotvisibleonMRIscan
d)Changeinwaterlossduringfluiddeprivationtest
e)None
CorrectAnswer-B
Ans:b.Basalvasopressinlevel>1pg/ml
[RefGanong25th/698;Guyton12th/488-89;AKJain6th/674]
FailuretoProduceADH:"Central"DiabetesInsipidus.
Thetreatmentforcentraldiabetesinsipidusisadministrationofa
syntheticanalogofADH,desmopressin,whichactsselectivelyon
V2receptorstoincreasewaterpermeabilityinthelatedistaland
collectingtubules.
Desmopressincanbegivenbyinjection,asanasalspray,ororally,
anditrapidlyrestoresurineoutputtowardnormal.
ThepolyuriaanilpolydipsiaofnephrogenicDIarenotaffectedby
treatment*ithstandarddosesofDDAVP.
23.AllareUreacycleenzymesexcept:
a)Ornithinetranscarbamylase
b)Carbamoyl-phosphatesynthetaseI
c)Argininosuccinase
d)Citrullinesynthase
e)Argininosuccinicacidsynthetase
CorrectAnswer-D
Answer:(D)Citrullinesynthase[RefHarper30th/290-96,
29th/274-88;Lippincott
24.Non-polaraminoacidsare:
a)Proline
b)Lysine
c)Isoleucine
d)Arginine
e)Asparginine
CorrectAnswer-A:C
Ans:a.Prolinec.Isoleucine[RefHarper30th/16-22;Lippincott
6th/1-9;Satyanarayan4th/48]
AcidicandPolarsidechainsAsparticAcidGlutamicAcid
BasicandPolarsidechainsArginine,Lysine,Histidine
Uncharged&PolarsidechainsAsparginine,Glutamine,Serine,
Threonine,Tyrosine
NonPolarAminoAcidswithNonPolarsidechainsGlycine,
Alanine,Valine,Leucine,Isoleucine,Proline.
25.Trueaboutsqualene:
a)Presentinsubhumanprimateonly
b)Itisoneofthemajorcarbohydratesofbody
c)Itinvolvesinthesynthesisofcholesterol
d)Itinvolvesinthesynthesisofsteroids
e)None
CorrectAnswer-C:D
Ans:(C)Itinvolvesinsynthesisofcholesterol,(D)Itinvolvesin
synthesisofsteroids
Squaleneisahydrocarbonandatriterpene,andisanaturaland
vitalpartofthesynthesisofallplantandanimalsterols,including
cholesterol,steroidhormones,andvitaminDinthehumanbody.
Squaleneisusedincosmetics,andmorerecentlyasan
immunologicadjuvantinvaccines.
Itisanatural30-carbonorganiccompoundoriginallyobtainedfor
commercialpurposesprimarilyfromsharkliveroil(henceitsname),
althoughplantsources(primarilyvegetableoils)arenowusedas
well,includingamaranthseed,ricebran,wheatgerm,andolives.
Squaleneandomega2fattyacidhasunlikeomega3fishoilsmore
completeandeffectivechemicalgroups.
26.Molecularweightofproteincanbe
determined/estimatedby:
a)SDS-PAGE
b)Gelfiltrationchromatography
c)Agarosegelelectrophoresis
d)Ultracentrifugation
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
"SDS-PAGEiscommonlyusedformolecularweightdetermination
ofproteins"(Vasudevan5th/482)
"SDS-PAGEisapopulartechniquefordeterminationofmolecular
weightofproteins"(Satyanarayan4th/725)
"Sodiumdodecylsulfate-polyacrylamidegelelectrophoresis(SDS-
PAGE)isareliablemethodfordeterminingthemolecular
weight(MW)ofanunknownprotein".
"Thegelfiltrationchromatographytechniqueisusedfor"Separation
ofproteinmolecules,purificationofproteins&molecularweight
determinations"Ultracentrifugationisanindispensabletoolforthe
isolationofsubcellularorganelles,proteins,&nucleicacids.In
addition,thistechniqueisalsoemployedindeterminationof
molecularweightofmacromolecules\
27.GelusedinRNAelectrophoresis:
a)Agarosegel
b)Polyacrylamideplaingel
c)PolyacrylamideSDS(Sodiumdodecylsulphate)impregnated
Polyacrylamidegel
d)A&C
e)None
CorrectAnswer-A
Ans:a.Agarosegel
SeparationofRNAinagarosegelsisusedforanumberofdifferent
purposes,includingNorthernblotstomonitorRNAexpression
levels,checkingRNAintegrityandsizeselectionofRNAforcloning
experiments.
SeparationofRNAbasedonfragmentlengthrequiresconditions
thataredifferentfromDNAanalysis.
ThemostfrequentlyuseddenaturantsforRNAagarosegel
electrophoresisareformaldehyde,formaldehyde/formamide,and
glyoxalplusDMSO.
ThemostefficientRNAdenaturantismethylmercuryhydroxide.
Becauseofthehazardsassociatedwiththisdenaturant,itisthe
leastusedsystemforRNA
28.Whichoffollowingreleases/provide
energy:
a)ConversionofADPtoATP
b)Breakingofhighenergybondtolowenergybond
c)Conversionofpyruvatetolactate
d)Electricalgradientacrossinner&outersideofmitochondria]
membrane
e)Passageofe-throughFADinelectrontransportchain
CorrectAnswer-B:D:E
Ans:(B)Breakingofhigh...(D)Electricalgradientacross...(E)
Passageofe-throughFAD....
Inabsenceof0xygenpyruvateisreducedtolacticacid(without
producingATP).Inanaerobicglycolysis,pyruvateactsasa
temporaryH-store.
Itdehydrogenation(oxidizes),thereducedNADH+H+backto
oxidizedNAD+,sothatglycolysiscancontinueevenintheabsence
of02.Inpresenceof02,lacticacidcanbeoxidizedintopyruvicacid
again.
ElectrontransportiscoupledtothephosphorylationofADPbythe
transport("pumping")ofprotons(H+)acrosstheinnermitochondrial
membranefromthematrixtotheintermembranespaceat
ComplexesI,III,andIV.
Thisprocesscreatesanelectricalgradient(withmorepositive
chargesontheoutsideofthemembranethanontheinside)anda
pHgradient(theoutsideofthemembraneisatalowerpHthanthe
inside).
Theenergygeneratedbythisprotongradientissufficienttodrive
ATPsynthesis.Thus,theprotongradientservesasthecommon
intermediatethatcouplesoxidationtophosphorylation.
29.Whichofthefollowingisfeature(s)of
diabeticketoacidosis:
a)Decreasedtriglyceridelevel
b)Increasedfattyacidlevel
c)TLipoprotein
d)Decreasedketonebodies
e)HighAniongapacidosis
CorrectAnswer-B:C:E
Ans:(B)Increasedfattyacidlevel(C)TLipoprotein(E)High
Aniongapacidosis[RefHarper30th/231;Lippincott6th/339,
345;Satyanarayan4th/481,682;Harrison19th/2417-18]
DKAischaracterizedbyhyperglycemia,ketosis,andmetabolic
acidosis(increasedaniongap)alongwithanumberofsecondary
metabolicderangements,Leukocytosis,hypertriglyceridemia,and
hyperlipoproteinemiaarecommonlyfoundaswell
Increasedlacticacidproductionalsocontributestotheacidosis.The
increasedfreefattyacidsincreasetriglycerideandVLDLproduction.
VLDLclearanceisalsoreducedbecausetheactivityofinsulin-
sensitivelipoproteinlipaseinmuscleandfatisdecreased.
Hypertriglyceridemiamaybesevereenoughtocausepancreatitis.
Reducedinsulinlevels,incombinationwithelevationsin
catecholaminesandgrowthhormone,increaselipolysisandthe
releaseoffreefattyacids.Normally,thesefreefattyacidsare
convertedtotriglyceridesorvery-low-densitylipoprotein(VLDL)in
theliver.
30.Whichofthefollowingis/aretrueabout
pHofsolution:
a)Absoluteconcentrationofacid&salt
b)Relativeconcentrationofacid&saltinsolution
c)IncreaseoftemperatureincreasespH
d)AriseinH+concentrationdecreasespH
e)None
CorrectAnswer-B:D
Ans:(B)Relativeconcentration...,(D)AriseinH*concentra
tion....
"WhenpHmeasuredatroomtemperaturethereisnodirect
correlationbetweenpHandtemperature.
AriseinH+concentrationdecreasespHwhileafallinH+
concentrationincreasespH.ThereverseistrueforOH-
concentration
Theratioofsalttoacidconcentration-Actualconcentrationsofsalta
acidinabuffersolutionmaybevaryingwidely,withnochangein
pH,solongastheratiooftheconcentrationsremainsthesame
31.Truestatement(s)aboutMagnetic-
activatedcellsorting:
a)Itisamethodtoseparatespecificcellfromcomplexmixture
b)Fluorescentdyesareuses
c)Antibody-coatedmagneticnanoparticlesareused
d)Antibodiesusedarespecificforcertaincellsurfacemarkers
e)Magneticfieldisapplied
CorrectAnswer-A:C:D:E
Ans:(A)Itisamethod...,(C)Antibody-coatedmagnetic...,(D)
Antibodiesusedare...,(E)Magneticfieldisappli...
MACS,isaproceduredevelopedbyMiltenyiBiotectoseparatecells
fromcomplexmixturesusingantibody-coatedmagneticnano
particles.
Theantibodiesarespecificforcertaincellsurfacemarkers,either
expressedonyourpopulationofinterest(positiveselection),or
expressedonundesiredcelltypes(negativeselection).
Afteraddingtheantibody-coatedbeadstothecellmixtureand
incubating,thesuspensionisaddedtoaspecialsingle-use
separationcolumnaffixedtoamagnet,towhichthebeadsstick,
whileunlabeledcellsflowthrough.
32.Silverstainingisdonefor:
a)DNA
b)RNA
c)Karyotypinganalysis
d)Protein
e)Collagen
CorrectAnswer-A:B:C:D:E
Answer-(A)DNA(B)RNA(C)Karyotypinganalysis(D)Protein
(E)Collagen
Silverstainingisahighlysensitivemethodfordetectingproteinsand
nucleicacids(dsDNA&RNA)inpolyacrylamideslabgels.
Silverstainingistheuseofsilvertoselectivelyaltertheappearance
ofatargetinmicroscopyofhistologicalsections;intemperature
gradientgelelectrophoresis;andinpolyacrylamidegels.
Silverstainingisthemostsensitivemethodforpermanentstaining
ofproteinsornucleicacidsinpolyacrylamidegels.
Histologicalcharacterization:Silverstainingaidsthevisualizationof
targetsofinterest,namelyintracellularandextracellularcellular
componentssuchasDNAandproteins,suchastypeIIIcollagen
andreticulinfibresbythedepositionofmetallicsilverparticlesonthe
targetsofinterest.
33.Non-codingRNAis/are:
a)miRNA
b)SiRNA
c)tRNA
d)mRNA
e)rRNA
CorrectAnswer-A:B:C:E
Ans:a.miRN...,b.SiRNA...,c.tRNA...,e.rRNA...,[RefHarper
30th/394-95,368;en.wikipedia.org;Lippincott6th/417]
AlleukaryoticcellshavetwomajorclassesofRNA,theprotein
codingRNAs,ormessengerRNAs(mRNAs),andtwoformsof
abundantnon-proteincodingRNAsdelineatedonthebasisofsize:
thelargeribosomalRNAs(rRNA)andlongnoncodingRNAs
(lncRNAs)andsmallnoncodingRNAstransferRNAs(tRNA),the
smallnuclearRNAs(snRNAs)andthemicroandsilencingRNAs
(miRNAsandsiRNAs).
ThemRNAs,rRNAsandtRNAsaredirectlyinvolvedinprotein
synthesiswhiletheotherRNAsareparticipateineithermRNA
splicing(SnRNAs)ormodulationofgeneexpressionbyaltering
mRNAfunction(mi/SiRNAs)and/orexpression(lncRNAs).These
RNAdifferintheirdiversity,stability,andabundanceincells
34.PolymeraseIIIsynthesizes:
a)Fragment28SofrRNA
b)Fragment23SofrRNA
c)Fragment5SofrRNA
d)tRNA
e)mRNA
CorrectAnswer-C:D
Ans:c.andd[RefHarper30th/395-98;Lippincott428]
"RNApolymeraseIIIsynthesizestRNA,5SrRNA,andsomesnRNA
andsnoRNA"(Lippincott428)
35.TwostrandsofDNAis/areheldby:
a)Glycosidicbond
b)Hydrogenbond
c)Covalentbond
d)Ionicbond
e)Vanderwaalforce
CorrectAnswer-B
Answer(b)hydrogenbond[RefHarper30th/359;Lippincott
6th/396-97;Satyanarayan4th/75]
Thetwostrandsareheldtogetherbyhydrogenbondformed
bycomplementarybasepairs"(Satyanarayan4th/75)
"Thebasepairsareheldtogetherbyhydrogenbonds:twobetween
AandTandthreebetweenGandC.Thesehydrogenbonds,plus
thehydrophobicinteractionsbetweenthestackedbases,stabilize
thestructureofthedoublehelix.
36.Whichofthefollowingis/aretrueabout
Translation:
a)N-formylmethionineisfirstaminoacidinprokaryotes
b)UsesenergyinformofGMP
c)ElongationfactorEF-1&EF-2usedinprokaryotes
d)ElongationfactorPisusedineukaryoticorganism
e)Threeinitiationfactorsarerequiredinprokaryotes
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
methionine,whichisthefirstaminoacid"(Vasudevan5th/432)
"ElongationfactorPisaprokaryoticproteintranslation
factorrequiredforefficientpeptidebondsynthesison70S
ribosomesfromfMet-tRNAfMet.Itprobablyfunctionsindirectlyby
alteringtheaffinityoftheribosomeforaminoacyl-tRNA,thus
increasingtheirreactivityasacceptorsforpeptidylStepsinProtein
Synthesis
Inprokaryotes,threeinitiationfactorsareknown(IF-1,IF-2,andIF-
3),whereasineukaryotes,thereareoverten(designatedeIFto
indicateeukaryoticorigin).EukaryotesalsorequireATPforinitiation.
37.Nucleicacidamplificationtechniquesare:
a)PCR
b)RealtimePCR
c)DNACloning
d)NextgenerationDNAsequencing
e)None
CorrectAnswer-A:B
Ans:a.PCR...,b.Realtime....[RefHarper30th/458;Robbins
9th/180;Lippincott6th/479;Harrison19th/150e-7;http://link.
springer.corn]
Real-timePCRautomatesthelaboriousprocessofamplificationby
quantitatingreactionproductsforeachsampleinevery
Cycle.
Thereareseveralmethodsforamplification(copying)ofsmall
numbersofmoleculesofnucleicacidtoreadilydetectablelevels.
TheseNAATsincludePCR,LCR,stranddisplacementamplification,
andself-sustainingsequencereplication.
Theamplifiednucleicacidcanbedetectedafterthereactionis
completeor(inreal-timedetection)asamplificationproceeds.The
sensitivityofNAATsisfargreaterthanthatoftraditionalassay
methodssuchasculture.
38.Secondmessengeris/are:
a)Ca2+
b)DNA
c)Histone
d)cDNA
e)None
CorrectAnswer-A
Ans:a.Ca2+[RefHarper30th/501,91-92,179,343;Lippincott
6th/94-951
Nucleotides,suchascyclicadenosinemono-phosphate(cAMP)and
cyclicguanosinemonophosphate(cGMP),serveassecond
messengersinsignaltransductionpathways.
Twoofthemostwidelyrecognizedsecondmessengersystemsare
thecalciumlphosphatidylinositolsystem,andtheadenylylcyclase
system,whichisparticularlyimportantinregulatingthepathwaysof
intermediarymetabolism.
39.Trueaboutgeneticcode:
a)FollowMendelianlaw
b)Itistotalnumberofchromosomeinthebody
c)Itisnucleotidesequencewhichcodesforaminoacids
d)ItcodesforDNA
e)None
CorrectAnswer-C
Ans:c.Itisnucleotidesequencewhichcodesforaminoacids
MendelianGeneticsiswidelyregardedasthecornerstoneof
classicalgenetics.Itisasetofprimarybeliefsrelatingtothe
transmissionofhereditarycharacteristicsfromparentorganismsto
theiroffspring
Thegeneticcodeisadictionarythatidentifiesthecorrespondence
betweenasequenceofnucleotidebasesandasequenceofamino
acids.
TheNucleotideSequenceofanmRNAMoleculeConsistsofa
SeriesofCodonsThatSpecifytheAminoAcidSequenceofthe
EncodedProtein
40.Restrictionendonucleasecleaves:
a)dsDNA
b)RNA
c)Histone
d)Protein
e)ssDNA
CorrectAnswer-A
Ans:a.dsDNA
Restrictionendonucleases(restrictionenzymes),which
cleavedouble-stranded(ds)DNAintosmaller,moremanageable
fragments,hasopenedthewayforDNAanalysis"
Restrictionenzyme(REorRestrictionEndonuclease)isanenzyme
thatcleavedouble-strandedDNAQatspecificrecognitionnucleotide
knownasrestrictionsitesQ
ThecutDNAfragmentsbyREmayhavestickyends(cohesive
ends)?orbluntsends?dependingonthemechanismusedby
enzyme
DNAfragmentswithstickyendsareparticularlyusefulfor
recombinantDNAexperiments(hybridorchimericDNAmolecules)
Restrictionenzymeisnamedaccordingtotheorganismfromwhich
itwasisolated
41.PhospholipaseA2acton:
a)Phosphoglycericacid
b)Phosphate
c)Ca+
d)Phosphatidyl-inositol
e)None
CorrectAnswer-D
Ans:d.Phosphatidyl-inositol
Phospholipaseshydrolyzethephosphodiesterbondsof
phosphoglycerides,witheachenzymecleavingthephospholipidata
specificsite.
Phospholipasesreleasemoleculesthatcanserveasmessengers
(forexample,DAGandIP3),orthatarethesubstratesforsynthesis
ofmessengers(forexample,arachidonicacid.
Phospholipasesareresponsiblenotonlyfordegrading
phospholipids,butalsofor"remodeling"them.Forexample,
phospholipasesAlandA2removespecificfattyacidsfrom
membrane-boundphospholipids;thesecanbereplacedwith
alternativefattyacidsusingfattyacylCoAtransferase.
42.EnzymeusedinDNArepairis/are:
a)DNAgyrase
b)DNApolymerase
c)Restrictionendonuclease
d)DNAligase
e)None
CorrectAnswer-B:D
Ans:b.DNApoly...,d.DNA(RefHarper30th/382,389-92;
Lippincott6th/411-131
Whenthestrandcontainingthemismatchisidentified,an
endonucleasenicksthestrandandthemismatchednucleotide(s)
is/areremovedbyanexonuclease.
Additionalnucleotidesatthe5'-and3'-endsofthemismatchare
alsoremoved.Thegapleftbyremovalofthenucleotidesisfilled,
usingthesisterstrandasatemplate,byaDNApolymerase.
The3'-hydroxylofthenewlysynthesizedDNAisjoinedtothe5'-
phosphateoftheremainingstretchoftheoriginalDNAstrandby
DNAligase
43.Nucleosomecontains:
a)DNA
b)RNA
c)Chromatin
d)Histone
e)None
CorrectAnswer-A:D
Ans:a.DNAd.Histone[RefHarper30th/371-72;Lippincott6th/
409]
Histonesarehighlyalkalineproteinsfoundineukaryoticcellnuclei
thatpackageandordertheDNAintostructuralunitscalled
nucleosomes.
Theyarethechiefproteincomponentsofchromatin,actingas
spoolsaroundwhichDNAwinds,andplayingaroleingene
regulation.
WhenthehistoneoctamerismixedwithpurifieddsDNAunder
appropriateionicconditions,thesamex-raydiffractionpatternis
formedasthatobservedinfreshlyisolatedchromatin.Biochemical
andelectronmicroscopicstudiesconfirmtheexistenceof
reconstitutednucleosomes.
Inthenucleosome,theDNAissupercoiledinalefthandedhelix
overthesurfaceofthedisk-shapedhistoneoctamer
44.Serotonin,amediatorofinflammationin
ourbody,issecreted/releasedby:
a)Leukocytes
b)Endothelialcell
c)Mastcell
d)Platelet
e)Macrophage
CorrectAnswer-D
Answer-D.Platelet
Serotonin:Itisfoundintheintestinalmucosa,braintissue&
platelets.
Releaseofserotonin(andhistamine)fromplateletsisstimulated
whenplateletsaggregateaftercontactwithcollagen,thrombin,
adenosinediphosphate(ADP),andantigen-antibodycomplexes.
45.Autosomalrecessivedisease(s)is/are:
a)Sicklecellanaemia
b)Phenylketonuria
c)Tuberousscelerosis
d)Familialpolyposiscoli
e)Marfansyndrome
CorrectAnswer-A:B
Answer-(A)Sicklecellanaemia(B)Phenylketonuria
1.Metabolic-
Cysticfibrosis
Phenylketonuria
Galactosemia
Homocystinuria
Wilsondisease
Hemochromatosis
2.Hematopoietic
Sicklecellanemia
Thalassemias
3.Endocrine
Congenitaladrenalhyperplasia
4.Skeletal
Ehlers-Danlossyndrome
5.Nervous
Friedreichataxia
Spinalmuscularatrophy
46.Whichofthefollowingis/arefeatures(s)of
lewybodydementia:
a)Plaquecontainingbeta-amyloidpeptide
b)Depositionofa-synucleinprotein
c)Oftenresistanttostandardtreatment
d)Commoninelderly
e)Riskoffallingmaypresent
CorrectAnswer-B:C:D:E
Answer-(B)Depositionofa-synucleinprotein(C)Often
resistanttostandardtreatment(D)Commoninelderly(E)Risk
offallingmaypresent
Alpha-synucleincontainingLewybodiesoccurinthebrainstem,
midbrain,olfactorybulb,andneocortex.
Thisisaneurodegenerativedisorderclinicallycharacterizedby
dementiaandsignsofParkinson'sdisease.
Commoninelderly.
TheDLBclinicalsyndromeischaracterizedbyvisualhallucinations,
parkinsonism,fluctuatingalertness,falls.
47.TrueaboutAlzheimer'sdisease:
a)Morecommoninolderage
b)Impairmentoftheabilitytoremembernewinformation
c)Mainlyaffectslongtermmemory
d)Generalcognitivebehaviorimpairedinprodromalphase
e)Atrophyoffrontal&parietallobe
CorrectAnswer-A:B:D:E
Answer-(A)Morecommoninolderage(B)Impairmentofthe
abilitytoremembernewinformation(D)Generalcognitive
behaviorimpairedinprodromalphase(E)Atrophyoffrontal&
parietallobe
Alzheimer'sdisease(AD)isaslowlyprogressivediseaseofthe
brainthatischaracterizedbyimpairmentofmemory.
Alzheimer'sdiseaseisCommonin5thand6thdecade.
EarlyStage-
Thisisconsideredasamild/earlystageandthedurationperiodis2-
4years.
Frequentrecentmemoryloss.
Writingandusingobjectsbecomedifficultanddepressionand
apathycanoccur.
Secondstage-
Thisisconsideredasamiddle/moderatestageandthedurationis2-
10years.
DementiaofAlzheimer'stypeisassociatedwithDepressive
symptoms,Delusions,Apraxiaandaphasia.
Pervasiveandpersistentmemorylossimpactslifeacrosssettings.
Moderatestage-
Increasedmemorylossandconfusion.
Laststage-
Thisisconsideredastheseverestageandthedurationis1-3years.
Extremeproblemswithmood,behavioralproblems,hallucinations,
anddelirium.
48.TrueaboutHypersensitivitypneumonitis:
a)Occursduetoinorganicantigen
b)IncreasedCD8+Tcellsinbronchoalveolarlavage
c)Manifestsmainlyasanoccupationalandenvironmentdisease
d)Forsevereacutecases,oralsteroidsisgivenfor3-4weeks
e)Interstitialinflammatoryinfiltrateisseeninlung
CorrectAnswer-B:C:D:E
Answer-(B)IncreasedCD8+Tcellsinbronchoalveolarlavage
(C)Manifestsmainlyasanoccupationalandenvironment
disease(D)Forsevereacutecases,oralsteroidsisgivenfor3-
4weeks(E)Interstitialinflammatoryinfiltrateisseeninlung
Itismanifestedmainlyasanoccupationaldisease,inwhich
exposuretoinhaledorganicagentsleadstoacuteandeventually
chronicpulmonarydisease.
Bronchoalveolarlavagespecimensalsoconsistentlydemonstrate
increasednumbersofbothCD4+andCDB+Tlymphocytes.
HistologyshowsevidenceofaninterstitialinflammatoryinfiItratein
thelung.
Inacutecases,prednisoloneshouldbegivenfor3-4weeks,starting
withanoraldoseof40mgperday.
49.RScellhavingsameimmunophenotyping
arepresentinwhichsubtypesof
Hodgkin'slymphoma:
a)Nodularsclerosis
b)Lymphocytepredominant
c)Lymphocyterich
d)Mixedcellularity
e)Lymphocytedepletion
CorrectAnswer-A:C:D:E
Answer-(A)Nodularsclerosis(C)Lymphocyterich(D)Mixed
cellularity(E)Lymphocytedepletion
Inthefirstfoursubtypes-nodularsclerosis,mixedcellularity,
lymphocyte-rich,andlymphocytecells.
50.TrueaboutLyonisationofXchromosome:
a)InactivationofXchromosomeonlyinsomaticcell
b)InactivationofXchromosomeonlyingermcell
c)InactivationofXchromosomeinsomatic&germcellboth
d)MaximunnumberofBarrbodyisequaltoXchromosome
e)All
CorrectAnswer-A
Answer-A.InactivationofXchromosomeonlyinsomaticcell
Infemale,oneoftwoX-chromosome(eitherpaternalormaternal)is
inactivatedduringembryogenesisasstatedinLyonhypothesis.
Thisinactivationispassedtoallthesomaticcellwhilethegermcells
inthefemaleremainunaffected.
51.TwomostcommoncancerinIndian
womanis:
a)Carcinomabreast
b)Carcinomacervix
c)Carcinomacolon
d)Carcinomastomach
e)Carcinomalung
CorrectAnswer-A:B
Answer-(A)Carcinomabreast(B)Carcinomacervix
Inwomen,cancerbreast,cervixuteri,colorectum,ovary,lip&oral
cavity.
52.Whichofthefollowingisparaganglioma:
a)AdrenalPheochromocytoma
b)Extra-adrenalPheochromocytoma
c)Carotidbodytumour
d)Carcinoidtumour
e)Glomustympanicum
CorrectAnswer-B:C:E
Answer-(B)Extra-adrenalPheochromocytoma(C)Carotidbody
tumour(E)Glomustympanicum
Pheochromocytornaisachromaffin-cellneoplasmthatcanarisean
adrenal(adrenalmedulla)orextraadrenaltumor.
Extraadrenalpheochromocytomaisalsoreferredtoas
paraganglioma.
Thecarotidbodytumorisaprototypeofaparasympathetic
paraganglioma.
Glomustympanicum:Mostcommontumourinmiddleear.
53.Feature(s)ofXIIIfactordeficiencyis/are:
a)Delayedwoundclosure
b)Clotsolubilitytestsareabnormal
c)TaPTT
d)TPT
e)TBT
CorrectAnswer-A:B
Answer-A,DelayedwoundclosureB,Clotsolubilitytestsare
abnormal
Itcharacteristicallyleadstodelayedbleedingthatoccurshoursto
daysafterahemostaticchallenge.
Clotsolubilitytestsareabnormal.
54.Whichofthefollowingstatement(s)is/are
correctexcept:
a)IncreasedPTinextrinsicpathways
b)IncreasedaPTTininstrinsicpathways
c)Ifplateletcountis>1.5lac/microL,thennormalhomeo-stasis
present
d)BTisdecreasedinplateletabnormality
e)None
CorrectAnswer-D
Aswer-D.BTisdecreasedinplateletabnormality
Hemostasisisspontaneousarrestofbleedingbyphysiological
Process.
Prothrombintime(PT):
Thisassayteststheextrinsicandcommoncoagulationpathways.
Partialthromboplastintime(PTT):
Thisassayteststheintrinsicandcommonclottingpathway.
Prolongationgenerallyindicatesadefectinplateletnumbersor
function.
55.TrueaboutDentigerouscyst:
a)Arisesinrelationtouneruptedteeth
b)Itmostcommonlyencroachesmaxillaryantrum
c)Mandibularthirdmolariscommonsite
d)Commoninmandible
e)All
CorrectAnswer-A:C:D
Answer-A,ArisesinrelationtouneruptedteethC,Mandibular
thirdmolariscommonsiteD,Commoninmandible
Commoninlowerjaw(mandible)inwomen30-40years.
Itoccursinrelationtounerupted,permanent,molartooth,most
commonlytheupperorlowerthirdmolar.
56.Prognosticfactorsforcarcinoma
esophagusis/are:
a)Depthofinvasion
b)Lymphnodestatus
c)Tumourgrading
d)Stageofthedisease
e)All
CorrectAnswer-E
Answer-E,All
StageThemostreliableprognosticfacforforesophagealcanceris
thestageofthetumouratthetimeofdiagnosis.
Tumoursize
Lymphnodesstatus
Cancerhasspreadtodistantorgans
Cancerthatremainsaftersurgery
Tumourgrade
57.Trueaboutsurgicaljaundice:
a)Increaseofserumbilirubin
b)Increaseacidphosphatase
c)Increasealkalinephosphatase
d)Urinebilirubinisabsent
e)Stoolsterocobilinogenabsent
CorrectAnswer-A:C:E
Answer-A,IncreaseofserumbilirubinC,Increasealkaline
phosphataseE,Stoolsterocobilinogenabsent
Obstructivejaundice-
1.Biluribin
Direct&Indirect-increased
2.Urinebilirubin-increased
3.Serumalbumin-generallyunchanged
4.Alkalinephosphatase-Increased
5.Sterocobilinogen-absent
58.Whichofthefollowingmarkerfavours
diagnosisofpreinvasive&invasive
cervicalcancer:
a)Ki67
b)OncoproteinE6
c)p16INK4,cyclinE,andKi-67
d)OncoproteinE8
e)None
CorrectAnswer-A:B:C
Answer-A,Ki67B,OncoproteinE6C,p16INK4,cyclinE,andKi-
67
TheexpressionofE7determinestheinactivationofpRbwitha
consequentincreaseoffreeE2Finthecell,leadingtobothan
increaseofcyclin-dependentkinaseinhibitorpl6(p16INK4a)and
aberrantproliferation(markedbyincreasedlevelsofKi-67
expression).
59.Whichofthefollowingmarker/mutation
is/areseeninpapillarycarcinomaof
thyroid:
a)Synaptophysin
b)RET/PTC
c)P53
d)NTRK1
e)RAS
CorrectAnswer-B:D:E
Answer-B,RET/PTCD,NTRK1E,RAS
GeneticAlterationsinThyroidNeoplasia-
RET/PTC
BRAF
TRK
RAS
60.Whichofthefollowingis/aretrueabout
pregabalin:
a)Approveddrugfordiabeticneuropathy
b)Approvedfortreatmentofgeneralizedtonicclonicseizure
c)Peripheraledemaissideeffect
d)Somnolenceissideeffect
e)ApprovedforuseinPartialseizure
CorrectAnswer-A:C:D:E
Ans.a.ApproveddrugForDiabeticneuropathy;c.Peripheral
edemaissideeffect;d.Somnolenceissideeffect;e.Approved
foruseinpartialseizures.
[RefKDT7th/419;Katzung13th/4M,419;Harrisontgth/2682;
PharmacologybySatoskar24th139)
Pregabalinside-effectincludes:Cognitivechanges,sedation&
peripheraledema.
GABAanalog.
Antiseizureactivityandforitsanalgesicproperty.
Approvedforuseinneuropathicpain,includingpainfuldiabetic
peripheralneuropathy,postherpeticneuralgia&complexregional
painsyndrome.
Toxicityincluded-Somnolence,dizziness,ataxia
61.Drug(s)usedforoveractivebladder:
a)Oxybutinin
b)Tolterodine
c)Mirabegron
d)OnabotulinumtoxinA
e)Pirenzepine
CorrectAnswer-A:B:C:D
Ans.a.Oxybutynin;b.Tolterodine;c.Mirabegron;D.
OnabotulinumtoxinA
[R4KDf7th/117-18;Katzung13th/127-28;Rang&Date8th/366;
PharmacologybySatoskar24th/3OS-07]
OveractiveBladder:
AntimuscarinicdrugssuchasOxybutynin,Flavoxate,tolterodine&
trospiumareusedforbothneurogenic&non-neurogenicoveractive
bladder.
Sollfenacin&darifenacinarethenewdrugs(M3antagonist)foruse
inoveractivebladder.
Mirabegronisbeta-3adrenergicagonistusedforoveractivebladder.
OnabotulinumtoxinAisusedassingleintradetrusorinjection,to
treatoveractivebladder.
62.Allaretrueaboutwarfarinexcept:
a)ActthroughinhibitionofcoagulationfactorIX
b)Protaminesulphatereversesitsaction
c)MonitoringisdonethroughINR
d)TargetofINRwithwarfarinisgenerally2-3
e)Skinnecrosisisusuallyoccurin3-10daysofinitiationof
warfarin
CorrectAnswer-B
Ans:b.Protaminesulphatereversesitsaction.
[RefKDT7th/620-24;Katzung13th/590-92;Rang&DaleSth/30q
PharmacologybySatoskar24th/jN-301]
Warfarininducedskinnecrosisisararecomplicationcharacterized
bytheappearanceofskinlesion3-10daysafterinitiationof
treatment.
DoseofwarfarinadjustedtogiveanINRof2-4,theprecisetarget
dependingontheclinicalsituation.
Thereferencerangeforprothrombintimeisusuallyaround12-13
secondsandtheINninabsenceofanticoagulationtherapyis0.8-1.
2
Warfarin:Doseregulationisdonebyprothrombintime&INR
(Heparin/aPTT/clottingtime.
AntagonistisVitK(c.fHeparin-Protaminesulphate).
63.TrueaboutM/Aofdoxorubicin:
a)Intercalateb/wDNAstrands
b)InhibitionofDNApolymerase
c)InhibitionofRNApolymerase
d)InhibitionoftopoisomeraseII
e)Inhibitionofproteinsynthesis
CorrectAnswer-A:D
Ans.A.Intercalateb/wDNAstrands;D.InhibitionOf
TopoisomeraseII
[Ref:KDT7th/867;Katzung13th/932'j5;G6G1lth/1358;
PharmacologybySatoskar24th/835)
Doxorubicin:Itactsasanon-specificinhibitoroftopoisomerase-II,
thusinterferingwithDNAreplication.
64.Anticholinergicdrugside-effectincludes:
a)Constipation
b)Urinaryretention
c)Mydriasis
d)Hypothermia
e)Blurringofvision
CorrectAnswer-A:B:C:E
Ans:A.Constipation.B.UrinaryretentionC.MydriasisE.
Blurringofvision
[Ref:KDT7th/120;GdzG11th/194;Katzung13th/129;Rang&
Dale\th/164-65;PharmacologybySatoskar24th/301).
Bodytemperatureisfrequentlyelevated.
Unfortunately,children,especiallyinfants,areverysensitiveto
hyperthermiceffectsofatropine.
Constipation&urinaryretention(precipitationespeciallyinelderly)
canoccurwithatropine
Difficultyinswallowing,drymouth,ferer,dry-flushed&hotskin,
difficultyinmicturition,Mydriasis,photophobia,blurringofnear
vision,palpitations,dreadfulvisualhallucination,ataxia,delirium,
psychoticbehavior,weak&rapidpulse,hypotension,
cardiovascularcollapsewithrespiratorydepression,convulsion&
coma.
65.Whichofthefollowingis/aretrueabout
benefitsofSustainedreleaseformulation
ofdrugs:
a)Decreasedincidenceand/orintensityofundesiredeffects
b)Increasespotencyofthedrug
c)ReleaseofdrugislessinfluencedbypH
d)Prolongdrugeffect
e)Decreasedfrequencyofadministration
CorrectAnswer-A:C:D:E
AnsA.DecreasedIncidenceand/orIntensityofundesired
effects;c.ReleaseOfDrugIsLessInfluencedBypH;D.
Prolongdrugeffect;E.DecreasedFrequencyofadministration.
[Ref:KDf7th/35;G6'G11th/5;PharmacologybySatoskar24th/7;
http://www.pharmatutor.org/articles/review-sustained-release-
dosage'forms).
Sustainedreleaseimpliesslowreleaseofthedrugoveratime
period.
Itmayormaynotbecontrolledrelease
Advantagesofsustainedreleasedosageforms:
Controlofdrugtherapyisachieved.
Rateandextentofdrugabsorptioncanbemodified
Frequencyofdrugadministrationisreduced.
Patientcompliancecanbeimproved.
Drugadministrationcanbemadeconvenient
Maximizingtheavailabilityofdrugwithminimumdose.
Thesafetymarginofhighpotencydrugcanbeincreased.
66.Trueaboutdrug-responsecurve(DRC):
a)SteepestinmiddleportionoftheDRC
b)InvertedUshapedcurvemaybeforsomedrug
c)Rectangularhyperbola-whenplottedinlogarithmicscale
d)Sigmoidshape-whenplottedinlogarithmisused
e)Enablescomparisonofpotencyofdrugs
CorrectAnswer-A:B:C:E
Ans.(A)SteepestinmiddleportionoftheDRC(B)InvertedU
shapedcurvemaybeforsomedrug(C)Rectangularhyperbola-
whenplottedinlogarithmicscale(E)Enablescomparisonof
potencyofdrugs
Dose-ResponseRelationship:
Rectangularhyperbola.
Sigmoidalcurveindose-responserelationship:thesteepestportion
inthemiddle-wiki.
DRCisusedtomeasure-drugpotency,drugefficacy&drugsafety-
slideshare.
Somedrugscauselow-dosestimulationandhigh-doseinhibitionof
response.
TheseU-shapedrelationshipsforsomereceptorsystemsaresaidto
displayhormesis.
Severaldrug-receptorsystemscandisplaythispropertye.g.,
prostaglandins,endothelin,andpurinergicandserotonergic
agonists,amongothers),whichislikelytobeattherootofdrug
toxicity.
67.Trueaboutorganophosphoruspoisoning:
a)Atropineisbestforearlytreatment&maintenance
b)Pralidoximeisimportantforrestoringneuromuscular
transmission
c)Phenytoinistheprimarydrugusedforseizurecontrol
d)Mydriasispresent
e)Pralidoxime&atropineworkssynergistically
CorrectAnswer-A:B:E
Ans.(A)Atropineisbestforearlytreatment&maintenance
(B)Pralidoximeisimportantforrestoringneuromuscular
transmission(E)Pralidoxime&atropineworkssynergistically
[RefReddy32nd/495-97;G&Gltth/21};KDT7th/111:13th/979-80;
PharmacologybySatoskar24th/297]
OrganophosPhorusPoisoning:
AIIcaseofAnti-ChEpoisoningmustbepromptlygivenatropine2
mgi.Vrepeatedevery10mintilldryness&othersignsof
atropinizationappear.
Continuedtreatmentwithmaintenancedosesmayberequiredfor1-
2weeks
Theuseofoximesinorganophosphatepoisoningissecondaryto
thatofatropine.Moreventheclinicalbenefitofoximesishighly
variable.
Controlofconvulsionswithjudicioususeofdiazepam.
Ocularmanifestationsincludemarkedmiosis'ocularpain'
conjunctivalcongestion,diminishedvision,ciliaryspasm,Andbrow
ache.
Atropineinsufficientdosageeffectivelyantagonizestheactionsat
muscarinicreceptorsites,andtoamoderateextentatperipheral
ganglionicandcentralsites
68.Whichofthefollowingdrug(s)actby
inhibitingproteinsynthesisbyattaching
to50Sribosome:
a)Tetracycline
b)Ampicillin
c)Isoniazid
d)Imipramine
e)Ethionamide
CorrectAnswer-B:C
Ans.(B)Ampicillin(C)Isoniazid
[KDT7th/734,768;Katzung13th/789]
Tetracyclinesbindto30Sribosome&inhibitaminoacylRNA
attachmenttotheAsite
Erythromycin&clindamycinbindto50Sribosome&hinder
translocationoftheelongatedpeptidechainbackfromAsitetoP
site.PeptidesynthesismaybeprematurelyTerminated.
ChloramPhenicolbindsto50Ssubunit'Itinterferewithpeptidebond
formation&transferofpeptidechainfromPsite
Aminoglycosidesbindtoseveralsitesat30S&50Ssubunits-freeze
initiation,interferewithpolysomeformation&causemisreadingof
mRNAcode
69.OCPefficacydecreaseswithconcurrent
administrationofwhichofthefollowing
drug(s):
a)Phenytoin
b)Ampicillin
c)Isoniazid
d)Imipramine
e)Ethionamide
CorrectAnswer-A:B
Ans.(A)Phenytoin(B)Ampicillin
[RefKDT7th/326;Katzung13th/712;Rang&DaIe9th/434:
PharmacologybySatoskar24th/967).
Contraceptivefailuremayoccurwithconcurrentadministration
of:
Enzymeinducer:Phenytoin,phenobarbital,primidone,
carbamazepine,rifampin,ritonavir-Metabolismofestrogenic&
progestationalcomponentisincreased.
Tetracyclines-ampicillin.
Deconjugationofestrogenssecretedinbilefailstooccurtheir
enterohepaticcirculationisinterruptedbloodlevelfal
70.Allaretrueabouttamoxifeneexcept:
a)Usedasadjuvanttherapyinestrogenreceptorpositivebreast
cancer
b)Approvedfortheprimaryprophylaxisofbreastcancerinhigh
riskwoman
c)Noeffectonuterus
d)Pro-estrogeneffectonbone
e)CauseendometrialCa
CorrectAnswer-A:C:D:E
Ans.(A)Usedasadjuvanttherapyinestrogenreceptorpositive
breastcancer(C)Noeffectonuterus(D)Pro-estrogeneffecton
bone(E)CauseendometrialCa
[Ref;KDT7th/101'02;Katzung13th/106]
NMislocatedinneuromuscularjunction6causedepolarizationof
muscleendPlate
NNlocatedonautonomicganglia,adrenalmedulla&CNS
Mostsmoothmuscles&glandshaveM26M3subtypes;M3
Predominates.
Achisamajorneurotransmitteratautonomic,somaticaswellas
centralsites.ReleaseofAchfromnerveterminalhelpinsynaptic
transmission
71.
Whichoffollowingtrueregarding
acetylcholinereceptors:
a)M2receptor-heart
b)MIreceptor-smoothmuscle
c)NMreceptorispresentonneuromuscularjunction
d)Synapticjunction-Achistransmitter
e)NNlocatedonadrenalmedulla
CorrectAnswer-A:C:D:E
Ans.(A)M2receptor-heart(C)NMreceptorispresenton
neuromuscularjunction(D)Synapticjunction-Achis
transmitter(E)NNlocatedonadrenalmedulla
[Ref;KDT7th/101'02;Katzung13th/106]
NMislocatedinneuromuscularjunction6causedepolarizationof
muscleendPlate
NNlocatedonautonomicganglia,adrenalmedulla&CNS
Mostsmoothmuscles&glandshaveM26M3subtypes;M3
Predominates.
Achisamajorneurotransmitteratautonomic,somaticaswellas
centralsites.ReleaseofAchfromnerveterminalhelpinsynaptic
transmission
72.Whichofthefollowingdrug(s)comesin
riskcategoryBofFDAteratogenicrisk
categoriesforpregnancy:
a)Phenytoin
b)Resperidone
c)Olanazapine
d)Clozapine
e)Arpirazole
CorrectAnswer-D
Ans.D.Clozapine
[Ref:KDT7th/90;Katzung13th/1018;Rang6Dale8th/700;
PharmacologybySatoskar24th/1122;http://schizophreniabulletin-
oxfordjournal]
CategoryA:
Norisktofetusinhumanstudies
Levothyroxine
Potassium
Supplementation
MgSO4
CategoryB
Animalstudiesshownorisk
Humanstudiesarelacking
Penicillins
Cephalosporins
Macrolides
Brimonidine
CategoryC
AnimalstudiesshowPositiveteratogenicrisk
Humanstudiesarenotavailable
Albuterol
Zidovudine
CCB
Morphine
Atropine
CategoryD
Humanandanimalstudiesshowpositiveteratogenicrisk
Canbeusedinpregnancybecauseofbenefitsgreaterthanrisk
mightbeacceptable.
Corticosteroids
Azathioprine
Carbamazepine
Valproate
Methotrexate
Lithium
CategoryX
Humanandanimalstudiesshowpositiveteratogenicrisk
Absolutelycontraindicatedinpregnancybecauseofriskgreaterthan
benefits.
Thalidomide
isotretinoin
Fluoroquinolones
Tetracyclines
Chloramphenicol
Warfarin
ACEinhibitors
73.Whichofthefollowingistrueregarding
ropinirolewrtL-dopa:
a)Cognitivesymptomimproves
b)Lowerincidenceofhallucination
c)Causeexcessivesleepiness
d)Moreeffectiveinthetreatmentofpatientswhohavedeveloped
on/offphenomena
e)Provideneuroprotectiveeffect
CorrectAnswer-C:D:E
Ans.C,CauseexcessivesleepinessD,Moreeffectiveinthe
treatmentofpatientswhohavedevelopedon/offphenomena
E,Provideneuroprotectiveeffect
[Ref:KDT7th/430-31;G&G535-j8;Katzung13th/478;Rang6Date
8th/494-95;PharmacologybySatoskar24th/237
Allthedopamineagonistsinlargerdosescancoutetevere
neuropsychiatricadverseeffects.
Ropinirole&Pramipexole
SelectiveD2/D1receptoragonists
Bettertolerateddtdonotshowthefluctuationsinefficacyassociated
withlevodopa.
Theydo,however,causesomnolence6sometimeshallucinations
(recentevidencesuggeststhattheymaypredisposetocompulsive
behaviours,suchasexcessivegambling,overeating6sexual
excess,relatedtotherewardfunctionsofdopamine
Adisadvantageofcurrentdopamineagonistsistheirshortplasma
halfLife(6-8hr),requiring3timesdailydosagethoughslowrelease
oncedailyformulationsarenowavailable
Trialhavefoundthemtoaffordsymptomreliefcomparableto
levodopa.
Sometrialshavenotedlowerincidenceofdyskinesias6motor
fluctuationsamongPatientstreatedwiththesedrugsthandose
treatedwithlevodopa
Itislongeractingthanlevodopa.
Highincidenceofhallucination&sleepiness
74.Trueaboutmethanolpoisoning:
a)Gastricdecontaminationishelpful
b)Formate&formaldehydeareactivemetabolite
c)TakingwithEthanolcausemoretoxicity
d)Fomipezoleaspecificantagonist,isgivenfortreatment
e)Causehighaniongapacidosis
CorrectAnswer-A:B:D:E
Ans.A,GastricdecontaminationishelpfuB,Formate&
formaldehydeareactivemetaboliteD,Fomipezoleaspecific
antagonist,isgivenfortreatmentE,Causehighaniongap
acidosis
[Ref:KDT7th/394-96;Katzung13th/393;Pharmacologyby
Satoskar24th/9s-96).
TreatmentofMethylAlcohol
Fomepizole,analcoholdehydrogenaseinhibitor,isapprovedforthe
treatmentofethyleneglycolpoisoningandmethanolpoisoning.
Ethanolusedintravenouslyastreatmentformethanolpoisoning.
Methanolconcentrationshigherthan50mg/dlarethoughttobean
absoluteindicationforhemodialysisandtreatmentwithfomepizole
orethanol,althoughformatebloodlevelsareabetterindicationof
clinicalpathology.
Hospitalisation,nursingcare
Gastriclavage,activatedcharcoal
Treatmentofacidosis/hypoglycemia
Inhibitionofmethanolmetabolism-Givingethylalcoholdtfomepizole
(aspecificinhibitorofalcoholdehydrogenase&drugofchoicefor
methanolpoisoning)
Promotemetabolicdegradationofformate:folinicacidtogetherwith
folicacid
Diuretics,urinealkalinisation
Hemodialysisinseverecase
Maintenanceofnutrition
75.S/EofBevacizumabincludes:
a)Hypertension
b)Hemoptysis
c)Malena
d)Cerebellarstroke
e)Notcausegastrointestinalperforation
CorrectAnswer-A:B:C:D
Ans.A,HypertensionB,HemoptysisC,MalenaD,Cerebellar
stroke
[Ref:KDT7th/871:Katzung13th/937-38;Rang&Dale8th/;
PharmacologybySatoskar24th/840).
S/EofBevacizumab:
Hypertension
Arterialthromboembolism-heartattack6stroke
Vesselinjury6haemorrhages
Heartfailure
Proteinuria
Gastrointestinalperforation
Healingdefect
76.TNF-aInhibitorsareusedfor:
a)Ulcerativecolitis
b)Crohn'sdisease
c)Rheumatoidarthritis
d)Psoariasis
e)Lichenplanus
CorrectAnswer-A:B:C:D
Ans.A,UlcerativecolitisB,Crohn'sdiseaseC,Rheumatoid
arthritisD,Psoariasis
[RefHanison19th/1961;NeenaKhanna5th/58,68;CMDT2016/641;
KDT7th/883-84).
TNF-alphaInhibitors:Use
Etanercept-Rheumatoidarthritis,severe/refractoryankylosing
spondylitis,plaquepsoriasis,polyarticularidiopathicjuvenilearthritis.
Infliximab-refractoryrheumatoidarthritis,ankylosingspondylitis,
psoriasis,fistulatingCrohn'sdisease,ulcerativecolitis
Adalimumab-Useaslikeinfliximab
Certolizumab-Crohn'sdisease
Golimumab-ulcerativecolitisPsoriasis:TreatmentincludesTNF
blockerslikeetanercept,infliximab.
77.Antibioticofchoicefor
Stenotrophomonasmaltophiliainfection
is:
a)Ampicillin
b)Trimethoprim-sulfamethoxazole(TMP-SMX)
c)Penicillin
d)Ciprofloxacin
e)None
CorrectAnswer-B
Ans:b.Trimethoprim-sulfamethoxazole(TMP-SMX)
78.Whichofthefollowingis/areparaphilia:
a)Pedophilia
b)Sodomy
c)Frotteurism
d)Voyeurism
e)Exhibitionism
CorrectAnswer-A:C:D:E
Ans:A.PedophiliaC.FrotteurismD.VoyeurismE.Exhibitionism
[RefSynopsisofPsychiatrybyKaplondrSaddockllth/593-97;
Reddy32nd/411;NeerajAhuja7th/124-26;Parikh7th/411-12J
Paraphiliasorperversionsaresexualstimulioractsthatare
deviationsfromnormalsexualbehaviors,butarenecessaryfor
somepersonstoexperiencearousalandorgasm.
AccordingtotheDiagnosticandStatisticalManualofMental
Disorders,fifthedition(DSM-5),thetermparaphilicdisorderis
reservedforthosecasesinwhichasexuallydeviantfantasyor
impulsehasbeenexpressedbehaviorally.
Individualswithparaphilicinterestscanexperiencesexualpleasure,
buttheyareinhibitedfromrespondingtostimulithatarenormally
considerederotic.Theparaphiliacperson'ssexualityismainly
restrictedtospecificdeviantstimulioracts.
DSM-5listspedophilia,frotteurism,voyeurism,exhibitionism,sexual
sadism,sexualmasochism,fetishism,andtransvestismwithexplicit
diagnosticcriteriabecauseoftheirthreattoothersand/orbecause
theyarerelativelycommonparaphilias.Therearemanyother
paraphiliasthatmaybediagnosed
79.Whichofthefollowingjointisbest
predictorofageof16-17yearbyX-ray:
a)Knee
b)Elbow
c)Hip
d)Wrist
e)Ankle
CorrectAnswer-D:E
Ans:(D)Wrist(E)Ankle[RefReddy32nd/78,77,74;Parikh7th/
61-63]
Forestimationofage:TakeX-ray
6-12yearsElbowjoint,Wristjoint,6yr-centerforlowerendof
ulna(A);medialepicondyleofthehumerus(A)
9years:Olecranon(A)
9to11years:Trochelaofhumerus(A)
10thto11thyear:Pisiform(A)
11thyear:Lateralepicondyleofhumerus(A)
13to16years:X-rayofpelviselbowjoint&pelvis(13thyr-separate
centersintriradiatecartilageofacetabulum(A)
12to14years:Lessertrochanteroffemur(A)
14thyear:Crestofilium(A),fusionofmedialepicondyleof
humerus,lateralepicondylewithtrochlea
15thyear:fusionoftriradiatecartilageofacetabulum
16-17year:wrist
Crestofilium:18-19.
Ischealtuberostty,clavicle(innerend):21-22(F),23-24(M)
80.Whichofthefollowingis/arefeature(s)of
humanhair:
a)Medullaryindex:<0.3
b)Cortexisthin
c)Cortexisthick
d)Medulla-narrow
e)Medulla-wider
CorrectAnswer-A:C:D
Ans:a.Medullaryindex...,c.Cortexisthick...,d.Medullanar....
[RefReddy32nd/91;Parikh7th/499]
Trait
HumanHair
Animalhair
Character
Fine&thin
Coarse&thick
Cuticularscalesare
Cuticle
Cuticularscalesare
very
large&havestep-
short,broad,thin&
likeor
irregularlyannular
wavyprojections
Thin,rarelymore
Cortex
Thick,well-striated
than
&4to10timesas
twiceasbroadas
broadasmedulla
medulla
Variesconsiderably,
Medulla
usuallynarrow,discontinuous, Continuous&wider
fragmentedorentirelyabsent
Mostlypresentinthe
Pigment
Evenlydistributed
medulla
medulla
Specificfordifferent
Precipitin
Specificforhuman
animals
Medullaryindex
(Diameterof
Below0.3
Above0.5
medulla/
Diameterof
shaft)
81.Whichofthefollowingistrue
statement(s)aboutexhumation?
a)Policecanorderforexhumation
b)Executivemagistratecanorderforexhumation
c)Postmortemcannotbedoneonexhumatedbody
d)CrPC176(4)isrelatedtoenquiryofexhumatedbody
e)CrPC174isrelatedtoenquiryofexhumatedbody
CorrectAnswer-B:D
Ans:b.Executivemagistrate...,d.CrPC176(4)isrelated...
[RefReddy32nd/128-29;Parikh7th/133-34]
Itisdiggingoutofanalreadyburiedbodylegallyfromthegrave
ThereisnotimelimitforexhumationinIndia
Autopsiesareperformedonexhumedbodies:
(1)Incriminalcases,suchashomicide,suspectedhomicide
disguisedassuicideorothertypesofdeath,suspiciouspoisoning,
deathasaresultofcriminalabortion&criminalnegligence;
(2)Incivilcases,suchasaccidentaldeathclaim,insurance,
workmen'scompensationclaim,liabilityforprofessionalnegligence,
survivorship&inheritanceclaimsordisputedidentity
Authorisation:Thebodyisexhumatedonlywhen,thereisawritten
orderfromtheexecutivemagistrate.Thebodycanheexhumatedby
anygovernmentdoctor
Thebodyisexhumatedunderthesupervisionofamedicalofficer&
magistrateinthepresenceofapoliceofficer
Wheneverpracticable,themagistrateshouldinformtherelativesof
thedeceased&allowthemtoremainpresentattheenquiry(176(4)
Cr.P.C)
82.Trueaboutcadavericspasm:
a)Samemechanismasrigormortis
b)Mechanismisunknown
c)Alsok/ainstantaneousrigor
d)Occuronlyincoldenvironment
e)Canbeseeninsomedrowningcase
CorrectAnswer-B:C:E
Ans:b.Mechanism...,c.Also1c/a...,e.Canbeseen....
CadavericSpasm(CatalepticRigidityorInstantaneousRigor)isa
rarecondition.Inthis,themusclesthatwerecontractedduringlife
becomestiffandrigidimmediatelyafterdeathwithoutpassinginto
thestageofprimaryrelaxation,anditsMechanismisunknown
Itoccursespeciallyincasesofsuddendeath,excitement,fear,
severepain,exhaustion,cerebralhaemorrhage,injurytothe
nervoussystem,firearmwoundofthehead,drowning,convulsant
poisons(suchasstrychnine).
83.Cause(s)ofOpisthotonusis/are:
a)Cocaine
b)StrychnosNuxVomicaseed
c)Strychnine
d)Codeine
e)Curare
CorrectAnswer-B:C
Ans:B.StrychnosNuxVomicaseedC.Strychnine
Strychnine(alkaloidfromseedsofstrychnosnux-vomica)cause
opisthotonus(Parikh7th/639-40)
"Strychnine:Theconvulsionsaremostmarkedinantigravity
muscles,sothatthebodytypicallyarchesinhyperextension
(opisthotonus)"(Reddy32nd/581)
CausesofOpisthotonus:Arnold-Chiarisyndrome,Meningitis,
Braintumor,Gaucherdisease,Growthhormonedeficiency
(occasionally),Glutaricaciduriaandorganicacidemias(formsof
chemicalpoisoning).
84.WhichofthefollowingisNOTrape:
a)Sexualintercoursewithwife,ofagebelow15year,with
consent
b)Sexualintercoursewithwife,ofage16year,withconsent
c)Sexualintercoursewithagirlbelow18yearsofage,with
consent
d)Sexualintercoursewithagirlof18yearwithconsent
e)Sexualintercoursewithwifewhoislivingseparatelyfrom
himunderadecreeofseparation,oranycustomorusage
withherconsent
CorrectAnswer-B:D:E
Ans:b.Sexualintercoursewith...,d.Sexualintercoursewitha
girl...,e.Sexualintercoursewithwifewhoisliving......[Ref
Reddy32nd/392-95;Parikh7th/389-911
Rape:TheCriminalLaw(Amendment)Bill,2013(5.375,I.P.C)
AcctoGazetteNotificationofGOIregardingCriminalLaw
(amendendment)Act,2013releasedon2april,2013,1tisage15
year.
ExceptiontoS.375,I.P.C:Sexualintercourseorsexualactsby
amanwithhisownwife,thewifenotbeingunder15years.
Thereiscontroversialreferenceregardingageofwife,either16or
15yearinReddy(old&newed.)&Parikh.
Withherconsent,whenthemanknowsthatheisnotherhusband
andthatherconsentisgivenbecauseshebelievesthatheis
anothermantowhomsheisorbelievesherselftobelawfully
married.
Withherconsentwhen,atthetimeofgivingsuchconsent,by
reasonofunsoundnessofmindorintoxicationortheadministration
byhimpersonallyorthroughanotherofanystupefyingor
unwholesomeSubstance,sheisunabletounderstandthenature
andconsequencesofthattowhichshegivesconsent.
Withorwithoutherconsent,whensheisundereighteenyearsof
age.
Whensheisunabletocommunicateconsent
85.Inwhichofthefollowingcondition(s),
childrenarepronetofungal&viral
infection:
a)Thymicaplasia
b)Agammaglobulinemia
c)Lymphocytopenia
d)Severecombinedimmunedeficiencies(SCID)
e)Chediak-Higashisyndrome
CorrectAnswer-A:C:D
Ans:(A)Thymicaplasia(C)Lymphocytopenia(D)Severe
combinedimmunedeficiencies(SCID)
[RefHarrison19th/2104-08;Ananthanarayan9th/171-76;Jawetz
27th/146-47;Greenwood16th/148J
Tcelldisordersaffectbothcell-mediatedandhumoralimmunity
makingthepatientsusceptibletoviral,protozoalandfungal
infections.Viralinfectionssuchasthosebycytomegalovirusand
attenuatedmeaslesinthevaccinecanbefatalinthesepatients.
LymphocytopeniaismostoftenduetoAIDSorundernutrition,butit
alsomaybeinheritedorcausedbyvariousinfections,drugs,or
autoimmunedisorders.Patientshaverecurrentviral,fungal,or
parasiticinfections.
Hypogammaglobulinemialeadstorecurrentbacterialinfections.
Viral&fungalinfectionsarecontrolledbycell-mediatedimmunity,
whichisnormalinhypogammaglobulinemicindividual.
86.Whichofthefollowingistype3
hypersensitivityreaction(immune
complexdisease):
a)SLE
b)DiabetesMellitusI
c)Goodpasteursyndrome
d)Multiplesclerosis
e)Bronchialasthma
CorrectAnswer-A
Ans:a.SLE
[RefAnanthanarayan9th/162-67;Robbins9th/201;lawetz27th/145
46;Greenwood16th/144]
Type3Hypersensitivityreaction(Immunecomplexdisease)
Ananthanarayan9th/162,Itistwotypes-arthusreaction&serum
sickness.
thedamageiscausedbyantigen-antibodycomplexes.Thesemay
precipitatein&aroundsmallbloodvesselscausingdamagetocells
secondarily,oronmembranes,interferingwiththeirfunction.
87.Whichofthefollowinginfectionhas
incubationperiod
a)Brucella
b)Gonorrhoea
c)Syphilis
d)HBV
e)Leishmaniasis
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)
"Brucella:Theincubationperiodvariesfrom1weektoseveral
months,andtheonsetoffeverandothersymptomsmaybeabrupt
orinsidious"(Harrison19th/194e-2)
Syphilis:Clinicaldiseasesetsinafteranincubationperiodofabout
amonth(range10-90days)"(Ananthanarayan9th/372)
"Syphilis:Themedianincubationperiodinhumans(-21days)
suggestsanaverageinoculumof500-1000infectiousorganismsfor
naturallyacquireddisease;theincubationperiodrarelyexceeds6
weeks.
Gonococcalinfectioninmen:Acuteurethritisisthemostcommon
clinicalmanifestationofgonorrheainmalepatients.Theusual
incubationperiodafterexposureis2-7days,althoughtheinterval
canbelonger&somemenremainasymptomatic(Harrison
19th/1005)
88.StainusedforMycobacterium
tuberculosisis/are:
a)Ziehl-Neelsentechniqueofstaining
b)Auramine-rhodaminestain
c)Gomorimethenaminesilverstain
d)Kinyounstain
e)Gramstaining
CorrectAnswer-A:B:D
Ans:a.Ziehl-Neelsentechni...,b.Auramine-rhodaminesta...,d.
Kinyounstain
[RefHarrison19th/1113;Ananthanarayan9th/346-48;Lippincott
Microbiology3rd/21;Jawetz27th/38;TextBookofDiagnostic
microbiologybyConnieR.Mohan3rd/691;Greenwood16th/15]
WhenstainedwithcarbolfuchsinbyZiehl-Neelsenmethodorby
fluorescentdyes(Auramine0,Rhodamine),mycobacterium
tuberculosisreistdecolourisationby20%sulphuricacid&are
thereforecalledacidfast.
Ziehl-Neelsenmethoddphenol-auramineproceduresaremethods
ofgreatpracticalimportanceinthediagnosisofmycobacterial
diseases".
TheKinyounmethod,orKinyounstain,isanacid-fastprocedure
usedtostainanyspeciesofthegenusMycobacteriumandNocardia
species.Itinvolvestheapplicationofaprimarystain(carbol
fuchsin),adecolorizer(acid-alcohol),andacounterstain(methylene
blue)"
89.Foodbornediseasesare:
a)Japaneseencephalitis
b)Hemophilia
c)HBV
d)Botulism
e)Typhoidfever
CorrectAnswer-D:E
Ans:d.Botuli...,e.Typhoid...,[RefPark23rd/657]
Theterm"food-bornedisease"isdefinedas:"Adisease,usually
eitherinfectiousortoxicinnature,causedbyagentsthatenterthe
bodythroughtheingestionoffood."Withthecateringsystems,food-
bornediseasesareontheincreasethroughouttheworld.
DuetotoxinsproducedbycertainbacteriaLIKEBotulism,
StaphylococcuspoisonS
Bacterialdiseases:-Typhoid,fever,Paratyphoidfever,
salmonellosis,staphylococcalintoxication,C.perfringens,
Shigellosisbrucellosisetc.
90.WhichofthefollowingisNOTlysine
positivenon-fermentor:
a)Burkholderiapseudomallei
b)Burkhomeliamallei
c)Burkholderiacepacia
d)Stenotrophomonasmaltophilia
e)Pseudomonasaeruginosa
CorrectAnswer-A:B:E
Ans:a.Burkholderia...,b.Burkhomelia...,e.PseudomonasAeru
......
TheBurkholderiacepaciacomplex(BCC)andStenotrophomonas
maltophiliaarecloselyrelatedgroupsofnonfermentinggram-
negativebacilli(NFGNBs)havingasimilarspectrumofinfections
rangingfromsuperficialtodeep-seatedanddisseminatedinfections.
Identificationoftheselysinedecarboxylase-positiveNFGNBslags
behindinmostIndianlaboratories.Asimplifiedidentificationscheme
wasdevisedforthesetwopathogensthatallowedustoisolatethem
withanincreasingfrequencyatourtertiarycareinstitute.
91.Apersonissufferingfromacquired
immunodeficiencydisease(AIDS)&visited
thezoo.Aftersomedays,heiscom
plainingofheadache&cough.Hehas
alsohavesomeneurologicalsymptoms.
OnstainingofCSFsample,itshowscap
sulatedyeast.Likelyinfectionis:
a)Histoplasma
b)Aspergillus
c)Cryptococcus
d)Blastomycosis
e)Coccidioidomycosis
CorrectAnswer-C
Ans:C,Cryptococcus
LikeCNSdisease,pulmonarycryptococcosiscanfollowanindolent
course,andthemajorityofcasesprobablydonotcometoclinical
attention.
Pulmonarycryptococcosiscanbeassociatedwithantecedent
diseasessuchasmalignancy,diabetes,andtuberculosis.
CryptococcusInfectioncanbeacquiredbyinhalationof
desiccatedyeasts(orbasidiospores)fromfecesofpigeonorother
birds
DirectmicroscopicexaminationofIndiaink-stainedwetfilmsof
materialfromlesionsrevealscapsulated,buddingyeastcells;the
capsuleareprominentintheIndiainkpreparatio
92.NormalfloraofOralcavityis/areexcept:
a)Veillonella
b)Anerobicmicrococci
c)Geotrichum
d)Gemella
e)Yersinia
CorrectAnswer-A:B:C:D
Ans:a.Veillone...,b.Anerobicmicroc...,c.Geotrich...,d.
Gemell.
Morethan700bacterialspeciesorphylotypes,ofwhichover50%
havenotbeencultivated,havebeendetectedintheoralcavity.
Themouthcontainsaplethoraoforganisms-pigmented&non-
pigmentedmicrococci;someofwhichareaerobic,grampositive,
aerobic,sporebearingbacilli,coliforms,proteus&lactobacilli
Thegumpocketb/wtheteeths,&thecryptsofthenostrilshavea
widespectrumofanaerobicflora-anerobicmicro-cocci,
microaerophilic&anaerobicstreptococci,vibrios,fusiformbacilli,
corynebactriumspecies,actinomyces,leptothrix,mycoplasma,
Neisseriaeb?bacteriodesareallfoundinvaryingextents.Among
fungi,candidaergeotrichumhavebeenreported.
93.Goldstandarddiagnostictestfor
babeiosisis:
a)Peripheralbloodsmearexamination
b)BloodCulture
c)PCR
d)ELISA
e)Indirectfluorescentantibody(IFA)test
CorrectAnswer-A
Ans:a.Peripheralbloodsmear...,
[RefHarrison19th/1385-86;PanikerParasitology7th/85;Chatterjee
Parasitology13th/137;LippincottMicrobiology3rd/225;Jawetz
27th/708;Greenwood16th/599]
Microscopicexaminationofstainedbloodsmearisgoldstandard
testforbabesiosis"
Aspecificdiagnosisusuallyisestablishedbymicroscopic
examinationofGiemsa-stainedthinbloodsmears.Babesia
trophozoitesappearround,pear-shaped,orameboid.
Theringformismostcommonandlacksthecentralbrownish
deposit(hemozoin)typicalofPlasmodiumfalciparumtrophozoites.
Otherdistinguishingfeaturesaretheabsenceofschizontsand
gametocytesandtheoccasionalpresenceoftetrads("Maltese
cross").
Ifparasitescannotbeidentifiedbymicroscopyandthediseaseis
stillsuspected,amplificationofthebabesial18SrRNAgeneby
polymerasechainreaction(PCR)isrecommended.Quantitative
PCRhasgreatlyloweredthethresholdfordetectionofB.microti
DNA
94.Trueaboutlisteriamonocytogens
infection:
a)Commoninpregnantwomen
b)Commoninelderly
c)Commoninchildren
d)Commoninnewborns
e)Ampicillinisdrugofchoice
CorrectAnswer-A:B:D:E
Ans:a.Commoninpregnant...,b.Commoninelderly...,d.
Commoninnewborns...,e.Ampicillin.
[RefHarrison19th/982-84;Ananthanarayan9th/395-96;
LippincottMicrobiology3rd/98;Jawetz27th/197-98;
Greenwood16th/195-96]
Listeriainfectionsaremostcommoninpregnantwomen,fetuses
andnewborns,andinimmunocompromisedindividuals,suchas
olderadultsandpatientsreceivingcorticosteroids"(Lippincott
Microbiology3rd/98).
Thediseaseaffectspregnantwomen,newborns,adultswith
weakenedimmunesystems,andtheelderly,
Listeriamonocytogenesisafood-bornepathogenthatcancause
seriousinfections.
Meningitisinolderadults(especiallywithparenchymalbrain
involvementorsubcorticalbrainabscess)shouldtrigger
considerationofL.monocytogenesinfection.
95.TrueaboutJapaneseencephalitis:
a)Mostsevereepidemicspreadoccuredin2006
b)MainvectorinIndiaisculextritaeniorhynchus
c)Spreadbyaedesmosquito
d)Indiastillnotabletodevelopvaccineindigenously
e)Pigsareamplifierhost
CorrectAnswer-B:E
Ans:(B)MainvectorinIndiaisculextritaeniorhynchus(E)Pigs
areamplifierhost
[RefPark23rd/284-87;Harrison19th/1315;Ananthanarayan
9th/52022,519]
During2006,therewasalargeoutbreakofchikungunyainIndia,
with1.39millionofficiallyreportedcasesspreadover16states;
attackrateswereestimatedat45%insomeareas"
Thevirusisparticularlycommoninareaswhereirrigatedricefields
attractthenaturalavianvertebratehostsandprovideabundant
breedingsitesformosquitoessuchasCulextritaeniorhynchus,
whichtransmitthevirustohumans.
Additionalamplificationbypigs,whichsufferabortion,andhorses,
whichdevelopencephalitis,maybesignificantaswell.Vaccination
oftheseadditionalamplifyinghostsmayreducethetransmissionof
thevirus.
96.NotAIDSdefiningcancer:
a)Analcarcioma
b)Hodgkin'slymphoma
c)Cervialcancer
d)Non-Hodgkinslymphoma
e)Kaposicarcinoma
CorrectAnswer-A:B
Ans:(A)Analcarcioma(B)Hodgkin'slymphoma
[RefHarrison19th/1268;Ananthanarayan9th/576-77;Lippincott
Microbiology3rd/302]
TheneoplasticdiseasesconsideredtobeAIDSdefiningconditions
areKaposi'ssarcoma,non-Hodgkin'slymphoma,andinvasive
cervicalcarcinoma.
Inaddition,thereisalsoanincreaseintheincidenceofavarietyof
non-AIDS-definingmalignanciesincludingHodgkin'sdisease;
multiplemyelotna;leukemia;melanotna;andcervical,brain,
testicular,oral,lung,gastric,liver,renal,andanalcancers.
97.TrueaboutPlasmodiumfalciparum:
a)IncreasedsizeofinfectedRBC
b)Crescentricshapedgametocyte
c)Delicateringpresent
d)Small&multipleringscommon
e)Erythrocytepreference-oldcells
CorrectAnswer-B:C:D
Ans:(B)Crescentricshapedgametocyte(C)Delicatering
present(D)Small&multipleringscommon
[RefHarrison19th/1369;ParasitologybyChatterjee13th/103;
ParasitolgybyPaniker7th/75]
Ringstage-delicate,small,doublechromatin,multiplerings
common,Accoleformsfound
Macrogametocyte-Crescentric,deepbluecytoplasm,largediffuse
nucleus
Thematuregametocytesareroundinshape,exceptinP,
falciparum,inwhichtheyarecrescent-shaped
Schizont:Fillstwo-thirdofredbloodcellwhichisnotenlarged-
Chatterjee13th/103
Infectederythrocyte-Normalsize,Maurer'scleft,sometimes
basophilicstippling
Erythrocytepreference-youngerythrocyte,butcaninfectallstages
98.Whichofthefollowingstatementis/are
trueaboutGiardia:
a)Causebloodydiarrhorea
b)InvasivetoGImucosa
c)Morecommoninhypogammaglobulinemicperson
d)Lesscommoninachlorohydria
e)Metronidazoleiseffectiveintreatment
CorrectAnswer-C:E
Ans:(C)Morecommoninhypogammaglobulinemicperson(E)
Metronidazoleiseffectiveintreatment[RefParasitologyby
Chatterjee13th/47-48;ParasitolgybyPaniker7th/32-33;Harrison
19th/1406]
Metronidazole,trimidazole,furazoilidonehavebeenfoundtobe
effectiveforgiardiasis
G.lambliaistypicallyseenwithinthecryptsofduodenal&jejunal
mucosa.Itdoesnotinvadethetissue,butremainstightlyadheredto
intestinalepitheliumbymeansofthesuckingdisc
Tepersonhavingagammaglobulinemia,malnourishedpersonsare
moresusceptibletogiardiasis
99.Inwhichorganismcanbeisolated:
a)CSFspecimenoftetanusinfection
b)CSFspecimenoflisteriamonocytogenes
c)Fromvalvesinrheumaticvalvulitis
d)Frommyocardiumindiphthericmyocarditis
e)Meningococcalrash
CorrectAnswer-B:E
Ans:(B)CSFspecimenoflisteria
monocytogenes(E)Meningococcalrash
L.monocytogenes:Thediagnosisistypicallymadebycultureof
blood,cerebrospinalfluid(CSF),oramnioticfluid.L.monocytogenes
maybeconfusedwith"diphtheroids"orpneumococciingram-
stainedCSFormaybegram-variableandconfusedwith
Haemophilusspp.
Petechiallesion:Meningococcimaysometimesbedemonstratedin
petechiallesionsbymicroscopy&culture.
100.Trueaboutcytomegalovirus-
a)Characteristicowleyeappearance
b)Type5Humanherpesvirustype
c)Lymphocyteenlargement
d)Causecongenitalinfection
e)Lymphoproliferative
CorrectAnswer-A:B:D
Ans:a.Characteristic...,b.Type5Human...,d.Cause
congenital....
[RefHarrison19th/1190-91;Ananthanarayan9th/473-74;Jawetz
27th/470-74]
Itiscytomegalic(notlymphoproliferative,whichoccurinHHV4,6&
7)
Characterizedbyenlargementofinfectedcells
Congenitalinfection-Intrauterineinfectionleadstofetaldeathor
cytomegalicinclusiondiseaseofnewbornwhichisoftenfatal
101.Whichofthefollowingis/aretrueabout
Mycoplasmapneumoniainfection
except:
a)Causesmanyextrapulmonarymanifestations
b)Coldagglutinintiterisnotincreased
c)Causeatypicalpneumonia
d)Paucityofrespiratorysignsonphysicalexamination
e)Coughistypicallyproductive
CorrectAnswer-B:E
Ans:b.Coldagglutinin...,e.Coughistypically
Coldhemagglutininsforgroup0humanerythrocyteappearinabout
50%ofuntreatedpatients,inrisingtiter,withthemaximumreached
inthethirdorfourthweekafteronset.
Atiterof1:64ormoresupportsthediagnosisofM.pneumoniae
infection.
Thecoughistypicallynonproductive,butsomepatientsproduce
sputum.Headache,malaise,chills,andfeverarenotedinthe
majorityofpatients.
102.Trueaboutenteroviruses:
a)In1999,wildpoliovirus2waseradicatedfromworld
b)Vaccineassociatedparalyticpoliomyelitis(VAPP)most
frequentlycausedbyserotype1vaccine
c)BivalentOPVcontainstype1&type3strain
d)PrimarycourseofOPVconsistsofonly1dose
e)CoxasackieA7&enterovirustype71causesasepticmeningitis
CorrectAnswer-A:C:D:E
Ans:(A)In1999,wildpoliovirus2waseradicatedfromworld
(C)BivalentOPVcontainstype1&type3strain(D)Primary
courseofOPVconsistsofonly1dose(E)CoxasackieA7&
enterovirustype71causesasepticmeningitis
[RefPark23rd/202-09;Harrison19th/1289-91;Ananthanarayan
9th/485]
Ofthe3strainsofwildpoliovirus,wildpoliovirustype2was
eradicatedin1999&casenumbersoftype3aredowntothe
lowest-everlevelswiththelastcasereportedinNov2012from
Nigeria.
TheWHOprogrammeonimmunization(EPI)&thenational
immunizationprogrammeinIndiarecommendedaprimarycourseof
3dosesofOPVatone-monthintervals,commencingthefirstdose
wheninfantis6weeksold.
Poliovirustype1isresponsibleformostepidemicsofparalytic
poliomyelitis.Type3alsocausesepidemicstoalesserextent..
Type2usuallycausesinapparentinfectionsinwesterncountriesbut
inIndiaparalysisduetotype2isquitecommon"
GROUP
SEROTYPE
Poliovirus
1-3
CoxsackievirusA 1-22AND24
CoxsackievirusB
1-6
s
Echovirus
1-9,11-27,
29-34
Numbered
(EV)68-78
echovirus
103.Trueaboutchickengunyafever:
a)CausedbysinglestrandedRNAarbovirus
b)Excruitingarthralgiainperipheraljoints
c)Antiviraltherapyisveryeffective
d)Absolutelymphocytosisispresent
e)Vectorisaedesmosquitoes
CorrectAnswer-A:B:E
Ans:(A)CausedbysinglestrandedRNA
arbovirus(B)Excruitingarthralgiainperipheral
joints(E)Vectorisaedesmosquitoes.[RefHarrison19th/13j3;
park23ril/289;Ananthanarayangth/440,519;Jawetz27th/548.
Chickengunya:Bloodcountsmaybenormal,orpatientsmayhave
leukopeniawithrelativelymphocytosis.
ThevectorisAedesaegypti,Itiscausedbyarbovirus(Family-
Togaviridae,Genus-Al?phavirus)(Ananthanarayan9th/517)
TheChikungunyavirusbysinglestrandedRNAvirus?
Chikungunyaisalocalwordmeaningdoublingupowingto
excruciatingjointpains
Thereisnospecifictreatment&usuallyselflimiting.Analgesics&
antipyreticsalongwithfluidsupplementationarerecommendedto
manageinfection&relievefever,jointpains&swelling.Drugslike
aspirin&steroidsshouldbeavoided
104.TrueaboutZikavirus:
a)Sexuallytransmitted
b)50%infectedpersondevelopsymptoms
c)Effectivetherapyavailable
d)TransmittedbyAedesvector
e)Transmissioninutero
CorrectAnswer-A:D:E
Ans:a.Sexuallytransmittedd.TransmittedbyAedesvectore.
Transmissioninutero[RefHarrison19th/1314;
ItisspreadmostlybythebiteofaninfectedAedesspecies
mosquitoes(A.aegyptiandA.albopictus).Thesemosquitoesare
aggressivedaytimebiters.
Itcanbepassedfromapregnantwomantoherfetus.Infection
duringpregnancycancausecertainbirthdefects.
ItcanbepassedthroughsexfromapersonwhohasZikatohisor
herpartners.Itcanbepassedthroughsex,eveniftheinfected
persondoesnothavesymptomsatthetime.
ThemajorityofpeopleinfectedwithZikavirusdonotdisplayany
symptoms
105.Biosafetylevel4infectionincludes:
a)Hantavirus
b)Nilevirus
c)Ebolavirus
d)Crimean-CongoHF
e)LyssaFever
CorrectAnswer-C:D:E
Ans:c.Ebolavirusd.Crimean-CongoHFe.LyssaFever[Ref
Harrison19th/1323,1328;consteril.corn/biosafety-levels;
thecerebrallounge.wordpress.corn]
Filoviruses(includesthreegenera:Cuevavirus,Ebolavirus,and
Marburgvirus)arecategorizedasWorldHealthOrganization(WHO)
RiskGroup4Pathogens.
BiosafetyLevel4-Hemorrhagicfevers,Marburgvirus,Ebola
virus,Lassavirus,Smallpox
106.Serologicaltestis/areusefulindiagnosis
ofwhichofthefollowingdisease:
a)Typhoid
b)Qfever
c)Acanthamoebainfection
d)Scrubtyphus
e)Brucellosis
CorrectAnswer-A:B:D
Ans:a.Typhoidb.Qfeverd.Scrubtyphus
ThediagnosisofQfeverisbasedmainlyonserologicaltests,such
asmicroagglutination,complementfixation,immunofluorescence&
ELISA.
Serologicaltests:Therearenotusedforearlydiagnosisofrickettsia!
diseases(includingQfever,scrubtyphus),fromatreatment
perspective,buttoconfirmthediagnosisforepidemiological
investigations.
Scrubtyphus:Serologicalassay(indirectfluorescentantibody,
indirectimmunoperoxidae&enzymeimmunoassays),aremainstays
oflaboratorydiagnosis.
Tubeagglutinationisroutinelyusedforserologicaldiagnosisof
typhoid,brucellosis&typhusfever.
107.Allaretrueaboutgasgangreneexcept:
a)Type1gangreneisfournier'sgangrene
b)Devitalizedtissuepredisposetogasgangrene
c)High02tensionintissueisimportantprecondition
d)a-toxinismaincauseofthetoxaemiaassociatedwithgas
gangrene
e)MainlycausedbyC.perfringens
CorrectAnswer-E
Ans:E.MainlycausedbyC.perfringens[RefHarrison19th/990-
95;Ananthanarayan9th/257-59;Jawetz27th/186-87;Greenwood
16th/231-35]
C.perfringensinassociationwithmixedaerobicandanaerobic
microbescancauseaggressivelife-threateningtypeInecrotizing
fasciitisorFournier'sgangrene.
Predisposinghostfactorsincludedebility,oldage&diabetes
a-toxinisgenerallyconsideredtobethemaincauseofthe
toxaemiaassociatedwithgasgangrene
"a-toxin:Thisisthemostimportanttoxinbiologically&isresponsible
forprofoundtoxaemiaofgasgangrene"
108.WhicharetransmittedbyDog:
a)Echinococcusgranulosus
b)ToxocaraCanis
c)Echinococcusmultiocularis
d)ToxoplasmaGondii
e)None
CorrectAnswer-A:C
Ans:A.EchinococcusgranulosusC.Echinococcus
multiocularis"[RefPark23rd/3}4;Hanison19th/1432,167
e-1:ChatterjeeParasitology13th/159;CMDT2016/
12801.
Alveolarechinococcosis(AE)iscausedbyinfectionwiththelarval
stageofEchinococcusmultilocularis.Theadulttapewormis
normallyfoundinfoxes,coyotes,anddogs.Infectionwiththelarval
stagesistransmittedtopeoplethroughingestionoffoodorwater
contaminatedwithtapewormeggs.
Toxocaracanis:Humaninfectionisbyingestionofeggs,whichare
shedinfecesofdog.
Toxoplasmagondii:Manacquiresinfectionbyingestionof
contaminatedfoodandwatercontainingsporulatedoocyst(fromcat)
orbyingestionofundercookedmeatcontainingtissuecysts"
109.Followupisnotrequiredinwhichof
thefollowingstudy:
a)Prospectivestudy
b)Retrospectivestudy
c)Cross-sectionalstudy
d)Longitudinalstudy
e)Cohortstudy
CorrectAnswer-B:C
Ans:b.Retrospectivestudy,c.Cross-sectionalstudy.[RefPark
23rd/62,69;Community
Cohort(Knownbyavarietyofnames-prospectivestudy,
longitudinalstudy,incidencestudy&forwardlookingstudy)isfollow
upstudywithindividualasunitofstudy(Park23rd/62,75)Case
controlstudies,oftencalledretrospectivestudies:
Noattritionproblems,becausecasecontrolstudiesdonotrequire
follow-upofindividualintothefuture.
Cross-sectionalstudies(Alsok/aprevalencestudy)issingle
examination(sonofollowup)ofacross-sectionofpopulationatone
pointintime-theresultsofwhichcanbeprojectedonthewhole
population.
Longitudinalstudies:Observationsarerepeatedinthesame
populationoveraprolongedperiodoftimebymeansoffollow-up
examinations.
110.Specialprotectionincludes:
a)Personalitydevelopment
b)lmmunizationagainstspecificdisease
c)Specificnutritionaldiet
d)Protectionfromoccupationalhazard
e)Environmentalmodification
CorrectAnswer-B:C:D
Ans:b.Immunizationagainst...,c.Specificnutritionaldiet...,d.
Protectionfromoccupational
SpecificProtection
Immunization
Useofspecificnutrients
Chemoprophylaxis
Protectionagainstoccupationalhazards
Protectionagainstaccident
Protectionfromcarcinogens
Avoidanceofallergens
Thecontrolofspecifichazardsinthegeneralenvironmente.g.,air
pollution,noisecontrol
Controlofconsumerproductquality&safetyoffoods,drugs,
cosmeticsetc
111.TrueaboutCivilregistrationsystemin
India:
a)Dualrecordsystem
b)Deficient
c)Headofinstitutionorofficer-inchargeisresponsiblefor
registration
d)Birth&Deathbothareregistered
e)Causeofdeathisrecorded
CorrectAnswer-B:C:D:E
Ans:b.Deficie...,c.Headofinstitution...,d.Birth&Death
both...,e.Causeofdeath
TheregistrationsysteminIndiatendedtobeveryunreliable,the
databeinggrosslydeficientinregardstoaccuracy,timeliness,
completeness&coverage.Thisisbecauseofilliteracy,ignorance,
lackofconcern,&motivation
Thecentralbirths&DeathRegistrationAct,1969fixesthe
responsibilityforreportingbirths&deaths.Whilethepublic(e.g,
parents,relatives)aretoreporteventsoccurringintheirhouseholds,
theheadsofhospital,nursinghomes,hotels,jailsordharmashalas
aretoreporteventsoccurringinsuchinstitutionstobeconcerning
registrar
Thetimelimitforregisteringtheeventsofbirth&thatofdeathsis21
daysuniformlyalloverIndia.Incaseofdefaultalatefeecanbe
imposed.
112.Trueaboutsilicosisallexcept:
a)Causedbyexposureofsilicaoxide
b)Severeexposure-wholelunglavagemayhelpfulin
alleviat_ingsymptoms
c)Fibrosisofupperlung
d)Fibroticchangecanbereversedafterstoppingexposure
e)MoreriskofTB&lungcancer.
CorrectAnswer-D
Ans:d-Fibroticchangecanbereversedafterstopping
exposure
Silicosisisprogressive&whatismoreimportantisthatsilicoticsare
pronetotuberculosis
Thereisnoeffectivetreatmentforsilicosis.Fibroticchangesthat
havealreadytakenplacecannotbereversed
Nodularfibrosis,morefrequentinapex&posteriorborder(upper
partoflung)(c.finasbestosisfibrosisinlowerhalfoflung)
Silicoticsaremorepronetodeveloppulmonarytuberculosis(butin
recentyearthereisdoubtwhethersilicoticsreallydevelopT.B.)
Foracutesilicosis,bronchoalveolarlavagemayalleviatesymptoms,
butdoesnotdecreaseoverallmortality.
113.Whichofthefollowingis/aretrue
aboutuseofBardiagram:
a)Comparisonof2categorialdatawhicharenot-additive
b)Comparisonof2categorialdatawhichareproportional
percentagecontributionofcategories
c)Piechartisusedforcomparisonof2categorialdatawhichare
proportionalpercentagecontributionofcategories
d)Comparisonofmagnitudeofdifferentfrequenciesindiscrete
data
e)Comparisonofcontinuousdata
CorrectAnswer-A:C:D
Ans:a.Comparison...,c.Piechartis...,d.Comparisonof
magnitude
BarDiagram
Lengthofbarrepresentsfrequencyofacharacter
Popularereasymethod
Usedforcomparisonofmagnitudeofdifferentfrequenciesin
discretedata
Spacingb/wanytwobarsshouldbenearlyequaltohalfofthewidth
ofthebar
3Type-simple,proportionate&multiple.
Categories Quantitytobe
Appropriatediagram
onx-axis representedony-axis*
Continuous Additive
Pieifproportionalcontribution
(frequencyor
ofthecategoriesistobe
percentage),
represented,otherwise
histogram
histogram
Linefordepictionoftrend,
otherwisebar
Addictive(frequencyor
Discreteor
Pieifproportionalpercentage
percentage),
categorical
contributionofthecategories
istoberepresented,
(number,rateorratio)
otherwisebar
bar
114.Benefitofverticalhealthprogramme
includes:
a)MorefocusonefficiencY
b)Morerapidresults
c)Dedicatedworkeralwaysavailable
d)Manyprogramscanrunatonetime
e)Effectivewayofmaximizingtheimpactoftheavailable
resources
CorrectAnswer-A:B:C:E
Ans:a.Morefocus...,b.Morerapid...,c.Dedicatedworker...,e.
Effectivewayof.
Verticalprogrammesare"socalledbecausetheyaredirected,
supervised,andexecuted,eitherwhollyortoagreatextent,bya
specializedserviceusingdedicatedhealthworkers"
Incontrast,anintegratedprogrammeis"theprocessofbringing
togethercommonfunctionswithinandbetweenorganizationsto
solvecommonproblems,developingacommitmenttosharedvision
andgoalsandusingcommontechnologiesandresourcestoachieve
thesegoals"
Verticalprogrammes(alsoknownasstand-alone,categoricalor
free-standingprogrammesortheverticalapproach)referto
instanceswhere"thesolutionofagivenhealthproblem[is
addressed]throughtheapplicationofspecificmeasuresthrough
single-purposemachinery"
115.TrueaboutReinke'soedema:
a)Usuallyunilateral
b)Commoninsmoker
c)Corticosteroidismainstayoftreatment
d)Involvewholeofmembranouspartofthevocalcords
e)Patienthaslowpitchvoice
CorrectAnswer-B:D:E
Answer-B,CommoninsmokerD,Involvewholeofmembranous
partofthevocalcordsE,Patienthaslowpitchvoice
Itisbilateralsymmetricalswellingofthewholeofmembranouspart
ofthevocalcords.
Thisisduetooedemaofthesubepithelialspace(Reinketspace)
ofthevocalcords.
Etiology-
Heavysmoking,
Chronicsinusitis&
Laryngopharyngealreflex
C/F-
Patientusesfalsecordsforvoiceproduction&thisgiveshimalow-
pitched&roughvoice.
Treatment-
Decorticationofthevocalcordsi.e.,removalofstripofepithelium,is
donefirstononeside&3-4weeksalterontheother.
116.Feature(s)ofScheibe'ssyndromeis/are:
a)Semicircularcanalfistula
b)Abnormalityinbonylabyrinth
c)Dysplasiaofcochlea
d)Middleearanaomaly
e)All
CorrectAnswer-C
Answer-C.Dysplasiaofcochlea
Itismostcommoninnerearanomaly.
Dysplasiaisseeninthecochlea&saccule;hencealsocalled
cochleosacculardysplasia.
Itisinheritedasanautosomalrecessivenonsyndromictrait.
117.Trueaboutnasopharyngealcarcinoma:
a)Level4cervicallymphnodenotinvolved
b)Radiotherapyistreatmentofchoice
c)Alsoc/aGuangdongtumour
d)MayassociatedwithU/Lotitismedia
e)AssociatedwithEBV
CorrectAnswer-A:B:C:D:E
Answer-A,Level4cervicallymphnodenot
involvedB,RadiotherapyistreatmentofchoiceC,Alsoc/a
GuangdongtumourD,MayassociatedwithU/Lotitis
mediaE,AssociatedwithEBV
Itismostlyseeninfifthtoseventhdecades.
Malesarethreetimesmorepronethanfemale.
Epstein-Barrvirusiscloselyassociatedwithnasopharyngeal
carcinoma.
DuetoobstructionofEustachiantube,thereisconductivehearing
loss,serousorsuppurativeotitismedia.
Radiotherapy:Itistreatmentofchoicefornasopharyngeal
carcinoma.
118.Trueabouttubercularotitismediaareall
except?
a)Spreadsthrougheustachiantube
b)Causespainlesseardischarge
c)Maycausemultipleperforations
d)Usuallyaffectsbothears
e)None
CorrectAnswer-D
Answer-D.Usuallyaffectsbothears
Tuberculosisofmiddleearisacomparativelyrareentityusually
seeninassociationwithorsecondarytopulmonarytuberculosis,
infectionreachesthemiddleearthrougheustachiantube.
Clinicalfeatures
Generally,tuberculosisofmiddleearisunilateral.
Itischaracterizedbypainlessotorrhoeawhichfailstorespondtothe
usualantimicrobialtreatment.Thereispainlesswateryotorrhea.
Singleormultipleperforationoftympanicmembrane.
119.EvidencebasedtherapyofBell'spalsy
include(s):
a)Facialnervemassage
b)Facialnervestimulation
c)Steroid
d)Acyclovir
e)All
CorrectAnswer-C
Answer-C.Steroid
1.Medicaltreatment
Prednisolone(steroid)isthedrugofchoiceandisstartedatinitial
visit.Initiationoftherapyduringfirst24hoursofsymptomconfersa
higherlikelihoodofrecovery.
Antiviraltherapy(Acyclovir)isaneweradjunctintreatingacute
facialpalsyofviralorigin(bothBell'spalsyandRamsayhunt
syndrome).
Mostsurgeonsthesedaysadvocatecombinationofsteroidsand
antiviraldrugs.
120.ApersonhasvertigowithoutCNS
involvement.Causesis/are:
a)Perilymphfistula
b)Otolithiasis
c)Vestibularneuritis
d)Meniere'sdisease
e)Multiplesclerosis
CorrectAnswer-A:B:C:D
Answer-A,PerilymphfistulaB,OtolithiasisC,Vestibular
neuritisD,Meniere'sdisease
Peripheral(Lesionsofendorgansvestibularnerve)
Meniere'sdisease
Benignparoxysmalpositional
vertigo
Vestibularneronitis
Labyrinthitis
Vestibulotoxicdrugs
Headtrauma
Perilymphfistula
Syphilis
Acousticneuroma
121.Cause(s)ofinMydriasis:
a)Organophosphoruspoisoning
b)Homersyndrome
c)Oculomotornervepalsy
d)Parasympatheticstimulation
e)All
CorrectAnswer-C
Answer-C.Oculomotornervepalsy
Carbolicacid,Chloralhydrate,Organophosphorus,Morphine
(opiate)and'NewHorn'i.e.neurosyphilis/tabesdorsalis(spinal
miosisorsmall,irregularArgyllRobertsonpupil)andHorner's
syndrome,Oculomotornervepalsy.
Atropineandcocainecausemydriasis.
122.Trueaboutprimaryopenangle
glaucoma:
a)Alsok/aChronicsimpleglaucoma
b)Hypermeteropeasaremorepredisposed
c)Polygenicinheritance
d)Laseriridotomyisusedfortreatment
e)Fundusexaminationrevealslargecup
CorrectAnswer-A:C:E
Answer-(A)Alsok/aChronicsimpleglaucoma(C)Polygenic
inheritance(E)Fundusexaminationrevealslargecup
Alsoknownaschronicsimpleglaucomaofadultonsetandis
typicallycharacterizedbyslowlyprogressiveraisedintraocular
pressure.
Associatedwithcharacteristicopticdisccuppingandspecificvisual
fielddefects.
Pathogenesis-
Heredity:POAGhasapolygenicinheritance.
Age-elderlybetween5thand7thdecades.
Myopesaremorepredisposedthanthenormals.
DiabeticshaveahigherprevalenceofPOAG.
POAGismoreinhyPertensives.
C/F
patientsusuallycomplainoffrequentchangesinpresbyopicglasses.
Patientsdevelopdelayeddarkadaptation.
Fundusexaminationshowlargecup.(0.6ormore)
Laseriridotomyisusedfortreatmentofprimaryangleclosure
glaucoma.
123.Cloudycorneais/areseen:
a)Klinefeltersyndrome
b)Turnersyndrome
c)Megalocornea
d)Mucopolysaccharidosis
e)All
CorrectAnswer-D
Answer-D.Mucopolysaccharidosis
S-Sclerocornea
T-Trauma
U-Ulcer
M-Mucopolysaccharidosis
P-Peteranomaly
ED-Congenitalhereditaryendothelialdystrophy
124.Ectopialentisisassociatedwithall
except-
a)Homocystinuria
b)Weil-Marchesanisyndrome
c)Marfansyndrome
d)Cockaynesyndrome
e)Osteogenesisimperfecta
CorrectAnswer-D:E
Answer-(D)Cockaynesyndrome(E)Osteogenesisimperfecta
Morecommon:
Marfansyndrome
Homocystinuria
Weil-Marchesanisyndrome
Sulfiteoxidasedeficiency
Hyperlysinemia
125.NotfeatureofFuch's
heterochromiciridocyclitis:
a)Whitenodulesontheanteriorsurfaceoftheiris
b)Koppeprecipitatespresentatbackofcornea
c)Granulomatoustypeoflowgradeanterioruveitis
d)Topicalcorticosteroidsareusedfortreatment
e)All
CorrectAnswer-C
Answer-C.Granulomatoustypeoflowgradeanterioruveitis
Fuchs'heterochromiciridocyclitisisachronicnongranulornatous
typeoflowgradeanterioruveitis.
Thediseaseischaracterisedby:
Heterochromiaofiris,
Diffusestromalirisatrophy,
FineKPsatbackofcornea,
Faintaqueousflare,
Absenceofposteriorsynechiae
Topicalcorticosteroidsareallthatisrequired.
126.Trueaboutiris:
a)Eyecolourisduetorelativenumberofmelanocytes
b)Stromaisresponsibleforpigmentation
c)Sphincterpupillaeissuppliedbyparasympatheticfibres
d)Dilatorpupillaeissuppliedbysympatheticfibres
e)Stromaiscoveredonitsanteriorsurfacebytwolayersof
pigmentedepithelium
CorrectAnswer-A:B:C:E
Answer-A,Eyecolourisduetorelativenumberof
melanocytesB,Stromaisresponsiblefor
pigmentationC,Sphincterpupillaeissuppliedby
parasympatheticfibresE,Stromaiscoveredonitsanterior
surfacebytwolayersofpigmentedepithelium
Eyecolorisdeterminedbytherelativenumberofmelanocyteinthe
stromaandofcoursethedensityofmelaningranulesproduced.
Irisiscomposedofastromacantainingbranchedconnectivetissue
cells,usuallypigmentedbutlargelyunpigmentedinblueirides.
Thestromaiscoveredonitsposteriorsurfacebytwolayersof
pigmentedepithelium.
Theirisisrichlysuppliedbysensorynervefibresderivedfromthe
trigeminalnerve.
Thesphincterpupillaeissuppliedbyparasympatheticautonomous
secretomotornervefibresderivedfromtheoculomotornerve,while
themotorfibresofthedilatormusclearcdefivedfromthecervical
sympatheticchain.
127.Whichofthefollowingis/arenotthe
feature(s)ofcornealulcerduetoherpes
virus:
a)RoseBengalstainingofmarginofulcer
b)Decreasedcornealsensitivity
c)Fluoresceinstainingofflooroftheulcer
d)Ringinfiltration
e)All
CorrectAnswer-A:B:C
Answer-A,RoseBengalstainingofmarginof
ulcerB,DecreasedcornealsensitivityC,Fluoresceinstainingof
flooroftheulcer
"Dendriticulcerbasestainswithfluorescein&themarginswithrose
Bengal.
Fluoresceininstallationilluminatedbybluelightshowsupcorneal
ulcerationatanearlystage.
Thecorneaisrelativelyinsensitive.Insevereforms,dendriticulcers
develop.
128.Allaretrueaboutchronicfatigue
syndromeexcept:
a)Fordiagnosis,durationoffatigueshouldbeatleast6month
b)Impairedmemoryandconcentrationmaypresent
c)Fatiguerelievedbyrest
d)Physicalexaminationshowsnoabnormalities
e)Cognitivebehavioraltherapyisusefulfortreatment
CorrectAnswer-C
Answer-C.Fatiguerelievedbyrest
Fatiguelastsforatleast6months
Fatigueisofnewordefiniteonset.
Fatigueisnottheresultofanorganicdiseaseorofcontinuing
exertion
Fatigueisnotalleviatedbyrest.
Fatiguesymptomsaresoarthroat,tendercervicaloraxilarylymph
nodes,musclepain,paininseveraljoints,headaches,malaise
129.Allaretrueaboutprimaryaldosteronism
except:
a)Oneofthemostcommoncauseofsecondaryhypertension
b)Hyperkalemia
c)Sodiumretention
d)Ratioofplasmaaldosteronetoplasmareninactivity(PA/PRA)
isausefulscreeningtest
e)Tetanymayoccur
CorrectAnswer-B
Answer-B.Hyperkalemia
Primaryhyperaldosteronismisoneofthemostcommoncauseof
secondaryhypertension.
Excessivelevelsofaldosteronecausesodiumretentionand
potassiumexcretion,withresultanthypertensionandhypokalemia.
Hypokalemiacancauseweakness,parethesias,visualdisturbances
andtetany.
Thediagnosisofprimaryhyperaldosteronismisconfirmedbythe
elvatedlevelofaldostetoneanddepressedlevelsofrenininthe
circulation(lowPRA).
Theratioofplasmaaldosteronetoplasmareninactivity(PA/PRA)is
ausefulscreeningtest.
130.Allaretrueaboutacutepericarditis
except:
a)Painradiatetoleftshoulder&arm
b)WidespreadelevationoftheSTsegments,oftenwithupward
concavity&thenreturntobaseline
c)Painrelievedbylyingsupine&intensifiedbysittingupand
leaningforward
d)Corticosteroidrelievessymptoms
e)High-pitchedscratchingorcrunchingnoisemayheardin
auscultation
CorrectAnswer-C
Answer-C.Painrelievedbylyingsupine&intensifiedbysitting
upandleaningforward
Thecharacteristicpainofpericarditisisretrosternal,radiatestothe
shouldersandneck(retrosternal,andleftprecoridal).
Characteristically,pericaridialpainmayberelievedbysittingupand
leaningforwardandisintensifiedbylyingsupine.
Apericardialfrictionrubisahigh-pitchedsuperficialscratchingor
crunchingnoise,producedbymovementoftheinflamed
pericardium.
TherearefourstagesofECGchangesintheevolutionofacute
pericarditis.
Instage1,thereiswidespreadelevationoftheSTsegments,often
withupwardconcavity,involvingtwoorthreestandardlimbleads
andV2toV6,withreciprocaldepressionsonlyinaVRand
sometimesV1,aswellasdepressionofthePRsegmentUsually
therearenosignificantchangesinQRScomplexes.
Instage2,afterseveraldays,theSTsegmentsreturntonormal,
andonlythen,orevenlater,dotheTwavesbecomeinverted(stage
3).
Ultimately,weeksormonthsaftertheonsetofacutepericarditis,the
ECGreturnstonormalinstage4.
Thepainisusuallyrelievedbyaspirin.
131.Malignancyassociatedwith
hypercalcemia:
a)Breastcancer
b)Smallcelllungcancer
c)Non-smalllungcancer
d)Prostatecancer
e)Multiplemyeloma
CorrectAnswer-A:C:D:E
Answer-A,BreastcancerC,Non-smalllungcancerD,Prostate
cancerE,Multiplemyeloma
Lungcarcinoma,breastcarcinoma,andmultlplemyelomaaccount
formorethan50%ofallcasesofmalignancy-associated
hypercalcemia.
Gastrointestinaltumarsandprostatecarcinomaarelesscommon
causesofhypercalcemia.
132.Whichofthefollowingmarkerssuggest
likelyprimarycancerincarcinomaof
unknownprimary(CUP):
a)CK7isfoundintumorsofthelung,ovary,endometrium&
breast
b)CK20+/CDX-2+/CK7?,suggestiveoflowergastrointestinal
cancer
c)Calretin&WT-1formelanoma
d)Chromogranin,synaptophysin&CD56aremarkerof
neuroendocrineprrimary
e)None
CorrectAnswer-A:B:D
Answer-A,CK7isfoundintumorsofthelung,ovary,
endometrium&breastB,CK20+/CDX-2+/CK7?,suggestiveof
lowergastrointestinalcancerD,Chromogranin,synaptophysin
&CD56aremarkerofneuroendocrineprrimary
CK7,CK20,thrombomodulin-Urothelial
CK7,CK20,CDX-2,carcinoembryonicantigen(CEA)-intestinal
Calretinin,WT-1-Mesothelioma
Chromogranin,synaptophysin,CD56-Neuroendocrine
133.Whichistrueaboutthrombolysisin
acuteischemicstroke:
a)Mosteffectiveifusedwithin3hour
b)Contraindicatedinh/opriorintracranialhaemorrahage
c)Useofheparinwithin48hrisnotacontraindication
d)Contraindicatedifplatelets<100,000permicroliter
e)All
CorrectAnswer-A:B:D
Answer-A,Mosteffectiveifusedwithin3
hourB,Contraindicatedinh/opriorintracranial
haemorrahageD,Contraindicatedifplatelets<100,000per
microliter
Intravenousthrombolysiswithrecombinanttissueplasminogen
activator(rt-PA)increasestheriskofhaemorrhagictransformationof
thecerebralinfarctwithpotentiallyfatalresults.However,ifitis
givenwithin4.5hoursofsymptomonsettocatefullyselected
patients,thehaemorrhagicriskisoffsetbyanimprovementin
overalloutcome.
134.Highaniongapmetabolicacidosisis/are
presentin:
a)Asthma
b)COPDwithCO2retention
c)Poorlycontrolleddiabetes
d)Renaltubularacidosis
e)All
CorrectAnswer-C
Answer-C.Poorlycontrolleddiabetes
Ketoacidosis
Diabetic
Alcoholic
Starvation
135.TrueaboutMcCune-Albrightsyndrome:
a)Occurinchildren&duringpuberty
b)Precociouspubertyinfemale
c)Involvelongboneoflimb
d)Associatedwithhypothyroidism
e)All
CorrectAnswer-A:B:C
Answer-A,Occurinchildren&duringpubertyB,Precocious
pubertyinfemaleC,Involvelongboneoflimb
McCune-Albrightsyndrome(MAS)ischaracterizedbythetriadof
polyostoticfibrousdysplasia,cafeaulaitskinpigmentation,and
peripheralprecociouspuberty.
Albrightsyndromeisprecocioussexualdevelopment,whichoccurs
mostofteningirls.
Theaverageageatonsetinaffectedgirlsisabout3yrandpuberty.
136.Increasedportalveinpressure&normal
hepaticveinpressurecanbeseeninall
except:
a)Alcoholiccirhhosis
b)Alcholoichepatitis
c)BuddChairisyndrome
d)Portalveinthrombosis
e)Inferiorvenacavaobstruction
CorrectAnswer-C:E
Answer-C,BuddChairisyndromeE,Inferiorvenacava
obstruction
"Budd-Chiarisyndrome(Obstructionofhepaticveinsatanysitefrom
efferentveinofthelobuletotheentryoftheIVCintorightatrium.
Posthepatic-Budd-Chiarisyndrome,Inferiorvenacavalwebs
137.Whichofthefollowingstatement(s)
is/areregardingAmericanHeart
Association(AHA)Guideline-2015for
cardiopulmonaryresuscitation(CPR)&
Emergencycardiovascularcare(ECC):
a)Chestcompression:ventilationCompressionventilationratio
withoutadvancedairway?rate30:2irrespectiveofrescuer&
ageofpatient
b)Compressionrate-atleast100/min
c)FailuretoachieveanETCO2of10mmHgbywaveform
capnographyafter20minutesofresuscitationhasbeen
associatedwithanextremelypoorchanceofreturnof
spontaneouscirculation(ROSC)
d)Limitinterruptionsinchestcompressionstolessthan10
seconds
e)None
CorrectAnswer-C:D
Answer-C,FailuretoachieveanETCO2of10mmHgby
waveformcapnographyafter20minutesofresuscitationhas
beenassociatedwithanextremelypoorchanceofreturnof
spontaneouscirculation(ROSC)D,Limitinterruptionsinchest
compressionstolessthan10seconds
Compressionrateismodifiedtoarangeofl00to120/min.
Compressionventilationratiowithoutadvancedairway-1or2
rescuers30:2
FailuretoachieveanETCO2ofI0mmHgbywaveform
capnographyafter20minutesofresuscitationhasbeenassociated
withanextremelypoorchanceofROSCandsurvival.
Theclarifiedrecommendatio-nforcfrestcompressiondepthfor
adultsisatleast2inches(Scm)butnotgreaterthan2.4inches(6
cm).
138.Trueaboutmultiplesclerosis:
a)Corticosteroidsareusedinacuteattack
b)IntravenousImmunoglobuliniseffectivemodeoftreat?ment
c)IFNa-usedinrecurrence
d)IFN-P-usedinrecurrence
e)Plasmapheresismaybeusedinsevererelapses
CorrectAnswer-A:D:E
Answer-(A)Corticosteroidsareusedinacuteattack(D)IFN-P-
usedinrecurrence(E)Plasmapheresismaybeusedinsevere
relapses
MaindrugsusedfortreatingmultiplesclerosisincludeInterferon-
1a
Frequencyofrelapsesinmultiplesclerosispatientisdecreasedby
beta-interferon/glatiramer.
Newerdrugapprovedforrelapseinmultiplesclerosispatientsis
Fingolimod.
Glucocorticoidsareusedtomanageeitherfirstattacksoracute
exacerbations.
Natalizumabisamonoclonalantibodyagainst4subunitof41
integrinonlymphocytes,usefulintreatingmultiplesclerosis.
Itreducestherelapseratewhengivenintravenouslyoncemonthly.
139.Extrathyroidfeatureofhypothyroidism
includes:
a)Pretibialmyxedema
b)Carpaltunnelsyndrome
c)Bradycardia
d)Thyroidacropathy
e)Peripheraledema
CorrectAnswer-B:C:E
Answer-(B)Carpaltunnelsyndrome(C)Bradycardia
(E)Peripheraledema
Commonsymptomsare-Weightgain,Fatigue,Dryskinandhair,
Menorrhagia,Hoarseness,coldness
CVS-Bradycardia,Myxoedema,hypertension
Nervoussystem-Carpaltunnelsyndrome,
Facialfeatures-purplishlips,malarflush,periorbitaloedema
Yellowingofskinoccursduetoaccumulationofincreasecarotene.
140.Whichofthefollowingistrueabout
medicationoveruseheadache:
a)Notassociatedwithtriptanuse
b)Restrictionofanalgesicsshouldbedone
c)Opioidismainlyresponsible
d)Preventivetherapyshouldbeencouragedafterstopping/
reducinganalgesic
e)None
CorrectAnswer-B:C:D
Answer-(B)Restrictionofanalgesicsshouldbedone
(C)Opioidismainlyresponsible(D)Preventivetherapyshould
beencouragedafterstopping/reducinganalgesic
medicationsthatarethemostcommonculpritsarecompound
analgesia(particularlycodeineandotheropiatecontaining
preparations)andtriptans,andMOHisusuallyassociatedwithuse
onmorethan10-15dayspermonth.
Managementisbywithdrawaloftheresponsibleanalgesics
Migraineprophylacticsmaybehelpfulinreducingtherebound
headaches.
141.Whichofthefollowingis/arefeature(s)of
acuteinterstitialnephritis:
a)Eosinophiluria
b)Peripheraleosinophilia
c)WBCcast
d)Grosshaematuria
e)Significantproteinuria
CorrectAnswer-A:B:C
Answer-(A)Eosinophiluria(B)Peripheraleosinophilia(C)WBC
cast
Peripheraleosinophiliacanoccur,especiallywithdruginduced.
Microscopichematuriaisinvariablypresent.
Urinalysiscanrevealwhitebloodcell,granularorhyalinecast.
Thepresenceofurineeosinophilsisneithersensitiveorspecific.
Proteinuriacanbeafeature,particularlyinNSAIDS-induced
interstitialnephritis.
142.Feature(s)ofBulbarpalsyis/are:
a)Dysphagia
b)Absentjawjerk
c)Absentgagreflex
d)Tongueatrophy
e)Tonguewasting&fasciculations
CorrectAnswer-A:B:C:D:E
Answer-(A)Dysphagia(B)Absentjawjerk(C)Absentgag
reflex(D)Tongueatrophy(E)Tonguewasting&fasciculations
Paralysisorlossoffunctionsuppliedbycranialnervearisingfrom
bulb(oldnameofmedullaoblongata).
AffectedCNare9,10,11&l2th.
Tongue-flaccid,wasted,fasciculationmaybepresent.
InvolvementofIX&XCN:Nasaltwang,nasalregurgitation,hoarse
voice,dysphagia,lossofsensationoverpl/3tongue,
weakcough,absentgagreflex&weakcoughreflex.
Inu/llesion,thereisneveracompleteparalysisofdeglutitionorof
articulation.
143.Allaretrueabouthepatorenalsyndrome
except:
a)Creatininelevelraised
b)Albumininfusiongiven
c)Livertransplantationimprovesrenalfunctions
d)Mayoccurincirrhosis
e)Lowdosedopamineinfusionisveryeffective
CorrectAnswer-E
Answer-E.Lowdosedopamineinfusionisveryeffective
Thehepatorenalsyndrome(HRS)isaformoffunctionalrenalfailure
withoutrenalpathologythatoccursinabout10%ofpatientswith
advancedcirrhosisoracuteliverfailure.
Therearemarkeddisturbancesinthcarterialrenalcirculationin
PatientswithHRS.
TyPeIHRS-asignificantreductionincreatinineclearancewithin1-2
weeksofpresentation.
Type2HRS-anelevationofserumcreatininelevel.
HRSisoftenseeninpatientswithrefractoryascites.
Treatment-
dopamineorprostaglandinanalogueswereusedasrenal
vasodilatingmedications.
Patientsaretreatedwithmidodrine,analpha-agonist,alongwith
octreotideandintravenousalbumin.
ThebesttheragyforHRSislivertransplantation.
144.Whichofthefollowingis/areusedfor
assessmentofcarbohydrate
malabsorption:
a)Schillingtest
b)Steatorrhoea
c)D-xylosetest
d)Glucosetest
e)Urinetest
CorrectAnswer-C
Answer-C.D-xylosetest
D-xyloseabsorptiontestisthemostcommonlyemployedtestfor
carbohydrateabsorption-Harrison
Anendoscopicmucosalbiopsyisthemorespecifictestandisnow
consideredessential.
D-xyloseisacarbohydratethatisabsorbedalmostexclusivelyinthe
proximalsmallbowelwithoutthehelpofpancreaticenzymes.A
positiveD-xylosetestindicatesmalabsorptionduetointestinal
mucosaldiseaseandthusbeusedasatestforassessmentof
mucosalfunction.
145.TrueaboutSwan-Ganzcatheter:
a)Measuresrightatrialpressure
b)Measuresleftventricularfillingpressure
c)MeasurePCWP
d)Insertedthroughleftsubclavianvein
e)InserteddirectlyinRightatrium
CorrectAnswer-A:B:C:D
Answer-(A)Measuresrightatrialpressure(B)Measuresleft
ventricularfillingpressure(C)MeasurePCWP(D)Inserted
throughleftsubclavianvein
Continuouscardiacoutputmonitoring.
CentraltemPeraturemonitoring
Measurementofpulmonaryarterypressure(canalsomeasureRA
andRVpressuresduringinsertion)
Measurementofmixedvenoussaturations
Estimationofdiastolicfillingofleftheart(normalPCWP2-12mmHg)
146.TreatmentofacuteHyperleukocytosis
includes:
a)Hydroxyurea
b)Isotretinoin
c)Leukapheresis
d)Vincristine
e)All
CorrectAnswer-A:C:D
Answer-(A)Hydroxyurea(C)Leukapheresis(D)Vincristine
Leukapheresisisthetreatmentofchoice.
InpatientswithAML,hydroxyureashouldbestarted.
InALLpatients,higherthan200,000/mm3patientsmaybetreated
withvinctistine,steroids,orboth.
147.Feature(s)of3rddegreeburnis/are:
a)Blisterformation
b)Verypainful
c)Nospontaneoushealing
d)Dryescharformation
e)Thrombosedvesselscanbeseenundertheskin
CorrectAnswer-C:D:E
Answer-C,NospontaneoushealingD,Dryeschar
formationE,Thrombosedvesselscanbeseenundertheskin
Entirethicknessofskindestroyed(intofat)
Anycolor(white,black,red,brown),dry,lesspainful(dermalplexus
ofnervesdestroyed)
Healbycontractionandscardeposition(noepitheliumleftinmiddle
ofwound)
Full-thicknessBurns(3degreeBURN)-thrombosedvesselscanbe
seenundertheskin.
148.TrueaboutBabcockforcep:
a)Teethatend
b)Serrationatend
c)Triangularorificeinblades
d)Usedforsoftdelicatetubularstructure
e)Curvedforcep
CorrectAnswer-C:D
Answer-C,TriangularorificeinbladesD,Usedforsoftdelicate
tubularstructure
Aninstrumentwitharatchet&atriangularerpansionwith
fenestrationsattheoperatingend
Itdoesnothaveanyteeth
Thisinstrumentcanbeusedtoholdintestine,thyroidgland,
mesoappendix,uterinetubeetc.
149.Gasusedincreatingpneumoperitonem:
a)Water
b)CO2
c)02
d)Air
e)CO
CorrectAnswer-B:C:D
Answer-B,CO2C,02D,Air
Gasesusedforpneumoperitoneumincludecarbondioxide(CO2),
air,oxygen,nitrousoxide(N20),argon,heliumandmixturesofthese
gases.
150.CO2isusedinlaproscopyforcreating
pneumoperitoneuminplaceofair
because:
a)Lessabsorptionfromperitonealsurface
b)Fastclearancefrombody
c)Lesssolubilityinblood
d)Electrocauteryissafetouse
e)Lessriskofgasembolism
CorrectAnswer-B:D:E
Answer-B,FastclearancefrombodyD,Electrocauteryissafeto
useE,Lessriskofgasembolism
CO2gasinsufflationispreferredbymostlaparoscopistsbecauseit
hasahighdiffusioncoefficientandisanormalmetabolicend
productrapidlyclearedfromthebody.
Also,CO2ishighlysolubleinbloodandtissuesanddoesnot
supportcombustion.
TheriskofgasembolismislowestwithCO2.
CardiacarrhythmiascanoccurwithCO2pneumoperitoneum.
151.Acutehaemorrhagicpancreatitis
producewhichofthefollowingsign:
a)Cullensign
b)Rovsingsign
c)Psoassign
d)GreyTurnersign
e)Kehrsign
CorrectAnswer-A:D
Answer-A,CullensignD,GreyTurnersign
Bleedingintothefascialplanescanproducebluishdiscolourationof
theflanks(GreyTurner'ssign)orumbilicus(Cullen'ssign).
152.Trueregardingurinarycatheterization
with16Frenchsize:
a)Itisthesuitablesizetouseinadultfemale
b)ItcancauseUTIinlongtermuse
c)Usedinmanagementofurethralobstruction
d)Diameteris4mm
e)Steriletechniquemustbeusedforinsertion
CorrectAnswer-A:B:C:E
Answer-A,ItisthesuitablesizetouseinadultfemaleB,Itcan
causeUTIinlongtermuseC,Usedinmanagementofurethral
obstructionE,Steriletechniquemustbeusedforinsertion
Foley'scatheterissterilizedbygammaradiation.UsuallyFoley's
catheteriskeptfor7days.
Size:
Adults--16F
Children--8For10F
Obstructionoftheurethrabyananatomicalconditionthat,makesit
dfficultforonetourinate:prostatehypertrophy,
prostatecancer,ornarrowingoftheurethra.
153.Whichofthefollowingis/aretrueabout
obstructiveuropathy:
a)Strictureinureteriscause
b)Stoneinureteriscause
c)RTAtype4canoccur
d)AbsenceofhydronephrosisonUSGruleoutobstructive
uropathy
e)Whenobstructionisabovethelevelofthebladder,bilateral
hydroureterandhydronephrosisoccurs
CorrectAnswer-A:B:C
Answer-A,StrictureinureteriscauseB,Stoneinureteris
causeC,RTAtype4canoccur
Anyobstructionatordistaltothebladderneckmayleadtoback
pressureaffectingbothkidneys.
Obstructionatorproximaltotheureteralorificeleadstounilateral
damage.
Partialobstructionleadstogradualprogressivemuscular
hypertrophyfollowedbydilation,decompensationand
hydronephroticchanges.
Acquiredurinarytractobstructionmaybeduetoinflammatoryor
traumaticurethralstrictures,ureteralorpelvicstones.
154.Trueaboutbranchialfistula:
a)Externalopeningneartheanteriorborderof
sternocleido?mastoid
b)Externalopeningatjunctionofupper&middlethirdof
sternocleidomastoidmuscle
c)Developduetopersistenceof2ndbranchialcleft
d)Openinoropharynx
e)Movewithswallowing
CorrectAnswer-A:C:D
Answer-A,Externalopeningneartheanteriorborderof
sternocleido?mastoidC,Developduetopersistenceof
2ndbranchialcleftD,Openinoropharynx
Thisisalwayscongenital&occursduetopersistent2ndbranchial
cleft.
Theexternalorificeisnearlyalwayssituatedinthelowerthirdofthe
neckneartheanteriorborderofthesternocleidomastoid.
Thepatientmaycomplainofadimple,dischargingmucus&the
dimplebecomesmoreobviouswhenthepatientisaskedtoswallow.
155.Trueabout1stdegreehaemorrhoid:
a)Painlessbleeding
b)Malaenaeoccur
c)Constipationmaybepresent
d)Prolapseondefaecation
e)Neverprolapse
CorrectAnswer-A:C:E
Answer-A,PainlessbleedingC,Constipationmaybe
presentE,Neverprolapse
FourDegreesofHaemorrhoids
Firstdegree:bleedonly,noprolapse
Seconddegree:prolapse,butreducespontaneously
Thirddegree:prolapseandhavetobemanuallyreduced
Fourthdegree:permanentlyprolapsed
156.Whichofthefollowingexaminationis
doneinsupineposition:
a)Tredelenburgposition
b)ReverseTredelenburgposition
c)Simsposition
d)Jackknifeposition
e)Lloyd-Daviesposition
CorrectAnswer-A:B:E
Answer-A,TredelenburgpositionB,ReverseTredelenburg
positionE,Lloyd-Daviesposition
"Tredelenburgposition:Lithotomywithheaddown
ReverseTredelenburgposition:Thepatientissupineonthe
operatingtablewiththetabletiltedup15"attheheadendtoreduce
venousengorgement.
"Mostcommonly,thepatientisexaminedintheleftlateral(Sims)
positiorwiththebuttocksoverlyingtheedgeoftheexamination
couchandwiththeaxisofthetorsocrossing,ratherthanparallel
with,theedgeofthecouch.
Thepronejackknifeorknee-elbowpositionsmaybeused.
Lloyd-DaviesPosition:ItisalsoknownastheTrendelenburg
positionwithlegsapart.
157.Trueaboutlipcarcinoma:
a)Commoninsmoker
b)Morecommoninlowerlip
c)Morecommoninupperlip
d)Alwayspainfultotouch
e)Distantmetastasisislate
CorrectAnswer-A:B:E
Answer-A,CommoninsmokerB,Morecommoninlower
lipE,Distantmetastasisislate
Lowerlipismoreofteninvolved
lncidenceoforalcancerissixtimesmoreinsmokerthannon-
smoker
Siteofpredilectionisb/wthemidline&commissureofthelip
Mostly,itissquamouscellcarcinoma,oftenseeninmalesintheage
groupof40-70years
L,Nmetastasesdeveloplate.Submental&submandibularnodes
arethefirsttobeinvolved;otherdeepcervicalnodesmayalsoget
involvedlater.
158.Trueaboutmediastinalteratoma:
a)Mostcommontumourofanteriormediastinum
b)Mostcommongermcelltumourofmediastinum
c)Morecommonlyoccursinanteriormediastinum
d)Containteeth,skin,hair,cartilageandbone
e)Histologicallygradedasdifferentiated&undifferentiated
CorrectAnswer-B:C:D:E
Answer-B,Mostcommongermcelltumourof
mediastinumC,Morecommonlyoccursinanterior
mediastinumD,Containteeth,skin,hair,cartilageand
boneE,Histologicallygradedasdifferentiated&
undifferentiated
Mostcommonmalignancyinyoungmenbetweenage15and35
years.
Primarymediastinalgermcelltumors(includingteratomas,
seminomas,andnonseminomatousmalignantgermcelltumors)are
aheterogeneousgroupofbenignandmalignantneoplasms.
Teratomasarethemostcommontypeofmediastinalgermcell
tumors.
Theycontaintwoorthreeembryoniclayersthatmayincludeteeth,
skin,hair(ectodermal),cartilageandbone(mesodermal),or
bronchial,intestinal,orpancreatictissue(endodermal).
MediastinalTeratomasmayeitherbe-
Mature:Welldifferentiated
Immature:Poorlydifferentiated
Withmalignanttransformation
159.Trueaboutinguinalherniainchildren:
a)Occurduetopersistenceofprocessusvaginalis
b)Defectinabdominalmaypresent
c)Mostcommonvarietyisdirecttype
d)Difficulttoreducenon-operatively
e)Morecommoningirls
CorrectAnswer-A:B:D
Answer-A,Occurduetopersistenceofprocessus
vaginalisB,DefectinabdominalmaypresentD,Difficultto
reducenon-operatively
Inchildren,ifinguinal(indirect)herniaispresentinoneside,then
processusvaginalisisintactonotherside.
Malesareaffectedaboutsixtimesmoreoftenthanfemales.
Indirectinguinalhernia-Canoccurinanyagefromchildhoodto
adult.
Inguinalherniaresultsfromafailureofclosureoftheprocessus
vaginalis.
160.Trueregardingtesticulartumour:
a)ForstageIseminoma-orchidectomyaloneusedfortreatment
b)ForstageIseminoma-orchidectomy+radiotherapyusedfor
treatment
c)StageInon-seminomatousgermcelltumour-orchidectmy
+radiotherapyusedfortreatment
d)Stagingisimportantforplanningmanagement
e)i3HCG&AFPmaybeusedasmarkertheresponseof
treatment
CorrectAnswer-B:D:E
Answer-B,ForstageIseminoma-orchidectomy+radiotherapy
usedfortreatmentD,Stagingisimportantforplanning
managementE,i3HCG&AFPmaybeusedasmarkerthe
responseoftreatment
TesticularTumour:Staging
StageI:Thetumourisconfinedtothetestis;
StageII:Nodaldiseaseispresentbutisconfinednodesbelowthe
diaphragm;
StageIII:Nodaldiseaseispresentabovethediaphragm;
StageIV:Nonlymphaticmetastaticdise
Inconfirmedcases,stagingisanessentialstepinplanning
treatment.
HCG&NSGCTswhenraised,thesemarkersareusedtomonitor
theresponsetotreatment.
161.Feature(s)ofFournier'sgangrene:
a)Necrotizingfasciitisofthemalegenitaliaandperineum
b)Diabetesisriskfactor
c)Urgentwidesurgicalexcisionofthedeadandinfectedtissueis
essential
d)Testisneedtoberemovedinallcases
e)None
CorrectAnswer-A:B:C
Answer-A,Necrotizingfasciitisofthemalegenitaliaand
perineumB,DiabetesisriskfactorC,Urgentwidesurgical
excisionofthedeadandinfectedtissueisessential
Fournier'sgangreneisanecrotizingfasctitisofthemalegenitalia
andperineumthatcanberapidlyprogressingandfatalifnottreated
promptly.
Riskfactors-
urethral
strictures,
perirectalabscesses,
poorperinealhygiene,
diabetes,
cancer,
humanimmunodeficiencyvirus(HIV)
Clinicalfeatures-
Clinicalsignsincludefevers,perinealandscrotalpain.
Cellulitis,eschars,necrosis,flakingskin,andcrepitusmayallbe
observed.
Treatment-
Urgentwidesurgicalexcisionofthedeadandinfectedtissueis
essential.
162.Whichofthefollowingis/arefeature(s)of
enlargedkidney:
a)Ballotable
b)Upperbordercanbereached
c)Shifttoparacolicgutteroncompression
d)Donotmovewithrespiration
e)Dullonpercussiononrenalangle
CorrectAnswer-A:E
Answer-A,BallotableE,Dullonpercussiononrenalangle
Itisareniformswelling
ltmovesveryslightlyuithrespirationasitcomesdownalittleatthe
heightofinspiration.
ltisballottable
Asickeningsensationisoftenfeltduringmanipulation
Ahandcanbeeasilyinsinuctedb/wtheupperpoleofswelling&the
costalmargin
Percussionwillrewalresonontnoteinfrontofakidneyswellingas
coilsofintestine&colonwillalwaysbeinfrontofthekidney.
163.Hypoparathyroidismcanoccurin:
a)Afterthyroidsurgery
b)Digeorgesyndrome
c)Radicalresectionofhead&neckcancer
d)MENI
e)All
CorrectAnswer-A:B:C
Answer-A,AfterthyroidsurgeryB,Digeorge
syndromeC,Radicalresectionofhead&neckcancer
Geneticdisorders(eg:DeGeorgesyndrome)
.Abnormalparathyroidglanddevelopment
.AbnormalPTHsynthesis
oActivatingmutationsofcalciumsensingreceptor(autosomal
dominanthypocalcemiaorsporadicisolatedhypoparathyroidism)
.Post-surgical(thyroidectomnparathyroidectomnradicalneck
dissection)
oAutoimmunepolyglandularsyndrome
164.Trueaboutbreastcyst:
a)Mostlyseeninpremenopausalperiod
b)Mostcommoninyoungwoman
c)Usuallyunilateral
d)Yellowish-greenishdischarge
e)Adheretounderlyingskin
CorrectAnswer-A:C:D
Answer-A,MostlyseeninpremenopausalperiodC,Usually
unilateralD,Yellowish-greenishdischarge
Classicallyseeninperimenopausalwomenmostlyinlastdecadeof
reproductivelife.
50%ofcystsaremultipleorrecurrent.
Cystfluidcanbestraw,colored,opaque,ordarkgreenandmay
containfleckofdebris.
Diagnosiscanbeconfirmedbyaspirationand/orultrasound.
165.Fibrocysticdiseasedifferfrom
fibroadenomabyhaving:
a)Painshiftwithcycle
b)Freelymobile
c)Usuallybilateral
d)Firm&rubbery
e)Welldemarcatedborder
CorrectAnswer-A:C
Answer-A,PainshiftwithcycleC,Usuallybilateral
Painful,oftenmultiple,usuallybilateralmassesinthebreast.
Rapidfructuationinthesizeofthemassesiscommon.
Frequently,painoccursorincreasesandsizeincreasesduring
premenstrualphaseofcycle.
Theselesionsarealwaysassociatedwithbenignchangesinthe
breastepithelium.
Themicroscopicfindingsoffibrocysticconditionindudecyst(gross
andmicroscopic),papillomatosis,adenosis,fibrosis,andductal
epithelialhyperplasia.
Clinicalfeatures-
Painortendernessoftencallsattentiontothemass.
Dischargefromthenipple.
Discomfortoccursorisincreasedduringthepemenstrualphaseof
thecycle.
Fibroadenoma-
Peakageofincidenceisat20year
Presentwithpainlesslump
Itissmooth,roundbordered,firmtohardinconsistency&freely
mobilewithinthebreast(socalledbreastmouse)
166.Testforincompetentvalvedoneby:
a)Coughimpulsetest
b)Trendelenburg
c)Percussationwavetravelinretrogradedirectionalongvaricose
vein
d)Percussationwavetravelinorthogradedirectionalongvaricose
vein
e)All
CorrectAnswer-A:B:C
Answer-A,Coughimpulse
testB,TrendelenburgC,Percussationwavetravelinretrograde
directionalongvaricosevein
Coughimpulsetest:saphenoofemoralincompetence
TrendelenburgI:saphenofemoralincompetence
TrendelenburgII:Perforatorincompetence
Multipletourniquettest:Siteofperforatorincompetence
Schwartztest:Superficialcolumnofblood
167.Whichofthefollowingis/aretrueabout
renalcarcinomaofT3astage:
a)InvolveGerotafascia
b)Involveperinephricfat
c)Renalveininvolvement
d)Inferiorvenacavainvolvement
e)Size>10cm
CorrectAnswer-B:C:E
Answer-B,InvolveperinephricfatC,Renalveininvolvement
E,Size>10cm
168.Trueaboutextracorporealshockwave
lithotripsy(ECWL):
a)C/Iinpregnancy
b)Lesssatisfactoryforhardstones
c)Stoneisbreakedintosmallpieceswhichcomesoutwithurine
d)Saferincoagulopathy
e)Endoscopicretrievalissometimesusedforimpactedstone
fragmentproducedbylithotripsy
CorrectAnswer-A:B:C:E
Answer-A,C/IinpregnancyB,Lesssatisfactoryforhard
stonesC,Stoneisbreakedintosmallpieceswhichcomesout
withurineE,Endoscopicretrievalissometimesusedfor
impactedstonefragmentproducedbylithotripsy
Crystallinestonesdisintegrateundertheimpactofshockwaves
producedbytheESWLmachine.
UretericcoliciscommonafterESWL.
TheprincipalcomplicationofESWLisinfection.
"Pregnantwomenand.patientswithlargeabdominalaortic
aneurysmsoruncorrectablebleedingdisordersshouldnotbe
treatedwithESWL.
169.Trueaboutcarcinomagallbladder:
a)Increasedbilirubinleveliscontraindicationforsurgery
b)Palliativetreatmentisforadvanceddisease
c)Metastaticrecurrenceiscommoninliver
d)Whengallbladderwallisinvolved,extendedcholecystectomy
isdone
e)Surgeryshouldbedoneinallcases
CorrectAnswer-B:C:D
Answer-(B)Palliativetreatmentisforadvanceddisease
(C)Metastaticrecurrenceiscommoninliver(D)Whengall
bladderwallisinvolved,extendedcholecystectomyisdone
IfGBcancerisfoundatcholecystectomy&ifmucosaaloneis
involved,thencholecystectomyissufficient
IfGBwallisinvolved,thenextendedcholecystectomyisdone
Radiationhasverysmallbenefit.Chemotherapyalsohasbeentried.
5-FU,mitomycinC,doxorubicinaredrugsused
Prognosisisverypoor.Aggressivesurgery&completeclearance
givebestresults.
Surgeryremainstheonlycurativeoptionforgallbladdercancer.
170.Trueaboutparamedianincision:
a)Itismadebelowumbilicus
b)Betterinobeseperson
c)Causeabdominalhernia
d)Cutanteriorsurfaceofrectussheath
e)Cutposteriorsurfaceofrectussheath
CorrectAnswer-C:D:E
Answer-(C)Causeabdominalhernia(D)Cutanteriorsurfaceof
rectussheath(E)Cutposteriorsurfaceofrectussheath
Use:provideslateralitytothemidlineincision,allowinglateral
structuressuchasthekidney,adrenalsandspleentobeaccessed.
Location:about2-5cmtotheleftorrightofthemidlineincision.
lncisionisoverthemedialaspectofthetransverseconvexityofthe
rectus.
Layersoftheabdominalwallskin,fascia(camper'sandscarpa's)
andtheanteriorrectussheathareincised.
Incisionsinanteriorandposteriorshectiisseperatedbymuscle
whichactsasabuttress,thereforeclosureandmoresecure.
171.Allaretrueaboutfullthicknessrectal
prolapseexcept:
a)Elderlyareatrisk
b)Commoninchildren
c)Morecommoninfemale
d)sensationofincompleteevacuation
e)Mayassociatedwithaweakpelvicfloor
CorrectAnswer-B
Answer-B.Commoninchildren
Commonlnelderlywomenwhoaremultipara
ConstiPationisimportantfeature
Tenesmuscommon
Somedegreeofincontinenceoffaeces&flatusisalwayspresent.
172.Whichofthefollowingis/arefeature(s)of
Keloid:
a)Collagenfibersarerandomlyarranged
b)TypeIVcollagendominates
c)Lesionwithhealthymarginremoved
d)Steroidisveryuseful
e)Goesbeyondmarginofwound
CorrectAnswer-B:D:E
Answer-(B)TypeIVcollagendominates(D)Steroidisvery
useful(E)Goesbeyondmarginofwound
Scarsareoftendescribedasbeingatrophic,hypertrophicand
keloid.
Ahypertrophicscarisdefinedasexcessivescartissuethatdoesnot
extendbeyondtheboundaryoftheoriginalincisionorwound.
Akeloidscarisdefinedasexcessivescartisstethatextendsbeyond
thebounilariesoftheoriginatincisionorwound.
IgEantibodyisleastcommonlyseeninkeloid.
eloidsgrowonparticularsites,theseare?
1. Centralchests(probablymostcommon,notsure)
2. Back
3. Shoulder
4. Earlobes
Etiologyofkeloid-
Keyfactors:Surgeryburns,vaccinations
Elevatedlevelsofgrowthfactor(moreoftype.8,collagen)
Lacerationorabrasion
Overthesternum(incision)
Inheritanceandinjection
Deeppigmentedskin
Histologyofbothhypertrophicandkeloidscars-
Excesscollagenwithhypervascularity
keloidswherethereismoretypeIIIcollagen.
Hypertrophicscarsimprovespontaneouslywithtime,whereaskeloid
scarsdonot.
keloidscarshavethicker,moreabundantcollagenbundles.
Treatment-
Intralesionalinjectionofsteroid(Triamcinoloneacetate)isnow
recommendedasthefirstlineoft/tforkeloid.
173.TrueaboutCongenitalhypertrophic
pyloricstenosis:
a)Shorteningofpyloriccanalonbariumcontrastimaging
b)Elongationofpyloriccanalonbariumcontrastimaging
c)Narrowingofpyloriccanalonbariumcontrastimaging
d)ThickenedpyloricmuscleonUSG
e)ChildshouldbegivennormalsalinewithKC1
CorrectAnswer-B:C:D:E
Answer-(B)Elongationofpyloriccanalonbariumcontrast
imaging(C)Narrowingofpyloriccanalonbariumcontrast
imaging(D)ThickenedpyloricmuscleonUSG(E)Childshould
begivennormalsalinewithKC1
Imagingconfirmationissoughtbymostcliniciantodifferentiatefrom
gastroesophagealreflex
Precaution:Emptystomachvianasogastrictubebeforestudy&
Removecontrastatend
Elongation&narrowingofpyloriccanal
Stringsign=passingofsmallbariumstreakthroughelongatedpyloric
channel(mostspecificsign)
Double/tripletracksign:crowdingofmucosalfoldsinpyloricchannel
174.Incomparisontoulcerativecolitis,which
ofthefollowingis/arefeature(s)of
crohn'sdisease:
a)Transmuralinflammation
b)Morecommoninsmoker
c)MorepANCApositivity
d)TNF-alphainhibitorroleonlyinCD
e)All
CorrectAnswer-A:B:D
Answer-(A)Transmuralinflammation(B)Morecommonin
smoker(D)TNF-alphainhibitorroleonlyinCD
CanaffectanypartofGIT,butmesites?terminalileum,ileocecal
valve,andcaecum.
Etiology-
Smokingisastrongriskfactor
OCPsandAppendicectomyincreaserisk
Morphology-
Skiplesions
Thickbowelwall
Stricturescommon
Transmuralinflammation
Noncaseatinggranulomas
Moderatepseudopolyps
Deep,knife-likeulcers
Fibrosis,serositis-Marked
Investigations-
70%ASCA+ve(antiSaccharomycescerevisiaeAb)10%pANCA
positive
Treatment
Anti-TNFtherapy(Infliximab,adalimumab,certolizumab)-first-line
agentstoinduceremissioninmoderatetoseverediseaseandto
maintainremission
175.Trueaboutparalyticileus:
a)Postoperativeileusprimarilyaffectsthestomachandcolon
b)Mostlyresolveafter24-72hours
c)Returnoffunctionoccursinthefollowingorder:stomach,large
bowelandsmallbowel.
d)Ifopioidisusedaspostoperativeanalgesia,thenchance
increases
e)Isananticipatedcomplicationsofabdominaloperations
CorrectAnswer-A:B:D:E
Answer-(A)Postoperativeileusprimarilyaffectsthestomach
andcolon(B)Mostlyresolveafter24-72hours(D)Ifopioidis
usedaspostoperativeanalgesia,thenchanceincreases(E)Is
ananticipatedcomplicationsofabdominaloperations
Etiology
Postoperative
Adegreeofileususuallyoccursafteranyabdominalprocedure
Self-limiting(24-72hours)
MaybeprolongedinHypoproteinemiaormetabolicabnormality
Intra-abdominalinflammation(peritonitis,abscess,retroperitoneal
hemorrhage)
Reflexileus:followingfracturesofspine/ribs,retroperitoneal
hemorrhageorapplicationofaplasterjacket
Metabolic&electrolytederangements(uremia,hypokalemia,
hyponatremia,hypoandhypomagnesemia,diabeticcoma,
hypoparathyroidism,hypothyroidism)
Drugs(opiates,psychotropicagents,anticholinergicagents,calcium
channelblockers)
Returnoffunctionoftheintestineoccursinthefollowingorder:small
bowel,largebowelandthenstomach
Paralyticileus,alsocalledpseudo-obstruction,isoneofthemajor
causesofintestinalobstructionininfantsandchildren.
176.Aciniccellcarcinomais/arefoundin:
a)Breast
b)Parotid
c)Lacrimalgland
d)Pancrease
e)Minorsalivarygland
CorrectAnswer-B:D:E
Answer-(B)Parotid(D)Pancrease(E)Minorsalivarygland
MajorSalivaryGlands(includingparotid)
MinorSalivaryGlands
Acinarcellcaricinomaaremalignantepithelialneoplasm(of
pancrease)
177.WhichareRadio-opaquestones:
a)Pureuricacid
b)Cysteine
c)Phosphate
d)Oxalate
e)Impureuricacid
CorrectAnswer-B:D:E
Answer-(B)Cysteine(D)Oxalate(E)Impureuricacid
RenalCalculus-
Oxalatestones
Phosphatecalculus-struvite
Uricacidanduratecalculi
Cystinecalculus
178.Trueaboutlymphangiomacircum
scriptum:
a)Compressibleswelling
b)Oftencontainclearfluid
c)Groupsofvesiclesarefoundonskin
d)Maypresentatbirthorshortlyafterbirth
e)None
CorrectAnswer-B:C:D
Answer-(B)Oftencontainclearfluid(C)Groupsofvesiclesare
foundonskin(D)Maypresentatbirthorshortlyafterbirth
ThistyPePresentsascircumscribedlesionwhichappearsassmall
vaicleorsmallblisterorslightlyelevatedskinpatch
Thesizevariesfrom0.5to4mmindiameter
Alargeareaofskinmaybeinvolvedontheinnersideofthethigh,
buttockontheshoulderorintheaxilla
Thewholelesionissoft&sPongY
Fluctuation,fluidthrill&translucencytestarealwayspositive.The
swellingisnotcompressible
Themarginsoftheswellingareindistinct
Theskinvesiclescontainclearfluid
Itisusuallyprominentatpubertyandmayoftenstartbleeding.
179.Sacral-teratoma/sacrococcygeal
teratomaisaderivativeof-
a)Primitivestreak
b)Ectoderm
c)Hypoblasts
d)Cranialneuropore
e)None
CorrectAnswer-A
Answer-A.Primitivestreak
Gastrulation&Hensen'snode:
In2ndweek-GastrulationoccursEstablishes3rdgermlayer
(mesoderm).
Gastrulationbeginswithprimitivestreakformationincaudalregion
ofepiblast.
PrimitivenodeorHensen'snodeorprimitiveknot:
Thickeningformedatcranialendofprimitivestreak.
Sacrococcygealformation:
FailureofHensen'snodetoregresscanleadtosacrococcygeal
formation.
Incompleteprimitivestreakregressionleavescaudalremnant
Sacrococcygealteratoma.
Arisefromresidualtototipotentialcellrests(Hensen'snode).
Sacrococcygealteratomademonstratestissuederivedfromallthree
celllayers.
Containvaryingproportionsofmature&immatureelements.
180.Trueaboutcentralvenous
catheterization:
a)Cathetermaybeplacedthroughsubclavianvein
b)IftheCVPislowinthepresenceofalowMAPorcardiac
output,thenfluidresuscitationisnecessary
c)Canbeusedforgainingvenousaccessinpatientwithpoor
peripheralveins
d)Subclavianveinrouteissafestintermofcomplications
e)All
CorrectAnswer-A:B:C
Answer-(A)Cathetermaybeplacedthroughsubclavianvein
(B)IftheCVPislowinthepresenceofalowMAPorcardiac
output,thenfluidresuscitationisnecessary(C)Canbeused
forgainingvenousaccessinpatientwithpoorperipheralveins
UsedformonitoringofCVEadministrationoffluidtotreat
hypovolemia&shock,infusionofcausticdrug&totalParenteral
nutrition,asPirationofemboli,insertionoftranscutaneouspacing
leads&gainingvenousaccessinpatientwithpoorperipheralveins.
CVPorrightatrialpressure(RAP)ismonitoredusingacatheter
insertedviaeithertheinternaljugularorthesubclavianvein.
TheCVPmayhelpinassessingtheneedforintravascularfluid
replacemant.
181.Trueaboutcareofpolytraumapatient:
a)CTscanofwholebodycanbedonetoexcludeinjuries
b)Longspinalcordinjurysupportisgivenifspinalcordinjuryis
suspected
c)Triageofinjurieswithcolourcodinglikered,yellow,green&
blackcanbedoneincaseofmasscasualty
d)Initialfluidmanagementisdoneasearlyaspossible
e)None
CorrectAnswer-A:B:C:D
Answer-(A)CTscanofwholebodycanbedonetoexclude
injuries(B)Longspinalcordinjurysupportisgivenifspinal
cordinjuryissuspected(C)Triageofinjurieswithcolour
codinglikered,yellow,green&blackcanbedoneincaseof
masscasualty(D)Initialfluidmanagementisdoneasearlyas
possible
BecauseofCT,anincreasingamountofbothblunt&penetrating
traumahasbeensafelymanagednonoperatively.
'Theavailabilityofhighresolutionmultislicescanners,promotingthe
developmentofprotocolsinsomecentersthatcallforearly
intergrationofcompletebody(i.e.head,cervicalmspine,chest,
abdomen&pelvis)CTscanningofselectedtraumapatient.
Intravenouslineiscriticalforintravenousvolumeresuscitation.
Triagesysteminvolvesacolor-codingschemeusingred,yellow,
green,white,andblacktags:Redindicateshighprioritytreatmentor
transfer,yellowsignalsmediumpriority,greenindicatesambulatory
patients&blackfordeadormoribund.
182.Whichofthefollowingistrueabout
suturetechnique:
a)Subcuticularsutureisusedwherecosmeticappearanceis
important
b)Verticalmattresscausescauseprominentstitchmarkscars
c)Horizontalmattressisusedforfragileskin
d)Verticalmattressisusedforfragileskin
e)None
CorrectAnswer-A:B:C
Answer-(A)Subcuticularsutureisusedwherecosmetic
appearanceisimportant(B)Verticalmattresscausescause
prominentstitchmarkscars(C)Horizontalmattressisusedfor
fragileskin
Thehorizontalmattressstitchisasuturetechniqueusedtoclose
wounds.
Thismakesitidealforholdingtogetherfragileskin.
Verticalmattresssuturearethatitprovidesclosureforbothdeep
andsuperficiallayers,andalsoallowsperfecteversionandvertical
oppositionofthesuperficialskinedges.
Subcuticularsuturetechniqueisusedinskinwhereacosmetic
appearanceisimportantarrdwheretheskinedgesmaybe
approximatedeasily.
183.Corticosteroidsareusefulinwhichofthe
followingpaediatricsdisease:
a)TBmeningitis
b)EndobronchialTB
c)Spinaventosa
d)Acutetuberculouspericardialeffusion
e)Severemiliarytuberculosis
CorrectAnswer-A:D:E
Ans.(A)TBmeningitis;b.EndobronchialTB;(D)Acute
tuberculouspericardialeffusion;(E)Severemiliary
tuberculosis
Corticosteroidsuseinpaediatrics:
Theseareusefulinthetreatmentofsomechildrenwithtuberculosis
disease.
Corticosteroidsdecreasemortalityratesandlong-termneurologic
sequelaeinsomePatientswithtuberculousmeningitisbyreducing
vasculitis,inflammation,and,ultimately,intracranialpressure.
Shortcoursesofcorticosteroids:Endobronchialtuberculosisthat
causesrespiratorydistress,localizedemphysema,orsegmental
pulmonarylesions.
Relievesymptomsandconstrictionassociatedwithacute
tuberculouspericardialeffusion.
Dramaticimprovementinsymptomsoftuberculouspleuraleffusion
andshiftofthemediastinum.
Severemiliarytuberculosishavedramaticimprovementwith
corticosteroidtherapyiftheinflammatoryreactionissoseverethat
alveolocapillaryblockispresent.
184.Eosinophiliainchildrenis/arepresentin:
a)Allergicrhinitis
b)Echinococcosis
c)Rheumatoidarthritis
d)Infectiousmononucleosis
e)Wiskott-Aldrichsyndrome
CorrectAnswer-A:B:C:E
Ans.(A)Allergicrhinitis;(B)Echinococcosis;(C)Rheumatoid
arthritis;(E)Wiskott-Aldrichsyndrome
Commoncausesofeosinophilia:
Acute:
Allergicdisorder:Asthma,atopicdermatitis,urticaria.drug
hypersensitivity,pemphigoid
Parasiticinfestation:Toxocara,ascaris,amebiasis,strongyloidiasis,
filarial,toxoplasmosis,trichinosia,schistosomiasis,malaria,scabies
Fungalinfections:Bronchopulmonaryaspergillosis,coccidiomycosis
Malignancy:Hodgkinlymphoma,Tcelllymphoma,acute
myelogenousleukaemia,myeloproliferativesyndrome
Hypereosinophilicsyndrome
Chronic:
Allergicdisorders:Pemphigus,dermatitisherpetiformis
Autoimmunedisorders:Inflammatoryboweldisease,rheumatoid
arthritis,Myeloproliferativesyndrome,hypereosinophilicsyndrome
,Loefflersyndrome.
Immunodeficiencysyndromes:HyperIgE,WiskottAldrichsyndrome;
Omennsyndrome;graftversushostreaction
Miscellaneous:Thrombocytopeniawithabsentradii;renalallograft
rejection;Addisondisease
185.Syndromenotassociatedwithchildhood
leukaemia:
a)Edwardsyndrome
b)Fanconisyndrome
c)Diamond-Blackanaemia
d)Patausyndrome
e)Kostmannsyndrome
CorrectAnswer-A:D
Ans.(A)Edwardsyndrome;(D)Patausyndrome
RiskfactorsforChildhoodLeukemia
Downsyndrome
Shwachman-Diamondsyndrome
Kostmannsyndrome
Li-Fraumenisyndrome
Fanconisyndrome
Bloomsyndrome.
Klinefeltersyndrome
Turnersyndrome
NeurofibromatosistypeI
Ataxia-telangiectasia
Severecombinedimmunedeficiency
Paroxysmalnocturnalhaemoglobinuria
186.AchildhasvitaminDdeficiencyrickets.
Whichofthefollowingis/arecorrect
regardingbiochemicalchanges:
a)Alkalinephosphatase
b)serumcalcium
c)parathyroidhormone
d)phosphate
e)25-(OH)D3
CorrectAnswer-A:C
Ans.(A)Alkalinephosphatase;(C)parathyroidhormone
BIOCHEMICALREACTIONS:
Serumcalcium:normalorlow
Serumphosphate:low
Alkalinephosphatase:high
Hypophosphatasiashowslowlevelofalk.phosphatase
PTH:High
Hypophophatemia
187.Trueaboutfetalalcoholsyndrome:
a)Increasedbirthweight
b)Normalfinemotordevelopment
c)Normalsocialskilldevelopment
d)Facialabnormalities
e)Intelligencesubnormal
CorrectAnswer-D:E
Ans.(D)Facialabnormalities;(E)Intelligencesubnormal
Fetalalcoholsyndrome
Highlevelofalcoholingestioninpregnancycancausedamageto
fetus,knownasfetalalcoholsyndrome.
Theharmfuleffectsmaybeduetoalcoholitselforduetooneofits
breakdownproducts.Someevidencesuggeststhatalcohol
mayimpairplacentaltransferofessentialaminoacidsandzinc,both
necessaryforproteinsynthesis,whichmayaccountforIUGR.
Characteristicsoffetalalcoholsyndromeinclude:?
IUGR(notlargeproportionatebody)
Microcephaly
Congenitalheartdefects(ASD,VSD)
Mentalretardation
FacialabnormalitiesShortpalpebralfissures,epicanthalfolds,
maxillaryhypoplasia,micrognathia,lowsetears,smoothphiltrum,
thinsmoothupperlip.
Minorjointanomalies
Hyperkineticmovements
188.Feature(s)ofcongenitalrubella
syndromeinclude:
a)Cataract
b)ASD
c)Deafness
d)Patentductusarteriosus
e)Alltheabove
CorrectAnswer-A:C:D
Ans.(A)Cataract;(C)Deafness;(D)Patentductusarteriosus
Congenitalrubellasyndrome(CRS)canoccurinadevelopingfetus
ofapregnantwomanwhohascontractedrubella,usuallyinthefirst
trimester.
Triadshows:PDA,cataractanddeafnes
Ifinfectionoccurs0?28daysbeforeconception,theinfanthasa
43%riskofbeingaffected.
Infectionin2ndtrimester?maybedeafnessonly.
>6wks?nomajorabnormalities
Diagnosis:Isolationofvirusincellculturesofthroatsamples,urine
orothersecretions.
DetectionofIgMinsingleserumsampleshortlyafterbirth.
PersistenceofRubellaIgGantibodiesserumbeyond1yearor
risingantibodytitreanytimeduringinfancyinanunvaccinatedchild
189.A4.2kgsbabyborntouncontrolled
diabeticmother.Thefollowingcondition
willnotoccurinthebaby:
a)Hypercalcemia
b)Hypoglycemia
c)Hyperbilirubinemia
d)Polycythaemia
e)Cardiovasculardefects
CorrectAnswer-A
Ans.(A)Hypercalcemia
NeonatalComplication:
Hypoglycaemia
Respiratorydistresssyndrome
Hyperbilirubinemia
Hypocalcemia
Hypomagnesemia.
Polycythemia
Cardiomyopathy
190.Trueaboutcaputsuccedaneum-
a)Oedematousswellingofscalp
b)Marginsareclearlydefined
c)Swellingresolvespontaneouslyafterfewdaysofbirth
d)Swellingremainsforthreemonths
e)Maximumsizeatbirth
CorrectAnswer-A:C:E
Ans.(A)Oedematousswellingofscalp;(C)Swellingresolve
spontaneouslyafterfewdaysofbirth;(E)Maximumsizeat
birth
Caputsuccedaneumisadiffuse,sometimesecchymoticedematous
swellingofthesofttissuesofthescalpinvolvingtheareaPresenting
duringvertexdelivery.
Itmayextendacrossthemidlineandacrosssuturelines.
Theedemadisappearswithinthelstfewdaysoflife.
Moldingoftheheadandoverridingoftheparietalbonesare
frequentlyassociatedandbecomemoreevidentaftercaputhas
receded;theydisappearduringthelstweeksoflife
Analogousswelling,discoloration,anddistortionofthefaceareseen
infacePresentations.
191.Achildhasfeverwithrednessofcheek.
Thecausativeorganismforthiscondition
is:
a)Herpesvirus
b)ParvovirusB-19
c)Adenovirus
d)Rubella
e)Roseola
CorrectAnswer-B
Ans.(B)ParvovirusB-19
Exanthemainfectiosum:
Thecharacteristicrashfirstappearsaserythematousflushingonthe
faceinaslappedcheekappearance(redcheek).
ThemostcommonmanifestationofparvovirusB19iserythema
infectiosum,alsoknownasfifthdisease,whichisabenign,self-
limitedexanthematousillnessofchildhood.
Itwasthe5thinaclassificationschemeofcommonchildhood
exanthems.
Thepreceding4exanthemsweremeasles,scarletfever,rubella,
andFilatov-Dukesdisease(anatypicalscarletfever),withroseola
infantumasthe"sixthdisease
192.Trueaboutminimalchangedisease-
a)Hypertensioniscommonlypresent
b)Mostcommoncauseofnephroticsyndromeinadults
c)Highdosesteroidsresultsinremissioninmostcases
d)Commonlyprogresstochronicrenalfailure
e)Reversiblelossofpodocytefunction
CorrectAnswer-C:E
Answer-(C)Highdosesteroidsresultsinremissioninmost
cases(E)Reversiblelossofpodocytefunction
Minimalchangedisease:
Alsok/alipoidnephrosa,footprocessdisease&Nildepositdisease
Thediseasesometimesfollowsarespiratoryinfectionorroutine
prophylacticimmunization'
Theonsetmaybeprecededbyanupperrespiratoryinfection,atopic
allergyorimmunisation.
Thediseasecharacteristicallyrespondtosteroidtherapy
Thebenigndisorderischaracterizedbydiffuseeffacementoffoot
processesofvisceralepithelialcell(podocytes).
mostfrequentcauseofnephroticsyndromeinchildren
Thevisceralepithelialchangesarecompletelyreversibleafrer
corticosteroidtherapy,concomitantwithremissionoftheproteinuria.
Thereiscommonlynohypertensionorhematuria.
Theappearanceofacuterenalfailureinadults.
193.Whichofthefollowingtrueaboutnew-
born&children:
a)Erythropoietinlevelismoreinpretermthanterm
b)Erythropoietingiventopretermonlyinsomespecialcases
c)ErythropoietingiventoPretermcancausecomplication
d)a&b
e)Noneoftheabove
CorrectAnswer-B:C
Ans.(B)Erythropoietingiventopretermonlyinsomespecial
cases;(C)ErythropoietingiventoPretermcancause
complication
Mostinfantswithbirthweightof<1KgRBCtransfusions.Akey
reasonwhythenadirhaemoglobinvaluesofprematureinfantsare
lowerthanthoseofterminfantsistheformergroup'srelatively
diminishedplasmaEPOlevelinresponsetoanaemia.
PreterminfantsexhibitasluggishEPOresponsetofalling
haematocritvalues.
LowplasmaEPOlevelproviderationaletheuseofrecombinant
EPOinthetreatmentofanemiaofprematurity.
ProperdosesofEPOandironeffectivelystimulateneonatal
erythropoiesis.However,theefficacyofEPOtherapytosubstantially
diminishtheneedfarRBCtransfusionhasnotbeen
convincinglydemonstrate,particularlyfarsick,extremelypremature
neonates,andrecombinantEPOhasnotbeenwidelyacceptedas
treatmentforanemiaofprematurity.
lnrarecases,somepreparationsofEPOhavebeenassociatedwith
thedevelopmentofanti-EPOantibodiesthatresultinsevereanemia.
194.Inwhichcondition(s),urethralopeningis
neverattipofglanspenis:
a)Epispadias
b)Hypospadias
c)Urethralstricture
d)Bladderexstrophy
e)Alloftheabove
CorrectAnswer-A:B:D
Ans.a.Epispadias;b.Hypospadias;d.Bladderexstrophy
Hypospadias
Acongenitaldisorderoftheurethrawheretheurinaryopeningisnot
attheusuallocationontheheadofthepenis.Itisthesecond-most
commonbirthabnormalityofthemalereproductivesystem,affecting
aboutoneofevery250malesatbirth.
EPISPADIAS
Anepispadiasisararetypeofcongenitalmalformationinwhichthe
urethraopensonthedorsum(theupperaspect)ofthepenis.Itis
oftenpartoftheconditiontermedEpispadias-exstrophyofthe
bladder.Epispadiasisamildformofbladderexstrophy,andin
severecases,exstrophyandepispadiascoexist.
195.Ingestionofwhichofthefollowing
mimicsscurvyinchild:
a)Magnesium
b)Potassiumiodide
c)Arsenic
d)Iron
e)Copper
CorrectAnswer-A
Ans.a.Magnesium
Hypermagnesemiaismostprobableanswerbecauseitalsocause
paralysis
Hypermagnesemiainhibitsacetylcholinereleaseatthe
neuromuscularjunction,producinghypotonia,hyporeflexia,and
weakness;paralysisoccursathighconcentrations.The
neuromuscular
196.Trueaboutboutonnieredeformity:
a)Flexionofproximalinterphalangealjoint&hyperextensionof
distalinterphalangealjoint
b)Hyperextensionofproximalinterphalangealjoint&flexionof
distalinterphalangealjoint
c)Flexionatproximalinterphalangeal&extensionat
metacarpophalangealjoint
d)Flexiondeformityoftheproximalinterphalangealjointoccur
duetotearincentralslipofextensortendon
e)Mayoccurinrheumatoidarthritis
CorrectAnswer-A:D:E
Ans.a.Flexionofproximalinterphalangealjoint&
hyperextensionofdistalinterphalangealjoint;d.Flexion
deformityoftheproximalinterphalangealjointoccurdueto
tearincentralslipofextensortendon;e.Mayoccurin
rheumatoidarthritis
Boutonnieredeformityisadeformedpositionofthefingersortoes,
inwhichthejointnearesttheknuckle(theproximalinterphalangeal
joint,orPIP)ispermanentlybenttowardthepalmwhilethefarthest
joint(thedistalinterphalangealjoint,orDIP)isbentbackaway(PIP
flexionwithDIPhyperextension).
Itcanbecausedbyacutonthetopofthefinger,whichcansever
thecentralslip(tendon)fromitsattachmenttothebone.Thetear
lookslikeabuttonhole("boutonni?re"inFrench).Insomecases,the
boneactuallycanpopthroughtheopening.
Boutonni?redeformitiesmayalsobecausedbyarthritis.
197.Trueaboutankylosingspondylitis:
a)Romanuslesionmaybefound
b)Ifleftuntreated,spinefusionmayoccur
c)Predilectionofthejointsoftheaxialskeleton
d)Bonyerosionsdonotoccur
e)all
CorrectAnswer-A:B:C
Ans.a.Romanuslesionmaybefound;b.Ifleftuntreated,spine
fusionmayoccur;c.Predilectionofthejointsoftheaxial
skeleton
Ankylosingspondylitis(marie-strumpelldisease)
Ankylosingspondylitisisachronicprogressiveinflammatorydisease
ofthesacroiliacjointsandtheaxialskeleton.
rototypeofseronegative(absenceofrheumatoidfactor)
spondyloarthropathies.
Inflammatorydisorderofunknowncause.
Usuallybeginsinthesecondorthirddecadewithamedianageof
23,in5%symptomsbeginafter40.
Maletofemaleratiois2-3:1
StrongcorrelationwithHLA-B270-95%ofcase
9sarepositiveforHLA-B27.
Jointsinvolvedinankylosingspondylitis
Ankylosingspondylitisprimarilyaffectsaxialskeleton.
Thediseaseusuallybeginsinthesacro-iliacjointsandusually
extendsupwardstoinvolvethelumbar,thoracic,andoftencervical
spine.
Intheworstcasesthehipsorshouldersarealsoaffected.Hipjoint
isthemostcommonlyaffectedperipheraljoint.
Rarelyknee(Ebenzar4th/e593)andankle(Apley's9thle67)are
alsoinvolved.Pathology
Enthesitisi.e.inflammationoftheinsertionpointsoftendons,
ligamentsorjointcapsuleonboneisoneofthehallmarksofthis
entityofdisease.
Primarilyaffectsaxial(spinal)skeletonandsacroiliitisisoftenthe
earliestmanifestationofA.S..
Involvementofcostovertebraljointsfrequentlyoccur,leadingto
diminishedchestexpansion(normal_5cm)
Peripheraljointse.g.shoulders,andhipsarealsoinvolvedin1/3rd
patients.
Extraarticularmanifestationslikeacuteanterioruveitis(in5%);rarely
aorticvalvedisease,carditisandpulmonaryfibrosisalsooccur.
Pathologicalchangesproceedinthreestages?
Inflammationwithgranulationtissueformationanderosionof
adjacentbone.
Fibrosisofgranulationtissue
Ossificationofthefibroustissue,leadingtoankylosisofthejoint.
Radiologicalfeaturesofankylosingspondylitis
Radiographicevidenceofsacroiliacjointisthemostconsistent
findinginankylosingspondylitisandiscrucialfordiagnosis.The
findingsare:-
SclerosisofthearticulatingsurfacesofSIjoints
Wideningofthesacroiliacjointspace
Bonyankylosisofthesacroiliacjoints
Calcificationofthesacroiliacligamentandsacro-tuberousligaments
Evidenceofenthesopathy-calcificationattheattachmentofthe
muscles,tendonsandligaments,particularlyaroundthepelvisand
aroundtheheel.
X-rayoflumbarspinemayshow:-
Squaringofvertebrae:Thenormalanteriorconcavityofthe
vertebralbodyislostbecauseofcalcificationoftheanterior
longitudinalligament.
ftLossofthelumbarlordosis.
Bridging`osteophytes'(syndesmophytes)
Bamboospineappearance
198.Trueaboutgiantcellsarcoma?
a)Mostcommonagegroupaffectedis20-40year
b)Proximalfemurismostcommonsiteaffected
c)Pulmonarymetastasisoccurin<3%ofcases
d)Alocallyaggressivetumor
e)Mayinvolvesacrum
CorrectAnswer-A:C:D:E
Ans.a.Mostcommonagegroupaffectedis20-40year;c.
Pulmonarymetastasisoccurin<3%ofcases;d.Alocally
aggressivetumor;e.Mayinvolvesacrum
GCT:
Itperhapsrepresentsthemostaggressivebenigntumorand
threatensthetruedefinitionofabenigncancerbecausebenign
pulmonarymetastasisdevelopinapproximately1%to2%ofgiant
celltumors.
CLINICALFEATURES
Thetumourisseencommonlyintheagegroupof20-40yearsi.e.,
afterepiphysealfusion.
Thebonesaffectedcommonlyarethosearoundthekneei.e.,lower-
endofthefemurandupper-endofthetibia.
Lower-endoftheradiusisanothercommonsite.
Thetumourislocatedattheepiphysis.
Itoftenreachesalmostuptothejointsurface.
Commonpresentingcomplaintsareswellingandvaguepain.
Sometimes,thepatient,unawareofthelesion,presentsforthefirst
timewithapathologicalfracturethroughthelesion.
199.Whichofthefollowingis/aretrueabout
simplebonecyst:
a)Mostcommonlyoccurinadult
b)Commonestsiteistheupperendofthehumerus
c)Cortexmaybethin
d)Causepathologicalfracture
e)Noriskofrecurrenceafterremoval
CorrectAnswer-B:C:D
Ans.b.Commonestsiteistheupperendofthehumerusc.
Cortexmaybethind.Causepathologicalfracture
SimpleBoneCyst(Alsok/aSolitaryorUnicameralCyst)
ltappearduringchildhood,inmetaphysisinoneofthelongbones&
mostcommonlylnproximalhumerusorfemur.
ltisnotatumour,ittendtohealspontaneously.
Itisseldomseeninadult
Thisconditionisusuallydiscoveredafterapathologicalfractureor
asanincidentalfindingonX-ray.
X-rayshowsawelldemarcatedradiolucentareainthemetaphysis
oftenextendinguptothephysealplate;thecortexnaybethinned&
theboneexpanded
Treatmentdependsonwhetherthecystissymptomatic,actively
growingorinvolvedinafracture
200.TrueaboutColle'sfracture:
a)Occuratdistalendofradius,about2cmfromdistalarticular
surface
b)Fracturealsoinvolvesradiocarpaljoint
c)Fracturealsoinvolvesproximalradioulnarjoint
d)Causeulnardeviation
e)Commoninwomen
CorrectAnswer-A:E
Ans.a.Occuratdistalendofradius,about2cmfromdistal
articularsurface;e.Commoninwomen
Colle'sFracture:
ThisisaFractureatthedistalendoftheradius,atits
corticocancellousjunction(about2cmfromthedistalarticular
surface),inadults,withtypicaldisplacement.
Itnearlyalwaysresultsfromafallonanout-stretchedhandcItis
commonestfractureinpeopleabovefortyyears
Particularlycommoninwomenbecauseofpostmenopausal
osteoporosis.
Displacement-dorsaldisplacement,dorsaltilt(mostcharacteristic),
lateraldisplacement,dorsaltilt,supination&impactionoffragments
Complication:Dinnerforkdeformity&Subluxationoftheinferior
radio-ulnarjoint(distalradiocarpaljoint)
Itismostcommonofallfractureinolderpeople.
201.Forassessingtheinjuryofmeniscusof
kneejoint,whichofthefollowingtest
is/aredone:
a)Apley'stest
b)Lachmanntest
c)McMurray'stest
d)Thessalytest
e)Hamiltonrulertest
CorrectAnswer-A:C:D
Ans.a.Apley'stest;c.McMurray'stest;d.Thessalytest
TestsforMeniscalInjuries?
Apley'sgrindingtest:formeniscusinjury
McMurray'stest-Thisclassictestforatornmeniscusisseldomused
nowthatthediagnosiscaneasilybemadebyMRI.Apositivetestis
helpfulbutnotpathognomonicanegativetestdoesnotexcludea
tear.
Thessalytest:Thistesthasshownahighdiagnosticaccuracyrate
atthelevelof95%indetectingmeniscaltears
202.A70yearoldladygotcompression
fractureofL1vertebra.Thereisno
neurologicaldeficittothispatient.What
advisewillyougiveforthisPatient:
a)VitaminDsupplementation
b)DoMRIscan
c)GoforscrewfixationofL1vertebra
d)TotakeDexamethasone
e)TotakeAlendronate
CorrectAnswer-A:E
Ans.a.VitaminDsupplementation;e.TotakeAlendronate
Itisacaseofosteoporoticfractureoflumbarspine
Treatmentcanbedividedintomedical&preventive.
Medical:
Highproteindiet,androgen,estrogen,VitaminD,fluoride,
alendronate,calcitonin,teripratide,denosumab&strontium(bothare
antiresorptiveagent).
Orthopaedictreatment:Exercise&Bracing(ASHbraceorTaylor
brace)
203.Whichofthefollowingindicateshigh
riskchoriocarcinoma:
a)InitialserumhCG>40,000mIU/mL
b)Priorchemotherapyfailure
c)Followingtermpregnancy
d)Metastasislimitedtolungandvagina
e)Longdurationofdisease
CorrectAnswer-A:B:C:E
Ans.a.InitialserumhCG>40,000mIU/mL;b.Prior
chemotherapyfailure;c.Followingtermpregnancye.Long
durationofdisease
Highriskfactorswhichindicatesthedevelopmentof
choriocarcinomaatthetimeofdiagnosisofahydatidiform
moleare:
Maternalagemorethan40years
Excessiveuterineenlargement
SerumhCGlevelsmorethan100,000mIU/ml
Thecaluteincystsgreaterthan6cmindiameter
Toxemia,hyperthyroidismandcoagulopathy
Trophoblasticembolization
Previouslytreatedchoriocarcinoma
204.Trueaboutmatureovarianteratoma:
a)Recurrenceiscommonafterexcision
b)ContainhairTeeth,bone&cartilage
c)Mostlybenign
d)Maybebilateral
e)Torsioniscommoncomplication
CorrectAnswer-B:C:D:E
Ans.b.ContainhairTeeth,bone&cartilage;c.Mostlybenign;
d.Maybebilateral;e.Torsioniscommoncomplication
Teratomaaredividedintothreecategories-
Mature(benign)e.g.dermoid
Immature(essentiallymalignant),e.g.solidteratoma&monodermal
orhighlyspecializede.g.stromaovarii"
DermoidCyst:
Ofallcystictumoursoftheovary5-10%aredermoid.
Itconstitute97%ofallovarianteratoma.
Itcontainssebaceousmaterial&hair&thewallislinedinpartby
squamousepitheliumwhichcontainshairfollicle&sebaceous
glands
Teeth,bone,cartilage,thyroidtissue&bronchialmucusmembrane
areoftenfoundinthewall
Dermoidcystsareinnocentovariantumoursbutepidermoid
carcinomaoccurinl.7%&sarcomatouschangehavebeen
described
Dermoidsarebilateralin12-15%
Torsionismostcommon(15-20%)&ruptureisanuncommon(1%)
complication
205.Poorprognosticfactorsforheartdisease
inpregnancyis/are:
a)EF30mmHgbyechocardiography
b)Priorcardiacfailure,arrhythmiaortransientischemicattack
c)Aorticvalvearea<1.5cm2
d)ClassIIIandClassIVNYHApatients
e)PeakLVoutflowtractgradient>30mmHgby
echocardiography
CorrectAnswer-B:C:D:E
Ans.b.Priorcardiacfailure,arrhythmiaortransientischemic
attack;c.Aorticvalvearea<1.5cm2;d.ClassIIIandClassIV
NYHApatients;e.PeakLVoutflowtractgradient>30mmHgby
echocardiography
Heartdiseasesinwhichpregnancywithpoorprognosis:
Marfansyndrome
Aorticdiseasewithdilatationof>50mmwithbicuspidaorticvalve.
Coarctationofaorta
Eisenmengersyndrome
Severefixedobstructivelesions(aorticstenosis,mitralstenosis,
pulmonicstenosis,hypertrophicobstructivecardiomyopathy)
NYHAclass3&4heartdiseases(severesystemicventricular
dysfunction/CHF)
Ejectionfraction<30-40%
Previousperipartumcardiomyopathywithanyresidualimpairmentof
LVfunction
Pulmonaryarterialhypertensionofanycause
Severecyanosis
206.Trueaboutabdominalhysterectomy:
a)Preferredforprolapseinpostmenopausalwoman
b)Ureterinjurycanbeavoidedbyopeningtheretroperitoneum&
identifyingureter
c)Postoperativecomplicationsarelessthanvaginalhysterectomy
d)Preferredinobesepatient
e)Enableswideexplorationofabdomen
CorrectAnswer-B:E
Ans.b.Ureterinjurycanbeavoidedbyopeningthe
retroperitoneum&identifyingureter;e.Enableswide
explorationofabdomen
AbdominalHysterectomy(AH)
Requiredforendometriosisandlargefibroids
Resultsingreatestmeanbloodloss
Injurytoureterisoneofthemostformidablecomplicationof
hysterectomy.Mostureteralinjuriescanbeavoidedbyopeningthe
retroperitoneumtodirectlyidentifyingtheureter
Hasthehighestincidenceoffebrilemorbidity
Posteriorwallofabdominalwoundinfection(obviously)
Longesthospitalisation
Enableswideexplorationofabdomen
Andslowesttorecover
Factorssuggestingpreferredroute:
Significantuterineenlargement
Inadequatetransvaginalaccess
Adnexalpathology&fixation
ObliterationofpouchofDouglas(endometriosis)
207.TrueaboutCoppercontainingIUCD:
a)Increasedcopperlevelinmilk
b)Increasedriskofectopicpregnancy
c)Increasedbleedinginmenstruationwithpain
d)ProvideprotectionagainstPID
e)Irregularmenses
CorrectAnswer-B:C:E
Ans.b.Increasedriskofectopicpregnancy;c.Increased
bleedinginmenstruationwithpain;e.Irregularmenses
CoppercontainingIUCDactslocallyinuterus,sonoaffecton
Culevelinmilk
ComplicationofIUCD:
Dysmenorrhoea
Menstrualdysfunction:prolonged&heavybleeding
PID:2-10timesgreateramongIUDusers.
Shouldpregnancyoccurwithadeviceinsitu,thereisriskofectopic
pregnancy(0.02%)
208.TrueaboutProgestogenonlypill:
a)Itistakendailyonthesametime
b)HigherfailureratethanCOC
c)Fertilityreturntonormalafterdiscontinuationwithoutanydelay
d)Suitedforlactatingwomenlactatingwomen
e)EctopicpregnancyriskaresameasCOC
CorrectAnswer-A:B:D
Ans.a.Itistakendailyonthesametime;b.Higherfailurerate
thanCOC;d.Suitedforlactatingwomenlactatingwomen
ProgestogenonlyPill(POP)/Minipil
Doesnothavesomemajorsideeffectsofcombinedpills&well
suitedforlactatingwomen;someprogestogens,infact,increase
milksecretion.
Side-effect:weightgain,irregularmenstrualbleeding,depression,
breastcancer,thromboembolism.
Advantage:Lactatingwomen,womenover35years,thosewith
focalmigraine,thoseintoleranttoestrogenoroestrogen
contraindicated,diabetic,hypertensive,sicklecellanaemia
Asregardstoreturnoffertility,fasterthanCOCusers
Contraindication:C/ItoPOParepreviousarepreviousectopic
pregnancy,ovariancyst,breast&genitalcancer,abnormalvaginal
bleedingactiveliver&arterialdisease,porphyria,livertumour.
209.Markersofmalignantovariantumour
is/are:
a)Inhibin
b)Betahumanchorionicgonadotropin
c)Alphafetoprotein(AFP)
d)Pax7
e)NB/70K
CorrectAnswer-A:B:C:E
Ans.a.Inhibin;b.Betahumanchorionicgonadotropin;c.Alpha
fetoprotein(AFP);e.NB/70K
TumourMarkerinEpithelialOvarianCancer:
CA-125:screeningofepithelialcancerofovary
Macrophagecolonystimulatingfactor(M-CSF)
OVXI
HER-2/Neu
Inhibin
hCG:ovarianchoriocarcinoma
BRCAI&BRCA2(Serouscarcinoma)
MLHI,MSH2&MSH6(HNPCCassociatedovariancancer)
AFP,hCG&CEA-Germcelltumour
Tumourmarker-forembryonalcarcinoma(AFBhCG)
Endodermalsinustumour(AFP)
Choriocarcinoma(hCG)
Germcelltumor-AFP,hCG,NB/70K,placentalalkalinephosphatase
&lactatedehydrogenase.
210.A30-yearladydeliveredababy.Whichof
thefollowingstatement(s)isnottrue
aboutpostpartumcontraception:
a)OCPisnotgivenbecauseitcancausesvenousthrombosis&
haveadverseimpactonmilkproduction
b)POPiscontraceptiveofchoiceforlactatingwomen
c)POPshouldbestartedafter6week
d)LNG-IUDisgoodinlactatingwomen
e)Fornon-lactatingwomen,ovulationnotoccursuntil12week
CorrectAnswer-E
Ans.e.Fornon-lactatingwomen,ovulationnotoccursuntil12
week
Non-lactating(Postpartum):Contraceptivepracticeshouldbestarted
after3week.Pillisgood;IUDisequallyeffectivealternative
POPissafeinlactatingwomen&canbestarted6weeksonwards.
LNGissaferthandesogestrel&gestagenfromthrombosispointof
view.
Intramuscular&progestogenimplantcanbeprescribed6weekafter
deliver
IUCDinsertionwithin10minofexpulsionofplacentaorwithin24hr
ofdeliveryisprovedsafe&effective
COCarecontraindicatedinthepuerperium,bothbecauseofits
adverseonmilksecretioninalactatingwomen&increasedriskof
thromboembolicepisode.COCcanbeprescribedtoanonlactating
woman3weeksafterdelivery.
211.Trueaboutplacentaaccreta:
a)Incidenceisabout1in2500Pregnancy
b)Incidenceincreasedinlastdecade
c)Absenceofdeciduabasalis
d)Fibrinoidlayerdeficient
e)Morecommoninprimi
CorrectAnswer-B:C:D
Ans.b.Incidenceincreasedinlastdecade;c.Absenceof
deciduabasalis;d.Fibrinoidlayerdeficient
Inplacentaaccretadeciduabasalisisabsentandplacentalvilliare
attachedtothemyometrium.
Riskfactors:
Patientswithahistoryofuterinesurgeryareatgreatestriskof
developinganaccreta.
Infact,thosewithapriorcesareansectioncarrya25%risk.
placentapreviainthepresenceofauterinescar
Others-prioruterinesurgery,endometrialablation,Asherman
syndrome,uterineleiomyomata,
212.Trueaboutlowgradesquamous
intraepitheliallesions:
a)Confinedtothelower1/3oftheepitheliumofcervix
b)Allcasesaretreatedbycryotherapy
c)30%progresstoinvasivecancerin10years
d)ItiskeptunderobservationwithPAPsmearorHPVDNAtests
e)Noneoftheabove
CorrectAnswer-A:D
Ans.(A)Confinedtothelower1/3oftheepitheliumofcervix&
(d)ItiskeptunderobservationwithPAPsmearorHPVDNA
tests
CIN-I(Lowgradesquamousintraepitheliallesions):Itisoftenseen
withinflammatoryconditionsliketrichomoniasis&HP&isreversible
followingtreatment.
Theundifferentiatedcellsareconfinedtothelower1/3ofthe
epithelium.
WomenwithCINI,confirmedonbiopsyiskeptunderobservation
withpapsmearfollowupat6monthsorHPVDNAtestsat12
month.Ifbothtestsarenegativeroutinerecall(screening)isdone.If
thesetestsarePersistentthentreatitasHSIL
213.Trueaboutendometriosis:
a)Laparoscopyisgoldstandardfordiagnosis
b)COCisusedtorelievemildPain
c)GnRHantagonistisusedtorelieveseverepain
d)Canbemanagedexpectantlyinasymptomaticcases
e)Noneoftheabove
CorrectAnswer-A:B:D
Ans.(A)Laparoscopyisgoldstandardfordiagnosis;(B).COCis
usedtorelievemildPain;(D)Canbemanagedexpectantlyin
asymptomaticcases
Friendsthisisthemostoftenaskedquestiononendometriosis.Itis
worthwhiletoknowafewdetailsonthistopic.
Empiricaltreatment:isforpainpresumedtobedueto
endometriosis.(inabsenceofdefinitivediagnosis)andincludes:--
Counselling
1. Analgesia
2. Nutritionaltherapy
3. ProgestinorOCP's
Analgesia:StudieshaveshownNSAID'sexceptniflumicacidare
moreeffectiveinchronicpainreliefduetoendometriosisor
dysmenorrheasuspectedtobeduetoendometriosis.
Hormonalmedicaltreatment:
Basisofmanagement:Sinceestrogenisknowntostimulatethe
growthofendometriosis,hormonaltherapyhasbeendesignedto
suppressestrogensynthesis,therebyinducingatrophyofectopic
endometrialimplantsorinterruptingthecycleofstimulationand
bleeding.
Indication:--Mildpelvicendometriosisinyoungwomen.?
Treatmentofresidualandrecurrentdiseasefollowingconservative
surgery.
214.Whichistrueregardingpremenstrual
dysphoricdisorder(PMDD):
a)Severedepressedmood
b)Painceasesatonsetofmenses
c)Depressionmaycontinueaftermenstrualperiod
d)Antidepressantisgivenfortreatment
e)Painceasesaftermensesisover
CorrectAnswer-A:D:E
Ans.(A)Severedepressedmood;(D)Antidepressantisgiven
fortreatment;(E)Painceasesaftermensesisover
Premenstrualsyndrome(PMS)&Premenstrualdysphoricdisorder
(PMDD)
PMSisoftennoticedjustpriortomenstruation(last7-10daysofthe
menstrualcycle)
Itshouldfulfilthefollowingcriteria:
Norelatedtoanyorganiclesion
Regularlyoccurringduringthelutealphaseofeachcycle.
Symptommustbesevereenoughtodisturbthelifestyleofwomen
orsherequiresmedicalhelp.
Symptomfreeperiodduringrestofthecycle
Whenthesesymptomsdisruptdailyfunctioningtheyaregrouped
underPMDD
Morecommoninwomenaged30-35yr.
Itmayrelatedtochildbirthoradisturbinglifeevent
Therearenopelvicfindingsexceptfeaturesofpelviccongestion.
5%sufferfromseveresymptomswhichinfluencedailyactivities
SSRI6NoradrenalineReuptakeinhibitors(SNRI)arefoundtobe
veryeffective
215.Trueaboutdiagnosisofgestational
diabetesmellitus(GDM):
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
CorrectAnswer-A:C:E
Ans.(A)Ifpostprandialsugar>200mg/dl,thenovertdiabetes;
(C)Iffastingsugaris>126mg/dl,thenovertdiabetes;(E)If
fastingsugaris110-125mg/dl,thenIGT
OVERTDIABETES:
Womenwitharandomplasmaglucoselevel>200mg/dL+classic
signsandsymptomssuchaspolydipsia,polyuria,andunexplained
weightlossorafastingglucoseexceeding125mg/dL.
Thediagnosticcutoffvalueforovertdiabetesisafastingplasma
glucoseof126mg/dLorhigher.
IGT:
Criteriafordiagnosisofimpairedglucosetolerance&diabetes
with75gmoralglucose:
ForfastingItsIGTif>100&<126
For2hourpostglucoseitsIGTif>140&<200
216.Trueaboutprimaryamenorrhoea:
a)InRokitansky-Kuster-Hausersyndrome,FSHisnormal
b)InTurnersyndrome,FSHisdecreased
c)InKallmansyndrome,FSHisincreased
d)InKallmansyndrome,LHisreduced
e)None
CorrectAnswer-A:D
Ans.(A)InRokitansky-Kuster-Hausersyndrome,FSHisnormal
and(D)InKallmansyndrome,LHisreduced
ASSOCIATEDCONDITION:
Turner'ssyndrome
Congenitaladrenalhyperplasia(CAH)
Androgeninsensitivitysyndrome
Testicularfeminizationsyndrome
PCOS
M?llerianagenesis/Utero-vaginalAgenesis/Mayer-Rokitansky-
Kuster-Hausersyndrome
DIAGNOSIS:
Buccalsmearandanexaminationofthepolymorphonuclear
leucocytestodetermineifchromatinpositive(probablyXX)or
chromatinnegative(probablyXOorXY);inothercasesafull
chromosomeanalysismaybeneededtoexcludemosaicismand
AIS.
HormonalinvestigationsshouldincludeLH,FSH,oestradioland
testosteronelevels.
Ultrasoundwillhelpdeterminethepresence,stateandsizeofthe
ovariesandanyfollicularactivity.
217.Inassistedbreechdelivery,aftercoming
headisdeliveredby:
a)Headdeliveredspontaneously
b)Pinardmanoeuvre
c)ModifiedMauriceau-Smellie-Veittechnique
d)Specialforcepfordeliveringheadisused
e)Praguemanoeuvre
CorrectAnswer-C:D:E
Ans.(C)ModifiedMauriceau-Smellie-Veittechnique;(D)Special
forcepfordeliveringheadisused;(E)Praguemanoeuvre
DeliveryoftheAftercomingheadofBreech
Variousmethodofsafedeliveryofaftercominghead
Burns-Marshallmethod:Forcepdelivery(Piperforcep,Dasforcep,
NevilleBarne'sforcep)
Malarflexion&shouldertraction(modifiedMauriceauSmellie-Veit
technique)
ArrestofafterComingHead
Burns-Marshallmethod
ModifiedMauriceau-Smellie-Veittechnique
Brachtmaneuver
Wigand-Martinmaneuver
Praguemaneuver
Forcepapplication
Duhrssen'sincision
Craniotomy
218.Whichofthefollowingis/are
ultrasonographicfindingoftwins:
a)Typeoftwinpregnancycanbediagnosedinfirsttrimester
b)Lambdasignindicatesdichorionicity
c)Tsignsuggestsmonochorionicdiamnioticpregnancy
d)Monozygotictwinsaremorecommon
e)All
CorrectAnswer-A:B:C
Ans.a.Typeoftwinpregnancycanbediagnosedinfirst
trimester;b.Lambdasignindicatesdichorionicity;c.Tsign
suggestsmonochorionicdiamnioticpregnancy
Sonography
Separategestationalsacs
Confirmationofdiagnosisasearlyas10thweekofpregnancy
Variabilityoffetuses,vanishingtwininsecondtrimester
Chorionicity(twinpeaksignorlamdasign)(10?13weeksof
gestation)
Thickseptumindichorionictwinsatbaseofthemembrane
withtriangularprojectionisknownaslambdaortwinpeaksign
Pregnancydating,Fetalanomalies
Fetalgrowthmonitoring,Presentationandlieoffetuses
Twintransfusionlocalization,Amnioticfluidvolume
219.Whichofthefollowingis/areusedin
psoriasis:
a)Highdoseoraldexamethasone
b)Methotrexate
c)TNF-alphainhibitor
d)Acitretin
e)NarrowbandUVB
CorrectAnswer-B:C:D
Ans.B,MethotrexateC,TNF-alphainhibitorD,Acitretin
Ref;.NeenaKhanna5th/54-59;Hartison19th/348;Roxburg
17th/138-42).
Systemiccorticosteroidsareonlyindicatedforgeneralizedpustular
psoriasisinpregnancy(impetigoherpetiformis).
Biologicalresponsemodifiersusedtotreatpsoriasisinclude:Tcell
inhibitors(alefacept,adalimumab,itolizumab).
Oralglucocorticoidsshouldnotbeusedinthetreatmentofpsoriasis
duetothepotentialfordevelopinglife-threateningpustularPsoriasis
whentherapyisdiscontinued.
220.Trueaboutskin:
a)Epidermisishighlyvascular
b)Melanocyteisderivedfromneuralcrest
c)Sebaecousgland-holocrine&absentinpalm
d)Apocrineglandpresentsinaxilla&groin
e)Hiraadenitissuppuritaisinfectionofapocrinegland
CorrectAnswer-B:C:D:E
Ans:B,MelanocyteisderivedfromneuralcrestC,Sebaecous
gland-holocrine&absentinpalmD,Apocrineglandpresentsin
axilla&groin&E,Hiraadenitissuppuritaisinfectionofapocrine
gland
[RefNeenaKhannaSth/119,451-53;Harrison19th/1099;Roxburgh
tTth/4-11;GeneralAnatomybyBDChaurasia5th/254-60
Hidradenitissuppurativa(Synonym-apocrineacne):Axillary
apocrinesweatglandinfection
Sebaceousglandsareholocrineinnature,
Thepigmentcells(melanocyte)oftheskinarederivedfromneural
crest.
Apocrinesweatglandsdrainsdirectlyintohairfolliclesintheaxillae&
groins
Sebaceousglandarelocatedthroughouttheskinexceptonpalms&
soles.
Glandsmadeupofacinioflipidcontainingcells,whichsecrete
sebumasaholocrinesecretion.
Eccrinesweatglandspresentalloverbody,especiallyonpalms,
soles&inaxillae.Humanhave2-24millioneccrinesweatglands
221.Acneiformeruptionis/aresideeffectof:
a)Tetracycline
b)Phenytoin
c)Isoniazid
d)Steroid
e)Potassiumiodide
CorrectAnswer-B:C:D:E
Ans:B,PhenytoinC,IsoniazidD,Steroid&E,Potassiumiodide
[RefNeenaKhanna5th/125;Harrison19th/356;Harrison14th/425;
Roxbug17th/Ea-55
Drug-inducedAcneiformEruptions:
Steroids(corticosteroids,androgens,anabolicsteroids),oral
antieMEtics,antituberculardrugs,anticonvulsants,halides(iodides.
bromides).
Trunkespeciallyback,facenaybeinvolved.
LesionsaremonomorPhic,consistingofpapulessometimespustule
222.Cicatricalalopeciais/areseenin:
a)Lichenplanopilaris
b)Discoidlupuserythematous
c)Andogenefflyum
d)Lichenplanus
e)Trichotillomania
CorrectAnswer-A:B:D
Ans.A.LichenplanopilarisB,Discoidlupuserythematous&
D,Lichenplanus
[RefNeenaKhanna5th/141;Hanison19th/355;Roxburg17th/270]
Thichotillomania(compulsivehair-pulling)ischaracterizedby
noticeablehairlosscausedbyperson!persistent&recurrentfailure
toresistimpulsetopullouthairs.
Nonscarringalopecia
A.Primarycutaneousdisorders
l.Telogeneffluvium
Androgeneticalopecia
Alopeciaareata
Tineacapitis
Traumaticalopecia
B.Drugs
C.Systemicdiseases
Systemiclupuserythematosus
Secondarysyphilis
Hypothyroidism
Hyperthyroidism
Hypopituitarism
Deficienciesofprotein,iron,biotin,andzinc
ll.Scarringalopecia
A.Primarycutaneousdisorders
Cutaneouslupus(chronicdiscoidlesions)
Lichenplanus
Centralcentrifugalcicatricialalopecia
Folliculitisdecalvans
Linearscleroderma(morphea)
B.Systemicdiseases
Discoidlesionsinthesettingofsystemiclupuserythematosus
Sarcoidosis
Cutaneousmetastases
223.WavelengthofUVBis:
a)250-280nm
b)280-320nm
c)320-400nm
d)400-700nm
e)100-200nm
CorrectAnswer-B
Ans.B.280-320nm
Thewavelengthfoundmosteffectiveintreatingskindiseasewith
phototherapyisUVBwithwardengfhof311(+-2nm)(narrowband
UVB,NBUVB).
Thewavelengthsbetween4(Nand7AOnmarevisibletothehuman
eye.
224.Whichofthefollowingstatement(s)
is/aretrueaboutphysicalurticaria
a)Cholinergicurticarialisprecipitatedbycold
b)Solarurticariaisskinsignoferythropoieticprotoporphyria
c)Dermatographismisanexample
d)Coldurticariaisprecipitatedbyemotion
e)None
CorrectAnswer-B:C
Ans.B,Solarurticariaisskinsignoferythropoietic
protoporphyria&C,Dermatographismisanexample
[RefNeenaKhannaSth/189;Harrison19th/i6i;Roxburg17th/74-74
).
PhysicalUrticarias:
Patientswithdermatographismexhibitlinearwhealsfollowingminor
pressureorscratchingoftheskin.
Solarurticariacharacteristicallyoccurswithinminutesofsun
exposureandisaskinsignofonesystemicdisease.
Coldurticariaisprecipitatedbyexposuretothecold,andtherefore
exposedareasareusuallyaffected.
Cholinergicurticariaisprecipitatedbyheat,exercise,emotionandis
characterizedbysmallwhealswithrelativelylargeflares.
225.Trueabouttracheostomy:
a)Tracheostomytubemayclosedbymucoussecretion&crust
formation
b)Copioussecretionfromtubeisalwaysduepulmonaryinfection
c)X-raychestshouldbedoneforconfirmationineverycase
d)Improperpositioningmayleadtofatalhaemorrhage
e)Displacingoftubeafter2weekismedicalemergency
CorrectAnswer-A:D
Ans.A,Tracheostomytubemayclosedbymucoussecretion&
crustformationD,Improperpositioningmayleadtofatal
haemorrhage
RefSchwartz9th/59-Iqhttp://www.nurses.com/;pL.Dhingra6th/
3I6-20;AjayYadav5th/48-49;MilloAnaesthaiaZth/232&IBit-72
Reintubationinthefirst36hoursaftertracheostomyIson
emergency.
TracheostomytubeshouldnotbedisturbedForthefirst48-72hr,
butthereafterthetubeischangeddaily&cleanedatregularinterval.
Recentstudydonotsupportobtainingaroutineposttracheostomy
chestX-ray.
Themostdramaticcomplicationistracheo-innominatearteryfistula
(TIAF).
Palpabletubepulsationsuggestimpendingerosionofanartery,
Trachealdeviationmaysignalabdomenbleeding
226.Trueaboutdesflurane:
a)Boilingpointis<230C
b)ChemicallyitisFlourinatedmethylethylether
c)Itincreasestheeffectofmusclerelaxant
d)Canbegivensafelytopatientsusceptibletomalignant
hyperthermia
e)Morepotentthanisoflurane
CorrectAnswer-A:B:C
Ans.A,Boilingpointis<230CB,ChemicallyitisFlourinated
methylethyletherC,Itincreasestheeffectofmusclerelaxant
[RefAjeyYadavSth/82;MorganSth/170&71)
Desflurane:
Fluorinatedmethylethylether
Boilingpointislessthan20C.
Producesmaximummusclerelaxationamongtheagents.
5timeslesspotentthanisoflurane.
Lossofpotency(theMACofdesfluraneis5timeshigherthan
isoflurane)
Immunemediatedhepatitisarareoccurrence.
hasthelowestblood:gassolubilityofthepotentvolatileanesthetics
227.Drug(s)notgivenastransdermalpatch:
a)Fentanyl
b)Diclofenac
c)Morphine
d)Clonidine
e)Buprenorphine
CorrectAnswer-B:C
Ans.B,Diclofenac&C,Morphine
[Ref:KDT7th/476
Transdermalfentanyl(Durogesic)hasbecomeavailableforusein
cancer/terminalillness.
Butransskinpatchescontainbuprenorphineanopioidpain
medication.
Clonidinetransdermaldelivery(patch)systemshavebeenavailable
sincethe1980
228.Endotrachealintubationis/areassessed
by:
a)Mallampatigrading
b)ASAphysicalstatusgrading
c)Thyromentaldistance
d)Teetharrangement
e)None
CorrectAnswer-A:C:D
Ans.A,MallampatigradingC,Thyromentaldistance&D,Teeth
arrangement
Ref:ManipalSurgery4th/1072-73;AjayYadav5th/53'124;Morgan
5th/312-13
ASAphysicalstatusgradingisforgeneralhealthstatusofpatient
(notforassessingintubation)
AssessmentofDifficultIntubation:
Mallampatigrading:ItisdonetoassessmouthoPening
Thyromentaldistance(distanceb/wthyroidnotchtomental
prominencewithfullyextendedneck)
Mentohyoiddistance:normal>5cm
AssessmentofTMjointfunction:Interincisorgap(mouthopening)
shouldbeatleast5cm(2fingerbreadth)
NeckMovement
229.Trueaboutphotodynamictherapyof
head&neckcancer:
a)Tumoursensitizerisused
b)Singletoxygenisproducedintumourcell
c)Aftertherapy,radiosensitizermayremainwithtumourcell
d)Hemoporphyringivenasradiosensitizer
e)Photosensitivityisaside-effectaftertherapy
CorrectAnswer-A:B:C:E
Ans.A,TumoursensitizerisusedB,Singletoxygenisproduced
intumourcellC,Aftertherapy,radiosensitizermayremainwith
tumourcell&E,Photosensitivityisaside-effectaftertherapy
RefSabiston236;Ballenger\Otorhinolaryngology16th/1324
Photodynamictherapyisanewtreatmentthatallowsdestruction
ofcancercellsandhasrecentlybeenexpandedtotheeradicationof
metaplasticcells,
Itbeginswiththeadministrationofatargetspecificphotosensitizer
thatiseventuallyconcentratedinthetargettissue.
Thephotosensitizingagentisthenactivatedwithawavelength-
specificlightenergysource,whichleadstogenerationoffree
radicalscytotoxictothetargettissue.
Applicationsreportedintheliteratureincludetreatingearly
radiographicallydetected,non-smallcelllungcancer,pancreatic
cancersquamouscellandbasalcellcarcinomaoftheskin,recurrent
superficialbladdercancer,Chestwallinvolvementfrombreast
cancerandevenchestwallrecurrenceofbreastcancer.
Givensystemically,thesedrugsarepreferentiallytakenupintumor
cells,renderingthemmoresensitivetolight-mediatedcellkilling
thantheirsurroundingtissues.
230.Whichofthefollowingcell(s)areless
radiosensitive:
a)Osteocyte
b)Erythroblasts
c)Chondrocyte
d)Spermatogonia
e)Lymphocyte
CorrectAnswer-A:C
Ans.A,Osteocyte&C,Chondrocyte
Ref:SumerSethi6th/174;Radiology&ImagingbyThayalanIst/310
Mostradiosensitivebloodcell-Lymphocyte
Leastradiosensitivebloodcell-platelet
Mostradiosensitivetissueofbody-Bonemarrow
Leastradiosensitivetissttcofbody-Nervoustissue/brain
HighRadiosensitive-Lymphoidorgans,bonemarrowblood,testes,
ovaries,intestines
LowRadiosensitive-Muscle,brain,spinalcord
231.Allaretrueaboutgammaknifeexcept:
a)Focussedradiationisdeliveredtotumor
b)Provideequalexposuretosurroundinghealthytissue
c)Itisatypeofstereotacticsurgery
d)Primarilyusedforsmallbraintumours
e)UsesCo-60assourceofradiation
CorrectAnswer-B
Ans.B.Provideequalexposuretosurroundinghealthytissue
Ref:SumerSethi6th/196-97
StereotacticRadiosurgerY:
Goalofstereotacticradiosurgeryistodeliverenoughradiationto
destroyorstopthegtorvfhofalesionpreviouslydefinedby
specializedimagingtechniqueswithoutadverselyaffecting
surroundingtissue.
GammaKnifeRadiosurgery:
Gammakniferadiosurgerykatypeofradiationtherapyusedtotreat
tumorsandotherabnormalitiesinthebrain.
Closeto200tinybearnsofradiationonatumor.
Gammaknife:
TheGammaKnifeisanadvancedradiationtreatmentforadultsand
childrenwithsmalltomediumbraintumors,abnormalbloodvessel
formationscalledartetiotenotrsmalformations,epilepsy,trigeminal
neuralgia,anerve.ott-ditiottthatcauseschronicpain,andother
neurologicalconditions.
The'blades"oftheGammaKnife"arethebeamsofgammaradiation
programmedtotargetthelesionatthepointwheretheyintersect.
GammaKnifeenablespatientstoundergoanon-invasiveformof
brainsurgerywithoutsurgicalrisks,alonghospitalstayor
subsequentrehabilitation.
232.Gammaradiationis/areproducedby:
a)Co-60
b)Caesium-137
c)P-32
d)Iridium-192
e)Strontium-90
CorrectAnswer-A:B:D
Ans.A,Co-60B,Caesium-137&D,Iridium-192
[Ref:SumerSethi6th/177,184;Radiology6ImagingbyThayalan
lst/17,278
Radiationemitted-Radionuclide
Gammarays-
Radium-226
Caesium-137
Cobalt-60
iridium-192
Gold-198
Samarium-153
Betarays:
Strontium-90
Yttrium-90
Phosphorus-32
Rhenium-188
Combinationofgammaandbetarays:
Rhenium-186
iodine-131
233.PreciseFNACcanbeobtainedbyusing:
a)USG
b)CT
c)EndoscopicUSG
d)MRI
e)Plain-Xray
CorrectAnswer-A
Ans.A.USG
RefDahnertRadiologyManual7th/368;Harshmohan7th/902-
l3;Robbins9th/333
RadiologicalimagingAidsforFNAC:
Non-palpablelesionrequiresomeformoflocalizationbyradiological
aidsforFNACtobecarriedout.
PlainX-rayfilmsareusuallyadequateforlesionswithinbones&for
somelesionswithinthechest
FNACofchestmayalsobeattemptedunderimageamplified
fluoroscopywhichallowsvisualizationofneedleplacementonthe
televisionmonitor
CTguidanceisalsousedforlesionswithinthechestdyAbdomen.
Themostversatileradiologicalaidisultrasonographicguidance
(USG)whichallowdirectvisualizationoFneedleplacementinreal
time&isfreefromradiationhazards.
ItisanextremelyvaluableaidforFNACofthyroidnodules,soft
tissuemasses,intra-abdominallesionsdtforintrathoracicwhich
aboutthechestwall,butnohelpindeepintrathoraciclesionsorin
bonylesions
PrecisionofUSGandCTscaniscomparableforguidanceinFNAC
fromthoracicmasslesions
234.TrueaboutsignalcharacteristicofCSF
onMRI&FLAIR:
a)HyperintenseonT1WI
b)HypointenseonTIWI
c)HyperintenseonT2WI
d)FLAIRreducesCSFsignal
e)FLAIRincreasesCSFsignal
CorrectAnswer-B:C:D
Ans.B,HypointenseonTIWIC,HyperintenseonT2WI&
D,FLAIRreducesCSFsignal
Ref:SumerSethi6th/15;Radiology6ImagingbyThayalanIst/386-
89]
MRISignalCharacteristic
CSF:HypointenseonTIWI,hyperintenseonT2W1.
Grey/Whitematter:Greymatterisgrey&whitematterswhiten
T1W1&relationshipisreversedonT2W1.
Thefluid,-attenuatedinversion-recovery(FLAIR)useslongerT1
(2400ms)&TR(7000ms)toreducethesignallevelofCSF&other
tissuewithlongTlrelaxationconstant.
ItreducesCSFsignal&otherwater-boundanatomyinMRimage
byusingaTldetectedatornearthebouncepointofCSF.
FLAIRMRItechniquesconsistofaninversionrecoverypulsetonull
thesignalfromCSFandalongechotimetoproduceaheavilyT2-
weightedsequence.
235.ContrastagentwhicharenotusedforCT
scan:
a)Water
b)CO2
c)Bariumcompounds
d)Iodinatedhigh-osmolalitycontrastmedia
e)Polyethyleneglycol
CorrectAnswer-B
Ans.B.CO2
RefSumerSethi6th/20;Radiology6ImagingbyThayalan159;
DahnertRadiologyManual7th/1147-48
Radiocontrastagentsareatypeofmedicalcontrastmediumusedto
improvethevisibilityofinternalbodilystructuresinX-ray-based
imagingtechniquessuchascomputedtomography(CT),
radiography&fluoroscopy.
Radiocontrastagentsaretypicallyiodineorbariumcompounds.
Whenanagentimprovesvisibilityofanarea,itiscalled"contrast
enhancing
Gadoliniumisakeycomponentofthecontrastmaterialmostoften
usedinmagneticresonance(MR)exams.
Saline(saltwater)andairarealsousedascontrastmaterialsin
imagingexams.
Bariumsulfatecontrastmediacontinuetobethepreferredagents
foropacificationofthegastrointestinaltractforconventional
fluoroscopicexaminations
Thecurrentuseofiodinatedwater-solublecontrastmediais
primarilylimitedtoselectsituations
Twocommercidwater-solubleiodinatedhigh-osmolalitycontrast
media(HOCMs)specificallydesignedforentericopacificationarein
commonuse.Gastrografinand,Gastroview
236.TrueaboutUSG:
a)Usesmostcommonlyfrequencyof20-50MHzfordiagnostic
ultrasound
b)Workonprincipleofpiezoelectriceffect
c)Ultrasonicwavesonlypenetratesgas,notliquid
d)Gasfilledmicrobubblesareusedascontrastmedia
e)None
CorrectAnswer-B:D
Ans.B.Workonprincipleofpiezoelectriceffect&D.Gasfilled
microbubblesareusedascontrastmedia
RefSumerSethi6th/9-10;Radiology&ImagingbyThayalan334-
40
Contrast-enhancedUltrasound(CEUS):
Applicationofultrasoundcontrastmediumtotraditionalmedical
sonography.
Commerciallyavailablecontrastmediaaregx-filled(airor
perfluorocarbon)microbubblesthatareadministeredintravenously
tothesysferniccirculation.
Microbubbleshaveahighdegreeofechogenicity(theabilityofan
objecttoreflectultrasoundwaves)
237.Trueaboutfindingofpleuraleffusion:
a)CTscancandistinguishbetweenapleuraleffusionanda
pleuralempyema
b)USGcandetectverysmallamountoffluid
c)X-ray-homogenousopacitywithobliterationofCPangle
d)MRIcannotdifferentiatemalignantfrombenignpleuraldisease
e)MRIcandifferentiatemalignantfrombenignpleuraldisease
CorrectAnswer-A:B:C:E
Ans.,A,CTscancandistinguishbetweenapleuraleffusionand
apleuralempyemaB,USGcandetectverysmallamountof
fluidCX-ray-homogenousopacitywithobliterationofCP
angle&EMRIcandifferentiatemalignantfrombenignpleural
disease
Ref:SumerSethi6th/49;DahnertRadiologyManual7th/446;WHO
ManualofRadiographicInterpretation2002/4I_42
Imagingcriteriaare:
Homogenousdensity
Densityindependentportion
Upright:CostophrenicangleinpAview
Lateralyiew:Anteriorandposteriorportionsofgutter
Lateraldecubitusposition:Alongsides
Supineposition:Alongposteriorly,givingdiffusehazinessonthe
sideofeffusion
Silhouetteofupperlimitofdensity
UppermarginhighinaxillainpAview(yellowarrows)
Uppermarginhighanteriorlyandposteriorlyinlateralview
Thisisjustanillusion
Lossofsilhouette:Intheimagesbelownotelackofidentifiableleft
diaphragmbeforeandvisiblediaphragmafterclearanceoffluid
(Silhouettesignprinciple)
Mediastinalshift
PleuralEffusion-X-Ray
First300mlnotvisualizedonPAyiew
Lateraldecubitusviewsmaydetectaslittleas25ml
PleuraleffusiononCTscan:
CTscanningisexcellentatdetectingsmallamountsoffluidandis
alsooftenabletoidentifyunderlyingintrathoraciccauses(e.9.
malignantpleuraldepositsorprimarylungneoplasms)aswellas
subdiaphragmaticdiseases1e.g.subdiaphragmaticabscess).
238.Trueaboutschizophrenia:
a)Q-EEGfindingisoneofdiagnosticcriteriaforschizophrenia
b)Psychosurgerycanbedoneforsomeresistantcases
c)Familyhistoryofschizophreniaispoorprognosis
d)Depressionmaybefound
e)Onsetonlyafter40yearofage
CorrectAnswer-B:C:D
Ans.B,Psychosurgerycanbedoneforsomeresistant
casesC,Familyhistoryofschizophreniaispoorprognosis&
D,Depressionmaybefound
[Ref:Ahuja7th/54-68;SynopsisofPsychiatrybyKaplan&Sadock
11th/300-32s
Schizophrenia:
Equallyprevalentinmales&females.
Onset-Before25yrs.Peakage-10to20yrs(males)&25to35
yrs.(Females)
EEGrecordingshowsdecreasedalphaactivity,increasedtheta&
deltaactivity.
QuantitativeEEG(qEEG)istheanalysisofthedigitizedEEG,andin
laytermsthissometimesisalsocalled'BrainMapping'.
Psychosurgeryisnotroutinelyindicated.
Whenused,thetreatmentofchoiceislimbicleucotomyinsome
caseswithseyere&veryprominentdepression,anxietyor
obsessionalsymptoms
239.Whichofthefollowingis/arenotside-
effectoflithium:
a)Seizure
b)Hyporeflexia
c)Nephrogenicdiabetesinsipidus
d)Alopecia
e)Tremor
CorrectAnswer-B
Ans.B.Hyporeflexia
Ref:SynopsisofpsychiatrybyKaplan6Sadock11th/985-88;KDT
7th/449;pharmacologybySatoskar2ith/225
Lithium:
Mildtoxicity:GIdisturbances,drowsiness,muscularweakness,
alopecia,allergicreaction,blurredvision,glycosuria,polyuria&
weightgain.
Chronicadministration:goiterformation,hypothyroidism&ECG
changes
Embryotoxicity:Liisembryotoxic&increasestheriskofEbstein's
anomaly
Hyper-reflexia
invalidquestionid
This post was last modified on 11 August 2021