Download PGI PG PGI 2016 November Solved Question Paper

1.Posteriorinterosseousnervesuppliesall
except:
a)Extensorcarpiradialislongus
b)Extensorcarpiulnaris
c)Extensordigitorum

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d)Extensorindices
e)Flexorcarpiulnaris
CorrectAnswer-A:E
Ans.(a)Extensorcarpiradialislongus,(e)Flexorcarpiulnaris
Theposteriorinterosseousnerveisapuremotornerve

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andinnervatessupinator&extensorcarpiradialis.
Itsupplies:?
1. Extensorcarpiulnaris
2. Extensordigitorum
3. Extensordigitiminimi

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4. Abductorpollicislongus
5. Extensorpollicislongusandbrevis
6. Extensorindicis

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2.Muscle'sofanteriorcompartmentoflegis/
are:

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a)Peroneustertius
b)Peroneusbrevis
c)Peroneuslongus
d)Flexordigitorumlongus
e)Flexorhallucislongus

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CorrectAnswer-A
Ans.(a)Peroneustertius
The4musclesintheanteriorcompartmentofthelegare-thetibialis
anterior,extensordigitorumlongus,extensorhallucislongus,and
fibularis(Peroneus)tertius

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3.Branchesofinternalcarotidarterydirectly
arisingfromit:
a)Posteriorcommunicatingartery
b)Superiorhypophysealartery

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c)Inferiorhypophysealartery
d)PosteriorcerebralArtery
e)RecurrentarteryofHeubner
CorrectAnswer-A:B:C
Ans.(a)Posteriorcommunicatingartery,(b),Superior

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hypophysealartery,(c)Inferiorhypophysealartery
InternalCarotidArteryBranches:
Ophthalmicartery
Posteriorcommunicatingartery
Anteriorchoroidalartery

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Anteriorcerebralartery:Orbital;FrontalandParietalbranches
Middlecerebralartery:Deeporperforatingbranch;temporalbranch;
FrontalbranchandParietalbranches

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4.Allaretrueaboutvestibularnerveexcept:

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a)Ithastwodivision-superiorandinferiorvestibular
b)Vestibularnucleisituatedatjunctionofponsandmedulla
c)Nervefibresrelayatscarpa'sganglion
d)Nucleusliesinmidbrainnearaqueduct
e)None

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CorrectAnswer-D
Ans.(d)Nucleusliesinmidbrainnearaqueduct
Vestibularnerve:
Themainnervedividesatandwithinthevestibular(Scarpa's)
ganglionintosuperiorandinferiordivision,whichareconnectedby

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anisthmus
Vestibularnucleiislocatedinfloorof4thventricle&issuppliedby
PICA.
Vestibularganglionisalsok/aScarpa'sganglion.
Vestibularnerveanastomosewithcochlearandfacialnerve.

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5.Trueabouttrochlearnerve:
a)Arisefromventralaspectofbrainstem
b)EntersorbitthroughannulusofZinn
c)Lesioncausesdiplopia
d)Nucleusofthetrochlearnerveislocatedinthecaudal

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mesencephalonbeneaththecerebralaqueduct
e)Damagecausesipsilateralpalsyofsuperiorobliquemuscle
CorrectAnswer-C:D
Ans.(c)Lesioncausesdiplopia,(d)Nucleusofthetrochlear
nerveislocatedinthecaudalmesencephalon

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Thetrochlearnervehascertainuniquefeatures:
Itistheonlycranialnervewhosefibersoriginatetotallyfromthe
contralateralnucleus.
Itistheonlycranialnervetoemergefromthedorsalsurfaceofthe
brainstem.

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Itisthemostslenderofallthecranialnerves.
Ithasthelongestintraduralcourseamongthethreeextraocular
motornerves.
Itsuppliesonlyonemusclei.e.superioroblique(Abducentcranial
nervealsosuppliesonlyonemusclei.e.Lateralrectus).

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6.Content(s)ofaortichiatus?
a)Thoracicduct
b)Aorta
c)Vagusnerve
d)Inferiorvenacava

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e)Azygosvein
CorrectAnswer-A:B:E
Ans.(a)Thoracicduct,(b)Aorta,(e)Azygosvein
TheaortichiatussituatedatthelevelofT12vertebra.
Structurespassingthroughaortichiatusalongwithaortaare:

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Thoracicduct
Azygosvein
Hemiazygosvein

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7.Whichflexortendonzoneinhandisknown
asNoman'sland?

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a)ZoneI
b)ZoneII
c)ZoneIII
d)ZoneIV
e)ZoneV

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CorrectAnswer-B
Ans.(b)ZoneII
ZoneIIextendsfromthemiddleofthemiddlephalanxtodistal
palmarcrease.Itcontainsbothflexortendonsuperficialisandflexor
tendonprofundus.

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IthasbeencalledNoMan'sLand.'or"NoMan'sZonebecause
repairinthiszoneisverydifficult.

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8.Correctstatementaboutmeiosis:
a)Somaticcellsnotdividebymeiosisbecausenumberof
chromosomesreducestohalf

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b)Occuringermcellwhichresultinhaploidcells
c)Onespermatocyteproducesonespermandoneoocyte
producesoneovum
d)Germcellundergoesdivisiontoformdiploidcellandincrease
theirnumber

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e)Bodyneedsmeiosistoproducelargeno.ofeggsandsperms
CorrectAnswer-A:B:E
Ans.(a)Somaticcellsnotdividebymeiosis(b)Occuringerm
cellwhichresult(e)Bodyneedsmeiosistoproduce.
Meiosis:

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Meiosisisatypeofcelldivisionthatreducesthenumberof
chromosomeslntheparentcellbyhalfandproducesfourgamete
cells.
Thisprocessisrequiredtoproduceeggand,spermcellforsexual
reproduction

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Meiosisbeginswithaparentcellthatlsdiploidandformsfour
daughtercellsthatarehaploid,whichhavehalfthenumberof
chromosomesofthediploidcells.

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9.

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Cross-sectionofmedullaatthelevelofmid-
olivarysectionthroughtheflooroffourth
ventriclecontainswhichofthefollowing
structure?
a)Trapezoidbody

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b)Dorsalnucleusofvagus
c)Nucleusoftractussolitarius
d)Nucleusambigus
e)Superiorvestibularnucleus
CorrectAnswer-B:C:D

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Ans.(b)Dorsalnucleusofvagus,(c)Nucleusoftractussolitarius,
(d)Nucleusambiguus

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10.Truestateinent(s)aboutOlfactorysystem
:
a)Olfactorymucosacoverupper1/3ofnasalcavity

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b)Olfactorypathwaypassesviathalamustoorbitofrontalcortex
c)Adaptationtoodourdeveloponlyafter1-2minutes
d)OlfactoryreceptorsactviacAMP
e)Rateofolfactorynerveimpulseschangeapproximatelyin
proportiontothelogarithmofstimulusstrength

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CorrectAnswer-A:B:D:E
Ans.(A)Olfactorymucosacoverupper1/3ofnasalcavity
(B)Olfactorypathwaypassesviathalamustoorbitofrontal
cortex(D)OlfactoryreceptorsactviacAMP(E)Rateofolfactory
nerveimpulseschangeapproximatelyinproportiontothe

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logarithmofstimulusstrength
Rateofolfactorynerveimpulseschangeapproximatelyinproportion
tothelogarithmoFstimulusstrength.
Theolfactoryreceptorsadaptabout5O%inthefirstsecondorso
afterstlmulatlan.Thereafter,theyadaptverylittleandveryslowly.

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Adaptation:Itdevelopswithinsecondsonminutes,dependingon
thenatureofthesubstance.
Weber-FechnerLawstatesthatthesubjectivesensation(ofodor,
soundorlightintensity)isproportionaltothelogarithmof!the
stimulusintensity''

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ThereceptorintheolfactorymucousmembranearecoupledtoG-
proteins.
Olfactoryregions:theUpper1/3oflateralwalls(uptosuperior

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concha),correspondingpartofthenasalseptumandtheroofofthe
nasalcavityfromtheolfactoryregion'Here,mucousmembraneIs

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palerincolor

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11.Trueaboutspecialanatomyand
Physiologyoflung:
a)Surfactantpreventcollapseofsmallalveoliintolargerone
b)Largeralveolihasmoretendencytocollapsethansmaller

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alveoliinabsenceofsurfactant
c)Surfactantdecreasechanceofcollapse
d)Surfactantincreasessurfacetension
e)Withsurfactant,largealveolitendtobecomesmallerand
smalleronestendtobecomelarger

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CorrectAnswer-A:C:E
Ans.(A)Surfactantpreventcollapseofsmallalveoliintolarger
one(C)Surfactantdecreasechanceofcollapse(E)With
surfactant,largealveolitendtobecomesmallerandsmaller
onestendtobecomelarger

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Upperregionalveolihavelargervolumes.
Alreadyfilledwithairandarelesscompliantcomparedtothoseto
dependentregions
LowsurFacetensionalveoliaresmall-duetothepresenceinthe
fluidliningthealveoliofsurfactant,alipidsurface-tension-lowering

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agent.
Surfactantdeficiencyisanimportantcauseofinfantrespiratory
distresssyndrome(IRDS,alsoknownashyalinemembrane
disease.
Surfacetensioninthelungsoftheseinfantsishigher,andthe

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alveoliarecollapsedlnmatryareas(atelectasis).

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12.Allaretrueaboutacromegalyexcept:
a)IncreasedIGF-1levels
b)Excessivegrowthoccursbeforefusionoftheepiphysesofthe
longbones

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c)Somatostatinanaloguescanbeused
d)Growthhormonelevelsincreased
e)Transsphenoidalsurgicalresectionisthepreferredprimary
treatmentforpituitaryadenoma
CorrectAnswer-B

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Ans.B.Excessivegrowthoccursbeforefusionofthe
epiphysesofthelongbones
Inacromegaly,IGF-IlevelsareinvariablyhighandreflectaLog-
LinearrelationshipwithclrculatlngGHconcentrations.
Foracromegaly,somatostatinanaloguesandGHreceptor

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antagonistsareindicated
Age-matchedserumIGF-Ilevelsareelevatedinacromegaly.
Somatostatinanaloguesareusedasadjuvanttreatmentfor
preoperativeshrinkageoflargeinvasivemacroadenomas.
Transsphenoidalsurgicalresectionbyanexperienced.surgeonis

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thepreferredprimarytreatment.
Tumorsofthesomatotrophsoftheanteriorpituitary(pituitary
adenomas)secretelargeamountsofgrowthhormone,leadingto
glgantbmlnchlUrenandacromegalyinadults.
Hypersecretionofgrowthhormoneisaccompaniedby

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hypersecretionofprolactinin20-40%ofpatientswithacromegaly.

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13.Truestatement(S)is/are:
a)Vasopressinincreaseonlywaterreabsorption,notsolute
reabsorption
b)AldosteroneincreaseNa+reabsorptionfromtubules

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c)GlomerularfiltrateofPCThassimilarosmolarityasofplasma
d)UrineishyperosmolarinearlyDCT
e)Generallyurineosmolarityequalstoplasmaosmolarity
CorrectAnswer-A:B:C
Ans(A)Vasopressinincreaseonlywaterreabsorption,not

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solutereabsorption(B)AldosteroneincreaseNa+reabsorption
fromtubules(C)GlomerularfiltrateofPCThassimilar
osmolarityasofplasma
Antidiuretichormone(ADH,Vasopressin)increasespermeabilityof
distaltubules(mildaction)andcollectingducts(mainly)to

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water)increaseswaterreabsorption.
Aldosteronecausesretentlonofsodlumtromthekidneyand
increasedurinaryexcretionofpotassium;ithaslittleeffectonwater
excretion.
PCT:Theosmolalityoffluidstntubuleisunchangedatapprox.

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3(X)mosmie,isotonicityismaintained.
ThetubularfluidenteringtheDCTisalwayshypotonictoplasma.
ThefluidinthedescendinglimboftheloopofHenlebecomes
hypertonicaswatermovesoutofthetubuleintothehypertonic
interstitium.

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Intheascendinglimbltbecomesmoredilutebecauseofthe
movementofNa+andCl-outofthetubularlumen,and.whenfluid
reachesthetopoftheascendinglt.

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AdrenalmineralocorticoidssuchasaLDosteroneincreasedtubular
reabsorptionofNa+inassociationwithsecretionofK+andH+and

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alsoNa+reabsorptionwithCl-.

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14.Rapidlyadaptingreceptor(s)is/are:
a)Painreceptor
b)Paciniancorpuscles
c)Musclespindle

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d)Golgitendonorgans
e)Meissnercorpuscles
CorrectAnswer-B:D:E
Ans.(B)Paciniancorpuscles(D)Golgitendonorgans
(E)Meissnercorpuscles

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Rapidlyadapting:Rapidlyadaptingmechanoreceptorsinclude
Meissnercorpuscleend-organs,Paciniancorpuscleend-organs,
hairfolliclesreceptorsandsomefreenerveendings.
Merkel'sdiscsandMelssner'scorpusclesaretactilereceptors.
Theyarerapidlyadaptingreceptors.

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Paciniancorpuscles:Theyrespondtodeformationcausedbyfirm
pressureandarequietlyadapting.

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15.Whichofthefollowingis/aretrueabout
normallevel:
a)TotalCalcium:8.5-10.5mg/dL

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b)Sodium:135-145mmol/L
c)Potassium:3.5-5.1mmol/L
d)Creatinine:0.6-2.6mg/dL
e)TSHlevel:0.1-3.1mIU/L
CorrectAnswer-A:B:C

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Ans.(A)TotalCalcium:8.5-10.5mg/dL(B)Sodium:135-145
mmol/L(C)Potassium:3.5-5.1mmol/L
Davidson22ed/1308,HarrisonL9rh/2762,2763,
TSH-.2-4.5mU/L
Calcium(total):8.5-10.5mg/dL

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Potassium-3.5-5.0meq/L
Sodium-136-146meq/L
Serumcreatinine-0.6-1.6mg/dl

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16.TrueaboutActionPotentialinskeletal
musclefibersandnervefibres:

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a)Skeletalmusclefibresconductionvelocityis1/4ofthick
myelinatednervefiber
b)Actionpotentialofbothqualitativelysimilar
c)Restingmembranepotentialalmostsame
d)Durationofactionpotentialsameinboth

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e)Actionpotentialofbothquantitivelysimilar
CorrectAnswer-B:C
Ans.(B)Actionpotentialofbothqualitativelysimilar
(C)Restingmembranepotentialalmostsame
MuscleActionPotential-ComparisonwithNerveActionPotential

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GuytonIlth/89
Restingmembranepotential:about-80to-90millivoltstoskeletal
fibers-thesameaslnlargemyelinatednervefibers.
Durationofactionpotential1to5millisecondstnskeletalmuscle
aboutfivetimesaslongasinlargemyelinatedfibers..

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Velocityofconduction:3to5m/sec-about1/13ththevelocityof
conductioninlargemyelinatedteraefibersthatexciteskeletal
muscle.

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17.Tissueelevationofwhichofthefollowing
causevasoconstriction:

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a)Na+
b)K+
c)Mg
d)Ca2+
e)H+

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CorrectAnswer-D
Ans.D.Ca2+
VascularControlbylonsandOtherChemicalFactorsGuyton
12th(SAE)/269
Anincreaseincalciumionconcentrationcausesvasoconstriction.

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Anincreaseinpotassiumionconcentration,.withinthephysiological
range,causesvasodilation.
Anincreaseinmagnesiumionconcentrationcausespowerful
vasodilation.
Anincreaseinhydrogenionconcentration(decreaseinpH)causes

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dilationofthearterioles.
Anionsthathavesignificanteffectsonbloodvesselsareacetateand
citrate.AnIncreaseincarbondioxideconcentrationcausesmoderate
vasodilationinmosttissuesbutmarkedvasodilationinthebrain.

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18.Whichofthefollowingstatement(s)is/are

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truechangesattimeofovulation:
a)GnRHleveldecreases
b)Gonadotropinhormonesurge
c)hCGsurge
d)1`Prostaglandins

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e)Activationofproteolyticenzymes
CorrectAnswer-B:D:E
Ans.B,GonadotropinhormonesurgeD,1`Prostaglandins&
E,Activationofproteolyticenzymes
Ovulation:

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ThemidcycleLHsurgeisresponsibleforadramaticincreasein
localconcentrationsofprostaglandinsandproteolyticenzymesin
thefollicularwall.
Thesesubstancesprogressivelyweakenthefollicularwalland
ultimatelyallowaperforationtoform.

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Ifpregnancydoesoccur,placentalhCGwillmimicLHactionand
continuallystimulatethecorpusluteumtosecreteprogesterone.
FeedbackEffects:
At36-48hbeforeovulation,theestrogenfeedbackeffectbecomes
positive,andthisinitiatestheburstofLHsecretion(LHsurge)that

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producesovulation.
Ovulationoccursabout9afterLHpeak-FSHsecretionalsopeaks,
despiteasmallriseininhibin,probablybecauseof.thestrong
stimulationofgonadotropesbyGnRH.
Duringthelutealphase,thesecretionofLHandFSHislowbecause

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oftheelevatedlevelsofestrogen,progesterone,andinhibin.

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19.Comprehensionpreservedinwhichofthe
follwingaphasia
a)Broca'saphasia
b)Conductionaphasia

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c)Wernicke'saphasia
d)Gobalaphasia
e)Anomicaphasia
CorrectAnswer-A:B:E
Ans.A,Broca'saphasiaB,Conductionaphasia&E,Anomic

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aphasia
Repetition
Comprehension ofSpoken Naming
Fluency
Language

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Preserved
Wernicke's
Impaired
Impaired
Impaired or

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increased
Preserved
Broca's
(except
Impaired

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Impaired Decreased
grammar)
Global
Impaired
Impaired

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Impaired Decreased
Conduction
Preserved
Impaired
Impaired Preserved

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Nonfluent
Preserved
Preserved Impaired Impaired
(motor)transcortical
Fluent(sensory)

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Impaired
Preserved Impaired Preserved
transcortical
No

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No

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Isolation
Impaired
Echolalia Impaired purposeful
speech
Preserved

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exceptfor
Anomic
Preserved
Preserved Impaired word-
finding

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pauses
Impairedonlyfor
Pureword
spoken
Impaired

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Preserved Preserved
deafness
language
Impairedonlyfor
Purealexia

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Preserved Preserved Preserved
reading

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20.Vomitingcentre(s)involvedinpost-
operativevomiting
a)Areapostrema

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b)Chemoreceptortriggerzone(CTZ)
c)Reticularformationlocatedinmedulla
d)Nucleustractussolitarius
e)Basalganglia
CorrectAnswer-A:B:D

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Ans.A,AreapostremaB,Chemoreceptortriggerzone(CTZ)&
D,Nucleustractussolitarius
PostoperativeNauseaandVomiting(PONV):
PONVisdefinedasanynausea,retching,orvomitingoccurring
duringthefirst24-48haftersurgeryinpatients.

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Accordingtoourcurrentmodel,thebrainstructuresinvolvedinthe
pathophysiologyofvomitingaredistributedthroughoutthemedulla
oblongataofthebrainstem,notcentralized,lnananatomically
defined'vomitingcentre'.
Suchstructuresincludethechemoreceptortriggerzone(cRTZ),

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Locatedatthecaudalendofthefourthventricleinthearea
postrema,andthenucleustractussolitarius(NTS),locatedin
theareapostremaandlowerpons.
PONVcanbetriggeredbyseveralperioperativestimuli,including
opioids,volatileanaesthetics,anxiety,adversedrugreactions,and

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motion.

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21.HGPRTareinvolve,andgoutcanbea
feature.
a)HGPRTdeficiency
b)HGPRToveractivity

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c)PRPPsynthetasedeficiency
d)Glucose6-phosphatasedeficiency
e)Glucosephosphatedehydrogenasedeficiency
CorrectAnswer-A:D
Answer.(a)HGPRTdeficiency,(d)Glucose6-phosphatase

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deficiency
[Ref:Harper30th/354-56;Satyanarayan4th/269-70,394-951
VonGierke'sdisease(Type1glycogenstoragedisease):
HyperuricemiaoccursduetoGlucose6-phosphataseenzyme
defect.

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HGPRTdeficiency(asseeninLesch-Nyhansyndrome):Increased
productionofpurines
Glucose6-phosphatasedeficiency:Purineoverproduction.
Goutisusuallyprecededandaccompaniedbyhyperurlcemta
(plasmauricacidlevel>0.4Immol/L).

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Hlperuricemiaiscausedbydacreasedrenalextretlon,lncreased
productlon"orincreasedintakeoturlcacid

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22.Hyperphenylalaninemiaoccursdueto:
a)Phenylalaninehydroxylasedeficiency
b)Phenylalaninehydroxylaseoveractivity

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c)Dihydrobiopterinreductasedeficiency
d)Tyrosinehydroxylasedeficiency
e)Defectindihydrobiopterinbiosynthesis
CorrectAnswer-A:C:E
Answer:(a)Phenylalaninehydroxylase...,(c)Dihydrobiopterin

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reductase...,(e)Defectindihydrobiopterinbiosynthesis
Hyperphenylalaninemiasarisefromdefectsinphenylalanine
hydroxylaseitself(typeI,classicphenylketonuriaorPKU),in
dihydrobiopterinreductase(typesIIandIII),orindihydrobiopterin
biosynthesis(typesIVandV).Alternativecatabolitesareexcreted.

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PKUiscausedbyadcficiencyotphenylalaninehydroxyl.ase,isthe
mostcommonclinicallvencounteredinbornerrorofamino
acidmetabolism.
Hyperphenylalaninemiamayalsobecausedbydeficienciesinany
oftheseveralenzymesrequiredtosynthesizeBH4,or

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indihydropteridinereductase,whichregeneratesBH4fromBH2.
BH4isalsorequiredfortyrosinehydroxylaseandtryptophan
hydroxylase,whichcatalyzereactionsleadingtothesynthesisof
neurotransmitters,suchasserotoninandreversethecentral
nervoussystem(CNS)effectsduetodeficienciesin

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neurotransmitters.

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23.Oxidativephoephoryletlonnotinhiblted
by:
a)Fluoride
b)2,4-dinitrophenol(DNP)

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c)Oligomycin
d)Carboxin
e)Ouabin
CorrectAnswer-A:D:E
Answer:(a)Fluoride,(d)Carboxin,(e)Ouabin(Ref:Harper

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30th/132-33;Lippincott6th/79;Satyanarayan4th/233-34;
Chatterjea7th/132-341
TherearethreesitesinrespiratorychainwhereATPisformedby
oxidativephosphorylation.Threesitesare-Sitel(Complex-I),Site
Il(ComplexIII)andSiteIll(ComplexIV).Complexll(Succinate

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dehyfuogenaseFAD)isnotinvolvedinoxidativephosphorylation.
2,4-dinitrophenol(DNP)Dinitrocresol,Trifluorocarbonylcyanide
phenylhydrazone,Pentachlorophenol
Aspirin(inhighdose),Highconcentrationofthermogenin,thyroxine
andlongchainfreefattyacids,Antibiotics-valinomycin,gramicidinA

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andnigercinareinhibitoresofoxidativephosphorylation
CarboxininhibitcomplexII,whichisnotinvolvedinoxidative
phosphorylation(sonotincludedinanswer)"?Chatterjea7h/134
"OuabainisacardiacglycosidethatactsbyinhibitingtheNW/IC-
ATPasesodium-potassiumionpump"-Harper30th/491

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Fluoride:Itinhibitstheactivitiesofcertainenzymes.Sodium
fluorideinhibitsenolase(ofglycolysis)whilefluoroacetateinhibits

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aconitase(ofcitricacidcycle)"-Satyanarayan4th/420.

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24.TrueaboutApolipoproteii.
a)Constituteperipheralregionofplasmalipoproteins

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b)DividedintoA,B,Conly
c)ApoA-Iisthemajorproteincomponentofhighdensity
lipoprotein(HDL)
d)ApoA,BandCarefurtherdivided
e)Roleinenzymeactivation

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CorrectAnswer-A:C:D:E
Answer.(a)Constituteperipheralregionof...,(c)ApoA-Iisthe
majorprotein...,(d)ApoA,BandCare...,(e)Roleinenzyme...
[Ref:Harper30th/254-55;Satyanarayan4th/318;
http://noprniscairres.in/bitstream;onlinelibrary.wiley.com]

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Apolipoproteins(apo)playveryimportantrolesinthesynthesisand
catabolismofplasmalipoproteins,inlipidtransport,andas
activatorsofcertainenzymesassociatedwithlipidandlipoprotein
metabolism
Apolipoproteinsaretheproteincomponentofplasma

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lipoproteinswhichconsistofacoreoftriglyceridesandcholesterol
estersandaperipheralregionofphospholipid,sphingolipidand
protein.
ApoA-Iisthemajorproteincomponentofhighdensity
lipoprotein(HDL)andaminorcomponentofchylomicronsandvery

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lowdensitylipoprotein(VLDL).
Apolipoproteinsaredividedbystructureandfunctionintofive
majorclasses,AthroughE,withmostclasseshaving
subclasses,forexample,apolipoprotein(orapo)A-IandapoC-
II.

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---

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25.Aminoacidscontaininghydroxylgroup:
a)Threonine
b)Tyrosine
c)Serine
d)Tryptophan

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e)Valine
CorrectAnswer-A:B:C
Answer:(a)Threonine,(b)Tyrosine,(c)SerineLippincott6th/4
Serine,threonine,andtyrosineeachcontainapolarhydroxyl
groupthatcanparticipateinhydrogenbondformation.

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Thesidechainsofasparagineandglutamineeachcontainacarbon
ylgroupandanamidegroup,bothofwhichcanalsoparticipatein
hydrogenbonds"-

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26.CytochromeP45Ois/areinvolvedln:
a)Hydroxylationofxenobiotics

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b)Methylationofxenobiotics
c)Deaminationreaction
d)Involvedinhydroxylationofsteroids
e)Druginteraction
CorrectAnswer-A:C:D:E

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Ans.(a)Hydroxylationofxenobiotics,(c)Deaminationreaction,
(d)Involvedinhydroxylationofsteroids,(e)Druginteraction
[Ref:Harper30th/584-85;KDT7th/23-26;Lippincott6th/;
Satyanarayan4th/639-40]
CytochromeP450sareinvolvedinphaseI(hydroxulation)ofthe

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metabolismofxenobiotics,notinphaseII.Methylationof
xenobioticsoccurinphaseIIbymethyltransferase

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27.Trueaboutroleofphospholipids:
a)Celltocellrecognition
b)Cellsignaling

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c)PrecursorofSecondMessengers
d)Mediatorsofinflammation
e)Regulatemembranepermeability
CorrectAnswer-B:C:D:E
Answer:(b)Cellsignaling,(c)PrecursorofSecond

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Messengers,(d)Mediatorsofinflammation,(e)Regulate
membranepermeability
(Ref:Harper30th/212,216,253-54;Robbins9th/83-84;
Satyanarayan4th/36-37)
Glycoprotein(fibronectin,laminin)isinvolveincell-cell

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recognitionandadhesion.
Theinositolispresentinphosphatidylinositolasthestereoisomer,
myoinositol.Phosphorylated
phosphatidylinositols(phosphoinositides)areminorcomponentsof
cellmembranes,butplayanimportantpartincellsignalingand

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membranetrafficking.
Sphingomyelinsarealsofoundinlargequantitiesinthemyelin
sheaththatsurroundsnervefibers.Theyarebelievedtoplaya
roleincellsignalingandinapoptosis.
Phosphatidylinositolisthesourceofsecondmessengers

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inositoltriphosphateanddiacylglyceol,thatareinvovedthe
actionofsomehoromones.

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28.Correctstatementaboutmembrane:
a)Phospholipidsundergorapidlateraldiffusion
b)Transversemovementoflipidsacrossthemembraneisfaster

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thanprotein
c)Hydrophobiccoreofthephospholipidbilayerremainsconstantly
inmotionbecauseofrotationsaroundthebondsoflipidtails
d)Phospholipdsthathaveonefattyacylgroup,cannotformthe
bilayer

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e)Phospholipidsspanwholebilayer
CorrectAnswer-A:C:D
Ans.a)Phospholipidsundergo...,(c)Hydrophobiccoreofthe
phospholipid...,(d)Phospholipdsthathaveonefattyacyl...
(Ref:Harper30th/215-17,478-90;Satyanarayan4th/650-51;

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

en.wikibooks.org]
Membranesaremainlymadeupoflipids,proteinsandsmallamount
ofcarbohydrate.Phospholipidsarethemostcommonlipidspresent
andtheyareamphipathicinnature.
Thehydrophobiccoreofthephospholipidbilayerisconstantlyin

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motionbecauseofrotationsaroundthebondsoflipidtails.
Hydrophobictailsofabilayerbendandlocktogether.However,
becauseofhydrogenbondingwithwater,thehydrophilichead
groupsexhibitlessmovementastheirrotationandmobilityare
constrained.Thisresultsinincreasingviscosityofthelipidbilayer

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closertothehydrophilicheads.
Thelysophosphollpi.dshaveonlyonefattyacylgroup,itcannotform
thebilayerasthepolarheadsaretoolarge,similarlycholesterolalso
cannotformbilayersastherigidfitsedringsystenxsandadditional

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nonpolartailsaretoolarge".

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---

29.DuringDNAreplicationwhichbond
breaks:
a)Phosphodiesterbonds
b)Phosphatebond
c)Hydrogenbond

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d)Glycosidicbonds
e)None
CorrectAnswer-C
Answer:c.Hydrogenbond[Ref:Lippincott6th/397-400;Harper
30th/381-86;Satyanarayana4th/524-29]

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WhenDNAreplicates,ahelicaseenzyme"unzips"thedoublehelix,
breakingthehydrogenbondsthatholdittogetherinthecenter
Thetwostrandsofthedoublehelixseparatewhenhydrogenbonds
betweenthepairedbasesaredisrupted.Disruptioncanoccurinthe
laboratoryifthepHoftheDNAsolutionisalteredsothatthe

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nucleotidebasesionize,orifthesolutionisheated.

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30.whichnNAcontalneabnormalpurineand
pyrimidine:
a)tRNA
b)23SrRNA

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c)16SrRNA
d)5SrRNA
e)mRNA
CorrectAnswer-A
Answer:a.tRNA

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tRNAmoleculecontainahighpercentageofunusalbases,for
example,dihydrouracilandhaveextensiveintra-chainbasepairing
thatleadstocharacteristicsecondaryandtertiarystructure"-
Lippincott6th/418.
ThetRNAmoleculescontainahighpercentageofunusualbases

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(forexample,dihydrouracil)andhaveextensiveintrachainbase-
pairingthatleadstocharacteristicsecondaryandtertiarystructure.
TransferRNAisuniqueamongnucleicacidsinitscontentof
"unusual"bases.Anunusualbaseisanypurineorpyrimidinering
excepttheusualA,G,C,andUfromwhichallRNAsare

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---

31.Componentof50Sribosomalzubunit:
a)16SRNA
b)18SRNA
c)5.8RNA
d)5SRNA

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e)23SRNA
CorrectAnswer-D:E
Answerd.5SRNA,(e)23SRNA(Lippincott6th/436):
The50Ssubunitisprimarilycomposedofproteinsbutalsocontains
single-strandedRNAknownasribosomalRNA(rRNA).rRNAforms

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secondaryandtertiarystructurestomaintainthestructureandcarry
outthecatalyticfunctionsoftheribosome.
Itincludesthe5SribosomalRNAand23SribosomalRNA.
50Sincludestheactivitythatcatalyzespeptidebondformation
(peptidyltransferreaction),preventsprematurepolypeptide

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hydrolysis,providesabindingsitefortheG-proteinfactors(assists
initiation,elongation,andtermination),andhelpsproteinfoldingafter
synthesis.

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32.TrueaboutChromatin,remodeling:
a)EnergyisrequiredtodisplacethehistoneoctamersfromDNA

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ortranslocatethemontoneighboringDNAsegments
b)Histonemodificationsbyspecificenzyme
c)Donotinvolveenzymes
d)Aberrationsinchromatinremodelingproteinsmaybe
associatedwithcancer

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e)None
CorrectAnswer-A:B:D
Answer:aEnergyisrequiredtodisplacethehistone...,(b)
Histonemodificationsby...,(d)Aberrationsinchromatin...
[Ref:Harper30th/735,438-39;Lippincott6th/422,460;Harrison

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19th/102e-7]
Chromatinremodelingisthedynamicmodificationof
chromatinarchitecturetoallowaccessofcondensedgenomic
DNAtotheregulatorytranscriptionmachineryproteins,and
therebycontrolgeneexpression.

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chromatinremodelingcomplexesdisplacethehistone
octamersfromDNAortranslocatethemontoneighboringDNA
segments,therebyexposingunderlyingDNAsequencesto
sequencespecificregulatoryfactors.
histoneacetylaseandotherenzymaticactivitiesareassociated

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withthecoregulatorsinvolvedinregulationofgene
transcription.
Aberrationsinchromatinremodelingproteinsarefoundtobe
associatedwithhumandiseases,includingcancer.

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33.Bestassessmentofproteinbinding

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regionsonaDNAmoleculecanbedone
by:
a)DNAfootprinting
b)RTPCR
c)Microarray

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d)Westernblotting
e)Northernblotting
CorrectAnswer-A
Answer-(a)DNAfootprinting[Ref:www.biotecharticles.com;
www.biologyexams4u.comLippincott6th/473]

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DNAfootprinting-Anin-vitrotechniquetofindoutprotein
bindingregionsonaDNAmolecule.Thetechniqueisalso
calledasDNAseIfootprinting.Thousandsofproteins
(enzymes)areinteractingwithDNAinthenucleusfor
regulatingactivitieslikereplication,transcription,translation

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etc.
DNAFootprintingisamoleculartechniqueusedtoidentifythe
specificDNAsequence(bindingsite)thatbindstoaprotein.
Thistechniquemainlyusedtoidentifythetranscriptionfactors
whichbindtopromoter,enhancerorsilencerregionofgeneto

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regulateitsexpression.Thereforetheregulationoftranscript
ionofagenecanbestudiedusingthismethod.

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34.Featuresofchronicmyelogenous
leukemia(CML)-
a)Bonemarrowbiopsyisnecessaryfordiagnosis

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b)PresenceofBCR-ABLgenewhichdirectsthesynthesisof
BCR-ABLtyrosinekinase
c)Dasatinibisusedinimatinibresistantcases
d)Generalizedpainfullymphadenopathyispresentingfeaturein
mostcases

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e)Myeloblastsusuallyconstitutemorethan10%ofallwhitecells
inchronicphase
CorrectAnswer-A:B:C
Answer-A,B,C,Bonemarrowbiopsyisnecessaryfor
diagnosis,(B)PresenceofBCR-ABLgenewhichdirectsthe

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synthesisofBCR-ABLtyrosinekinase(C)Dasatinibisusedin
imatinibresistantcases
Splenomegalyispresentin90%
Imatinib,dasatinibandnilotinibspecificallyinhibitBCRABLtyrosine
kinaseactivityandreducetheuncontrolledproliferationofwhite

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cells.
ThediseaseisdrivenbytheBCR-ABL1chimericgeneproduct,a
constitutivelyactivetyrosinekinase.
Commonmanifestationsareofanemiaandsplenomegaly,
lymphadenopathy,andextramedullarydisease(skinor

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subcutaneouslesions)
Thebonemarrowishypercellularwithmarkedmyeloidhyperplasia
andahighmyeloid-to-erythroidratioof15-20:1.

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35.TrueaboutCysticfibrosis-
a)OccursdueCFTRgenemutationonchromosome7

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b)Meconiumileusispresentin>90%cases
c)CFTRgenecanbedetectedantenately
d)Poorbodygrowth
e)Alloftheabove
CorrectAnswer-A:C:D

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Answer-A,C,D,OccursdueCFTRgenemutationon
chromosome7(C)CFTRgenecanbedetectedantenately
(D)Poorbodygrowth
Theprimarydefectincysticfibrosisresultsfromabnormalfunction
ofanepitheltalchloridechannelproteinencodedbythecystic

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fibrosistransmembraneconductanceregulator(CFTR)geneon
chromosome7.
Contentsoftheintestinallumenaredifficulttoexcretewhichresults
inmeconiumileus.
SequencingtheCFTRgeneisthegoldstandardfordiagnosisof

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cysticfibrosisPoorbodygrowth

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36.Trueaboutcaspases-
a)Caspasesinitiateapoptosisbyextrinsicandintrinsicpathway
b)Caspasesareproteaseenzyme
c)Caspasesarereceptor

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d)Caspasesinhibitapoptosis
e)Causesnonenzymaticdegradationofcriticalcellular
components
CorrectAnswer-A:B
Answer-A,B,Caspasesinitiateapoptosisbyextrinsicand

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intrinsicpathway(B)Caspasesareproteaseenzyme
Apoptosisresultsfromtheactivationofenzymescalledcaspases.
Theprocessofapoptosismaybedividedintoaninitiationphase
(intrinsicpathway)andexecution(extrinsicpathway).
Twodistinctpathwaysconvergeoncaspaseactivation:

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Themitochondrialpathwayandthedeathreceptorpathway
Caspasesareafamiyofendoproteases.
Theactivationoftheseenzymeistightlycontrolledbytheir
productionasinactivezymogensthatgaincatalyticactivityfollowing
signalingeventspromotingtheiraggregationintodimersor

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macromolecularcomplexes"

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37.Trueaboutminimalchangedisease-
a)Hypertensioniscommonlypresent
b)Mostcommoncauseofnephroticsyndromeinadults
c)Highdosesteroidsresultsinremissioninmostcases

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

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Minimalchangedisease:
Alsok/alipoidnephrosa,footprocessdisease&Nildepositdisease
Thediseasesometimesfollowsarespiratoryinfectionorroutine
prophylacticimmunization'
Theonsetmaybeprecededbyanupperrespiratoryinfection,atopic

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allergyorimmunisation.
Thediseasecharacteristicallyrespondtosteroidtherapy
Thebenigndisorderischaracterizedbydiffuseeffacementoffoot
processesofvisceralepithelialcell(podocytes).
mostfrequentcauseofnephroticsyndromeinchildren

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Thevisceralepithelialchangesarecompletelyreversibleafrer
corticosteroidtherapy,concomitantwithremissionoftheproteinuria.
Thereiscommonlynohypertensionorhematuria.
Theappearanceofacuterenalfailureinadults.

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38.Feature(s)ofAdultpolycystickidney

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diseaseis/are:
a)Renalenlargement
b)Smallkidney
c)Spiderlegdeformityonintravenousurography
d)Ultrasoundshowsmultiplecysts

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e)Alloftheabove
CorrectAnswer-A:C:D
Answer-A,C,D,Renalenlargement(C)Spiderlegdeformityon
intravenousurography(D)Ultrasoundshowsmultiplecysts
ADPKDischaracterizedbytheprogressivebilateralformationof

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renalcrisis.
Inhieritence-autosomaldominant
Characterizedbymultipleexpandingcystsofbothkidneys.
Ingrossappearance,thekidneysarebilaterallyenlarged.
Thepainmayresultfromrenalcystinfection,hemorrhage,or

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nephrolithiasis.
'Intravenousurographypolycystickidneydisease:Thespiderlegs,
deformityofthecalyces.

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39.Whichis/arecausedbyprotein
misfolding:

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a)Creutzfeldt-Jakobdisease
b)Bovinespongiformencephalopathy
c)Huntingtondisease
d)Alzheimerdisease
e)Parkinsondisease

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CorrectAnswer-A:B:C:D:E
Answer-A,B,C,D,E,Creutzfeldt-Jakobdisease(B)Bovine
spongiformencephalopathy(C)Huntingtondisease
(D)Alzheimerdisease(E)Parkinsondisease
Theproteinsfailtofoldintotheirnormalconfiguratoryinthis

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misfoldedstate,theproteinscanbecometoxicinsomeway(again
oftoxicfunction)ortheycanlosetheirnormalfunctionwhichis
knownasproteinmisfoldingdisease.
SuchdiseasesasCreutzfeldt-Jakobdisease,Alzheimer'sdisease,
Parkinson'sdisease,priondisease,amyloidosis,Bovinespongiform

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encephalopathy,Huntingtondisease.

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40.TrueaboutCreutzfeldt-JakobDisease:
a)Gliosisinthalamus
b)Spongiformswellingincerebralcortex
c)Brainatrophyinlatestage

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d)SlowandirregularbackgroundrhythmonEEG
e)None
CorrectAnswer-B:C:D
Answer-B,C,D,Spongiformswellingincerebralcortex
(C)Brainatrophyinlatestage(D)Slowandirregular

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backgroundrhythmonEEG
CJDisararedisorderthatmanifestsclinicallyasarapidly
progressivedementia.
TheprogressionofthedementiainCJDisusuallysorapidthatthere
islittleifanygrosslyevidentbrainatrophy.

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Microscopically,thehallmarkisspongiformchangeofthecerebral
cortex.
Inadvancedcasesthereissevereneuronalloss,reactivegliosis.
EEGabnormaltdesarepresentinnearlyallpatients,consistingofa
slowandirregularbackgroundrhythmwithperiodiccomplex

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discharges.

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41.Hereditarynon-polyposiscolorectal
cancer(HNPCC)is/arecommonly
associatedwith-
a)Endometrialcancer

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b)Cervicalcancer
c)Ovariancancer
d)Breastcancer
e)Thyroidcancer
CorrectAnswer-A:C

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Answer-A,C,Endometrialcancer(C)Ovariancancer
Hereditarynon-polyposiscolorectalcancer(HNPCC)-
Malignancies-Colonic,endometrial,ovarian,pancreatic,gastric.
Inherictance-autosomaldominant
Gene-ADMSH2,MLH1,MSH6,PMS1,PMS2

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42.FeaturesofNonbacterialthrombotic
endocarditis(NBTE)-
a)CommoninSLE
b)Presentonundersurfaceofvalve
c)Vegetativegrowthislargeandlooselyattachedtovalve

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d)Mayoccurafterpost-cardiaccatheterization
e)Sourceofsystemicemboli
CorrectAnswer-B:D:E
Answer-B,D,E,Presentonundersurfaceofvalve(D)May
occurafterpost-cardiaccatheterization(E)Sourceofsystemic

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emboli
Theseverrucaearetypicallysmall,singleormultiple,brownishand
occuralongthelineofclosureoftheleaflet.
VegetatianofNBTEissmallandlooselyattachedtotheunderlying
valve.

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Sourceofsystemicembolithatproducesignificantinfarctsinthe
brain,heart,spleenandkidneys.
Itfrequentlyoccurswithdeepvenousthrombosis,pulmonaryemboli.

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43.TrueaboutAlzheirnerdisease:
a)Mostcommoncauseofdementiainelderly

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b)Unusalbefore45yearsofage
c)Plaquesconsistsoftauprotein
d)Mayhavefamilyhistory
e)Shorttermmemoryisaffectedlessthanlong-termmemory
CorrectAnswer-A:B:D

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Answer-A,B,D,Mostcommoncauseofdementiainelderly
(B)Unusalbefore45yearsofage(D)Mayhavefamilyhistory
Alzheimer'sdisease(AD)isaslowlyprogressivediseaseofthe
brainthatischaracterizedbyimpairmentofmemoryandeventually
bydisturbancesinreasoning,planning,language,andperception.

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Alzheimer'sdiseaseisCommonin5thand6thdecade.
Trisomy21isassociatedwithalzheimer'sdementia.
Plaquecontainingbeta-amyloidpeptide,andneurofibrillarytangles
containingtauproteinoccursinneocortex.
Thecausesincludegenetic,environmental,andlifestylefactors.

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DementiaofAlzheimer'stypeisassociatedwithDepressive
symptoms,Delusions,Apraxiaandaphasia.
Recentmemoryloss(shorttermmemoryloss)isfeatureof
Alzheimer'sdisease.

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44.Negribodiesinanimalcanbebestseen

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in:
a)Hippocampus
b)Basalganglia
c)Cerebralcortex
d)Cerebellum

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e)Thalamus
CorrectAnswer-A:D
Answer-A,D,Hippocampus(D)Cerebellum
Theyaremostprominentinpyramidalcellsofthehippocampusand
Purkinjecellsofcerebellumbuthavebeenseeninnervecells

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throughoutthebrainandspinalcord.

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45.Trueaboutp53-
a)Hastyrosinekinaseactivity
b)Haspro-apoptoticactivity
c)Tumoursuppressorgene

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d)Hasanti-apoptoticactivity
e)None
CorrectAnswer-A:B:C
Answer-A,B,C,Hastyrosinekinaseactivity(B)Haspro-
apoptoticactivity(C)Tumoursuppressorgene

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p53isatumorsuppressorgeneanditisaproapoptoticfactor,i.e.it
promotesapoptosisifrepairofDNAdamageisunsuccessfulatG1
arrest.
Theproteinkinasesthatareknowntotargetthistranscriptional
activationdomainofp53.

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46.TrueaboutTakayasusyndrome:
a)InvolvessmallandMediumsizedvessels
b)Sharesmanyclinicalfeaturesofgiantcellarteritisifinvolves
aorta
c)Morecommoninmalethanfemale

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d)Granulomatousvasculitis
e)Alsocalledpulselessdisease
CorrectAnswer-B:C:E
Answer-B,D,E,Sharesmanyclinicalfeaturesofgiantcell
arteritisifinvolvesaorta(D)Granulomatousvasculitis(E)Also

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calledpulselessdisease
"Giantcellarteritis(GCA)isagranulomatousarteritisthat
predominantlyaffectsmedium-sizedarteriesintheheadandneck.
Itpredominantlyaffectstheaorta.
Takayasuarteritis(Pulselessdlsease):Thediseaseaffectschiefly

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youngwomen.
Takayasuarteritisisagranulomatousvasculitisofmediumsized
andlargerarteriescharacterizedprincipallybyoculardisturbances
andmarkedweakeningofthepulsesintheupperextremities.

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47.Whichareinheritablemalignancies:

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a)Breastcancer
b)Thyroidcancer
c)Wilmstumour
d)Retinoblastoma
e)Prostatecancer

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CorrectAnswer-A:B:C:D:E
Answer-A,B,C,D,E,Breastcancer(B)Thyroidcancer
(C)Wilmstumour(D)Retinoblastoma(E)Prostatecancer
Breast/ovarian-Breast,ovarian,colonic,prostatic,pancreatic
Wilm'stumour-Nephroblastoma,neuroblastoma,hepatoblastoma,

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rhabdomyosarcomaRetinoblastoma-Retinoblastoma,
osteosarcoma
Prostatecancer-prostate
Cowden'ssyndrome-Breast,thyroid,gastrointestinaltract,
pancreatic

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48.CausesofNon-megaloblasticmacrocytic
anameia-
a)Folatedeficiency
b)Leadtoxicity
c)Hypothyroidism

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d)Liverdisease
e)VitB12deficiency
CorrectAnswer-C:D
Answer-C,D,Hypothyroidism(D)Liverdisease
Causesinclude:

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Chronicalcoholism
Liverdisease
Hypothyroidism
Reticularfibrosis
Blood.disorderslikered-cellaplasia,aplastic

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anemia,myelodysplasticsyndromesandmyeloidleukemia
Drugsasazathioprine
Pregnancy

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49.Truestatement(s)aboutWilm'stumour-
a)Mostcommonlypresentsasasymptomaticabdominalmass

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b)Hereditarypredispositionispresentin50%cases
c)Bilateralin25%cases
d)Classictriphasiccombinationofblastemal,stromal,and
epithelialcelltypesisobserved
e)Mostcommoninchildren

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CorrectAnswer-A:D:E
Answer-A,D,E,Mostcommonlypresentsasasymptomatic
abdominalmass(D)Classictriphasiccombinationofblastemal,
stromal,andepithelialcelltypesisobserved(E)Mostcommon
inchildren

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Itisamalignanttumourofkidneywhichisseeninchildren
Tumouriscomposedofepithelialandmesothelialelements(bone,
cartilage,muscleetc)socalledasnephroblastoma(immature
embryonictissue)
Wilmstumor,alsoknownasnephroblastomaisacomplexmixed

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embryonalneoplasmofthekidneycomposedofthreeelaments:
blastema,epithelia,andstroma.
Clinicalfeatures-
Commoninfemalechildren(2-4years)
Massintheabdomen.

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Abdominaldistensionduetoenlargedkidney
Rarely,Wilm'stumourisbilateral
Hematuria

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50.Whichoffollowingisnotclassifiedas
Primitiveneuroectodermaltumour(PNET):

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a)Retinoblastoma
b)Medulloblastoma
c)Rhabdomyosarcoma
d)Ewingsarcoma
e)Carcinoidtumour

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CorrectAnswer-A:C:D:E
Answer-A,RetinoblastomaC,RhabdomyosarcomaD,Ewing
sarcomaE,Carcinoidtumour
Embryonaltumorsorprimitiveneuroectodermaltumors(PNET)are
themostcommongroupofmalignantCNStumorsofchildhood.

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PNETgroupincludes-medulloblastoma,supratentorialPNET,
ependymoblastoma,medulloepithelioblastoma,andatypicalteratoid/
rhaboidtumor(ATRT).
Ewing'ssarcomaiscloselyrelatedtoPNET,butnotPNET.
Recently,Ewingsarcomaandprimitiveneuroectodermaltumor

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(PNET)havebeenunifiedintoasinglecategory:
TheEwingsarcomafamilytumors(ESFT)basedonsharedclinical,
morphologic,biochemicalandmolecularfeatures

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51.GlucoselevelinCSFis/arereducedin:
a)Bacterialmeningitis

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b)Fungalmeningitis
c)Viralmeningitis
d)Tubercularmeningitis
e)Spirochetalmeningitis
CorrectAnswer-A:B:D

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Answer-A,BacterialmeningitisB,Fungal
meningitisD,Tubercularmeningitis
Normal-45-48mg/dL
Bacterialmeningitis-Markedlyreduced(low<45)
Fungalmeningitis-Markedlyreduced(low<45)

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Viralmeningitis-Normalorlow
Tubercularmeningitis-Reduced(low<45)
Spirochetalmeningitis-Normal

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52.Trueaboutproliferalivephaseofwound
healing

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a)Neutrophilsincreasesgradually
b)Macrophageincreasesgradually
c)CollagentypeIpresentpredominantly
d)CollagentypeIIIpresentpredominantly
e)Angiogenesisoccurs

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CorrectAnswer-D:E
Answer-D,CollagentypeIIIpresent
predominantlyE,Angiogenesisoccurs
Duringproliferation,thewoundis'rebuilt'withnewgranulation
tissuewhichiscomprisedofcollagenandextracellularmatrixand

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intowhichanewnetworkofbloodvesselsdevelop,aprocess
knownas'angiogenesis'.
Maturationisthefinalphaseandoccursoncethewoundhas
closed.ThisphaseinvolvesremodellingofcollagenfromtypeIIIto
typeICellularactivityreducesandthenumberofbloodvesselsin

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thewoundedarearegressanddecrease.

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53.Correctmatchofstainwithtissueis/are-
a)Perls'Prussianblue-ironintissue
b)VonKossa-collagen
c)Masson'strichrome-elastinfiber

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d)PAS-glycogen
e)PAS-Acidicandneutralmucin
CorrectAnswer-A:D:E
Answer-A,Perls'Prussianblue-ironintissueD,PAS-
glycogenE,PAS-Acidicandneutralmucin

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1.Masson'strichrome-Trichromehistologystains
Canbeusedtodistinguishbetweencellularitemsandextracellular
items
Canbeusedonconnectivetissue
2.VonKossastain-usedtoindicatecalciumandcalcium

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deposits
3.Periodicacidschiff(PAS)-AMucinstain
Usedforstainingglycogen
Usedtoshowglomeruli,basementmembranes,andglycogeninthe
liver.

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4.Perls'Prussianblue-Canbeusedtorevealthepresenceof
ironinbiologicaltissues

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54.Whichofthefollwingis/areactionof
estrogenexcept:
a)Developmentofthealveolarsystem

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b)Proliferationofstromaofbreast
c)Ductalgrowthofthebreast
d)CBoneresorption
e)Developmentoflobulesofbreast
CorrectAnswer-A:E

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Ans.(A)Developmentofthealveolarsystem(E)Development
oflobulesofbreast
Oestrogencausesonlyductdevelopment.
Progesteroneisresponsibleforglandulardevelopment.
Itpromotesthegrowthofthelobulesandalveolartissueinbreast.

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Promotesthedevelopmentofthealveolar(acinar)systemofthe
breast
Estrogen-functions:
Importantinmaintainingbonemassprimarilybyretargetingbone
resorption.

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Producedatpubertycausegrowthofbreastsproliferationofducts
andstroma,accumulationoffat.
Stimulatestromaldevelopmentandductalgrowthinthebreast
Contributetothegrowthofaxillaryandpubiahair.
Pigmentationintheskin,mostprominentintheregianofthenipplas

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andareolae.
Continuousexposuretoestrogensforprolongedperiodsleadsto
hyperplasiaoftheendometrium.

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Decreasetherateofresorptionofbonebypromotingapoptosisof
osteoclastsandbyantagonizingtheosteoclastogenicandpro-

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osteoclasticeffectsofparathyroidhormoneandinterleukin-6.

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55.Allaretrueaboutbisphosphonatesexcept
:
a)Preventreabsorptionofbonebyosteoclast
b)Structurallysimilartopyrophosphate

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c)Absorptionincreaseswithfood
d)Canbesafelygiveninliverdisease
e)None
CorrectAnswer-C
Ans.C.Absorptionincreaseswithfood

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Bisphosphonates(BPNs):
BPNsareanalogiesofpyrophosphate;carbonatomreplacing
orygenintheP-O-Pskeleton
AlloralBNPsarepoorlyabsorbedandproducegastricirritationas
majorsideeffect.

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Theyinhibitsboneresorptionandhaverecentlyattracted
considerableattentionbecauseoftheirabilitytoprevent
osteoporosisinadditiontotheirusefulnessinmetabolicbone
diseasesandhypercalcemia.
MOA:Localizetoregionsofboneresorption&exerttheirgreatest

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effectsonosteoclasts.
Foodreducesabsorptionevenfurther,necessitatingtheir
administrationonanemptystomach.
Nearlyhalfoftheabsorbeddrugaccumulatesinbone;the
remainderisexcretedunchangedintheurine.

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Decreasedrenalfunction,esophagealmotilitydisorders&peptic
ulcerdiseasearethemaincontraindications.

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56.Whichofthefollowingis/arenewerdrugs
forTB:
a)Bedaquiline

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b)Clofazimine
c)Coftaroline
d)Rifapentine
e)Etanercept
CorrectAnswer-A:B:D

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Ans.(A)Bedaquiline(B)Clofazimine(D)Rifapentine
NewerAnti-TBdrugs:
CommunityMedicinewithRecentAdvancesbySuryakantha
4ed/371
Rifabutin

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Rifapentine-400mgtwiceweekly.
Macrolides:Roxithrornycin,Clarithromycin,Azithromycin
Amikacin
Fluoroquinolones:Ciprofloxacin,ofloxacinandsparfloxacin
B-lactamantibiotic:trialsaregoingonwithamoxicillin-clavulanic

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acid
Clofazimine-200mg/d
Paromomycin
Cytokineimmunotherapy:IL-2,cytokinegammainterferonand
cytokineIL-12

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Bedaquiline-Multi-drugresistanttuberculosis(MDR-TB)-400mg/d

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57.Allaretrueaboutoralirontherapyin
anemiaexcept:
a)Mayworseninflammatoryboweldisease
b)Ittakesminimum2weeksforreticulocytecounttoincrease

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c)Generally3-6monththerapyisrequiredtoreplenishironstores
d)Gastrointestinalside-effectslimitsitsdose
e)Hblevelisgenerallyattainedin1-3month
CorrectAnswer-B
Ans.B.Ittakesminimum2weeksforreticulocytecountto

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increase
OralironTherapy:
Followingoraliron,normalHblevelisusuallyobtainedwithin1to3
months.
DependingmainlyontheinitialHblevel.

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Itisimportant,however,tocontinuewiththetherapyfor12-20
weeksaftertheHblevelhasreturnedtonormal,inordertoreplenish
thedepletedironstores.
Thereticulocytecountintheperipheralbloodbeginstorisewithina
week,reachesapeakat10to14daysandreturnstonormalafter3

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weeks
AdverseEffectsofOraliron:
Epigastricpain,heartburn,nausea,vomiting,bloatingstainingof
teeth,metallictaste,col:la,
Alterationofintestinalflora.

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Gastricirritationandconstipation.
TreatmentofironDeficiency:

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Abilityofthepatienttotolerateandabsorbmedicinaliron.

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58.Drugwhichcanbegivenbyinhalation
route:

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a)Zileuton
b)Steroid
c)Salbutamol
d)Tobramycin
e)None

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CorrectAnswer-B:C
Ans.(B)Steroid(C)Salbutamol
lnhalatlonalsteroids.Beclomethasone,dipropionate,budesonide,
fluticasonepropionate,flunisolideandciclesonide.
Salbutamol:usedinformoforal,i.m/s.candinhalation.

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Zileuton:Itisavailableonlyasextendedrelease(oral)formulation.
Tobramycin:Usedinformofi.m/i.v,eyedrop

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59.Liverfunctiontest(LFT)monitoringis/are
requiredinuseofwhichofthefollowing
DiseaseModifyingAntirheumaticDrugs

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(DMARDs):
a)Methotrexate
b)Hydroxychloroquine
c)Sulfasalazine
d)Leflunomide

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e)Gold
CorrectAnswer-A:D:E
Ans.(A)Methotrexate(D)Leflunomide(E)Gold
DMARDsUsedforthetreatmentofrheumatoidarthritis:
Hydroxychloroquine-Funduscopicandvisualfieldtestingevery12

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months.
Sulfasalazine-CBCevery2-4weeksforthefirst3months,then
every3months
Methotrexate&Leflunomide-CBC,creatinine,LFTsevery2-3
months

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Tocilizumab-CBCandLFTsatregularintervals

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60.Drugswhichcanbeusedingestational
hypertension:
a)Metoprolol
b)Labetalol

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c)Methyldopa
d)Sustainedreleasenifedipine
e)Losartan
CorrectAnswer-A:B:C:D
Ans.(A)Metoprolol(B)Labetalol(C)Methyldopa(D)Sustained

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releasenifedipine
Antihypertensiveagentsusedinpregnancy:Methyldopa,
lrydralazlne,labetalol,Nifedipine,atenolol.

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61.Adverseeffectsofmirtazapineis/are:
a)Insomnia

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b)Sedation
c)Sexualdysfunction
d)Vomiting
e)Weightgain
CorrectAnswer-B:E

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Ans.(B)Sedation(E)Weightgain
Mirtazapine
Importantadversedrugreactions
markedsedation
increasedappetite

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weightgain
Somnolence(mostcommon)
Drymouth
Constipation
Dizziness

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Myalgias
Increaseserumcholesterolconcentrationto20percent
Orthostatichypotension
Agranulocytosis

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62.Carbonicanhydraseinhibitors(S)is/are:

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a)Acetazolamide
b)Amiloride
c)Nitrofurantoin
d)Topiramate
e)None

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CorrectAnswer-A:D
Ans.(A)Acetazolamide(D)Topiramate
Carbonicanhydraseinhibitor:Topiramate,Acetazolamida,
methazolamide,dichlorphenamide
orallyinthetreatmentofglaucoma-Acetazolamida,methazolamide,

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dichlorphenamide
Topicallyactivecarbonicanhydraseinhibitors-Dorzolamideand
brinzolamide.

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63.Whichofthefollowingis/aretrueabout
Tacrolimus:

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a)Amacrolidesantibiotic
b)Structuresimilartocyclosporine
c)Derivedfromafungus
d)Tcellinhibitor
e)Hirsutismlessevidentthancyclosporine

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CorrectAnswer-A:D:E
Ans.(A)Amacrolidesantibiotic(D)Tcellinhibitor(E)Hirsutism
lessevidentthancyclosporine
Tacrolimus:
Immunosuppressantischemicallydifferentfromcyclosporine,but

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hasthesamemechanismofaction100timesmorepotent.
MacrolideantibioticproducedbyStreptomycestsukubaensis(a
bacteria)
MOA:
InhibitionofhelperTcellsviacalcineurin.

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BindstotheimmunophilinFK-bindingprotein(FKBP)
Therapeuticapplication,clinicalefficacyaswellastoxicityprofilaare
similartocyclosporine.
Hypertension,hirsutism,gurnhyperplasiaandhyperuricemiaare
lessmarkedthanwithcyclosporine,buttacrolimusismorelikelyto

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precipitatediabetes,causeneurotoxicityalopeciaanddiarrhoea.
Doselimitingtoxicityisrenal.

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64.TrueaboutLowmolecularweightheparin
(IAMB):
a)Anti-factorXaassaymonitoringrequiredineverypatient

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b)ItincreasesaPTTmorethanUFH
c)Canbesafelygiveninrenalfailure
d)Toxicityistotallyreversedbyprotaminesulphate
e)InactivatefactorXaselectively
CorrectAnswer-E

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Ans.E.InactivatefactorXaselectively
LowMolecularWeight(LMW)HeparinsandUFH
HeparinhasbeenfractionatedintoLMWforms(MW3000-7000)by
differenttechniques..
InactivateFactorXaselectively.

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TheyactonlybyinducingaconformationalchangeinATIIIand,not
byprovidingascaffoldingforinteractionofATIIIwiththrombin.
Asaresult,LMWheparinshavesmallereffectonaPTTandwhole
bloodclottingtimethanunfractionatedheparin(UFH).
Eliminatedprimarilybyrenalexcretionarenottobeusedinpatients

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withrenalfailure..
SinceaPTT/clottingtimesarenotprolonged,Laboratorymonitoring
isnotneeded.
Protaminedoesnotneutralizefondaparinuxanditonlypartially
reversestheanticoagulanteffectofLMWheparins.

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65.TrueaboutMafenide:
a)Canpenetrateeschars
b)Doesn'tcauseburningsensationwhenappliedtorawsurface
c)Canbeusedorally
d)Maycausemetabolicacidosis

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e)None
CorrectAnswer-D
Ans.D,Maycausemetabolicacidosis
Mafenide:
TypicalsulpHonamide.

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Usedonlytotally-inhibitsavarietyofgram-positiveandgram-
negativebacteria.
Biggestlimitation-Producesburningsensationandseverepain
whenappliedtorawsurface.
Mainlyemployedforbuntdressingtopreventinfection,butnotto

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heatalreadyinfectedcases.

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66.Whichofthefollowingis/aretrueabout
pharmacodynamicsofdrugs:
a)Affinitymeanshowstronglydrugbindstoreceptor
b)Efficacymeansmaximaleffectbyadrug

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c)Irreversibleantagonistmainlyformsionicbondswithreceptor
d)Agonistpotencydependsontwoparameters:affinityand
efficacy
e)Forantagonists,efficacyiszero
CorrectAnswer-A:B:D:E

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Ans.A,Affinitymeanshowstronglydrugbindsto
receptorB,EfficacymeansmaximaleffectbyadrugD,Agonist
potencydependsontwoparameters:affinityandefficacy&
E,Forantagonists,efficacyiszero
Irreversiblecompetitive(non-equilibrium)antagonismoccurswith

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drugsthatpossessreactivegroupsthatformcovalentbondswith
receptor.
ReceptorBlockAntagonisminvolvestwoimportantMechanisms
Reversiblecompetitiveantagonist
Irreversible,ornon-equilibrium,competitiveantagonism.

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Drugsactingonreceptorsmaybeagonistsorantagonists.
Agonistpotencydependsontwoparameters:affinity(i.e.tendency
tobindtoreceptors)andefficacy(i.e.ability,oncebound,toinitiate
changesthatleadtoeffects).
Forantagonists,efficacyiszero.

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67.Allaretrueaboutplasmaproteinbinding
except:
a)Acidicdrugsgenerallybindtoplasmaalbuminandbasicdrugs
toa,acidglycoprotein
b)Plasmabindingdeterminesvolumeofdistribution

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c)Moreplasmaproteinbindingmeansmorestorageinliver
d)Moreplasmaproteinbindingmeanslesspenetrationinvascular
membrane
e)Highdegreeofprotein.indinggenerallymakesthedruglong
acting

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CorrectAnswer-C
Ans.C,Moreplasmaproteinbindingmeansmorestoragein
liver
Drugswhicharehighlyproteinboundorionizedremainlargely
withinthevascularcompartmentandhaveverylowvolumeof

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distribution.
Acidicdrugsgenerallybindtoplasmaalbuminandbasicdrugstoa2
acidglycoprotein.
Albuminlsamajorcarrierforacidicdrugs.a1-acidglycoprotein
blindsbasicdrugs.

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Clinicallysignificantimplicationsofplasmaproteinbinding:
Bindingofadrugtoplasmaproteinalsolimitsthedrug'sglomerular
fiLtration.
Drugtransportandmetabolismalsoarelimitedbybindingtoplasma
proteins.

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Proteinbounddrugdoesnotcrossmembranes(exceptthrough

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largeparacellularspaces,suchasincapillaries).
Tendtohavesmallervolumesofdistribution.
Boundfractionofdruginnotavailableforaction.
Plasmaproteinbindingthustantamountstotemporarystorageofthe

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drug.
Highdegreeofproteinbindinggenerallymakesthedruglongacting,

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68.Firstpassmetabolismissignificant
problemindruggiventhrough:
a)Sublingualroute

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b)Rectalroute
c)Intramuscularroute
d)Directlyintostomach
e)Directlyintolargeintestine
CorrectAnswer-D

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Ans.D,Directlyintostomach
Allorallyadministereddru.gsareexposedtodrugmetabolizing
enzymesintheintestinalwallandliver(wheretheyfirstreach
throughtheportalvein).
Druggivendirectlyintothestomachandintestinestillhavetopass

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throughfirstpassmetabolismintheintestinalwallandinliver.
Approximately50%ofthedrugthatitisabsorbedfromtherectum
willbypasstheliver,thusreducingthehepaticfirst-passeffect.
Presystemicmetabolismlnthcgutandlivercanbeavoidedby
administeringthedrugthroughsublingual,transdermalorparenteral

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(i.v/i.m/intradermal/s.c)routes.
Theeventoffirstpassmetabolismdiffersfordlfierentdrugsandis
animportantdatennlnantoforalbioavallabiltty.
Thehepaticfirst-passeffectcanbeavoidedtoagreatextentbythe
useofsublingualtabletsandtransdermalpreparationsandtoa

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lesserextentbytheuseoFrectalsuppositories.
Subltngu.alabsorptionprovidesdirectaccesstosystemicnotportal-
velns.

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Thetranscanalrouteofiersthesameadvantage.

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69.Whichofthefollowingdyadsshow

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clinicallysignificantdruginteractions:
a)Vancomycin--AmphotericinB
b)Rantidine-Atorvastatin
c)Warfarin--Aspirin
d)Allopurinol--Azathioprine

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e)Aminoglycoside+Vancomycin
CorrectAnswer-A:C:D:E
Ans.A,Vancomycin--AmphotericinBC,Warfarin--
AspirinD,Allopurinol--Azathioprine&
E,Aminoglycoside+Vancomycin

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Druginteraction:
Drugsmayinteract,butmostcanbecategorizedas
pharmacoKInetic(absorptiondistribution,metabolism,excretion),
phartnacodlmamla(aMitiveorantagonisticeffects),orcombined
interactions.

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Eg:
Aminoglycosides,vancomycin,cyclosporineandothernephrotoxic
drugenhancetherenalimpairmentcausedbyamphotericinB
Allopurinolinhibitsthedegradationofi-mercaptopurineand
azathioprine;theirdosesshouldbereducedto?.

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Enhanced'anticoagulantactionofwarfarin:
HighdosesoFsalicylateshavesynergistichypoprothrombinemic
action&alsodisplacewarfarinfromproteinbindingsite.

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70.Trueaboutosmoticdiuretics:
a)Osmoticdiureticshavetheirmajoreffectinthedistal

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convolutedtubule
b)Contraindicatedincongestiveheartfailure
c)CausesHyperkalemia
d)Increasesrenalbloodflow
e)None

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CorrectAnswer-B:C:D
And.B,ContraindicatedincongestiveheartfailureC,Causes
Hyperkalemia&D,Increasesrenalbloodflow
OsmoticDiuretics:
Majoreffectintheproximaltubuleandthedescendinglimbof

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Henle'sloop.
InhibitsTransportprocessesinthethinkAscLH.
Uses:
Usedtoincreasewaterexcretioninpreferencetosodiumexcretion.
ExtracellularVolumeexpansion-Effectcancomplicateheartfailure

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andmayproducefloridpulmonaryedema-ContraindicatedinCHF.
Causesdehydration,Hyperkalemia,andHypernatremia
Headache,nausea&vomitingarecommonlyobservedinpatients
treatedwithosmoticdiuretics.

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71.Trueabouteffectofsteroidintakein

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inflammatoryconditions:
a)Proanaboliceffectonmuscles
b)Tglucoseinplasma
c)-vefeedbackoncorticotropin-releasinghormone(CRH)
production

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d)Maycauseosteoporosis
e)None
CorrectAnswer-B:C:D
Ans.B,TglucoseinplasmaC,-vefeedbackoncorticotropin-
releasinghormone(CRH)production&D,Maycause

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osteoporosis
Glucocorticoids:
GivenchronicallysuppressthepituitaryreleaseofACTH
Glucocorticoidsincreaseserumglucoselevel.
GlucocorticoidsstimulateRNAandproteinsynthesisintheliver,

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theyhavecatabolicandantianaboliceffectsintymphofuland
connectivetissue,muscla,peripheralfat'andsldn.
CortisolhasanegativefeedbackonACTHandCRHproduction.

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72.DrugthatcanpotentiateTorsadesde
pointes:

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a)Amiodarone
b)Sotalol
c)Chlorpromazine
d)Cisapride
e)Aspirin

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CorrectAnswer-A:B:C:D
Ans,A,AmiodaroneB,SotalolC,Chlorpromazine&D,Cisapride
TorsadesdePointes(VentricularTachycardia)
Antiarrhythmics:
Quinidine,procainamide,disopyramide,propafenone,amiodarone

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Antimalarials:
Quinine,mefloquine,artemisinin,halofantrine
Antibacterials:
Sparfloxacin,moxifloxacin
Antihistamines:

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Terfenadine,astemizole,ebastine
Antidepressants:
Amitriptylineandothertricyclics.
Antipsychotics:
Thioridazine,pimozide,aripiprazole,ziprasidone

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Prokinetic:
Cisapride

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73.WhichoftheFollowingarethegrounds
fordivorceforfemalesinIndia
a)Impotenceofmalepartner

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b)Extramaritalaffairofmaleaprtner
c)Infertilityoffemale
d)Unemploymentofmalepartner
e)Ifshewasmarriedbeforetheageoffifteenandshewantto
renouncesthemarriagebeforesheattainseighteenyearsof

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age
CorrectAnswer-A:B:E
Answer:(a)Impotenceofmalepartner,(b)Extramaritalaffairof
maleaprtner,(e)Ifshewasmarriedbeforetheageof
fifteen...(Ref:http://www.indidivorce.com/grounds-for-divorce-

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in-india.html:Parikh7h/367,386.6`h/5.1.5.24]
Adulteryisconsideredasanoffenceagainstmarriagebyboththe
PenallawandtheMatrimoniallawinIndiaandanyonecommitting
anadulterousactcanbepunishedunderlaw"
Impotencyandinfertilityarecompletelydistinctterms.Unlike

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impotency,infertilitycannotbegroundsfordivorce,theBombayhigh
court(HC)ruledonMonday.Jul24,2012.
HinduMarriageAct,1955?Adultery,Cruelty,Desertion,Mental
disorder,Leprosy,VenerealDisease,ifhusbandhasindulgedin
rape,bestialityandsodomy,ifshewasmarriedbeforetheageof

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fifteenandrenouncesthemarriagebeforesheattainseighteen
yearsofage.
Sterilefemaleisnotagroundfordivorce(Prematureejaculation,if

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leadstoimpotencythengroundfordivorce,otherwisenotgroundfor
divorce.

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Impotencyisagroundforannullingmarriage

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74.Bitemarkmayaidin:,
a)Assessmentofage
b)Identificationofaccused
c)Assessmentofheight

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d)Assessmentoftypeofteeth
e)CollectionofDNAsample
CorrectAnswer-B:C:E
Answer:(B,IdentificationofaccusedD,Assessmentoftypeof
teeth&E,Collectionof...[Ref:Ready33'?/98-100:Parikh7`h/83-

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84]
Bitemarkscanpermitpreciseidentificationbecausethe
alignmentofteethispeculiartoeachindividual.
Thefirststepinanalyzingthebiteistoidentifyitashuman.Animal
teethareverydifferentfromhumans'teeth,sotheyleavevery

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differentbite-markpatterns.Next,thebiteisswabbedfor
DNA,whichmayhavebeenleftinthesalivaofthebiter.The
dentistmustalsodeterminewhetherthebitewasself-inflicted.

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75.Featureofgunshotinjuryis/are:
a)Gutterinjury

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b)Greasecollar
c)Radiatingwound
d)Tissueopeningonoppositeend
e)alloftheabove
CorrectAnswer-E

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Answer-E,alloftheabove[Ref:Reddy33rd/224,32"d/205,235;
Parikh7`h/249-53,6`"/4.43-44;ForensicAnthropologyby
StevenByers4"/256]
Theimpactofbulletsonbonemaycausefracturelinestoform.The
twotypeoffracturelinesaredistinguishableoncranialvault:

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radiatingandconcentric.
Radiatingfracturelinesoriginatefromthesiteofimpactwherethey
moveoutwardinanydirection(thisisespeciallyseeninentrance
wound).
SmudgeRing/LeadRing/GreaseCollar!DirtCollarisduetothewipe

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ofthesoftmetalofthebullet,ordirtpresentonit,orgreasecarried
fromthebarrelandisdepositedroundtheentrancewoundinternal
totheabradedcollar.
Gutterfracture:Theyareformedwhenpartofthethicknessofthe
boneisremovedsoastoformagutter,e.g.,inobliquebulletwound"

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Bulletwound:Inexitwound,sizeisbiggerthanbullet.

---

76.Whichofthefollwingis/aretrue
regardingPerjury:
a)Wilfullygivingfalsestatementunderhe/sheeitherknowsor
believestobefalseordoesnotbelievetobetrue

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b)S.190IPCdealswithperjury
c)Voluntarilygivingfalseevidenceunderoathwhichhe/sheeither
knowsorbelievestobefalseordoesnotbelievetobetrue
d)Thewitnessisliabletobeprosecutedforperjury
e)None

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CorrectAnswer-A:C:D
Ans.(A)Wilfullygivingfalsestatementunderhe/sheeither
knowsorbelievestobefalseordoesnotbelievetobetrue
(C)Voluntarilygivingfalseevidenceunderoathwhichhe/she
eitherknowsorbelievestobefalseordoesnotbelievetobe

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true(D)Thewitnessisliabletobeprosecutedforperjury

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77.TrueaboutCorpusdelicti:
a)Medicalnegligence
b)Bodyofoffence
c)Itincludesbodyofthevictimandotherfactswhichare

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conclusiveofdeathbyfoulplay
d)Theessenceofcrime
e)None
CorrectAnswer-B:C:D
Ans.(B)Bodyofoffence(C)Itincludesbodyofthevictimand

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otherfactswhichareconclusiveofdeathbyfoulplay(D)The
essenceofcrime

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78.Whichisnotmethodofcrimescene
examination:
a)Grid

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b)Strip
c)Wheel
d)Composite
e)Pointtopoint
CorrectAnswer-D:E

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Ans.(d)Compositeand(e)Pointtopoint
[www.universalclass.com/articles/law/processing-a-crime-
scene.]
Sixbasiccrimescenesearchpatterns-Stripmethod,Wheelmethod,
Spiralmethod,Zonemethod,GridmethodandLinemethod.

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Theuseofanyoranumberofthesesearchmethodswillbe
determinedbythelocationandsizeoftheparticularcrimescene.

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79.AllisaretrueaboutRotavirusinfection
except:
a)Mostcommonlyseeninadultof>30yearagegroup

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b)Persontopersontransmissionmayoccur
c)Severityofdiseasedecreaseswitheachrepeatinfection
d)Commonestcauseofdiarrheaininfantsandchildren
e)Singleinfectionprovidelifelongimmunityagainstreinfection
CorrectAnswer-A:E

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Answer:(a)Mostcommonlyseenin...(e)Singleinfection
provide...
[Ref:Ananthanarayan9th/560-61;Park23'223;Harrison
19th/1287-88;Jawetz27h/534-35;Greenwood16th/525-26]
Reinfectionsarecornnon,buttheseverifirofdkeasedzcreaseswith

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eachrepeatintectlon.Therefore,severerotavirusinfectionsareless
commonamongolderchildrenandadultsthanamongyounger
individuals.
Rotadiarrheaisusuallyseeninchildrenbelowtheageoffiveyears,
butismostfrequentb/w6and24monthsofage.

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80.Trueaboutpseudomonasaeruginose:
a)Notlysinedecarboxylasepositive
b)Oxidasepositive
c)Producepyocyaninpigment
d)Gram-negativebacilli

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e)Has6-12flagella
CorrectAnswer-A:B:C:D
Answera)Notlysinedecarboxylasepositive(b)Oxidase
positive(c)Producepyocyaninpigment(d)Gram-negative
bacilli

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[Ref:Ananthanarayan9th/314-16;Harrison19th/1042-43
;Jawetz27th/137-39;Greenwood16th/282,16]
Itispositiveintheindophenoloxidasetest,andisSimmon'scitrate
positive,1-argininedihydrolasepositive,1-lysinedecarboxylase
negative,and1-ornithinedecarboxylasenegative.

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P.aeruginosa:Motilebyvirtueofoneortwopolarflagella"
Paeruginosaisanonfastidious,motile,gram-negativerodthat
growsonmostcommonlaboratorymedia,includingbloodand
MacConkeyagars.
TWooftheidentifyingbiochemicalcharacteristicsofpaeruginosa

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areaninabilitytofermentlactoseonMacConkeyagarandapositive
reactionintheoxidasetest.

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81.Whichofthefollowingis/areDNAviruses:
a)Herpesvirus
b)Hepadnaviridae

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c)Parvovirus
d)Orthomyxoviridae
e)Enteroviruses
CorrectAnswer-A:B:C
Answer:(a)Herpesvirus,(b)Hepadnaviridae,(c)Parvovirus

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[Ref:Ananthanarayan9th/428,439-40;Harrison19th/214e-1
;Jawetz27th/852]
herpesvirusesconsistsofarelativelylarge,double-stranded,linear
DNAgenomeencasedwithinanicosahedralproteincagecalledthe
capsid,whichiswrappedinalipidbilayercalledtheenvelope.

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PartiallydsDNAcirculargenome,about3.2kb.
Parvovirusesarelinear,nonsegmented,single-strandedDNA
viruses,withanaveragegenomesizeof5-6kb.

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82.TrueaboutZIKAvirus:
a)Belongtoflavivirus

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b)Firstcasedetectedin1953inNigeria
c)RTPCRisusefulindiagnosis
d)Causesmacrocephaly
e)Maypresentswithconjunctivitis
CorrectAnswer-A:C:E

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Answer:(a)Belongtoflavivirus,(c)RTPCRisusefulin
diagnosis,(e)Maypresentswithconjunctivitis(Ref:Harrison
19th/1314;www.cdc.gov;www.nytimes.corn]
ItisspreadmostlybythebiteofaninfectedAedesspecies
mosquitoes(A.aegptiandA.albopictus).T

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Itcanbepassedtoapregnantwomantoherfetus.Infectionduring
pregnancycancausecertainbirthdefects..
Real-timereversetranscription-polymerasechainreaction(RTPCR)
testingshouldbeperformedonserumcollectedduringthefirsttwo
weeksaftersymptomonset.

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There'snovaccineorspecifictreatmenttortlwdisease.Treatment
insteadfocusesonrelievingsymptomsandincludesrest,
rehydrationandmedicationsforfeverandpain.
Amaculopapularrash,conjunctivitis,myalgia,andarthralgiausually
accompanyorfollowthosemanifestations.

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---

83.Parasitewhichinfectsthroughingestion
ofaquaticvegetation:
a)Fasciolahepatica
b)Fasciolopsisbuski
c)Paragonimuswestermani

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d)Watsoniuswatsoni
e)Gastrodiscoideshominis
CorrectAnswer-A:B:D:E
Answer:(a)Fasciolahepatica,(b)Fasciolopsisbuski,(d)
Watsoniuswatsoni,(e)Gastrodiscoideshominis

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[Ref:Paniker'sParasitology7th/151;ChatterjeeParasitology
13"/174;Harrison19th/245e-1]
modeofinfectionofFasciolahepatica'Thedefinitivehostsheep
and,man,getinfectionbyingestionofmetacercariaeencystedon
aquaticvegetation.

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InfectiveformofFasclolopslsBush:Encystedmetacercariaeon
aquaticvegetarian.
SecondintermediatehostoffasciolopsisBusKiEncystmentoccurs
onaquaticplants,rootsofthelotus,bulbofwaterchestnutwhichact
assecondintermediatehost.

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SecondintermediatehostofGastrodiscoideshominis:aquaticplant.
Thecercariaeencystonwaterpl.ants.Manandanimalsbecome
infectedbyfeedinguponvegetationsharbouringthemetacercaria".

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84.whichofthefollowingdyadsofvector
withdiseaseis/arecorrectlymatched:

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a)Ratflea-Endemictyphus
b)Sandflea-Orientalsore
c)Blackfly-Kafaazar
d)Cyclops-Dracunculus
e)Louse-ChagasDisease

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CorrectAnswer-A:B:D
Answer:(a),(b)and(d)[RefPark23'/768;Paniker'sParasitology
7th/223]
RatfleaBubonicplague,endemictyphus,chiggerosis,
hymenolepisdiminuta.

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SandflyKala-azar,orientalsore,sandflyfever,oroyafever.
CyclopsGuinea-wormdisease,fishtopeworm(D.lotus).

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85.Allarefeaturesofscrubtyphusexcept:l
a)Blackeschar
b)Maculo-papularrash

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c)Morecommoninruralareas
d)Ciprofloxacinisdrugofchoice
e)Tickbornedisease
CorrectAnswer-D:E
Answer:(d)Ciprofloxacinisisdrugofchoice,(e)Tickborne

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disease
(Ref:Ananthanarayan9th/408;Harrison19th/1159;Park
23rd/300;MedicalmicrobiologybyGreenwood16th/372]
"Scrubtyphus:Onetypicalfeatureisthepunched-outulcercovered
withablackenedscab(eschar)whichindicatesthelocationofmite

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bite"
"Scrubtyphus,:Mosttravel-acquiredcasesoccurduringvisitstorural
areasinendemiccountriesforactivitiessuchascamping,hikingor
rafting,buturbancaseshavealsobeendescribed.Tetracyclineis
drugofchoice"-Park23rd/300

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""Scrubtyphus,originallyfoundinscrubjungles,hasalsobeen
identifiedinavarietyofotherhabitats,suchassandybeaches,
mountaindesertsandequatorialrain-forests"-Ananthanarayan
9th/408

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86.Unlikenocardia,Actinomycosisis;

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a)Facultativeanaerobes
b)Notacidfast
c)EndogenousCauseOfdisease
d)Environmentalsaprophyte
e)Growatwiderangeoftemperaturerange

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CorrectAnswer-A:B:C
Ans.(a)Facultativeanaerobes,(b)Notacidfast,(c)
Endogenouscauseofdisease[Ref:Ananthonarayangh/j9l-
93;Jawetz2vh/295,198-99;Greenwoodl6h/221-22;Hanison
lN/l088

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Actinomycetearefacultativeanaerobes,butoftenfailtogrow
aerobicallyonprimaryculture.Theygrowbestunderanaerobicor
microaerophilicconditionswiththeadditionof5-10%carbondioxide.
Facultativeanaerobes,Growat35-37?C,Oralcommensals,Non-
acidfastmycelia,Endogenouscauseofdisease

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---

87.Allofthefollowingarecausedby
dermatophytesexcept:
a)Madurafoot
b)Athlete'sfoot
c)Athlete'sfoot

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d)Favus
e)None
CorrectAnswer-A
Answer:(A)Madurafoot[Ref:Ananthanarayan9th/596-97;
Harrison19th/1358]

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"Madurafoot(eumycetomaornadurantycosis)iscausedbyfungi-
scedosporium,madurellamycetomatisandM.grisea,acremonium
spp.,exophialaspp.,aspergillusspp.fusariumspp."
"Favus:Achronictypeofringworminwhichdensecrusts(scutula)
developinthehairfollicles,leadingtoalopeciaandscattering.

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"Kerlon:Severeboggylesionswithmarkedinflammatoryreaction
thatsometimesdevelopsinscalpinfectionduetodermatophytes"

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88.Whichofthefollowinghasleastminimum
infectivedose(MID)requiredforcausing
infection:

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a)Salmonellatyphi
b)Campylobacterjejuni
c)Shigelladysentery
d)Vibriocholera
e)None

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CorrectAnswer-C
Ans.(c)Shigelladysentery[Ref:Ananthanarayan
9th/287,295;Greenwood16th/261,252,289]
"Shigellacausebacillarydysentery.Infectionoccurbyingestion.The
minimuminfectivedoseislow:asfewasI0-I(Nbacilliarecapableof

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initiatingthedisease,probablybecausetheysurvivegastricacidity
betterthanotherenterobacter"-Ananthanarayan.

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89.Whichtypeofbacteriacannotsurvivein
absenceofoxygen:
a)Obligateaerobe

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b)Facultativeanaerobes
c)Microaerophilic
d)ObligateAnaerobes
e)Facultativeaerobes
CorrectAnswer-A

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Ans.(a)Obligateaerobe[Ref:Ananthanarayan50/24-
25;Greenwood16th/41]
Aerobicbacteriarequireoxygenforgrowth.Theymaybeobligate
aerobeslikethecholeravibrio,whichwillgrowonlyinthepresence
ofoxygen,orfacultativeanaerobeswhichareordinarilyaerobicbut

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canalsogrowintheabsenceofoxygen,thoughlessabundantly.
Mostbacteriaofmedicalimportancearefacultativeanaerobes.
Anaerobicbacteria,suchasclostridia,growintheabsenceof
o>rygenandtheobligateanaerobesmayevendieonexposureto
oxygen.

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Microaerophilicbacteriaarethosethatgrowbestinthepresenceof
lowoxygentension.

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90.AllaretrueaboutHINIinfluenzaexcept:
a)ZanamivircommonlygiventhroughIVroute
b)Fatalitymoreinsomehighriskgroup

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c)RT-PCRisusedforinvestigation
d)WHOlatesttrivalentinfluenzavaccinecontainstwoinfluenzaA
subtypes(H3N2andH1N1)andoneinfluenzaBcomponent
e)CDClatestquadrivalentinfluenzavaccinecontainstwo
influenzaAsubtypes(H3N2andH1N1)andtwoinfluenzaB

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component
CorrectAnswer-A
Answer(a)ZanamivircommonlygiventhroughIVroute[Ref:
Park23'd/l56-59;AnanthanarayanEh/4gg-504;Harrison1Eh/t
209-t4;KDT7h/802-03]

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WHO:Itisrecommendedthattrivalentvaccinesforuseinthe2017
southernhemisphereinfluenzaseasoncontainthefollowing
1. AnA/Michigan/45/2015(H1N1)pdm09-likevirus;
2. AnA/HongKong/4801/2014(H3N2)-likevirus;and
3. AB/Brisbane/60/2008-likevirus.

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RT-PCRprovidesthemosttimelyandsensitivedetectionofthe
infection
PandemicinfluenzaA(Hlnl)Treatment:oseltamiviradultoraldose
is75mgtwicedailyfor5days.Zanamivirdoseistwoinhalation(2x
5mg)twicedailyfor5days

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---

91.Trueaboutserummarkerofinactive
carrierphaseofchronicHepatitisB:
a)HbsAg+ve
b)HbeAg+ve
c)Anti-HBeantibodypositive

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d)LowlevelDNA
e)IncreasedALT
CorrectAnswer-A:C:D
Answer:(a)HbsAg+ve,(c)Anti-HBeantibodypositive,(d)
LowlevelDNA(Ref:Ananthanarayan9`h/543-48;Harrison

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19th/2032-33,2007;Davidson22"?/950-52;Park23rd/215.1
ChronicHBVInfection:Inactivecarriersarepatientswithcirculating
hepatitisBsurfaceantigen(HBsAg),normalserum
aminotransferaselevels,undetectableHBeAg,andlevelsofHBV
DNAthatareeitherundetectableorpresentatathresholdof103

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IU/mL.
Therelativelyreplicativephaseischaracterizedbythepresencein
theserumofHBeAgandHBVDNAlevelswellinexcessof103-104
IU/mL,sometimesexceeding109IU/mL;bythepresenceintheliver
ofdetectableintrahepatocytenucleocapsidantigens(primarily

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hepatitisBcoreantigen[HBcAg]);byhighinfectivity;andby
accompanyingliverinjury.

---

92.Whichofthefollowingmechanismis/are
usedbybacteriatoescapehostdefence
mechanism:

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a)Mycobacteriumtuberculosispreventintracellularkillingby
inhibitingphagolysosomeformation
b)StreptococcuspyogenesbyMprotein
c)Neisseriameningitidisbycapsularpolysaccharide
d)Staphylococcusaureusbyiron-regulatedoutermembrane

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proteins
e)PolysaccharidecapsulesofH.influenzae
CorrectAnswer-A:B:C:E
Answer:(a)Mycobateriumtuberculosis...(b)Streptococcus
pyogenes...(c)Neisseiameningtitides...(e)Polysaccharide...

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[Ref:Ananthanarayan9`'/350,212;
textbookofbacteriology.net/antiphago;Jawetz27h/158-65;
Greenwood16th/244]
Thebacteriasurviveinsideofphagosomesbecausetheyprevent
thedischargeoflysosomalcontentsintothephagosome

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environment.Specifically,phagolysosomeformationisinhibitedin
thephagocyte.ThisisthestrategyemployedbySalmonella,M.
tuberculosis,Legionellaandchlamydiae.
Survivalinsidethephagolysosome-Mycobacteria(including
M.tuberculosisandMycobacteriumleprae).

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MproteinandfimbriaeofGroupAstreptococciSurface
slime(polysaccharide)producedasabiofilmbyPseudomonas
aeruginosa

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MproteinandfimbriaeofGroupAstreptococciSurface
slime(polysaccharide)producedasabiofilmbyPseudomonas

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

aeruginosa
antiphagocyticsubstancesonbacterialsurfaces
include:PolysaccharidecapsulesofS.pneumoniae,Haemophilus
influenzae,TreponemapallidumandKlebsiellapneumoniae

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93.TrueaboutGasgangrene:

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a)Onsetisusuallyacute
b)Painlesscondition
c)Woundisswollen
d)Atfirstwoundisduskyorred,laterbecomespale
e)Causedbygram+veorganism

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CorrectAnswer-A:C:E
Ans:(a)Onsetisusuallyacute,(c)Woundisswollen,(e)
Causedbygram+veorganism
[Ref:Davidson22''d/305;Land826`/57;;Harrison19th/990-95;
Ananthanarayan9th/257-59;Jawetz27th/186-87;Greenwood

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16th/231-35]
Gasgangrene(clostridia)myonecrosis)isdefinedasacuteinvasion
ofhealthylivingmuscleundamagedbyprevioustrauma,andismost
commonlycausedbyC.perfringens.
Severepain,crepitus,brawnyindurationwithrapidprogressionto

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skinsloughing,violaceousbullae,andmarkedtachycardiaare
characteristicsfoundinthemajorityofpatients.
TraumaticgasgangreneC.perfringensmyonecrosis(gasgangrene)
isoneofthemostfulminantgram-positivebacterialinfectionsof
humans.

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Theinfectionischaracterizedbythesuddenonsetofexcruciating
painattheaffectedsiteandtherapiddevelopmentofafoul-smelling
woundcontainingathinserosanguineousdischargeandgas
bubbles.
Thewoundproducesathin,brown,sweet-smellingexudate,in

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whichGramstainingwillrevealbacteria.

---

---

94.Allaretrueaboutdenguevirusexcept:
a)Belongtoflaviviridae
b)TypeDEN4ismostcommoninIndia
c)Mainvectorsareaedesaegyptiandaedesalbopictus

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d)VirushaspositivesenseRNA
e)VectorissensitivetoDDT
CorrectAnswer-B
Ans:(b)TypeDEN4ismostcommon...(Ref:Park23'/246-56;
Ananthanarayan9th/523;Harrison19th/1318-19;Jawetz27th/552-

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541
BelongtogenusflaviviruswithpositivesenseRNA(Harrison
19th214e-1table)
Allthe4serotypesi.edengu1,2,3and4havebeenisolatedinIndia
butatpresentDENV-1andDENV-2serotypesarewidespread,

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Vector-AedesaegyptiandAedesalbopictusarethetwomost
importantvectorsofdengue

---

95.Whichofthefollwingis/aretrueabout
Dengufever:
a)PositiveTourniquettestmeansmorethan10petechiaeper

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squareinch
b)Causedbyflavivirus
c)Aedesaegypticusandalbopictusaremostimportantvectorin
India
d)IgM/IgGratiosmaybeusedtodistinguishprimaryfrom

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

secondaryinfection
e)Novaccineavailableatpresent
CorrectAnswer-A:B:C:D:E
Answer:A,PositiveTourniquettestmeans...B,Caused
by...C,Aedesaegypticusandalbopictus...D,IgM/IgGratiosmay

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

beused...E,Novaccineavailable...(Ref.:Park23'/246-56;
Davidson22'/323,-Ananthanarayan9th/523;Harrison19th/1318-
19;Jawetz27h/552-54]
Positivetorniquettest(i,e.10ormorepetechiaepersquareinch)is
mostcommonhemorrhagicphenomenon.InDHFthetestusually

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givesadefinitepositivewith20petechiaeormore-Park23'd/249
Vaccine-Sofarthereisnosatisfactoryvaccineandnoimmediate
prospectofpreventingthediseasebyimmunization-Park23'/254
"ThediagnosisismadebyIgMELISAorpairedserologyduring
recoveryorbyantigen-detectionELISAorRT-PCRduringtheacute

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phase"-Harrison19m/1318-19

---

96.Autoclaveis/areusedforsterilizationof:
a)Woodenmaterial
b)Metallicinstrument
c)Plastic

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d)Glasswares
e)Fibro-opticbronchoscope
CorrectAnswer-B
Ans:(b)Metallicinstrument[Ref:Ananthanarayan50/37,30-32;
Greenwood16th/77-78;Chakraborty2nd/45-46;en.wikipedia.org]

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Autoclavesinoperationtheatersisusedtosterilizesurgical
instrument,OTgarments,linen,gloves,masks,gownetc.However,
itisnotsuitableforplastics"-CommunityMedicinewithRecent
AdvancesbySuryakantha

---

97.Whichofthefollowingis/aretrue

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abouttuberculosisinindiaexcept?
a)Indiahasapproximately1/41hofGloballoadofTB
b)MDR-TBamongnotifiednewpulmonaryTBpatientsisabout
5%
c)5%ofTBpatientsestimatedtobeHIVpositive

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d)MDR-TBamongretreatmentcasesisabout15%
e)incidenceisaround2millionnewTBcasesannually
CorrectAnswer-D
Answer:D,MDR-TBamongretreatmentcasesisabout
15%(Ref:Park23rd/176-77;CommunityMedicinebyPiyush

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Gupta1'x/192-97;CommunityMedicinewithRecentAdvances
bySuryakantha4"/364-70]
IndiaisthehighestTBburdencountryintheworldintermof
absolutenumberofincidentcasesthatoccureachyear.Itaccounts
forone-fourthoftheestimatedglobalincidentTBcasesin2013"

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MDR-TBamongnotifiednewpulmonaryTBpatientswasabout
2.2%andamongretreatmentcaseswasabout15%
Currently,multidrug-resistantTBisaglobalconcernandis
encounteredin3%ofallnewcasesand12%ofretreatmentcases.
Approximately5%ofTBpatientsestimatedtobeHIVpositive-

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PiyushGupta1"/194,Park23rd/177

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98.Importanceoflepromintestareallexcept:
a)Onlyhasepidemiologicalsignificance
b)Prognosticvalue
c)Tellsaboutimmunitystatusofleprosypatients

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d)Differentiatebetweendifferenttypesofleprosy
e)Predictivevalue
CorrectAnswer-A
Answer:(a)Onlyhasepidemiologicalsignificance(Ref:Park
23rd/320-21;CommunityMedicinewithRecentAdvancesby

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Suryakantha4th/539-40
Thetesthaspredictivevalueaswell.Itgivesanindicationoftherisk
ofthediseaseamongcontactsofopencases.
Thetesthasanepidemiologicalvalueaswell.Itindicatesthe
incidenceandprevalenceofinfectionamongchildren.Inthefirst6

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monthsoflife,mostchildrenareleprominnegative.Theybecome
positiveprogressivelyastheirageadvances.
Thetwodrawbacksthatstandinthewayofthistestbringusedfor
diagnosisare:(i)positiveresultsinnon-cases,and(ii)negative
resultsinlepromatousandnear-lepromatouscases

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99.Aleprosypersonispresentedwith
involvementsofsuralandradialnerve.
Whichtypeofregimenyouwillgive:
a)MultibacillarytreatmentX9month
b)MultibacillarytreatmentX12month

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c)MultibacillarytreatmentX15month
d)PaucibacillarytreatmentX6month
e)SingledosetreatmentofRifampicin,Ofloxacinand
Minocycline(ROM)
CorrectAnswer-B

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Answer(b)MultibacillarytreatmentX12month[Ref:Park
23rd/323-24;CommunityMedicinebyPiyushGuptalst/282-83;
CommunityMedicinewithRecentAdvancesbySuryakantha
4th/535-45;NeenaKhanna5th/272-84]
Itisapureneuritictypeofleprosy.ItisacaseofMultibacillary

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leprosyfortherapeuticpurpose(accordingtoWHOclassification,
morethanonenervetrunkinvolvementistermedasmultibacillary
fortreatmentpurpose.
manyconsiderthatpureneuriticleprosybelongstothe
paucibacillarygroupsinceallofthemareacid-fastbacillinegativeon

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skinsmearsbydefinitionandaremostlyleprominpositive.
AccordingtopresentNLEPguidelinesinIndia,whenonenerve
trunkisinvolvedinleprosyitisconsideredaspaucibacillary,and
whenmorethanonenervetrunkisinvolved,itisconsideredas
multibacillaryfortherapeuticpurposes.

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100.Whichofthefollowingistrueaboutdata
representation:
a)Histogramisusedforpresentationofdiscretedata
b)Randomdotsinscatterdiagram--nocorrelation
c)Pictogramisrepresentedbysmallpicturesorsymbols

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d)Piechartisrepresentedbyquadrangularfigures
e)Regressiongraphissaidtobelinearwhentheincreaseor
decreaseinthevariablesremainsproportionalindifferent
subjects
CorrectAnswer-B:C:E

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Answer:4.(b)Randomdotsinscatterdiagram...,(c)Pictogram
isrepresented...,(e)Regressiongraphissaidlinear...
[Ref:Park23rd/845-47;CommunityMedicinebyPiyushGupta
1st/652;CommunityMedicinewithRecentAdvancesby
Suryakantha4th/694-99,729-30]

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Therewillbeasmanypointsasthereareindividualsinthe
observation.Whenallthepointareplotted,thediagramgivesthe
pictureofascatter.Hencethename'Scatterdiagram'(Dot
diagram).
Thedirectionofscatterhelpstodeterminethepresenceorabsence

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oftheassociation.Ifthescattertakesthedirectionmidwaybetween
thetwoaxes,itsignifiespositiveassociation(correlation)
Ifittakesadirectionatrightanglestomidwayscatteritindicates
negativeassociation.
Ahaphazardscatterrepresentsneitherpositivenornegative

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association.

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101.TrueaboutProgramevaluationand
reviewtechnique(PERT):
a)Betterthancriticalpathmethodforsmallproject
b)RecurrentactivitiesisbettermonitoredthanCPM

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c)Activitiesaredividedintosmallgoals
d)Mainobjectivetomonitorcost
e)Itisamanagementtechniquebetterfornon-researchactivities
thanCPM
CorrectAnswer-C

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Answer:(c)Activitiesaredividedintosmallgoals(Ref:Park
23rd/872;CommunityMedicinebyPiyushGupta1st/783;
CommunityMedicinewithRecentAdvancesbySuryakantha
4'h/860]
PERT(ProgrammeEvaluationandReviewTechnique)isa

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managementtechniquewhichmakespossiblemoredetailed
planningandmorecomprehensivesupervision.
Itaidsinplanning,schedulingandmonitoringtheproject;itallows
bettercommunicationb/wthevariouslevelsofmanagement;it
identifiespotentialproblems;itfurnishescontinuous,timelyprogress

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reports;itformsasolidfoundationuponwhichtobuildanevaluation
andcheckingsystem
TheessenceofPERTistoconstructanArrowDiagram.The
diagramrepresentsthelogicalsequenceinwhicheventsmusttake
place

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102.Whichofthefollowingis/aremorein
humanmilkthancowmilk:
a)Protein
b)Iron
c)Carbohydrate

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d)Fat
e)Energy
CorrectAnswer-B:C
Answer:(b)Iron,(c)Carbohydate[Ref:Park23rd/630;
CommunityMedicinewithRecentAdvancesbySuryakantha

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4th/620]

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103.WhichofthefollowingIs/aretrue:
a)Serialinterval=gapintimeb/winvasionbyaninfectiousagent
andtheappearanceofclinicalfeature
b)Latentperiod=theperiodfromdiseaseinitiationtodisease

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detectioninnon-infectiousdisease
c)Incubationperiod=timeb/wtheonsetoftheprimarycaseand
thesecondarycase
d)Generationtime=timeperiodbetweentheonsetoftheinfection
andthemaximuminfectivityofthehost

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e)Communicableperiod=Itisaperiodduringwhichthereservoir
isinfectioustoothers
CorrectAnswer-B:D:E
Ans.B,Latentperiod=theperiodfromdisease...D,Generation
time=timeperiodbetween...andE,Communicableperiod=It...

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[Ref:Park23rd/99-100;CommunityMedicinewithRecent
AdvancesbySuryakantha4th/281-82]
Thetermlatentperiodisusedinnon-infectiousastheequivalentof
incubationperiodininfectiousdisease.Latentperiodhasbeen
definedas"theperiodfromdiseaseinitiationtodiseasedetection.

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Generationtimeisdefinedas"theintervaloftimeb/wreceiptof
infectionbyahostandmaximalinfectivityofthathost"
Ingeneral,generationtimeisroughlyequaltotheincubationperiod.
However,thesetwotermsarenotthesame
CommunicablePeriodisdefinedas"thetimeduringwhichan

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infectiousagentmaybetransferreddirectlyorindirectlyfroman
infectedpersontoanotherperson,fromaninfectedanimaltoman,
orfromaninfectedpersontoananimal,includingarthropods

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104.Teststocheckpasteurizationofmilk:
a)Phosphatasetest

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b)Standardplatecount
c)Methylenebluetest
d)Nitricacidtest
e)Coliformcount
CorrectAnswer-A:B:C:E

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Answer:(a)Phosphatasetest,(b)Standardplatecount,(c)
Methylenebluetest,(e)Coliformcount
(Ref:Park23rd/655;CommunityMedicinewithRecent
AdvancesbySuryakantha4th/186]
Nitricacidtestisdoneepidemicdropsy(argemoneoildetection)"-

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Park23rd/658
Phosphatasetest:Thistestiswidelyusedtochecktheefficiencyof
pasteurization.Thistestisbasedonthefactthatrawmilkcontains
anenzymecalledphosphatasewhichisdestroyedonheatingata
temperaturewhichcorrespondscloselywiththestandardtimeand

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temperaturerequiredforpasteurization
MethylenebluetestPasteurizationofMilkPark23rd/655
Itkillsnearly90%ofthebacteriainmilkincludingthemoreheat-
resistanttuberclebacillusandtheQfeverorganisms.Butitwillnot
killthermoduricbacterianorthebacterialspores

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105.Allistrueaboutforeignbodyimpaction
inearexcept-
a)Objectslocatedmedialtoisthmusofcanalisdifficulttoremove
b)Syringingisusedforremovalofvegetativeforeignbody
c)Syringingusesroomtemperaturewater

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d)Blunthookisusedtoremoveroundedforeignbody
e)GAispreferredinchildrentoremoveforeignbodies
CorrectAnswer-B
Answer-B.Syringingisusedforremovalofvegetativeforeign
body

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Methodsofremovingaforeignbodyinclude:forcepsremoval,
syringingsuction,microscopicremovalwithspecialinstrumentsand
postauralapproach.
Foreignbodiesofvegetableoriginsuchasnuts,peasandbeans,
arehygroscopicandshouldnotbesyringed.

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Noattemptsshouldbemadetoremovesmoothsphericalobjects
suchasbeadsbyforceps.
Beadswhichhaveadiameterlessthanthatoftheisthmuscanbe
syringed;largeronesarebetterremoved,withahook.

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106.Allaretrueaboutepistaxisexcept:

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a)Keisselbach'splexusissourcein90%cases
b)Ifanteriorpackingisleftinnoseformorethan48hrsantibiotic
coverageisgiven
c)Anteriornasalpackiseasytoinsertandlesstraumaticthan
balloontemponade

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d)Trottermethodisfirstaidmethod
e)Cauteristaionisdoneinrefractorycasesundergeneral
anaesthesia
CorrectAnswer-C
Answer-C.Anteriornasalpackiseasytoinsertandless

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traumaticthanballoontemponade
Keisselbach'splexus:Thisplexusisthecommonestsiteofbleeding
(90%ofcases)
Anteriornasalpacking-Prophylacticantibodiesshouldbeusedit
packisinaplaceformorethan24hours.

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Aballoontamponademaybeusedasanalternativetoanterior
nasalpackingandThisislesstraumaticasitisbestsuitedfpr
epistaxis.
Trotter'smethod-Patientmayputinthesittingpositionwiththehead
bendingforwardswithmouthopen.

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Nasalendoscopyassistedbipolarcauterizationundergeneral
anaesthesiamaybedonetocoagulatethebleederincase
ofepistaxlsisrefractorytoconservativemeasures.

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107.TrueaboutSecretoryotitismedia:
a)TypeCtympanogrammaybeseeninearlystageofotitismedia

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witheffusion
b)Flattympanogramispresent
c)Leadstoconductivedeafness
d)Presenceofcleftpalatereducesitschance
e)MostcommoncauseisEustachiantubedysfunction

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CorrectAnswer-A:B:C:E
Answer-A,B,C,E,TypeCtympanogrammaybeseeninearly
stageofotitismediawitheffusion(B)Flattympanogramis
present(C)Leadstoconductivedeafness(E)Mostcommon
causeisEustachiantubedysfunction

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Thisisaninsidiousconditioncharacterizedbyaccumulationofnon-
purulenteffusioninthemiddleearcleft.
Eustachiantube(ET)dysfunctionisconsideredthemajoretlologic
factorinthedevelopmentofmiddleeardisease.
TypeBtympanogram:Aflatordome-shaped,graph.Seeninmiddle

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earfluidorthicktympanicmembrane.
TypeCtympanogram:SeeninEustachiantubeobstructionorearly
stageofotitismediawitheffusion.
Hearingloss-Hearinglossisofconductivetypeof20-40dB.
MalfunctioningofEustachiantube(causesincludepalataldefects

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e.gcleftpalate,palatalparalysis)andincreasedsecretoryactivityof
middleearmucosa.

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108.Whichcausereddishlesionontongue:
a)Medianrhomboidglossitis
b)Hairyleukoplakia

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c)Lichenplanus
d)Geographictongue
e)Fordyce'sspots
CorrectAnswer-A:D
Answer-A,D,Medianrhomboidglossitis(D)Geographic

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tongue
RedLesionsofOralCavitylesion-
Papillomas
Pemphigoid
Erythroplakia

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Granular-celltumour
Epulides
Hemangioma

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109.TrueStatementregardingwaxinear-
a)Syringingandinstrumentalmanipulationaregenerallydoneto

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removeimpactedwax
b)Ifwaxishardandimpacted,ceromiilyticsubstancesisusedto
softenwax
c)Insyringingfluidisinjectedalongthelowerwallofthemeatus
d)Waxhasantibacterialproperty

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e)None
CorrectAnswer-A:B:D
Answer-A,B,D,Syringingandinstrumentalmanipulationare
generallydonetoremoveimpactedwax(B)Ifwaxishardand
impacted,ceromiilyticsubstancesisusedtosoftenwax

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(D)Waxhasantibacterialproperty
WaxhasacidicpHandisbacteriostaticandfungistatic.
Ifwaxistoohardandimpacted,toberemovedbysyringeor
instrument,itshouldbesoftenedbydropsof5%sodiumbicarbonate
inequalpartsofglycerineandwater.

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Hydrogenperoxide,liquidparaffinoroliveoilmayalsoachieve
thesameresult.Commercialdropscontainingceruminolyticagent
paradichlorobenzene2%canalsobeused.
Waxisremovedeitherbyinstrumentalmanipulationorbysyringe.
Theauricleispulledupwardsandbackwardstostraightenoutthe

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meatus,andthefluidisinjectedalongtheupperwallofthemeatus.

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110.Trueaboutspasmodicdysphonia-
a)Aneurologicalproblem
b)Mostlypsychogenicinorigin
c)Hyperadductionofvocalcordmaybeseen

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d)Botulinumtoxinrelivesspasm
e)Speechtherapyisbeneficial
CorrectAnswer-A:C:D:E
Answer-A,C,D,E,Aneurologicalproblem(C)Hyperadduction
ofvocalcordmaybeseen(D)Botulinumtoxinrelivesspasm

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(E)Speechtherapyisbeneficial
"spasmodicdysphoniaisaneurologicaldisorderaffectingthevoice
musclesinthelarynx,orvoicebox.
Etiologyisunknownbutltisusuallystress-related.
Botulinumtoxinlnjectionintothelaryngealmuscleshasbeentriedin

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thetreamentofspasticdysphonia.
Voicetherapyisusefultoimprovevoiceonlywhencombinedwith
injection

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111.Feature(s)ofperitonsillarabscess:
a)Foulbreath

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b)Hotpotatovoice
c)Shiftingofuvulainoppositeside
d)Difficultyinswallowingevenownsaliva
e)Alwayspresentsasb/1severepaininthroat
CorrectAnswer-A:B:C:D

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Answer-A,FoulbreathB,HotpotatovoiceC,Shiftingofuvulain
oppositesideD,Difficultyinswallowingevenownsaliva
Clinicalfeaturesaredividedinto:?
General:Theyareduetosepticaemiaandresembleanyacute
infection.

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Theyincludefever(upto104?F),chillsandrigors,generalmalaise,
bodyaches,headache,nauseaandconstipation.
Local:
Severepaininthroat.Usuallyunilateral.
Odynophagia.Itissomarkedthatthepatientcannotevenswallow

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hisownsalivawhichdribblesfromtheangleofhismouth.Patientis
usuallydehydrated.
Muffledandthickspeech,oftencalled"Hotpotatovoice".
Foulbreathduetosepsisintheoralcavityandpoorhygiene.
Ipsilateralearache.ThisisreferredpainviaCNIXwhichsupplies

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boththetonsilandtheear.
Trismusduetospasmofpterygoidmuscleswhichareinclose
proximitytothesuperiorconstrictor.

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112.Trueaboutantrochoanalpolyp-
a)Startsasedemaofmaxillarysinusmucosa

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b)Suppressedbysteroids
c)Comesoutviaaccessoryostiumandgrowsinthechoanaand
nasalcavity
d)Morecommoninadultsthanchildren
e)Commonlypresentsasunilateralnasalobstruction

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CorrectAnswer-A:C:E
Answer-A,Startsasedemaofmaxillary...C,Comesoutvia
accessoryostium...E,Commonlypresentsasunilateral...
Age-Commoninchildren
Aetiology-Infection

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Number-Solitary
Laterality-Unilateral
Origin-Maxillarysinusneartheostium
Growth-Growsbackwardstothechoana;mayhangdownbehind
thesoftpalate

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Sizeandshape-Trilobedwithantral,nasalandchoanalparts.
Choanalpartmayprotrudethroughthechoanaandfillthe
nasopharynxobstructiongbothsides
Recurrence-Uncommon,ifremovedcompletely
Treatment-Polypectomy;endoscopicremovalorCaldwellLuc

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operationifrecurrent.

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113.Trueaboutcomponentofvision2020-
a)Cataractsurgeryshouldbeperformedatprimarylevel
b)Retinalsurgeryshouldbeperformedattertiarylevel
c)Needtodevelop10centreofexcellenceattertiaryleveland

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100trainingcentreatadvancedtertiarylevel
d)Ophthalmianeonatorumisincludedinchildhoodblindness
e)Primaryvisioncentercoversapopulationof50000
CorrectAnswer-B:D:E
Answer-B,Retinalsurgeryshould...D,Ophthalmia

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neonatorum...E,Primaryvisioncenter...
Attheprimarylevel,thehealthworkerscreensforcataractand,
reportsthosewithvisionlessthanalocallydeterminedguideline.
Atthesecondarylevel,cataractsurgeryshouldbeperfomedwith
equalemphasisonthequalityandquantityofsurgery

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Atthetertiarylevelliestheprovisionoffacilitiesforsurgical
treatmentofcomplicatedcasessuchascongenitalcataract,
subluxatedlens,complicatedcataractsandcataractassociatedwith
systemicdiseases.
TheGovernmentofIndiahasadopted'Vision2020:RighttoSight'

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under'NationalProgrammeforControlofBlindness'.
Targetdiseasesidentifiedforinterventionunder'Vision
2020'initiativeinIndiaincluded-
1. Cataract,
2. Childhoodblindness,

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3. Refractiveerrorsandlowvision,
4. Cornealblindness,
5. Diabeticretinopathy,

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6. Glaucoma,and
7. Trachoma(focal)

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Childhoodblindness-
Commoncausesofchildhoodblindnessareophthalmia
neonatorum,injuries,congenitalcataract.
Eyecareinfrastructuredevelopment-
PrimarylevelVisionCentre:Thereisaneedtodevelop20000vision

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centres.
Secondarylevel-secondarylevelpopulatianof500000
EachadvancedtertiaryLevelcenterofexcellencewillcatertoa
populationof50millions.

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114.TrueaboutNodularepiscleritis-

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a)CanbeassociatedwithSLE
b)Takelongertimetoresolvethandiffusevariety
c)Moresymptomaticthandiffusetype
d)Painless
e)Elevatedhardnodule

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CorrectAnswer-A:B:C:E
Answer-A,CanbeassociatedwithSLEB,Takelongertimeto
resolvethandiffusevarietyC,Moresymptomaticthandiffuse
typeE,Elevatedhardnodule
Thisisabenigninflammatoryaffectationofthedeepsubconjunctival

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connectivetissues,includingthesuperficial
sclerallamellae,andfrequentlyaffectsbotheyes.
Twotypesofpresentationsmayoccur:
1. simpleordiffuseepiscleritis;and
2. nodularepiscleritis.

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Innodularepisclerittsacircumscribednoduleofdenseleucocytic
infiltrationwhichisishard,tenderandimmovable.
Nodularepisleritistendstobemoresymptomaticandtakeslongerto
resolve.
Nodularepiscleritisischaracterizedbyapinkorpurpleflatnodule.

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Bothepiscleritisandscleritisaremainlyseeninadultscanbe
associatedwithotherconditionssuchasrheumatoidarthritisand
systemiclupuserythematosus(SLE).
Theremaybelittleornopain.

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115.Whichtypeofcataractis/areassociated

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withMyotonicdystrophy:
a)Posteriorsubcapsular
b)Anteriorsubcapsular
c)Nuclearcataract
d)Corticalcataract

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e)Alloftheabove
CorrectAnswer-A
Answer-A.Posteriorsubcapsular
Myotonlcdystrophyisassociatedwith,posteriorsubcapsulartypeof
presenilecataract.Christmastreecataractistypicallyseeninthis

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condition.

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116.WhatistheWHOcriteriafordefining
blindness:
a)<3/60visionwithavailablecorrection
b)<6/60visionwithavailablecorrection

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c)<3/60visionwithbestcorrection
d)<6/60visionwithbestcorrection
e)<3/60visionwithoutcorrection
CorrectAnswer-C
Answer-C.<3/60visionwithbestcorrection

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AsperWHO,blindnessisdefinedasVisualacuityoflessthan3/60
inthebettereyewithbestpossiblecorrection.

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117.TrueaboutAcanthamoebickeratitis-
a)Moreinthosewearingrigidgaspermeablethansoftcontact
lensesuser

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b)Canoccurasopportunisticinfectioninpatientswithherpetic
keratitis
c)Canbeculturedonnon-nutrientagarenrichedwithE.coli
d)Painfulcondition
e)Radialkerato-neuritismayoccur

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CorrectAnswer-B:C:D:E
Answer-B,Canoccurasopportunisticinfection..C,Canbe
culturedonnon-nutrient...D,PainfulconditionE,Radialkerato-
neuritismayoccur
Cornealinfectionwithacanthamoebaresultsfromdirectcorneal

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contactwithanymaterialorwatercontaminatedwiththeorganism.
Itsoccurrenceisfrequentlyassociatedwiththewearingofsoft
contactlenses.
Acanthamoebakeratitiscanalsooccurasopportunisticinfectionin
patientswithherpetickeratitis,bacterialkeratitis,bullouskeratopathy

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andneuroparalytickeratitis.
Symptoms-
Veryseverepain
Initiallesionsofacanthamoebakeratitisareintheformfineepithelial
andsubepithelialopacities,andradialkerato-neuritis.

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Laboratorydiagnosis:Cultureonnon-nutrientagat(E.colienriched)

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118.Trueaboutferritinlineineye:
a)Ferry'sLine-cornealepithelialironlineattheedgeoffiltering
blebs
b)StockersLine-Cornealepithelialironlineattheedgeof

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pterygium
c)Hudson-Stahliline-visibleallaroundthebaseofconein
Keratoconus
d)Fleischer'sring:Horizonatlcornealepithelialironlineatthe
inferioronethirdofcorneaduetoaging

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e)Coat'swhitering-Aformofirondepositatthelevelof
Bowman'slayerofcornea
CorrectAnswer-A:B:E
Answer-A,Ferry'sLine-cornealepithelial...B,StockersLine-
Cornealepithelial...E,Coat'swhitering-Aformofirondeposit

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...
Ferry'sLine=cornealepithelialironlineattheedgeoffiltering
blebs.
StockersLine-Cornealepithelialironlineattheedgeofpterygium
Hudson-StahilLine=Horizontalcornealepithelialironlineatthe

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inferioronethirdofcorneaduetoaging.
Fleischer'sring:VisibleallaroundthebaseofconeinKeratoconus
Coat'sring:remnantsofaforeignbody.Theremnantsarefineiron
depositsinthecornea.

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119.Whichofthefollowingisthefeatureof

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sodiumfluoresceinangiography
comparedtoindocyaninegreen
angiography:
a)Inchoroidalcirculationitpassesfreelyacrosstheendothelium
b)Diffusefreelythroughretinalcapillaries

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c)Albuminbindingislessthanindocyaninegreen
d)Bind<50%toalbumin
e)Stimulatedbyalongerwavelengthoflight
CorrectAnswer-A:C
Answer-A,C,Inchoroidalcirculationitpassesfreelyacross

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theendothelium(C)Albuminbindingislessthanindocyanine
green
Uponenteringthecirculation,approximately8O%ofthedye
moleculcsbindtoplasmaproteins.
Indocyaninegreen:bindsprimarily(95%)toalbumin.

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Inthechoroidalcirculation,fluoresceinpassesfreelyacrossthe
endotheliumofthecapillariestotheextravascularspaces
Aphysiologicalbarriertothedyepresentsthepassageacross
Bruch'smembraneandtheintactretinalpignentepithelium.
Thefunduscamerahasamechanismtousebluelight(420-49Onm

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wavelength)forexcitingthefluoresceinpresentinbloodvessels.

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120.Trueaboutphthisisbulbi-
a)Sizeofeyedecreases
b)Removedbyenucleationoperationespeciallyifpainful
c)IOPincreasesinlatestage

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d)CalcificationmayoccurinBowman'slayerofcornea
e)None
CorrectAnswer-A:B:D
Answer-A,B,D,Sizeofeyedecreases(B)Removedby
enucleationoperationespeciallyifpainful(D)Calcificationmay

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occurinBowman'slayerofcornea
Itisthefinalstageendresultofanyformofchronicuveitis.
Asaresultofittheeyebecomessoft,shrinksandeventually
becomesasmallatrophicglobe(phthisisbulbi).
Commonlytheretinalpigmentedepitheliummayundergoa

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metaplasialeadingtointraocularossification(calcification)inthe
end-stageofphthisisbulbi.
Enucleation+/-prosthesisinsertlonisperformedifthereis
associatedchronicpainorforcosmeticreasons.

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121.Advantageofcontinuouscurvilinear

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capsulorhexisovercanopener
technique-
a)Preferredmethodofanteriorcapsulotomyinphaco
emulsification
b)Morechancesofposteriorcapsularopacification

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c)Keepsthenucleusinplace
d)Resistsradialtears
e)Helpsinstabilizingandcenteringthelensimplant
CorrectAnswer-A:C:D:E
Answer-A,C,D,E,Preferredmethodofanteriorcapsulotomy

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inphacoemulsification(C)Keepsthenucleusinplace
(D)Resistsradialtears(E)Helpsinstabilizingandcentering
thelensimplant
Can-opener'stechnique.Initanirrigatingcystitome(orsimplya26
gaugeneedle,bentatitstip)isintroducedintotheanteriorchamber

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andmultiplesmallradialcutsaremadeintheanteriorcapsulefor
360degree.
Condnuouscircularcapsulorhexis(CCC)-Recentlythisisthemost
commonlyperformedprocedure.Inthistheanteriorcapsuleistorn
inacircularfashioneitherwiththehelpofanirrigatingbent-needle

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cystitomeorwithacapsulorrhexisforceps.
Can-openercapsulotomycanbeusedwithphacoemulsificotion.
CCCresistsradialtears
CCCstabilizesthenucleus.
CCCalsohelpsstabilizeandcentrethelensimplant.

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---

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122.Whichofthefollowingis/arefeatureof
aorticstenosis-
a)Durationbetweenonsetofsymptomanddeathisgenerally10-
15year
b)Anginaoccursmainlybecauseoffixedcoronarybloodflows

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c)Noincreaseincardiacoutputdespiteexercise
d)Ejectionsystolicmurmurradiatingtoneckmaypresent
e)Leftventricularhypertrophy
CorrectAnswer-C:D:E
Answer-C,D,E,Noincreaseincardiacoutputdespiteexercise

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(D)Ejectionsystolicmurmurradiatingtoneckmaypresent
(E)Leftventricularhypertrophy
Theaveragetimetodeathaftertheonsetofvarioussymptoms
isasfollows:
anginapectoris,3years

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syncope,8years
dyspnea,2years
congestiveheartfailure,1.5-2years.
Mildormoderatestenosis:
usuallyasymptomatic

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Exertionaldyspnoea
Angina
Exertionalsyncope
Suddendeath
Episodesofacutepulmonaryoedema

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Signs

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Ejectionsystolicmurmur
Slow-risingcarotidpulse
Thrustingapexbeat(LVpressureoverload)
Narrowpulsepressure

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Signsofpulmonaryvenouscongestion(e.g.crepitations)
ThemurmnurofASischaracteristicallyanejection(mid)systolic
murmur.
TheLVbecomesincreasinglyhypertrophiedandcoronarybloodflow
maythenbeinadequate.

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123.Trueaboutorganophosphate-induced
delayedpolyneuropathy:
a)Usuallyoccursafter2-3monthofacuteexposure
b)Involvesbothsensoryandmotornerve
c)Steroidisusedfortreatment

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d)Incompleterecovery
e)None
CorrectAnswer-A:B:D
Answer-A,B,D,Usuallyoccursafter2-3monthofacute
exposure(B)Involvesbothsensoryandmotornerve

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(D)Incompleterecovery
Organophosphate-induceddelayedpolyneuropathy(OPIDN)isa
rarecomplicationthatusuallyoccurs2-3weeksafteracute
exposure.Itisamixedsensory/motorpolyneuropathy.
Recoveryisoftenincomplete

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124.UnlikeChildPughscoring,MELDscore
have:
a)Bedsideassessmenteasy
b)Prothrombintimeexpressedasinternationalnormalizedratio
(INR)

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c)Serumcreatinineestimation
d)Fourcomponentisusedinscoring
e)Albuminlevelestimation
CorrectAnswer-B:C
Answer-B,Prothrombintimeexpressedasinternational

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normalizedratio(INR)and(C)Serumcreatinineestimation
Thisscoreiscalculatedironthreenoninvasiuevariables:the
prothrombintimeexpressedastheinternationalnormalizedratio
(INR),theserumbilirubinlevel,andtheserumcreatinine
concentration

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MELDiscurrentlyusedtoestablishprioritylistingforliver
transplantation.

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125.Riskfactorsassociatedwithhealthcare
associatedpneumonia(HCAP)-
a)Acutecarehospitalizationforatleast2daysinthepreceding

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90days
b)Homeinfusiontherapy
c)Immunosuppressivediseaseorimmunosuppressivetherapy
d)Antibiotictherapyinthepreceding90days
e)Hospitalizationfor>48h

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CorrectAnswer-A:B:C:D:E
Answer-(A)Acutecarehospitalizationforatleast2daysinthe
preceding90days(B)Homeinfusiontherapy
(C)Immunosuppressivediseaseorimmunosuppressive
therapy(D)Antibiotictherapyinthepreceding90days

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(E)Hospitalizationfor>48h
Acutecarehospitalizationforatleast2daysinthepreceding90
days
Residenceinanursinghomeorextendedcarefacility
Homeinfusiontherapy,includingchemotherapy,withinthepast30

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days
Long-termdialysiswithinthepast30days
Homewoundcare
Familymemberwithaninfectioninvolvingamultipledrugresistant
pathogen

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Immunosuppressivediseaseorimmunosuppressivetherapy

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126.Allarefeature(s)ofsarcoidosisexcept:
a)HighCD4:CD8ratio
b)Hypercalciuriaandhypercalcimiamaybepresent
c)fSerumlevelsofangiotensin-convertingenzyme(ACE)

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d)Schaumanandasteroidbodiesarepathognomic
e)None
CorrectAnswer-D
Answer-D.Schaumanandasteroidbodiesarepathognomic
Hypercalcemiaand/orHypercalciuriaoccursinabout10%of

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sarcoidosispatients.
Bronchoalveolarlavagefluidlnsarcoidosisisusuallycharacterized
byanincreaseinlymphocyteandahighCD4/CD8ratio.
"Schaumanandasteroidbodies-althoughcharacteristic,thesecells
arenotpathognomicofsarcoidosisbecausetheymaybe

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encounteredinothergranulomatousdiseases.
Thegranulomaisthepathologichallmarkofsarcoidosis.
"Serumlevelsofanglotensin-convertingenzyme(ACE)canbe
helpfulinthediagnoslsofsarcoidosis.

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127.Transudativepleuraleffusionoccursin:

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a)Urinothorax
b)Dresslersyndrome
c)Nephroticsyndrome
d)Myxedema
e)Congestiveheartfailure

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CorrectAnswer-A:C:D:E
Answer-(A)Urinothorax(C)Nephroticsyndrome
(D)Myxedema(E)Congestiveheartfailure
Congestiveheartfailure
Cirrhosis

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Pulmonaryembolization
Nephroticsyndrome
Peritonealdialysis
Superiorvenacavaobstruction
Myxedema

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Urinothorax

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128.Trueaboutprimarysclerosing
cholangitis:
a)Involvesonlyintrahepaticbileduct,notextrahepaticbileduct
b)AssociatedwithInflammatoryboweldisease

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c)Causesmacronodularcirrhosis
d)Periductalfibrosisofsmallerbileducts
e)None
CorrectAnswer-B:D
Answer-(B)AssociatedwithInflammatoryboweldisease

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(D)Periductalfibrosisofsmallerbileducts
PSCischaracterizedbylnflammationandobliterativefibrosisof
lntrahepaticandextrahepaticbileductswlthdilationofpreserved
segments.
Inflammatoryboweldisease,particularlyulcerativecolitis,coexists

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inapproximately70%ofindividualswithPSC.
Primarysclerosingcholangltiscausesmicronodularcirrhosis.
Followingchangesareseen-fibrosingcholangitis,periductalfibrosis,
dilationofinterveningbileductsandcholestatiswithfullblown
pictureofbiliarycirrhosis"

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129.Trueaboutinsulinoma:
a)Encapsulated
b)Mostlymultiple
c)AssociatedwithMEN-I
d)Enucleationisthetreatmentofchoiceforbenigntumour

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e)Histologysimilartonormal(3-cells
CorrectAnswer-A:C:D:E
Answer-(A)Encapsulated(C)AssociatedwithMEN-I
(D)Enucleationisthetreatmentofchoiceforbenigntumour
(E)Histologysimilartonormal(3-cells

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Insulinomaisusuallysolitaryandwellencapsulatedtumour
10%aremultiple(alwaysassociatedwithMEN1)and10%are
malignant.
Microscopically,thetumouriscomposedofcordsandsheetofwell-
dffirentiatedBeta-cellswhichdonotdifferfromnormalcells.

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Enucleationisthetreatmentofchoiceforbenigninsulinomas.

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130.TrueaboutHypersensitivity
pneumonitis:
a)Occursduetoinorganicantigen
b)IncreasedCD8+Tcellsinbronchoalveolarlavage

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c)Manifestsmainlyasanoccupationalandenvironmentdisease
d)Forsevereacutecases,oralsteroidsisgivenfor3-4weeks
e)Interstitialinflammatoryinfiltrateisseeninlung
CorrectAnswer-B:C:D:E
Answer-(B)IncreasedCD8+Tcellsinbronchoalveolarlavage

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(C)Manifestsmainlyasanoccupationalandenvironment
disease(D)Forsevereacutecases,oralsteroidsisgivenfor3-
4weeks(E)Interstitialinflammatoryinfiltrateisseeninlung
Itismanifestedmainlyasanoccupationaldisease,inwhich
exposuretoinhaledorganicagentsleadstoacuteandeventually

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chronicpulmonarydisease.
Bronchoalveolarlavagespecimensalsoconsistentlydemonstrate
increasednumbersofbothCD4+andCDB+Tlymphocytes.
HistologyshowsevidenceofaninterstitialinflammatoryinfiItratein
thelung.

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Inacutecases,prednisoloneshouldbegivenfor3-4weeks,starting
withanoraldoseof40mgperday.

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131.AllaretrueaboutSjOgren'ssyndrome
execept-
a)Bilateralparotidglandenlargement

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b)Parotidglandenlargementmaybepainful
c)Xerostomiamaypresent
d)Progressiontolymphoma
e)Malesareaffectedmorethanfemales
CorrectAnswer-E

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Answer-E.Malesareaffectedmorethanfemales
Sjogren'ssyndromeisanautoimmunedisorderassociatedwith
parotidglands.
Itaffectswomenmore(40-60years)
ClinicalFeatures-

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Dryeyes(keratoconjuctivitissicca)
Xerostomia
Vaginaldryness
Raynaud'sphenomenon
Lymphoma

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Splenomegaly

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132.FeatureofFelty'ssyndromeis/are-
a)Seropositiveforrheumatoidfactor
b)Splenomegaly
c)Longstandingrheumatoidarthritis

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d)Neutrophilia
e)Keratoconjunctivitissicca
CorrectAnswer-A:B:C:E
Answer-(A)Seropositiveforrheumatoidfactor
(B)Splenomegaly(C)Longstandingrheumatoidarthritis

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(E)Keratoconjunctivitissicca
Feltysyndromeisapotentiallyseriousconditionthatisassociated
withrheumatoidarthritis.
Clinicalfeatures-
Lymphadenopathy

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Vasculitis,
legulcers
Splenomegaly
Weightloss
Recurrentinfections

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Skinpigments
Keratoconjunctivitissicca
SeropositiveforRF

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133.MalignanciesassociatedwithAIDS-
a)PrimaryCNSlymphoma

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b)Cervicalcancer
c)Kaposisarcoma
d)Ovariancancer
e)Endometrialcancer
CorrectAnswer-A:B:C:D

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Answer-(A)PrimaryCNSlymphoma(B)Cervicalcancer
(C)Kaposisarcoma(D)Ovariancancer
TheneoplasticdiseasesconsideredtobeAIDSdefiningconditions
areKaposi'ssarcomanon-Hodgkin'slymphoma,andinvasive
cervicalcarcinoma,ovariancarcinoma.

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134.Malignancyassociatedwith
hypercalcemia:
a)Breastcancer
b)Smallcelllungcancer
c)Non-smalllungcancer

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d)Prostatecancer
e)Multiplemyeloma
CorrectAnswer-A:C:D:E
Answer-A,BreastcancerC,Non-smalllungcancerD,Prostate
cancerE,Multiplemyeloma

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Lungcarcinoma,breastcarcinoma,andmultlplemyelomaaccount
formorethan50%ofallcasesofmalignancy-associated
hypercalcemia.
Gastrointestinaltumarsandprostatecarcinomaarelesscommon
causesofhypercalcemia.

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---

135.TrueaboutSevereCombined
Immunodeficiency(SCID):
a)Adenosinedeaminaseenzymemaybegivenfortreatment
b)Haematopoieticstemcelltransplant(HSCT)iscurative
c)MostcommoninheritanceisXlinkedrecessiveandautosomal

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recessive
d)Lymphocytosisispresentinmostcases
e)Increasedriskofinfectionbypneumocystisjiroveci
CorrectAnswer-A:B:C:E
Answer-A,Adenosinedeaminaseenzyme...B,Haematopoietic

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stem...C,Mostcommoninheritance...E,Increasedriskof
infection...
Themostcommonform,accountingfor5o%to6o%ofcases,X-
linkedandinheritedintheautosomalrecessivemode.
Adenosinedeaminasedeficiency:Thisthefirstimmunodeficiency

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diseaseassociatedwithanenzymedeficiency.
PersonswithSCIDhavesevereinfectionsbyCandidaalbicans,
Pneumocystisjiroveci,Pseudomonas,cytomegalovirus,varicella.
HSCtransplantationisthemainstayoftreatment.

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136.Proximalrenaltubularacidosis(RTA)

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is/areassociatedwith:
a)Fanconianemia
b)Multiplemyeloma
c)Leadpoisoning
d)Sjogren'ssyndrome

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e)SLE
CorrectAnswer-A:B:C
Answer-A,FanconianemiaB,MultiplemyelomaC,Multiple
myeloma
lnheritedFanconi'ssyndromeCystinosis.

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HeavymetaltoxicitYLead,cadmiumandmercuryPoisoning
Wilson'sdisease
DrugsCarbonicanhydraseInhibitorslfosfamide
ParaproteinaemiaMyeloma
Amyloidosis

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Hyperparathyroidism

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137.Highaniongapacidosisis/areassociate
a)Lacticacidosis
b)Ethyleneglycolpoisoning
c)Aspirinoverdose

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d)Diarrhea
e)Renaltubularacidosis
CorrectAnswer-A:B:C
Answer-A,LacticacidosisB,Ethyleneglycol
poisoningC,Aspirinoverdose

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Lacticacidosis
Ketoacidosis(diabetic,alcoholic,starvation)
Toxins(ethyleneglycol,methanol,glycol,pyroglutamicacid)
Renalfailure(acuteandchronic)

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138.Tubularproteinuriais/areseenin:

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a)Multiplemyeloma
b)Wilsondisease
c)Leadpoisoning
d)Fanconisyndrome
e)None

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CorrectAnswer-B:C:D
Answer-B,WilsondiseaseC,LeadpoisoningD,Fanconi
syndrome
Tubularproteinuriaoccursasaresultoffaultyreabsorptionof
normallyfilteredproteinsintheproximaltubule,suchasBeta2-

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microglobulinandimmunoglobulinlightchains.
Causesincludeacutetubularnecrosis,toxiinjury(lead,
aminoglycosides),drug-inducedinterstitialnephritis,andhereditary
metabolicdisorders(WisondiseaseandFanconisyndrome).

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139.AllaretrueCeliacdiseaseexcept-

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a)Antiendomysialantibodyispresent
b)Oat,ryeandbarleycanbesafelygiven
c)Associatedwithdermatitisherpetiformis
d)Associatedwithgliadin
e)Noriskfordevelopmentofcancer

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CorrectAnswer-B:E
Answer-B,Oat,ryeandbarleycanbesafelygivenE,Noriskfor
developmentofcancer
Itisaninflammatorydisorderofthesmallboweloccurringin
geneticallysusceptibleindividuals,whichresultsfrom

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intolerancetowheatglutenandsimilarproteinsfoundinrye,barley
and,toalesserextent,oats.
Serumantibodies-IgAantigliadin,antiendomysial,andanti-tTG
antibodies-arepresent.
Celiacdiseaseisassociatedwithdermatitisherpetiformis(DH).

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Themostimportantcomplicationofceliacdlseaseisthe
developmentofcancer.

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140.RespiratoryfailuretypeIIis/areseenin-
a)Myastheniagravis
b)AcuteexacerbationinCOPD

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c)AcutesevereAsthma
d)Pulmonaryedema
e)Pulmonaryembolism
CorrectAnswer-A:B:C
Answer-A,MyastheniagravisB,Acuteexacerbationin

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COPDC,AcutesevereAsthma
Acutesevereasthma
AcuteexacerbationofCOPD
Upperairwayobstruction
Acuteneuropathies/paralysis

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Narcoticdrugs
Primaryalveolarhypoventilation
Flailchestinjury

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141.Photosensitivityis/arenotseenin-
a)Acuteintermittentporphyria

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b)Variegateporphyria
c)Porphyriacutaneatarda
d)Congenitalerythropoieticporphyria
e)Erythropoieticprotoporphyria
CorrectAnswer-B

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Answer-B.Variegateporphyria
Ferrochelatase-erythropoieticprotoporphyria
Protoporphyrinogenoxidase-Variegateporphyria
PBGdeaminase-acuteintemittent
Uroporphyrinogensynthetase-Congenitalerythropoieticporphyria

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Uroporphyrinogendecarboxylase-porphyriacutaneatarda

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142.Trueabout4thheartsound:
a)Lowpitch
b)Presentduringearlydiastole
c)Absentinatrialfibrillation

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d)Producedintheventricleduringventricularfillingphase
e)Presentinsevereleftventricularhypertrophy
CorrectAnswer-A:C:D:E
Answer-A,LowpitchC,AbsentinatrialfibrillationD,Produced
intheventricleduringventricularfillingphaseE,Presentin

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severeleftventricularhypertrophy
Fourthheartsounds(S4):
Lowpitched
Pre-systolicsoundproducedintheventricleduringventricularfilling
Producedduringsecondrapidfillingphase(beforeS1)

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Bestheardwithbellofstethoscope.
Theright-sidedS4ispresentinpatientswithrightventricular
hypertrophysecondarytoeitherpulmonicstenosisorpulmonary
hypertension.

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143.Trueaboutatrialflutter:

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a)Narrow-complextachycardiaofupto150/min
b)Pwaveabsent
c)Associatedwith2:1,3:1or4:1AVblock
d)Besttherapyiscatheterablation
e)Occurduetomacrore-entrycircuitwithintherightatrium

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CorrectAnswer-A:C:D:E
Answer-A,Narrow-complex...C,Associatedwith...D,Best
therapy...E,Occurduetomacrore-entry...
Atrialflutterischaracterisedbyalarge(macro)re-entrycircuit,
usuallywithintherightatriumencirclingthetricuspidannulus.

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Theatrialrateisapproximately300/min,andisusuallyassociated
with2:7,3:1or4:1AVblock
Atrialfluttershouldalwaysbesuspectedwhenthereisanarrow-
complextachycardiaof150/min.
Forrecurrentepisodesofcommonatrialflutter,catheterablationof

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thecavotricuspidisthmusabolishesthearrhythmiainover90%of
patient.

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144.PositiveECGsign(s)ofischemiain
Treadmilltestis/are-
a)UpslopingdepressionoftheSTsegmentmVbelowbaseline

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b)DownslopingdepressionoftheSTsegment>0.1mVbelow
baseline
c)JunctionalST-segment
d)Tachycardia
e)Ventricularprematurebeats

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CorrectAnswer-B
Answer-B.DownslopingdepressionoftheSTsegment>0.1mV
belowbaseline
ThcischemiaST:-segmentresponegenerallyisdefinedasflator
downslopingdepressionoftheSTsegmant>O.1mV

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belowbaseline(i.e.,thaPRsegnent)andlastinglongerthanO.08s.
UpslopingorjunctionalST-segmentchangesarenotconsidered
characteristicofischemiaanddonotconstituteapositivetest.

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145.Whichofthefollowingis/areincludedin
managementofacuteischemicstroke-

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

a)UnfractionedHeparin
b)LMWH
c)Streptokinase
d)Aspirin
e)Recombinanttissueplasminogenactivator(rt-PA)

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CorrectAnswer-D:E
Answer-D,AspirinE,Recombinanttissueplasminogenactivator
(rt-PA)
RecombinantTissueplasminogenActivator(RtPA)istheonly
thrombolyticagentthatisapprovedforthetreatmentofacute

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ischaemicstroke.
Useofaspirinwithin48hofstrokeonsetreducedbothstroke
recurrenceriskandmortalitymininally.

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146.Finding(s)Inhemolyticanemiais/are:
a)Increaseinconjugatedbilirubin

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b)Increaseinunconjugatedbilirubin
c)Increaseinurineurobilinogen
d)Increaseinfaecalstercobilinogen
e)Increasedbilirubininurine
CorrectAnswer-B:C:D

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Answer-B,IncreaseinunconjugatedbilirubinC,Increasein
urineurobilinogenD,Increaseinfaecalstercobilinogen
DecreaseHaemoglobin
IncreasedUnconjugatedbilirubin
Increaselactatedehydrogenase

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IncreaseReticulocytes
Increaseurobilinogen

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147.Trueaboutidiopathicthrombocytopenic
purpura:
a)Inchildren,itisusuallyanchronicdisease

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b)Self-limitedcourseinacuteform
c)Inadults,itisamoreacutedisease
d)Immune-mediateddestructionofplatelets
e)None
CorrectAnswer-B:D

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Answer-B,Self-limitedcourseinacuteformD,Immune-
mediateddestructionofplatelets
Itisanacquireddisorderinwhichthereisimmune-mediated
destructionofplateletsandpossiblyinhibitionofplateletrelease
fromthemegakaryocyte.

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lnchildren,itisusuallyanacutediseasemostcommonlyfollowing
aninfection,andwithaselflimitedcourse.
Inadults,itisamorechronicdisease.

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148.Trueaboutcoagulationdisorders-
a)InDICbothPTandaPTTincrease

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b)HemophiliaCisaXlinkedrecessivecondition
c)FactorVIIIcanbegiveninhemophiliaB
d)HemophiliaAisinheritedasX-linkedrecessive
e)None
CorrectAnswer-A:D

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Answer-A,InDICbothPTandaPTTincreaseD,HemophiliaAis
inheritedasX-linkedrecessive
HemophiliaA:InheritanceisX-linkedrecessive,leadingtoaffected
malesandcarrierfemales.
CommonfindingsincludetheprolongationofPTand/oraPTT;

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---

149.Plexiformlesionisprominentinwhich
groupofpulmonaryhypertension-
a)Recurrentthromboemboli
b)Interstitiallungdiseases
c)FamilialpulmonaryHTN

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d)Congenitalheartdiseasewithleft-to-rightshunts
e)Pulmonaryhypertensionassociatedwithhuman
immunodeficiency
CorrectAnswer-C:D:E
Answer-C,FamilialpulmonaryHTND,Congenitalheart

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disease...E,Pulmonaryhypertensionassociated...
Plexiformlesionsaremostprominentinidiopathicandfamilial
pulmonaryhypertension,unrepairedcongenitalheartdiseasewith
lefttorightshuntsandpulmonaryhypertensionassociatedwith
humanimmunodeficiency.

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---

150.Inwhichofthefollowingcondition,non-
hepaticsurgeryisassociatedwithmost
adverseoutcome:
a)Child-PughscoreB
b)Child-PughscoreC

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c)Acuteviralhepatitis
d)Acutealcoholichepatitis
e)Chronicviralhepatitis
CorrectAnswer-B
Answer-B.Child-PughscoreC

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Table3.Child-PughGradingSystem
Class
TotalPoints
A:well-compensateddisease
5-6

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B:functionalcompromise-worseningdisease 7-9
C:decompensateddisease
10-15

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151.Trueaboutmultiplesclerosis:
a)Periventricularinvolvementcan'tbeseenbyimagingstudies

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b)Mayproducemasslesion
c)Autoimmuneinflammatorycondition
d)OligoclonalbandsmaybepresentinCSF
e)Spinalcordinvolvementmayoccur
CorrectAnswer-B:C:D:E

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Answer-B,MayproducemasslesionC,Autoimmune
inflammatoryconditionD,Oligoclonalbandsmaybepresentin
CSFE,Spinalcordinvolvementmayoccur
"ElevatedIgGincerebrospinalfluidanddiscretebandsofIgG
(oligoclonalbands)arepresentinmanypatients.

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ItisanautoimmunediseaseoftheCNScharacterizedbychronic
inflammationdemyelination,gliosis(scarring)andneuronalloss;the
coursecanberelapsing-remittingorprogressive.

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152.Safesttransplantationapproachinliver
disease-

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a)Directlytransplantingembryonicstemcellintheliver
b)Transplantingdonorhepatocytesintoliver
c)Transplantingmesenchymalstemcellfromadiposetissueto
liver
d)Injectingerythropoietinintobody

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e)None
CorrectAnswer-C
Answer-C.Transplantingmesenchymalstemcellfromadipose
tissuetoliver
Today,autologous(fromthepatient)adiposetissuestemcellarethe

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onlystemcellsthathavebeenusedclinicallyfortreatingliver
disease.
Manytrialshaveshownthatpatientswithlivercirrhosishave
benefittedfromautologousadiposetissuederivedmesenchymal
stemcells

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153.Trueaboutpostoperativeileus:
a)Colonrecoversearlierthansmallintestine
b)Smallintestinemostcommonlyaffected
c)Adhesionismostcommoncause
d)Usuallyresolveswithin48-72hour

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e)Radiographsshowdiffuselydilatedbowelwithairinthecolon
andrectum
CorrectAnswer-D:E
Answer-D,Usuallyresolveswithin48-72hourE,Radiographs
showdiffuselydilatedbowelwithairinthecolonandrectum

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Ileusthatoccursimmediatelyaftersurgeryintheabsenceof
precipitatingfactorsandresolveswlthln2to4daysisreferredtoas
primaryorpostoperativeileus.
Postoperativeileusaffectsthestomachandcolonprimarily.
Afterlaparotomy,smallbowelmotilityretunwithinseveralhours,

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gastricmotilitywithin24to48hours,andcolonicmotilityin48to72
hours.
Abdominalradiographsrevealdiffuselydilatedbowelthroughoutthe
intestinaltractwithairinthecolonantdrectum.

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154.Trueaboutsecondarybacterial

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peritonitis-
a)MarkedleukocytosiswithleftshiftoftheWBCstobandforms
b)Usuallycausedbypolymicrobialinfection
c)Maybeassociatedwithappendicularperforation
d)Associatedwithcirrhosisoftheliver

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e)None
CorrectAnswer-A:B:C
Answer-A,Markedleukocytosiswithleft...B,Usuallycausedby
polymicrobial...C,Maybeassociatedwith...
Secondaryperitonitisdevelopswhenbacteriacontaminatethe

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peritoneumasaresultofspillagefromanIntraabdominalviscus
Patientsarefebrile,withmarkedleukocytosisandaleftshiftofthe
WBCstobandforms.
Peritonealinfectionisusuallycausedbytwoormorebacterial
strains.

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155.Correctstatementaboutintestinal
ischemia:
a)Watershedzonesareusuallyaffected
b)Arterialischemiclesionhasbetterdemarcationthanischemia
causedbyimpairedvenousdrainage

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c)Cryptsmaybehyperproliferative
d)Microscopicexaminationmayshowcoagulativenecrosisofthe
muscularispropria
e)Surfaceepitheliumisnormal
CorrectAnswer-A:B:C:D

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Answer-AWatershedzones...,B,Arterialischemiclesionhas
better...C,CryptsmaybehyperproliferativeD,Microscopic
examination...
Intestinalresponsestoischemiaoccurintwophases-
1. Theinitialhypoxicinjuryoccursattheonsetofvascular

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compromise.
2. Reperfusioninjury,isinitiatedbyrestorationofthebloodsupplyand
itisatthistimethatthegreatestdamageoccurs.
Colonisthemostcommonsiteofgastrointestinalischemia,mucosal
andmuralinfarctionmayinvolveanylevelofthegutfromstomach

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toanus.
Therebcoagulativenecrosisofthemuscularispropriawithin2to4
days,andperforationmayoccur.
Microscopicexaminationofischemicintestinedemonstratethe
characteristicatrophyorsloughingofsurfaceepithelium.

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Cryptsmaybehyperproliferative.

---

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156.TrueaboutColorectalcancer:
a)Rightsidecancerusuallypresentswithobstructivesymptoms
b)MaybeassociatedwithHNPCC
c)Left-sidedcancerpresentswithalterationinbowelhabit

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d)Leftsidecolonismorecommonlyinvolved
e)All
CorrectAnswer-B:C:D
Answer-B,MaybeassociatedwithHNPCCC,Left-sidedcancer
presentswithalterationinbowelhabitD,Leftsidecolonismore

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commonlyinvolved
Tumorsoftheleftsideofthecolonwhicharefarmorecommon.lt
usuallypresentwithachangeinbowelhabitorrectal
bleeding,whilemoreproximallesionstypicallypresentlaterwithiron
deficiencyanaemiaoramass.

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HereditaryNonpolyposisColonCancer(Lynch'sSyndrome):Itis
characterizedbythedavelopmentofcolorectalcarcinomaatan
earlyage.
Tumorsoftheleftcoloncangraduallyoccludethelumen,causing
changesinbowelhabitswithalternatingconstipationandincreased

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frequencyofdefecation.

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157.Trueaboutthyroidcancer:
a)Follicularcancerismorecommoninradiationexposedpatient
b)Harthlecellcarcinomahasbetterprognosisthanfollicular
cancer

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c)Follicularcancerhavebetterprognosisthanpupillarycancer
d)Insularvariantofpapillarycarcinomahasbetterprognosisthan
papillarycancer
e)MedullarycarcinomaisassociatedwithMEN-2b
CorrectAnswer-E

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Answer-E,MedullarycarcinomaisassociatedwithMEN-2b
MedullarythyroidcarcinomainMEN2Bdevelopsearlierandismore
aggresivethaninMEN2A.
PapillaryCarcinomasarethemostcommonformofthyroidCancer.
Harthlecellcarcinomamayhaveaworseclinicalprognosis.

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158.TrueaboutSchatzkiring:
a)Containtrueesophagealmuscle
b)Concentricsymmetricnarrowingofloweresophagus
c)Consistsofesophagealmucosaaboveandgastricmucosa
below

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d)Dysphagiaisusuallytosolidfoods
e)Associationwithrefluxdisease
CorrectAnswer-B:C:D:E
Answer-B,Concentricsymmetricnarrowingofloweresophagus
CConsistsofesophagealmucosaaboveandgastricmucosa

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below,D,DysphagiaisusuallytosolidfoodsE,Associationwith
refluxdisease
Schatzki'sringisathinsubmucosalcircumferentialringinthedistal
oesophagus,usuallyatthesquamocolumnarjunction.
Itconsistsofesophagealmucosaaboveandgastricmucosabelow.

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Itdoesnothaveacomponentoftrueesophagealmusclethe
dysphagiaisusuallytosolidfoodsonlyandcomesonabruptlywith
nearlycompleteobstruction.
Thereisastrongassociatianwlthrefluxdisease.

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159.Trueaboutintestinaltypeofgastric

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cancer-
a)Incidencedecreasednowadays
b)AssociatedwithH.pyloriinfection
c)Morecommoninmalethanfemale
d)Betterprognosisthandiffuse

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e)Morecommonthandiffusetype
CorrectAnswer-A:B:C:D
Answer-A,IncidencedecreasednowadaysB,Associatedwith
H.pyloriinfectionC,MorecommoninmalethanfemaleD,Better
prognosisthandiffuse

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"Forunclearreason,theincidenceandmortalityratesforgastric
cancerhavedecreasedmarkedlyduringthepast65years.Gastric
cancerincidencehasdecreasedworldwidebutremainshighin
Japan,China,ChileandIreland"-Harrison16/e,p524
Morecommoninwomen.

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Theprognosisbelessfavourable.
Intestinalmetaplaslaoccursduetopersistentirritationofthegastric
mucosa,mostcommonlyfromH.pyloriinfection.
TheLaurensystemseparatesgastricadenocarcinomaintointestinal
ordiffusetypesbasedonhistology.

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---

160.CorrectstatementaboutIntussusception
inchildrenis/areallexcept-
a)Appendixisthemostcommonleadingpoint
b)Ileocolicisthemostcommonsite
c)Usuallypresentswithpainwithoutvomiting

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d)Canbecorrectedbyairandbariumenema
e)Diagnosisisconfirmedonabdominalultrasound
CorrectAnswer-A:C
Answer-A,Appendixisthemostcommonleading
pointC,Usuallypresentswithpainwithoutvomiting

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Mostintussusceptionsinchildrenareseenfromtwomonthstotwo
yearsofageintussusceptionissecondarytoapathologicallead
polnt,suchasaMeckel'sdiverticulum,entericduplicationcystor
evenasmallbowellymphoma.
Classically,apreviouslyhealthyinfantpresentswithcolickypainand

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vomiting.

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161.Non-absorbablesuture(s)is/are:
a)Silk
b)Catgut
c)Polypropylene

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d)Polyester
e)Nylon
CorrectAnswer-A:C:D:E
Answer-A,SilkC,PolypropyleneD,PolyesterE,Nylon
Non-absorbablesuturesare:Silk,Linen,Surgical

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Steel,Linen,Polyester,Polybutester,Polypropylene,polyethylene,
Nylon.

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162.Correctstatementaboutsurgicalsite
infection-
a)CanoccursduetoenvironmentalflorainOT

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b)Superficialinfectionrequirere-surgicalexplorationofwound
c)Doesnotoccurlaterthan14dayspost-operative
d)Shavingisbeneficialforprevention
e)Canoccurevenafter1yrincaseofimplantleftinsitu
CorrectAnswer-A:B

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Answer-A,Canoccursduetoenvironmentalflorain
OTB,Superficialinfectionrequirere-surgicalexplorationof
wound
TheycanoccuranytimefromOto3Odaysaftertheoperationorup
to7yearafteraprocedurethathasinvolvedtheimplantationofa

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foreignmaterial.
Preoperativehairremoval(clipping)shouldbedoneimmeditately
beforeanoPeration.

---

163.Regardingpre-operativeantibiotic
prophylaxis,whichofthefollowing

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statement(s)is/arecorrect:
a)Shouldbestarted2daysbeforesurgery
b)Shouldbegivenhalfanhourpriortosurgery
c)Notneededincleansurgery
d)Shouldbegivenmorethan1hourbeforesurgery

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e)None
CorrectAnswer-B
Answer-B.Shouldbegivenhalfanhourpriortosurgery
"Antibioticprophylaxisisindicatedformostcleancontaminatedand
contaminated.

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Antibioticsstartedaslateas7to2hoursafterbacterial
contaminationaremarkedlylesseffective.

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164.GradeIII(contaminated)woundis/are-
a)Appendicularperforation
b)Woundcontaminatedwithgrossfecalmaterialspillage

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c)Woundinurinarytractwithoutunusualcontamination
d)Surgeryoveracleansite
e)Incisionthroughabscess
CorrectAnswer-B
Answer-B.Woundcontaminatedwithgrossfecalmaterial

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spillage
Contaminatedwounds(classIII)includeopenaccidentalwounds
encounteredearlyafterinjury,thosewithextensiveintroductionof
bacteriaintoanormallysterileareaofthebodyduetomajorbreaks
insteriletechnique(e.g.,opencardiacmassage),grossspillageof

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viscuscontentssuchasfromtheintestine,orincisionthrough
inflammed,albeitnonpurulenttissue.

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165.Trueabouttesticularcancer-
a)Seminomaismorecommonthannon-seminoma
b)Cryptorchidismisassociatedwithseminoma

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c)RetroperitonealLNdissectionisdoneforgradeIItesticular
tumour
d)Usuallypresentsaspainlesstesticularlump
e)Seminomasmetastasisemainlyviahaematogenousroute
CorrectAnswer-A:B:C:D

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Answer-A,Seminomaismore
common...B,Cryptorchidism...C,RetroperitonealLN
dissection...D,Usuallypresents...
Seminomaisthemostcommontypeofgermcelltumour.
Amajorriskforthedevelopmentoftesticularcanceris

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cryptorchidism.
Seminomasmetastasisemainlyviathelymphaticsand
haematogenousspreadisuncommon.
Usuallythepatientpresentswithapainlesstesticularlump.

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166.Trueaboutobstructivejaundice-

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a)Cholangiocarcinomacauseintermittentjaundice
b)Courvoisierlawrelatedtopancreaticheadcancer
c)Cholangitispresentswithfeverandjaundice
d)Increaseinurineurobilinogen
e)Increaseinfecalurobilinogen

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CorrectAnswer-B:C
Answer-B,Courvoisierlawrelatedtopancreatichead
cancerC,Cholangitispresentswithfeverandjaundice
examinationoftendemonstratesclinicalsignsofjaundice,cachexia
isoftennoticeableandapalpablegallbladderispresentifthe

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obstructionisinthedistalcommnonbileduct(Courvoisier'ssign).
StoneinCBD:Intermitentpain,intermitentfeverandlntermittent
jaundiceareclassicalofstoneinCBD.
Cholangitis:Themostcommonpresentationisfever,epigastricor
rightupperquadrantpain,andjaundiceandisknownasCharcot's

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triad.
UrineUrobilinogen:Absent
StoolsSterocobilinogen-Absent

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167.Truestatementregardingsurviving
sepsisguideline:

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a)ActivatedproteinCisuseful
b)qS0FAshouldbeassessedincaseofprolongstayofpatientin
ICU
c)SuggestagainsttheuseofIVimmunoglobulinsinpatientswith
sepsis

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d)Recommendtheuseoferythropoietinfortreatmentofanemia
associatedwithsepsis
e)Recommendempiricbroad-spectrumtherapy
CorrectAnswer-B:C:E
Answer-B,qS0FAshouldbeassessed...C,Suggestagainstthe

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useofIV...E,Recommendempiric...
RecombinanthumanactivatedproteinCwascompletelyomitted
fromthe2Ol2guidelines.
"AhigherSOFAscoreisassociatedwithanincreasedprobabilityof
mortality.

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Patientswithsuspectedinfectionwhoarelikelytohaveaprolonged
ICUstayortodieinthehospitalcanbepromptlyidentifiedatthe
bedsidewithqSOFA.
Recommendempiricbroad-spectrumtherapywithoneormore
antimicrobialsforpatientspresentingwithsepsisorsepticshockto

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coveralllikelypathogens.
AgainstusingIVhydrocortisonetotreatsepticshockpatientsif
adequatefluidresuscitationandvasopressortherapyareableto
restorehemodynamicstability.

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Recommendagainsttheuseoferythropoietinfortreatmentof

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anemiaassociatedwithsepsis.

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168.Truestatementregardingsurviving
sepsisguideline:
a)ActivatedproteinCisuseful
b)qS0FAshouldbeassessedincaseofprolongstayofpatientin

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ICU
c)SuggestagainsttheuseofIVimmunoglobulinsinpatientswith
sepsis
d)Recommendtheuseoferythropoietinfortreatmentofanemia
associatedwithsepsis

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e)Recommendempiricbroad-spectrumtherapy
CorrectAnswer-B:C:E
Answer:(b)qS0FAshouldbeassessedin...,(c)Suggestagainst
theuseofIV...,(e)Recommendempiricbroad-...
[Ref:Harrison19th/1758;wwwfoamcast.org/2017/01/19;

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jamanetwork.com/journakSchwartz9th/128-29]

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169.Trueaboutmanagementofpepticulcer-
a)Vagotomy-decreasesacidsecretion
b)Earlydumpingsyndromeoccursduetohypoglycaemia
c)Latedumpingconsistsofabdominalandvasomotorsymptoms

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d)BillrothIgastrectomyhashighrateofmorbidityandmortality
e)Highlyselectivevagotomyhaslowincidenceofsideeffects
CorrectAnswer-A:D:E
Answer-A,Vagotomy-decreasesacidsecretionD,BillrothI
gastrectomyhashighrateofmorbidityandmortalityE,Highly

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selectivevagotomyhaslowincidenceofsideeffects
Highlyselectivevagotomyhasmostsatistactoryoperationfor
duodenalulceration,withalowincidenceofsideeffects.
BillrothIcarrieswithitthemorbidityandmortalityassociatedwith
anygastricresection

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Invagotomy,sectionofthevagusnerves,whfuharecritiaally
involvedlnthesecretionofgastricacid.,reducesthemaximalacid
outputbyapprorximately5OPercent.
EarlydumpingconsistsofabdominalandvasomotorsymPtoms.
Latedumpingisreactivehypoglycaemia.Thecarbohydrateloadin

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thesmallbowelcausesariseintheplasmaglucose,which
inturn,causesinsulinlevelstorise,causingasecondary
hypoglycemia.

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170.Trueaboutsurgicalocclusivedressing-
a)Maintainmoistureinwound

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b)Providesmechanicalsupport
c)Preventsmicrobialentry
d)WideMeshishelpful
e)Usedforhighlyexudativewounds
CorrectAnswer-A:B:C

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Answer-A,MaintainmoistureinwoundB,Providesmechanical
supportC,Preventsmicrobialentry
Wounddressingscanbecategorizedintofourclasses:
nonadherentfabrics;
absorptivedressings;

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occlusive
dressings;
creams,
ointmentsandsolutions
"Occlusivedressingclassprovidesmoistureretention,mechanial

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protectionandabarriertobacteria.
Widemeshgauzeiscompositionofabsorptivedressing.

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171.Whichofthefollowingnippledischarge
ismostprobablyphysiological-
a)B/Lspontaneousdischarge

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b)B/Lmilkydischargewithsqueezingfrommultipleducts
c)U/Lbloodydischarge
d)U/Lbloodydischargewithsqueezingfromasingleduct
e)U/Lspontaneousserousdischarge
CorrectAnswer-B

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

Answer-B,B/Lmilkydischargewithsqueezingfrommultiple
ducts
Nippledischargeisclassifiedaspathologicifitisspontoneous,
unilateral,blaody,serous,clear,orassociatedwlthamass.
Physiologicaldischargeisusuallybilateral,involvesmultipleducts,

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andisassoctatedwithnipplestimulationorbreastcompression.
Unilateral,localizedtoasingleduct.
Themostcommoncauseofspontaneousnippledischargefroma
singleductisasolitaryintraductalpapilloma.

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172.TrueaboutFatnecrosisinwomen:

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a)Historyoftraumacanbeelicitedin>90%cases
b)Morecommoninlactatingwomen
c)Canbeeasilydifferentiatedfrommalignancyonmammography
d)Nomalignant
e)None

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CorrectAnswer-D:E
Answer-D,NomalignantE,None
Traumaispresumedtobethecause,thoughonlyabout5O%of
patientsgiveahistoryofinjury.
Fatnecrosisisararelesionofthebreast.

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Acarcinoma,evendisplayingskintetheringandnippleretraction,
andbiopsyisrequiredfordiagnosis.
Fatnecrosiscanmimiccancerbyproducingapalpablemassora
densltyonmamtnographythatmaycontaincalcifications.

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173.Trueaboutomphaloceleisall,EXCEPT:

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a)Umbilicalcordinsertsintothesac
b)Incidenceofapproximately1in5000livebirths
c)Abdominalwalldefectmeasures4cmindiameter
d)Visceracoveredbyperitoneum
e)Noneoftheabove

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CorrectAnswer-E
Answer-E.Noneoftheabove
Omphalocelereferstoacongenitaldefectoftheabdominalwallin
whichthebowelandsolidvisceraarecoveredbyperitoneumand
amnioticmembrane.

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Theumbilicalcordinsertsintothesac.
Theabdominalwalldefectmeasures4cmindiameter.
Omphalocelehasanincidenceofapproximately1in5000live
births.
Theabdominalviscera(commonlyliverandbowel)arecontained

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withinasaccomposedofperitoneumandamnionfromwhichthe
umblicalcordarisesattheapexandcenter.

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174.Feature(s)ofoesophagealatresiawith
trachea-oesophagealfistula:
a)Droolingofsaliva

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b)Associatedwitholigohydramnios
c)Nasogastrictubecannotpassesintostomach
d)MaybeassociatedwithVACTERLanomalies
e)Abdominaldistension
CorrectAnswer-A:C:D:E

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Answer-A,C,D,E,Droolingofsaliva(C)Nasogastrictube
cannotpassesintostomach(D)Maybeassociatedwith
VACTERLanomalies(E)Abdominaldistension
Affectedinfantspresentsoonafterbirthwithdroolingandcyanotic
episodesonattemptingtofeed.

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Theremayhavebeenpolyhydramniosduetofailuretoswallow
amnioticfluid.
Thediagnosisisconfirmedwhenanasogastrictubegoesnofurther
thantheupperoesophagealpouchonthechestx-rayand
abdominalgassignifiesthetracheo-oesophagealfistula.

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TheVACTERLascociation(uertebral,anorectal,cardiac,
tracheoesophageal,renal,andlimbanomalies)ispresentof25%of
cases.
Astheneonatecoughsandcries,airistransmittedthroughthe
fistulaintothestomach,resultinginabdominaldistension.

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175.Correctstatement(s)abouthypospadias
is/are:
a)Urethralopeningonventralaspect
b)Chordaeondorsalaspect
c)Maybeassociatedwithpeniletorsion

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d)Proximalvarietiesaremorecommon
e)Couponsspongiosumisdeficient
CorrectAnswer-A:C
Answer-A,C,Urethralopeningonventralaspect(C)Maybe
associatedwithpeniletorsion

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Thereisincompletedevelopmentoftheprepuce,calledadorsal
hood,inwhichtheforeskinisonthesidesanddorsalaspectofthe
penileshaftandabsentventrally.
Thereisavariabledegreeofchordae(aventralcurvatureofthe
penismostapparentonerection)

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"Peniletorsionisafairlycommoncongenital(presentfrombirth)
conditionthatcanaffectanymaleinfant.

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176.TrueaboutBronchogeniccyst:
a)Morecommoninanteriormediastinumthanmiddle
mediastinum

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b)Mayhavemalignantpotential
c)Producesymptomswhichareusuallycompressiveinnature
d)Air-fluidmaybeseenonchestX-ray
e)Mostlyasymptomatic
CorrectAnswer-B:C:D:E

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

Answer-B,C,D,E,Mayhavemalignantpotential(C)Produce
symptomswhichareusuallycompressiveinnature(D)Air-fluid
maybeseenonchestX-ray(E)Mostlyasymptomatic
Bronchogeniccystsarethemostcommonprimarycystsofthe
anteriormediastinum.

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ThediagnosisisconfirmedbyCTasasphericalfluid-ormucus
fillednonenhancingmass.Anairfluidlevelmaybepresentonchest
Xray.
Twothirdsofbronchogeniccystsareasymptomatic.
Malignantdegenerationhasbeenreported.

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---

177.ApatienthasGlasgowcomascalescore
-E1VTM2.Whatisnotrequiredfor
his/hermanagement:
a)Headendelevation
b)Totalparenteralnutrition

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c)Stressulcerprophylaxis
d)Centrallineplacement
e)None
CorrectAnswer-E
Answer-None

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Domain
Response
Score
Spontaneous
4

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Tospeech
3
Eyeopenng
Topain
2

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

None
1
Oriented
5
Confused

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

4
Bestverbalresponse Inappropriate
3
Incomprehensible
2

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None
1
Obeying
5
Localizing

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

4
Withdrawal
Bestmotorresponse
3
Flexing

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4
Extending
1
None

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6

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5
Deepcomeordeath
4
Totalscore
Fullyalertandoriented 5

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3
1

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178.Trueaboutpyomyositis-
a)Staphylococcusaureusisthemostcommoncausative
organism

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b)Streptococcuspyogensisthemostcommoncausative
organism
c)Quadricepsisoneofthemostcommonlyaffectedmuscle
d)Treatmentinvolvesdrainageofabscesswithoutantibiotic
coverage

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e)BestdetectedbyMRI
CorrectAnswer-A:C:E
Answer-A,C,E,Staphylococcusaureusisthemostcommon
causativeorganism(C)Quadricepsisoneofthemost
commonlyaffectedmuscle(E)BestdetectedbyMRI

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Pyomyositisisanacutebacterialinfectionoftheskeletalmuscle
causedbyStaphylococcusaureus.
Itmaybeprimaryorsecondarytoapenetratinginjuryorcontiguous
anatomicinfection.
Ittypicallyaffectsthemajormusclesofthelowerextremityandthe

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glutealmuscles.
Patientsusuallypresentswithpain,tendernessandedemaofthe
involvedmusclegroup.
Abscesscandevelopinthemusclegroups.Diagnosisisconfirmed
byneedleaspirationoroperativeincisionanddrainage.

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Treatmentinvolvesadequatedrainagealongwithantibiotictherapy
againstStaphylococcusaureus.
Pyomyositisischaracterizedbyalocalizedinfectiousprocess,
conventionalpurulence,lackofsurroundingtissuenecrosis

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179.Allofthefollowingaretrueabout

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prostatespecificantigenexcept-
a)Normallevelis10-14ng/ml
b)ItmayElavatedinBPHandCaProstate
c)Itisproducedbyprostate
d)Itisaglycoprotein

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e)None
CorrectAnswer-A
Answer-A.Normallevelis10-14ng/ml
Itisaglycoproteinproducedonlyintheprostaticcells(bothbenign
&malignant).

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Normalserumlevellessthan4ng/ml
4-10ng/ml>thisrangeiscommonforbothBHPandCa.
Morethan10ng/mlapprox75%willhavecancer.

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180.Feature(s)ofPattersonKellysyndrome:
a)Dysphagia

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b)Morecommoninmalethanfemale
c)Achlorhydria
d)Treatmentconsistsofdilationofoesophagusbyoesophageal
bougies
e)All

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CorrectAnswer-A:C:D
Answer-A,C,D,Dysphagia(C)Achlorhydria(D)Treatment
consistsofdilationofoesophagusbyoesophagealbougies
Classicalfeaturesofthissyndromeincludedysphagia,irondeficieny
anaemia,glossitis,angularstomatitis,koilonychia(spooningofnails)

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andachlorhydria.
Affectsfemalespast40years
Dilatatianofthewebbedareabyoesophagealbougies

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181.Allarefeature(s)ofBeckwidth-Wideman
syndromeexcept:

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a)Omphalocele
b)Macrosomia
c)Hyperglycemia
d)Visceromegaly
e)None

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CorrectAnswer-C
Answer-C.Hyperglycemia
Beckwidth-Wiedemannsyndromeisanovergrowthsyndromethatis
characterizedbyvisceromegaly,macroglossia,
macrosomia,mphaloceleandhyperinsulinemichypoglycemia.

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---

182.Correctstatementaboutelectrocautery-
a)Inmonopolarmodeoneelectrodeusedatsurgicalfieldand
secondelectrodeisattachedtopatientplate
b)Patientplateshouldhaveconductivejellytoensureproper
contactwithbody

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c)Burnmaybeseenatsiteofpatientplate
d)Cuttinghasmorevoltagethancoagulation
e)None
CorrectAnswer-A:B:C:D
Answer-A,B,C,D,Inmonopolarmodeoneelectrodeusedat

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surgicalfieldandsecondelectrodeisattachedtopatientplate
(B)Patientplateshouldhaveconductivejellytoensureproper
contactwithbody(C)Burnmaybeseenatsiteofpatientplate
(D)Cuttinghasmorevoltagethancoagulation
High-frequancyalternatingcurrentcanbedeliveredineitherunipolar

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orbipolarfashion.
Theunipolar(ormonopolar)deviceiscomposedofagenerator,an
electodeforapplication,andanelectrodeforthereturningcurrentto
completethecircuit.
Complicationsofdiathermy:Electrocution,Explosionanl,Burns.

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183.Mostcommonpost-operatives
complaintsofpatientsis/are:
a)Pain
b)Nausea
c)Vomiting

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d)Shivering
e)Sedation
CorrectAnswer-A:B:C
Answer-A,B,C,Pain(B)Nausea(C)Vomiting
Nausea,vomitingandpainaremostcommonpost-opcomplications.

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184.Trueaboutabdominalaorticaneurysm-
a)Mostcommonbelowrenalartery
b)Maypresentsaspulsatileabdominalmass
c)Atherosclerosisismostcommoncause
d)Forasymptomaticaneurysmsrepairisindicatedifthediameter

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is>4cm
e)None
CorrectAnswer-A:B:C
Answer-A,B,C,Mostcommonbelowrenalartery,(B)May
presentsaspulsatileabdominalmass(C)Atherosclerosisis

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mostcommoncause
9O%ofabdominalaorticaneurysm(AAA)ofsize>4cmindiameter
isduetoatherosclerosis.
Malearemorefrequentlyaffectedthanfemale.
Theaneurysmmostcommonlyarisesbelowthelevelofrenalartery.

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Itisusuallydetectedonroutineexaminationasapalpable,pulsatile,
expansile,andnontendermass.

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185.Trueaboutconstitutionalgrowthdelay-
a)Baselinegrowthhormonedecreased
b)IGF-flevelsislowforchronologicalage

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c)Growthdelayonlyoccursafter2-3yearsofage
d)Pubertyspurtisdelayed
e)Finalheightiswithinnormallimits
CorrectAnswer-B:D:E
Ans.(b)IGF-Ilevelsislowforchronologicalage,(d)Puberty

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spurtisdelayed,(e)Finalheightiswithinnormallimits
ConstitutionalGrowthDelay
Thesechildrenarebornwithanormallengthandweightandgrow
normallyforfirst6-12monthsoflife.
Theirgrowththenshowsadecelerationsothattheheightand

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weightfallbelowthe3rdcentile.
By3yrofage,normalheightvelocitylsresumedandtheycontinue
togrowjustbelowandparalleltothe3rdcentilewithanormalheight
velocity.
Theonsetofpubertyandadolescentgrowthspurtlsalsodelayedin

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thesechildrenbutfinalheightiswithinnormallimits.
Boneageislowerthanchronologicalageandcorrespondstothe
heightage.
Historyofdelayedpubertyanddelayedheightspurtisusually
presentinoneorbothparents.

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IGF-1levelstendtobelowerchronologicalagebutwithinthenormal
rangeforboneage
Pubertalgrowthspurtisdelayed.
Growthhormoneresponsestoprovocativetestingtendtobelower

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thaninchildren

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---

186.Featureofpallidbreathholdingspellin
comparisontocyanoticbreathholding
spell:
a)Morecommonthancyanoticbreathholdingspell
b)Elicitedbypainfulstimulus

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c)Bradycardiaisprominent
d)Atropineisgiveninrefractorycases
e)None
CorrectAnswer-B:C:D
Ans.(b)Elicitedbypainfulstimulus.(c)Bradycardiais

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prominent,(d)Atropineisgiveninrefractorycases
Breathholdingspells
Breathholdingspellisaparoxysmaleventoccuringin0.1%-5%of
healthychildrenfromtheageof6monthsto6years.
Thenameforthisbehaviourmaybemisnomerinthatitconnotes

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prolongedinspiration.Infact,breath-holdingoccursduringexpiration
andisreflexive(notvolitional)innature.
Therearetwomajortypesofbreathholdingspells?
1.Cyanoticform(morecommon):
Temporarydisappearanceoradecreaseinintensityofthesystolic

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murmurisusualasflowacrosstherightventricularoutflowtract
diminishes.
Paroxysmalhypercyanoticattacks(hypoxic,"blue,"or"tet"spells)
areaparticularproblemduringthe1st2yearsoflife.
Theinfantbecomeshyperpneaandrestless,cyanosisincreases,

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gaspingrespirationsensue,andsyncopemayfollow.

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Mostfrequentlyinmorningoninitiallyawakeningorafterepisodesof
vigorouscrying
2.Pallidform:
Triggeredbysuddenfrightorpainorfallingwithaminorinjurytothe

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head
Childmaygaspandgiveabriefcry
Childbecomespale,losesconsciousnessandbecomeslimp
Childmaybecomesweatyandmaystiffenandhaveafewbody
jerksorlosebladdercontrol.

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Treatment:
Asubgroupofinfantswithbreathholdingspellshaveirondeficiency
anemia.Irontherapymaytreatnotonlytheanemia,butalsothe
breath-holdingspells.
Pallidinfantilesyncopemayrespondtoatropinesulfate,whichis

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usedonanongoingbasisifspellsarefrequent,orintermittentlyif
spellsaresituationallypredictable(suchaswithvenepuncture).

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187.Whichofthefollowingfindingisnormal
ininfant?
a)Papilledemaisrareinraisedintracranialpressure

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b)Floppyinfant
c)Strokingpatellartendonofonesideleadstocontractionon
oppositeside
d)Elbowcrossmidlineifpassivelydonebyexaminer
e)Parachutereflex

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CorrectAnswer-A:C:E
Ans.(a)Papilledemaisrareinraised,(c)Strokingpatellar
tendonofonesideleadstocontractiononoppositeside(e)
Parachutereflex
Inincreasedintracranialtension(ICT),thereisseparationofthe

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cranialsutures,widefontanelsandincreasedheadcircumference.
TheMacewen'sorcrackpotsignindicatesraisedintracranial
pressureaftersuturesandfontanelhaveclosed.
Papilledemaisunusualininfantunlesstheincreaseinintracranial
pressureisveryrapid.

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Botulismcausesacuteflaccidparalysisfloppyinfantwhichisnot
anormalfinding.
Thekneejerkinaninfantmayproduceacrossedadductor
response(tappingthepatellartendoninonelegcausescontraction
intheoppositeextremity),which,ifpresent,doesnotbecome

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abnormaluntil6-7moofage.
Whentheupperextremityofanormalterminfantispulledgently
acrossthechest,theelbownormallydoesnotquitereachthe

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midsternum(scarfsign).Theelbowofahypotoniainfantextends
beyondthemidlinewithease"

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Theparachutereflexisdemonstratedbysuspendingthechildbythe
trunkandbysuddenlyproducingforwardflexionasifthechildwere
tofall.Thechildspontaneouslyextendstheupperextremitiesasa
protectivemechanism.Theparachutereflexappearsbeforethe
onsetofwalking.

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188.Whichvaccineisrecommendedat2
yearsofageaccordingtolatestIAP
guidelines:
a)MMR
b)Pneumococcalconjugate

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c)VaricellaRubella
d)BoosterofTyphoidConjugateVaccine
e)IPVbooster
CorrectAnswer-D
Ans.(d)BoosterofTyphoidConjugateVaccine

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Recommendedageatwhichthevaccinesshouldbereceived
andtypeofvaccine:
AGE
VACCINE
AtBirth

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HepatitisB
DTaP-Diphtheria,Tetanus,Acellular
Pertussis
IVP-InactivatedPoliovaccine
2months

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HepatitisB
Pneumococcalvaccine
HIB-HaemophilusinfluenzaTypeB
Rotavirusvaccine
DTaP

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IVP
4months
Pneumococcalvaccine
HIB
Rotavirusvaccine

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DTaP
IVP
HepatitisB
6months
Pneumococcalvaccine

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HIB
Influenzavaccine**
Rotavirusvaccine
MMR-Measles,Mumps,Rubella
12months

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Pneumococcalvaccine
HepatitisA
DTaP
15months
HIB

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Varicella
18months
HepatitisA
2years
BoosterofTyphoidConjugateVaccine

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DTaP
MMR
4to6yearsofage
IVP
Varicella

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Tdap
11yearsofageto
Meningococcalvaccine
adult
HPV(humanpapillomavaccine)

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---

189.Achildispresentingfeaturesofrickets
includingchangesonbonesandhas
hypophosphatemia.Whichofthe
followingistrue:
a)ItiscommonlycausedbyXlinkedrecessivedisorder

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b)Normalzoneofprovisionalcalcificationadjacenttothe
metaphysisispresent
c)Thereisdefectofmineralizationofmatrix
d)CRFmaybethecause
e)Renaltubuledysfunctionleadstohypophosphatemia

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CorrectAnswer-C:E
Ans.(c)Thereisdefectofmineralizationofmatrix,(e)Renal
tubuledysfunctionleadstohypophosphatemia
X-linked.hypophosphatemicrickets(XLH)inheritedindominant
manner(notrecessive)

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Radiologicalchangesarecharacteristicallyseenatmetaphysis.
Thefirstchangeislossofnormalzoneofprovisionalcalcification
adjacenttothemetaphysis.
Rickets,adiseaseofgrowingbone,occursinchildrenonlybefore
fusionoftheepiphyses,andisduetounmineralizedmatrixatthe

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growthplates.
RADIOGRAPHICFINDINGS:
Thickeningandwideningofepiphysis
Cuppingandfrayingofmetaphysis

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Irregularmetaphysealmargins
Flaringofanteriorendsofribs
Ricketicrosary
Bowingofdiaphysis

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---

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190.Whichofthefollowingis/aretrueabout
atrialseptaldefect(ASD):
a)Ostiumprimumismostcommontype
b)Surgeryusuallydonebefore3year
c)Secondheartsound-Wideandfixed

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d)Softdelayeddiastolicrumbleatleftlowerleftsternalborder
e)None
CorrectAnswer-B:C:D
Ans.(b)Surgeryusuallydonebefore3year,(c)Secondheart
sound-Wideandfixed,(d)Softdelayeddiastolicrumble

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ClinicalmanifestationsofASD
PatientswithASDaregenerallyasymptomatic.
Mildeffortintoleranceandrespiratorytractinfectionmayoccur.
CHFisrare.
Physicalexamination

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Parasternalimpulse
Systolicthrillat2ndleftinterspace.
AccentuationofS,duetoloudtricuspidcomponent.
WidesplitandfixedS2.
Ejectionsystolicmurmuratthesecondandthirdleftinterspaces.

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Delayeddiastolicmurmuratthelowerleftsternalborder.
ASDwithmitralstenosisLutembachersyndrome.
Chestx-rayinASD
Mildtomoderatecardiomegalyarterysegment.
Prominentpulmonary

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Rightatrialandrightventricularenlargement.

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Relativelysmallaorticshadow
Plethoriclungfields.

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191.RiskfactorforNeuraltubedefectis/are:
a)Diabeticmother

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b)MTHFRmutation
c)Antiepilepticdrugintake
d)Methotrexateintake
e)All
CorrectAnswer-E

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Ans.E.AllA,DiabeticmotherB,MTHFR
mutationC,AntiepilepticdrugintakeD,Methotrexateintake
ETIOLOGY:
Teratogens-(hyperthermia,sulphas,antihistaminic,nutrition
deficienciesandanticonvulsantsuse)

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Moststronglytied=carbamazepine,valproicacid(folateantagon)
Folatedeficiency

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192.Trueaboutbreastmilkjaundiceis/are:
a)Appearsafterweek
b)Typicallybilirubinlevelisaround10-20ng/d1

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c)Phototherapyisuseful
d)Managedconservatively
e)Diaperstainingispresentingfeature
CorrectAnswer-A:B:C:D
Ans.(a)Appearsafter1week,(b)Typicallybilirubinlevelis

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around10-20ng/d1(c)Phototherapyisuseful,(d)Managed
conservatively
BREASTMILKJAUNDICE:
Occurslaterinnewbornperiod,withbilirubinlevelpeakingin6thto
14thdays.

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First,atbirth,thegutissterile,andnormalgutfloratakestimeto
establish.
Breastmilkcontains:
GlucuronidaseIncreasedeconjugationandenterohepatic
recirculationofbilirubin.

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Highepidermalgrowthfactor(EGF)IncreaseBilirubinuptakein
thegut(enterohepaticcirculation)
Second,breast-milkofsomewomencontains3-alpha-20-beta
pregnanediol.
Itinhibitsuridinediphosphoglucuronicacid(UDPGA)glucuronyl

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transferaseresponsibleforconjugationandsubsequentexcretionof
bilirubin.
Inthenewbornliver,activityofglucuronyltransferaseisonlyat0.1-
1%ofadultlevels,soconjugationofbilirubinisalreadyreduced.

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Third,lipoproteinlipaseinbreastmilkproducesincreasedFFAthat

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inhibithepaticglucuronyltransferase,whichdecreasesconjugation
ofbilirubin.
TREATMENT:
Phototherapy:
Anynewbornwithatotalserumbilirubingreaterthan359mol/l(21

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mg/dL)shouldreceivephototherapy

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193.Highriskinfantare:
a)Birthorder>3
b)Twinning
c)Birthweight<3kg

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d)Failuretogainweightfor3consecutivemonths
e)Artificialfeeding
CorrectAnswer-B:C:E
Ans.(b)Twinning,(d)Failuretogainweightfor3consecutive
months,(e)Artificialfeeding

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Highriskinfantrisk
Birthweightlessthan2.5kg
Twins
Birthorder5ormore
Artificialfeeding

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Weightbelow70%ofexpectedweight(i.eIIandIIIdegreeof
malnutrition)
Failuretogainweightduringthreesuccessivemonths
ChildrenwithPEM,diarrhoeaWorkingmother/oneparent

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194.Trueaboutcephalohematoma:

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a)Maximumatbirththenregress
b)Occursduetoforcepinjurytoperiosteum
c)Edematousswellingofsofttissue
d)Localizedcollectionofbloodbelowperiosteum
e)Mayextendacrossthemidlineandacrosssuturelines

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CorrectAnswer-B:D
Ans.(b)Occursduetoforcepinjurytoperiosteum,(d)
Localizedcollectionofbloodbelowperiosteum
Cephalohematoma:
Itiscausedbyinjurytotheperiosteumoftheskullduringlaborand

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delivery.
Thisleadstodevelopmentofhemorrhageoveroneorbothparietal
boneswithpalpableedgesappreciatedasthebloodreachesthe
limitsoftheperiosteum.
Itisacollectionofbloodlnb/wthepericraniumand.theflat

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bone(subperiosteal)oftheskullusuallyunilateraland,overa
parietalbone

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195.Trueaboutnewborns:
a)Apgarscoreprovideanimmediateestimateofthephysical
conditionofthebaby

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b)APGARscoringisdoneatlmin
c)APGARscoringat5minhasnoprognosticvalue
d)NormalrespiratoryrateisRRis30-60breaths/min
e)Normalheartrate>100beats/min
CorrectAnswer-A:B:D:E

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Ans.a.Apgarscoreprovideanimmediateestimateofthe
physicalconditionofthebaby;b.APGARscoringisdoneatl
min;d.NormalrespiratoryrateisRRis30-60breaths/min;e.
Normalheartrate>100beats/min
APGAR:

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Ababy'sfirsttest
Quickassessmentofthenewborn'soverallwell-being
Givenone-minuteafterbirthandfiveminutesafterbirth
Rates5vitalareas
APGARat1min,indicatorsforneonatalresuscitation

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LatertimesAPGARscore(after5minutes)indicatesaboutlong
termneurologicaldamage(notneonatalmortality)
Signs
0
1

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2
Heartbeatsper
Absent
Slow(<100)
>100

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minute
Respiratoryeffort
Absent
Slow,irregular
Good,crying

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Someflexionof
Muscletone
Limp
Activemotion
extremities

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No
Reflexirritability
Cryorcough

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No
Reflexirritability

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response Grimace
Cryorcough
Blueor
Bodypink,extremities Completely
Color

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pale
blue
pink

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196.Maximumrisktofoetusoccurswhen
maternalinfectionwithrubellaoccurs

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duringwhichofthefollowingtime:
a)6-12week
b)12-l8week
c)14-20week
d)20-24week

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e)32-36week
CorrectAnswer-A
Ans.(a)6-12week
Ingeneral,theearlierinpregnancyinfectionoccurs,thegreaterthe
damagetothefetus.Maximumdamagetothefetusoccurswhen

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infectionisacquiredinthefirsttrimesterofpregnancy.
Duringacuterubellainpregnancy,therateofcongenitalinfectionis
over90%inthe12firstweeksofpregnancy,approximately60%in
weeks13to17,25%inweeks18to24andthenincreasesagain
duringthelastmonthofpregnancy

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---

197.Trueaboutparacetamoltoxicityin
children:
a)HypernatremiaiscommonsideeffectofN-acetylcysteine
b)Liverfailuremayoccurafter3-4days
c)N-acetylcysteineisverylesseffectiveifgivenafter24hourof

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paracetamolingestion
d)N-acetylcysteinebegivenorallyorIV
e)Renaldamagealsomayoccur
CorrectAnswer-B:C:D:E
Ans.b.Liverfailuremayoccurafter3-4days;c.N-

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acetylcysteineisverylesseffectiveifgivenafter24hourof
paracetamolingestion;d.N-acetylcysteinebegivenorallyorIV;
e.Renaldamagealsomayoccur
Acetaminophenintoxicationlsacommoncauseofacuteliverfailure
inadolescentsandadults.

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Acetaminophentoxicityresultsfromtheformationofahighly
reactiveintermediatemetabolite,N-acetyl-p-benzoquenoneimine
(NAPQI).
Theacutetoxicdoseofacetaminophenisgenerallyconsideredto
be>200mg/kglnchildrenyoungerthan12yrofage,asingle

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ingestionof>7.5gisconsideredaminimumtoxicdosein
adolescentsandadults.
Adolescentshaveahigherincidenceoftoxicplasmaconcentration
afteringestionthandochildren,andtheirexposuresareoften
associatedwithintentionaloverdose.

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AnIVpreparationofNACLsalsoavailable

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N-acetylcysteinecancausenausea&vomitinganddiarrhoeaor
constipation.
Rarely,itcancauserashes,fever,headache,drowsiness,lowblood
pressureandliverproblems.

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---

198.Allaretrueaboutanteriorcruciate
ligamentexcept?
a)Commonlyoccursasaresultoftwistingforce
b)MaybeassociatedwithSegondfracture
c)Rarelyassociatedwithmeniscalinjury

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d)Lachmantestishighlysensitivetestfortear
e)None
CorrectAnswer-C
Ans.(c)Rarelyassociatedwithmeniscalinjury

---

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Symptoms:
SignsandsymptomsofanACLinjuryusuallyinclude:
Aloud"pop"ora"popping"sensationintheknee
Severepainandinabilitytocontinueactivity
Rapidswelling

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Lossofrangeofmotion
Afeelingofinstabilityor"givingway"withweightbearing
Complications
Higherriskofdevelopingosteoarthritisintheknee.Arthritismay
occurevenifyouhavesurgerytoreconstructtheligament.

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Segondfractureduetoavulsionattheanterolateralcapsular
attachment.SegondfractureshaveaveryhighassociationwithACL
tearsand,meniscalinjuries
Diagnosis:
Injurytotearofanteriorcruciateligamentcanbedetectedusing

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lachmanandanteriordrawertest.
Lachmanntestisasimilartesttoanteriordrawertestinwhich

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anteriorglideofthetibiaisjudgedwiththekneein10-15degreesof
flexion.

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199.PiraniscoringofCTEVincludesall

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except?
a)Curvatureofthemedialborderofthefoot
b)Severityofthemedialcrease
c)Positionofthelateralpartoftheheadofthetalus
d)Emptinessoftheheel

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e)Severityoftheposteriorcrease
CorrectAnswer-A
Ans.(a)Curvatureofthemedialborderofthefoot
PIRANISCORING
ThePiraniscoreisasimple,easytousetoolforassessingthe

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severityofeachofthecomponentsofaclubfoot.
PiraniScoring:
Thecomponentsarescoredasfollows:
Eachcomponentmayscore0,0.5or1
Hindfootcontracturescore(HCFS):

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Midfootcontracturescore(MFCS):
1. Posteriorcrease
2. Emptyheel
3. Rigidequinus
Midfootcontracturescore(MFCS):

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1. Medialcrease
2. Curvatureoflateralborder
3. Positionofheadoftalus

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200.TrueabouttuberculosisofSpine:

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a)Middlepathregimenisusedinmanagement
b)Posteriorelementsofthespineismostcommonlyaffected
c)Commonlyspreadbyhematogenousroutefromlung
d)Acuteonsetparaplegiahasworseprognosis
e)Lowerthoracicandupperlumbarismostcommonsite

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CorrectAnswer-A:C:E
Ans.a.Middlepathregimenisusedinmanagement;C.
Commonlyspreadbyhematogenousroutefromlunge.Lower
thoracicandupperlumbarismostcommonsite
Route:

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Lymphogenousandhematogenousspreadhasbeenimplicated.in
thoracolumbarlesions.
Site:
UpperthoracicspinelsthemostcommonsiteofspinalTBin
children,thelowerthoracicandupperlumbarvertebraeareusually

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affectedinadults
Paradiscalisthecommonesttype.
Acuteonsetparaplegiahasabetterprognosis
Management:
1. Rest,

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2. DrugsIntensivePhase:HRO(5-6months);ContinuationPhase:HZ
(3-4months)+HR(4-5months);ProphylacticPhase:HE(4-5
months),
3. RadiologicalFollow-up(X-ray,MRI),d.GradualMobilisation+/-
Spinalbraces.managementofAbscess/Sinuses,

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4. ManagementofNeurologicalcomplications

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5. Surgery(ExcisionalsurgeryDefinitiveSurgery:IndicationofSurgery
inPott'sspine),
6. Post-operativecare

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201.Whichofthefollowingis/areindication

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ofsurgicalmanagementoffractureof
shaftofhumerus:
a)Fractureinelderly
b)Radialnerveinvolvementaftermanipulation
c)Pathologicalfractures

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d)Vascularinjury
e)Multiplefractures
CorrectAnswer-B:C:D:E
Ans.(b)Radialnerveinvolvementaftermanipulation,(c)
Pathologicalfractures,(d)Vascularinjury,(e)Multiplefractures

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FracturedShaftofHumerus:OperativeTreatment-Indications:
Severemultipleinjures:
Anopenfracture.
Segmentalfractures.
Displacedintra-articularextensionofthefracture

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Apathologicalfracture.
Afloatingelbow(simultaneousunstablehumeralandforearm
fractures)
Radialnervepalsyaftermanipulation.
Non-union

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Problemswithnursingcareinadependentperson

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202.Whichofthefollowingis/aretrueabout
Ewingsarcoma:
a)Vascularorigin
b)Ewing'ssarcomaissecondmostcommonprimarymalignant

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bonetumourinchildrenafterOsteosarcoma
c)Metaphysisoflongboneismostcommonsite
d)Feverandweightlossmaybepresent
e)Surgeryisveryusefulinmanagement
CorrectAnswer-B:D

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Ans.b.Ewing'ssarcomaissecondmostcommonprimary
malignantbonetumourinchildrenandadolescentafter
Osteosarcoma;d.Feverandweightlossmaybepresent
EwingSarcoma:
Ewing'ssarcomaarisesfromprimitiveneuroectoderm.

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MostcommonSite:Femurdiaphysis>tibiadiaphysis
Clinicalfeatures:
Occursbetween10-20yearsofage.
Thepatientpresentswithpainandswelling.
Historyoftraumaprecedingonset,butitisusuallyincidental.

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Oftenthereisanassociatedfever,inwhichcaseitmaybeconfused
withosteomyelitis.
Treatment
Thisisahighlyradio-sensitivetumourmeltsquicklybutrecurs.
Treatmentconsistsofcontroloflocaltumourbyradiotherapy,and

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controlofmetastasisbychemotherapy.
Themostcommonprimarymalignantbone

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tumorsareosteosarcoma(35%),chondrosarcoma(25%),and
Ewing'ssarcoma(16%).
Lessfrequently(5%)occurringtumorsarechordoma,malignant

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fibroushistiocytomaofbone,andfibrosarcomaofbone.
Themostcommonmalignantpediatricbonetumors
includeosteosarcomaandEwingsarcoma.

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203.Trueaboutgiantcellsarcoma?
a)Mostcommonagegroupaffectedis20-40year

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

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

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

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

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

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204.Spursignis/areseenin:

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a)Supracondylarfractureofhumerus
b)Radialheadfracture
c)Acetabulumfractureofpelvis
d)Talusfracture
e)None

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CorrectAnswer-C
Ans.(c)Acetabulumfractureofpelvis
Spurcells-Theyareirregularlydistortedredcellscontainingseveral
irregularlydistributedthornlikeprojections.
Cellswiththismorphologicabnormalityarealsocalled

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acanthocytes.
TheyareseeninSplenectomisedpatientsandpatientswithliver
disease.

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205.Cause(s)ofavascularnecrosisof
femoralHead:

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a)Fractureoffemoralneck
b)Steroiduse
c)alcoholuse
d)Sicklecelldisease
e)Caissondisease

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CorrectAnswer-A:B:C:D:E
Answer:A,FractureoffemoralneckB,SteroiduseC,alcohol
useD,SicklecelldiseaseE,Caissondisease
Causeofavascularnecrosisoffemoralhead:
ldiopathic-commonest

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Alcoholism
Steroidtherapy
Sicklecelldisease
Patientofrenaldialysis
Patientonanticancerdrug

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Post-partumnecrosis
Goucher'sdisease
Caisson'sdisease

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206.Whichofthefollowingarenotincluded
inGurd'scriteria?

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a)Centralnervoussystemdepressiondisproportionateto
hypoxaemia
b)Tachycardia<1l0bpm
c)Deepveinthrombosis
d)Axillaryorsubconjunctivalpetechiae

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e)HypoxaemiaPao2<60mHg,Fio2=0.4
CorrectAnswer-C
Ans.c.Deepveinthrombosis

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207.Correctstatementabouthandinfection?
a)OpeningofFelonbyfishmonthincisionispreferredincision

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technique
b)Felonismiddlevolarpulpinfection
c)Apicalsubungualinfection-V-shapedpieceisremovedfromthe
centerofthefreeedgeofthenailalongwithalittlewedgeofthe
fullthicknessoftheskinoverlyingtheabscess

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d)Whenthepusextendsbeneaththenail,itisnecessaryto
removethesomepartofnailforadequatedrainageofpus
e)None
CorrectAnswer-C:D
Ans.c.Apicalsubungualinfection-V-shapedpieceisremoved

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fromthecenterofthefreeedgeofthenailalongwithalittle
wedgeofthefullthicknessoftheskinoverlyingtheabscess;
d.Whenthepusextendsbeneaththenail,itisnecessaryto
removethesomepartofnailforadequatedrainageofpus
Inapicalsubungualinfection:Fordrainage,asmallVshapedpiece

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lsremovedfromthecentreofthatfreeedgeofthenailalongwitha
littlewedgeofthefullthicknessoftheskinoverlyingtheabscess.
Inacuteparonychia:Whenthepusextendsbeneaththenail,itis
necessarytoremovetheproximalone-thirdofthenailforadequate
drainage.

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DONOTperforma"fishmouth"incisionsincethismayresultsin:
Unstablefingerpad,neuroma.,and/orlossofsensation"
Thefelonshouldbeincisedintheareaofmaximumswellingand
tenderness.

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208.Trueaboutanatomyofvagina:

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a)Coveredbycolumnarepithelium
b)Coveredbynon-keratinizedstratifiedsquamousepithelium
c)Vaginalsecretionisfromtransudationofvaginalepithelium
d)Suppliedbycervicovaginalbranchoftheuterineartery
e)Anteriorwallislongerthanposteriorwall

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CorrectAnswer-B:C:D
Ans.b.Coveredbynon-keratinizedstratifiedsquamous
epithelium;c.Vaginalsecretionisfromtransudationofvaginal
epithelium;d.Suppliedbycervicovaginalbranchoftheuterine
artery

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HISTOPATHOLOGY:
Thevaginaiscomposedof4histologicallayers(internalto
external):
Nonkeratinizedstratifiedsquamousepithelium
Elasticlaminapropria

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Fibromuscularlayer
Adventitia
BLOODVESSELANDNERVESUPPLIES:
Arterialsupplytothevaginaisviatheuterineandvaginalarteries;
bothbranchesoftheinternaliliacartery.

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Venousreturn:vaginalvenousplexus,whichdrainsintotheinternal
iliacveinsviatheuterinevein.
Lymphaticdrainage:iliacandsuperficialinguinallymphnodes.
Theparasympatheticandsympatheticnervessupplyingthevagina
arederivedfromtheuterovaginalnerveplexus.Theuterovaginal

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plexusliesinthebaseofthebroadligament,eithersideofthe

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supravaginalpartofthecervix.
Inferiorfibresfromtheuterovaginalplexussupplythesuperiorpart
ofthevagina.Thesearederivedfromtheinferiorhypogastric
plexusandthepelvicsplanchnicnerves.

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Theinferiorpartofthevaginaisinnervatedbyabranchof
thepudendalnervecalledthedeepperinealnerve.

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209.Whichoffollowingis/arenotfertility
awarenessbasedmethods:
a)Withdrawalmethod

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b)Rhythmmethod
c)Cervicalmucusmethod
d)MTPpill
e)Sympto-thermalmethod
CorrectAnswer-A:D

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Ans.(a)Withdrawalmethod,(d)MTPpill
Allfamilyplanningmethodsthatattempttoidentifyfertiletimein
eachcycleandthenmodifysexualbehaviourarecalledFertility
AwarenessBasedMethods(FAB)
Theyareasfollows:

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Rhythmmethod/calendarmethod
Basalbodytemperaturemethod
Cervicalmucusmethod/Billingmethod.
Sympto-Thermalmethod
Standarddaysmethodusingcyclebeads

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Twodaymethod
Ovulationdetection
Coitusinterruptus
Lactationamenorrhoeamethod(LAM)
Abstinence

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210.Predisposingfactor(s)forobstetrical
haemorrhageis/are:
a)Obesity
b)Placentalabruption
c)Oligohydramnios

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d)Smoking
e)Instrumentaldelivery
CorrectAnswer-A:B:D:E
Ans.(a)Obesity,(b)Placentalabruption,(d)Smoking,(e)
Instrumentaldelivery

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Predisposingfactor(s)forobstetricalhaemorrhage:
AbnormalPlacentation
Placentaprevia
Placentalabruption
Placentaaccreta/increta/percreta

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Ectopicpregnancy
Hydatidiformmole
TraumaDuringLaborandDelivery
Episiotomy
Complicatedvaginaldelivery

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Low-ormidforcepsdelivery
Cesareandeliveryorhysterectomy
Uterinerupture-riskincreasedby:
Previouslyscarreduterus
Highparity

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Hyperstimulation

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Obstructedlabor
Intrauterinemanipulation
Midforcepsrotation
SmallMaternalBloodVolume

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Smallwomen
Pregnancyhypervolemianotyetmaximal
Pregnancyhypervolemiaconstricted
Severepreeclampsia
Eclampsia

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OtherFactors
Obesity
NativeAmericanethnicity
PreviousPPH
UterineAtony

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Overdistendeduterus
Largefetus
Multiplefetuses
Hydramnios
Distentionwithclots

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Anesthesiaoranalgesia
Halogenatedagents
Conductionanalgesiawithhypotension
Exhaustedmyometrium
Rapidlabor

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Prolongedlabor
Oxytocinorprostaglandinstimulation
Chorioamnionitis
Previousuterineatony
CoagulationDefects-lntensifyOtherCauses

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Placentalabruption
Prolongedretentionofdeadfetus
Amnioticfluidembolism
Saline-inducedabortion
Sepsissyndrome

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Severeintravascularhemolysis
Massivetransfusions
Severepreeclampsiaandeclampsia

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Congenitalcoagulopathies
Anticoagulanttreatment

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211.Allaretrueaboutpuerperalsepsis
except:
a)Temperature>380C(100.4oF)
b)Caesareansectionhasnoincreasedriskforsepsis
c)GroupAbeta-hemolyticstreptococcusisoneofcommon

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causativeorganism
d)Instrumentdeliveryincreasesrisk
e)Retainedplacentaisacause
CorrectAnswer-B
Ans.(b)Caesareansectionhasnoincreasedriskforsepsis

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Puerperalpyrexia--isdefinedasariseoftemperaturereaching
100.4?F(38?C)ormore(measuredorally)on2separateoccasions
at24hoursapart(excludingfirst24hours)withinfirst10days
followingdelivery.
Anyinfectionofgenitaltractwhichoccursasacomplicationof

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deliveryiscalledasPuerperalsepsis.
MostcommonsiteofPuerperalinfection--Placentalsite.
MostcommonmanifestationofPuerperalinfection--Endometritis.
MostcommoncauseofPuerperalsepsis--Streptococcus.
Mostcommonrouteofinfection--Directspread.

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Caesareansectioniseasilythemostcommonidentifiableriskfactor
fordevelopmentofpuerperalinfection.

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212.Truestatementregardinginvestigationin
endometrialcancer:
a)MRIissuperiortoCTindetectingmyometrialinvolvement

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b)CTissuperiortoMRIindetectingomentalmetastasis
c)USGisinitialinvestigationtobeperformed
d)USGisthebestinvestigation
e)None
CorrectAnswer-A:B:C

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Ans.a.MRIissuperiortoCTindetectingmyometrial
involvement;b.CTissuperiortoMRIindetectingomental
metastasisandc.USGisinitialinvestigationtobeperformed
DiagnosisofEndometrialCarcinoma
CTscanofpelvisandabdomenmaybeusedtodetectlymphnode

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metastases".
MRIcandetectMyocardialinvasion
SensitivityofPETindetectingpelvicnodemetastasesis80%
comparedtoMRI(70%)andCT(48%)"
"CTisusefulinthediagnosisoflymphnodemetastasisanddepthof

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myometrialinvasioninendometrialcancer"
"MRIissuperiortoCTorultrasoundindiagnosingadenomyosis,
myomasandendometrialcancer(includingmyometrialinvasion)

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213.TrueaboutDelivery,ofHIV+vewoman-
a)VaginaldeliveryhaslowerriskfortransmissionofHIVtochild

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thanCS
b)VaginaldeliveryhashigherriskfortransmissionofHIVtochild
thanCS
c)Instrumentationhasnoriskofincreasedinfection
d)Verticaltransmissionislessincaseswithpretermbirth

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e)NONE
CorrectAnswer-B
Ans.(b)VaginaldeliveryhashigherriskfortransmissionofHIV
tochildthanCS
Vaginalandemergencycaesareansectiondeliveries,prematurity,

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andlowCD4cellcountweremoststronglyassociatedwithinfants
infectionstatusinunivariateanalyses.
Childrendeliveredvaginallyorbyemergencycaesareansection
weremorelikelytobeinfectedthanthosedeliveredbyelective
caesareansection,withareductioninriskof79%associatedwith

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thelatter(P<0.001).
Similarly,infantsdeliveredbefore37weeksweremorethantwiceas
likelytobeinfectedthaninfantswhowerenotpremature.
Caesareansectionbeforeonsetoflabourandruptureofmembranes
approximatelyhalvestheriskofmother-to-childtransmission.

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Transmissionrate:
Duringpregnancy:5?10%
Duringlabouranddelivery:10?15%
Duringbreastfeeding:5?20%
Overallwithoutbreastfeeding:15?25%

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Overallwithbreastfeedingtosixmonths:20?35%
Overallwithbreastfeedingto18?24months:30?45%

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214.Whichofthefollowingis/aretrueabout
combinedoralcontraceptivepills:
a)Reducesriskofvenousthromboembolism

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b)Reducesriskofbenignbreastdisease
c)Protectsagainstendometrialcancer
d)DecreasedBonedensity
e)None
CorrectAnswer-B:C

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Ans.(b)Reducesriskofbenignbreastdisease,(c)Protects
againstendometrialcancer
OCPS
ADVANTAGES:
Controlsfertility

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TreatsMenorrhagia&polymenorrhoea.
Relievedysmenorrhoeaandpremenstrualtension
Preventsanaemia
Lowerschancesof
Fibrocysticdisease

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Ovariancyst
Ovarian,uterine&anorectalmalignancy
PID
Ectopicpregnancy
Usefulinacne,PCODandendometriosis

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PreventRA
NoncontraceptivebenefitsofOCPs:
Cyclestabilization

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Cureofmenstrualdisorder-usefulinmenorrhagia&polymenorrhea
Preventsanemia.

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Reducestheincidenceofectopicpregnancy.
Protectionagainstcancer?Ovarian,Endometrial
Benigntumour-Benignbreastdisease,Ovarianfunctionalcyst,
Fibromyomauterus
Protects-PID,Anemia,Endometriosis,PCOD,Acne,hirsutism,

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Rheumatoidarthritis,Osteoporosis

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215.TrueaboutamniocentesisandChorionic
villussampling:
a)In1sttrimester,amniocentesisisbetterthanChorionicvillus
sampling

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b)2ndtrimesteramniocentesishaslessfoetallossthanChorionic
villussampling
c)Amniocentesismayresultinoligohydraminos
d)Amniocentesisinlsttrimesterhaslowerriskoffoetallossthan
2ndtrimesteramniocentesis

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e)Amniocentesisinlsttrimesterhasmoreriskoftalipes
CorrectAnswer-B:C:E
Ans.b.2ndtrimesteramniocentesishaslessfoetallossthan
Chorionicvillussampling,c.Amniocentesismayresultin
oligohydraminos&e.Amniocentesisinlsttrimesterhasmore

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riskoftalipes
AdvantagesofCVSoveramniocentesis:
ThemainadvantageofCVSisthat,resultsareavailableearlierin
pregnancy.whichlessenparentalanxietywhenresultsarenormal.
Allowsearlierandsafermethodsofpregnancyterminationwhen

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resultsareabnormal.
CVSRisks:
Chancesoffetalloss/abortion.
Ifperformedearlierthan9weeks(typicallyaround7weeks),
increasedchancesoforomandibularhypogenesisandlimb

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reductiondefects.
Itcancauseruptureofmembranes.leakageofamnioticfluidand

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infection.
RhisoimmunizationcanoccurinRhnegativefemales.
ComplicationsofAmniocentesis:

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Chorioamnionitis(0.1%)
Procedurerelatedfetalloss
Leakageofamnioticfluidoccursinabout2%patients,butisusually
selfresolving.Persistentleakageofamnioticfluidcausing
oligohydramnios

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Talipesequinovarus
Vaginalbleeding(2-3%)
Rhisoimmunization
Pretermlabor
Respiratorydistress

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Intrauterinedeath(IUD)

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216.Duringexternalradiationtherapyfor
cervicalcancerwhichlymphnodeis/are
excluded?
a)Externaliliaclymphnode

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b)Commoniliaclymphnode
c)Internaliliaclymphnode
d)Sacrallymphnode
e)Obturatorlymphnode
CorrectAnswer-C

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Ans.(c)Internaliliaclymphnode
Thegoalofexternalirradiationincervicalcanceristosterilize
metastaticdiseasetopelviclymphnodesandtheparametriaand/or
todecreasethesizeofthecervixtoallowoptimalplacementof
intracavitaryradioactivesources.

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Patientswithknownorsuspectedmetastaticdiseasetoperiaortic
lymphnodesmaybeconsideredforextendedfieldirradiation.
LymphaticSpreadlncervicalcancer:
Thecervixisdrainedbypreureteral,Postureteral,anduterosacral
lymphaticchannels.

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Thefollowingareconsideredfirststationnodes:obturatorexternal
lilac,hypogastric,parametrial,presacral,andcommoniliac.
Para-aorticnodesaresecondstation,arerarelyinvolvedinthe
absenceofprimarynodaldisease,andareconsideredmetastases.

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217.Whichofthefollowingistrueabout

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vulvodynia:
a)Surgeryisusuallydoneforlocalizedvulvallesion
b)Painwithoutanysignificantlesion
c)Maybeassociatedwithirritablebowelsyndrome
d)Tricyclicantidepressantisuseful

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e)Psychologicalfactorisassociated
CorrectAnswer-B:C:D:E
Ans.(b)Painwithoutanysignificantlesion,(c)Maybe
associatedwithirritablebowelsyndrome,(d)Tricyclic
antidepressantisuseful,(e)Psychologicalfactorisassociated

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Vulvodyniaischronicpainofthevulva(externalfemalegenitalia)in
theabsenceoflocalizedinfection.Itisoftenassociatedwithirritable
bowelsyndrome(IBS)
Aetiology:
Swellingoforinjurytothenervesofthevulva.

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Spasmsorweaknessofthemusclesthatsupporttheorgansofthe
pelvis.
Afamilyhistoryofvulvodynia.
Symptoms:
Painisthemainsymptomofvulvodynia.Dependingonthe

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person,thepainmay:
Befeltonlyinonespot,suchasneartheopeningofthevagina,and
onlywhensomethingtouchesthatarea.Thisiscalledlocalized
vulvodynia.
Painmaybefeltonoraroundmostofthevulva,evenwhennothing

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touchesthoseareas.Thisiscalledgeneralizedvulvodynia.
Beconstantorcomeandgoformonthsorevenyears.
Bemildorverybad.
Befeltduringandaftersex.
Flareupwhenyousitonabicycle,putinatampon,orwipeyour

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vulva.
Othersymptomsmayinclude:
Burningorstinging.
Itching.
Swelling.

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Throbbing.
Rawness.
Treatment:
Medicines:
Physicaltherapy

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Behaviourtherapy
Psychosexualcounselling
Oestrogencreams
Lidocainejelly
Surgeryiscontraindicated

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TricyclicAntidepressants(amitriptyline,gabapentin)
Seizuremedicines
Nerveblocks
Medicatedcreams
Antihistaminescanhelprelieveitching.

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218.Indicationsforin-vitrofertilization(IVF):
a)Bilateraltubeblockage
b)Normalmalefactor
c)Hostilecervicalfactor
d)Proximaltubalblock

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e)Prematureovarianinsufficiency
CorrectAnswer-A:D:E
Ans.(a)Bilateraltubeblockage,(d)Proximaltubalblock,(e)
Prematureovarianinsufficiency
Indicationsofin-vitroFertilization(lVF)

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Mildendometriosis
Blockedfallopiantubesorfailedtubalsurgery
Failedintrauterineorfallopianinsemination
Immunologicalfactor
lnmaleandfemale

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Abnormalsemenfinding.
Idiopathicorunexplainedmaleorfemaleinfertility
Donorsemenorsperm

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219.Whichofthefollowingis/aretrueabout
managementofpregnancywithNYHA

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class3or4heartdisease:
a)Deliveryshouldbedoneinspecialisedhospitals
b)Oftentoleratemajorsurgicalprocedurespoorly
c)Caesareandeliveryislimitedtoobstetricalindications
d)Mortalityis5-20%

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e)Epiduralispreferredfordelivery&labourpainmanagement
CorrectAnswer-A:B:C:D:E
Ans.A,Deliveryshouldbedone...B,Oftentoleratemajor
surgical...C,Caesareandeliveryislimited
...D,Mortality...E,Epiduralispreferredfordelivery...

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NewYorkHeartAssociation(NYHA)classification:
NYHAClassI:Asymptomatic(mortality0-1%)
NYHAClassII:Symptomswithgreaterthannormalactivity(
mortality5-15%)
NYHAClassIII:Symptomswithregularactivity(mortality25-50%)

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NYHAClassIV:Symptomsatrest(mortality25-50%)
ManagementofNYHAclassIII&IV
Generalmanagement:Multidisplinaryteamapproach
Placeoftherapeutictermination
AdmissionforgradeIIIandIV:Throughoutpregnancy.

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CardiacindicationsofCS:
Coarctationofaorta
Aorticdissectionoraneurysm,
Aortopathywithaorticroot>4cm

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Warfarintreatmentwithin2weeks

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Anaesthesia:GAorepidural(preferred)
Vaginaldeliveryispreferredinmostcases,andlaborinductioncan
usuallybed.onesafely
Inabilitytotoleratemajorsurgicalprocedures.

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220.Whichofthefollowingischangesduring

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pregnancy:
a)Inlasttrimesterbloodvolumeincreaseby50%
b)Cardiacoutputincreaseby20%inlasttrimester
c)HemodynamicchangesinpregnancycancauseCHFfollowing
duringlabourandfollowingdeliveryinpre-existingcardiac

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lesions
d)Hypercoagulabilityoccurs
e)None
CorrectAnswer-A:C:D
Ans.(A)Inlasttrimesterbloodvolumeincreaseby50%;(C)

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HemodynamicchangesinpregnancycancauseCHFfollowing
duringlabourandfollowingdeliveryinpre-existingcardiac
lesions;(D)Hypercoagulabilityoccurs
HEMATOLOGICALCHANGES:
PARAMETERS

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CHANGES
Bloodvolume(mL)
by1500(30?40%)
Plasmavolume(mL)
by1250(40?50%)

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RedCellvolume(mL)
by350(20?30%)
TotalHb(g)
by85(18?20%)
SerumIron

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TIBC
Hematocrit
Diminished
Erythropoietin
(Neutrophilicleukocytosis-8,000to

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WBCcount

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WBCcount
20,000/mm3)
Plateletcountand
unchanged

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

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

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

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by27%
(mL)
Heartrate
by17%
(perminute)

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Unaffectedormid-pregnancydropof
Bloodpressure
diastolicpressureby5?10mmHg
Venous
100%

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pressure
Colloidoncotic
pressure
by14%
(mmHg)

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Systemic
vascular
by21%
resistance
(SVR)

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Pulmonary
vascular
by34%
reistance(PVR)
Totalextracellularvolume by16%

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Shiftofapicalimpulselaterallyandupwardsinthe
left4'hintercostalspace

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221.TruestatementaboutBreechdelivery:
a)Vasapreviaisacomplication
b)Fetalcongenitalmalformationincreasesbreechrisk

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c)Increasesfetalandmaternalmorbidity
d)Oligohydramniosincreasesbreechrisk
e)Increasesriskofhipjointdislocationofbaby
CorrectAnswer-B:C:D:E
Ans.(b)Fetalcongenitalmalformationincreasesbreechrisk(c)

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Increasesfetalandmaternalmorbidity(d)Oligohydramnios
increasesbreechrisk(e)lncreasesriskofhipjointdislocation
ofbaby
ETIOLOGY:
Prematurity

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Factorspreventingspontaneousversion:
Breechwithextendedlegs
Twins
Oligohydramnios
Septateorbicornuateuterus

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Shortcord,relativeorabsolute
IUDoffetus.
Favourableadaptation:
Hydrocephalus
Placentaprevia

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Contractedpelvis
Cornu-fundalattachmentoftheplacenta
Unduemobilityofthefetus
Hydramnios,

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Multiparawithlaxabdominalwall.

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Fetalabnormality:Trisomies13,18,21,anencephalyandmyotonic
dystrophy
BIRTHINJURIESASSOCIATEDWITHBREECHDELIVERY
COMPLICATIONS
Braindamage

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Spinalcordinjury
Fetaldistress
Umbilicalcordprolapse
Seizures
Cerebralpalsy

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Compressedumbilicalcord
Nervedamage
Umbilicalcordwrappedaroundbaby'sneck
Oxygendeprivation

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222.Complicationsofshoulderdystocia?

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a)Humerusfracture
b)Brachialplexusinjury
c)Birthasphyxia
d)Sacroiliacjointdislocationofmother
e)All

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CorrectAnswer-E
Ans.E.All
Complicationofshoulderdystocia:
Maternal:
PPH

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Rectovaginalfistula
Symphysealseparationordiathesis,withorwithouttransient
femoralneuropathy
3rdor4thdegreeepisiotomyortear
Uterinerupture

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Fetal:
Brachialplexuspalsy
Claviclefracture
Fetaldeath
Fetalhypoxia,withorwithoutpermanentneurologicdamage

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Fractureofthehumerus

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223.Whichofthefollowingistrueabout
monozygotictwinformation:
a)Ifdivisionoccursafterembryonicdiscformation,itresultsin
conjointtwin

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b)Ifdivisionoccurbefore72hrs,itresultsinformationof
diamniotic-dichorionictwins
c)Ifdivisionoccursb/w4-8days,itresultsinformationof
monochorionicmonoamniotictwin
d)Ifdivisionoccursafter8days-itresultsinformationof

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monochorionicmonoamniotictwin
e)None
CorrectAnswer-A:B:C:D
Ans.a.Ifdivisionoccursafterembryonicdiscformation,it
resultsinconjointtwinb.Ifdivisionoccurbefore72hrs,it

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resultsinformationofdiamniotic-dichorionictwinsd.If
divisionoccursafter8days-itresultsinformationof
monochorionicmonoamniotictwin
DEVELOPMENT:
Ifthedivisiontakesplacewithin72hoursafterfertilizationthe

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resultingembryoswillhavetwoseparateplacenta,chorionsand
amnions(D/D)
Ifthedivisiontakesplacebetweenthe4thand8thdayafterthe
formationofinnercellmasswhenchorionhasalreadydeveloped
diamnioticmonochorionictwinsdevelop(D/M)

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Ifthedivisionafter8thdayoffertilization,whentheamnioticcavity
hasalreadyformed,amonoamnioticmonochorionictwinsdevelop

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(M/M)

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224.Acantholysisis/arenotseenin:

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a)Lichenplanus
b)Bullouspemphigoid
c)Dermatitisherpetiformis
d)Hailey-Haileydisease
e)Pemphigusvulgaris

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CorrectAnswer-A:B:C
Ans.(A)Lichenplanus(B)Bullouspemphigoid(C)Dermatitis
herpetiformis
Acantholysis:
Separationofepidermalcellsfromeachother.

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AcantholyticdisordersincludesPemphigusfamily(including
paraneoplasticpemphigus),eosinophilicspongiosis,Darier's
disease,Hailey-Hailey'sdisease(Familialbenignchronic
pemphigus)andtransientacantholyticdermatosis(Grouer's
disease),aswellasspecifichistologicalpatternssuchasfocal

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acantholyticdyskeratosisandepidermolytichyperkeratosis.

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225.Cutaneousmarker(s)ofinternal
malignancyis/areallexcept:
a)Tripepalms
b)SignofLeser-Trelat

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c)Dermatomyositis
d)Migratorythrombophlebitis
e)Seborrheicpatchatback
CorrectAnswer-E
Ans.E.Seborrheicpatchatback

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CutaneousMarkersofInternalMalignancies:
Causes:
Metastases:Toskin.
Genodermatoses:Withanincreasedpredispositiontointernal
neoplasia.

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Exposuretocarcinogens:Whichresultinskinchangesaswellas
internalneoplasia.
Paraneoplasticsyndromes:Arecutaneousreactionpatterns
associatedwithinternalneoplasia.

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226.Nikolsky'ssignis/areseeninallexcept:

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a)Pemphigus
b)Hailey-Haileydisease
c)Staphylococcalscaldedskinsyndrome
d)Toxicepidermalnecrolysis
e)Groverdisease

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CorrectAnswer-D:E
Ans.(D)Toxicepidermalnecrolysis
Nikotsky'ssign:
Applicationoftangentialpressureonnormalskin(usuallyonpretibial
area)resultsinformationofnewbulla.

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Seenin:
Staphylococcalscalded-skinsyndrome
Epidermalnecrolysis.
Pemphigus
Stevens-Johnsonsyndrome.

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Grover'sdisease

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227.Trueaboutacuteparonychia:
a)Pusundernailbed
b)Pusmayextendtobaseofnail
c)Swellingofnailfold

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

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AcuteParonychia:
Paronychia:Inflammationofnailfolds.
Etiology:StaphyLococcusenterthenailfold
Clinicalfeature:Nailfoldisswollen,redandtender.Pusvisible
undernailfold/nailbed.

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228.CnrnnonentofAdvancedcardiovascular
lifesupport(ACLS)inaccordanceto
AHA2015guideline:
a)Chestcompression100-150perminute
b)Chestcompressionatleast5cm/2inch

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c)VasopressorsisusedtomaintainMAP>70mmHginnon-
responsivetofluids
d)1Breathevery8seconds
e)Vasopressinisusedasvasopressor
CorrectAnswer-B

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Ans.B.Chestcompressionatleast5cm/2inch
Basiclifesupport(BLS),advancedcardiovascularlifesupport
(ACLS),andpost-cardiacarrestcarealldescribeasetofskillsand
knowledgeappliedsequentiallyduringthetreatmentofpatientswho
haveacardiacarrest.

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ACLScomprisesthelevelofcarebetweenBLSandpost-cardiac
arrestcare
Updaterecommendationsforadvancedcardiaclifesupport
2015:
Thecombinedusevasopressinandepinephrineoffersnoadvantage

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tousingstandard-doseepinephrineincardiacarrest.
VasopressinhasbeenremovedfromtheAdultCardiacArrest
Algorithm-2015update.
AdvancedCardiacLifeSupport:
Continuouschestcompressionsatarateoflil)/rninto120/min,

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vnthoutpausesforventilation.Theproviderdeliveringventilation

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shouldprovide1breathevery6seconds(10breathsperminute).
Itmaybereasonabletoavoidandimmediate$rcorrecthypotension
(SBp<90mmHg,MAp<65mmHg)duringpost-cardiacarrest
care.

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229.Anaestheticagents(s)having
epileptogenicpotential:
a)Atracurium
b)Etomidate
c)Enflurane

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d)Pethidine
e)Propofol
CorrectAnswer-A:C:D
Ans.(A)Atracurium(C)Enflurane(D)Pethidine
Etomidate:Doesnothaveepileptogenicpotential.

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Enflurane:Athighdosesitproducesspikeandwavepatternin
EEGwhichculminatesintofranktonic-clonicseizure.
Atracurium:Itsmetabolicproductlaudanosine(Laudanosine
Toxicity)-seizuresprecipitated.
Ketamlnecanelicitseizuresinpatientswithanepilepticdiathesis.

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Propofol:Significantanticonvulsantactivity.

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230.Trueaboutxenonisare:
a)Environmentfriendly
b)Cheap
c)Lowbloodsolubility

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d)Inert
e)Stable
CorrectAnswer-A:C:D:E
Ans.(A)Environmentfriendly(C)Lowbloodsolubility(D)Inert
(E)Stable

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Advantagesanddisadvantagesofxenon(Xe)anesthesia:
Advantages:
Inert(probablynontoxicwithnometabolism).
Minimalcardiovasculareffects.
LowbloodsolubilitY.

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Rapidinductionandrecovery
Doesnottriggermalignanthyperthermia
Environmentalfriendly.
Nonexplosive
Disadvantages:

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Highcost
Lowpotency{MAC=70%)

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231.Ingastubing,rateofturbulentflow
dependsupon:
a)Viscosityofgas

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b)Pressuregradient
c)Lengthoftube
d)Radiusoftube
e)Densityofgas
CorrectAnswer-B:E

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Ans.(B)Pressuregradient(E)Densityofgas
Turbulent
Turbulentflowisproducedifflowrateisveryhighorifgaspasses
throughbends,constrictions.
Flowisrough.

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Reynold'snumbermustexceedto2000forturbulence.
Turbulentflowismoredependondensity

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232.Gasstoredinliquidstateincylinders:
a)Nitrogen
b)Helium

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c)CO2
d)Cyclopropane
e)Nitrousoxide
CorrectAnswer-C:D:E
Ans,(C)CO2(D)Cyclopropane(E)Nitrousoxide

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Oxygen,nitrogen,airandheliumarestoredincylindersasgases.
Nitrousoxide,carbondioxideandcyclopropanearestoredinas
liquidinequilibriumwithsaturatedvapour.
ColourofCylinders:
O2-Blackbodywithwhiteshoulder

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N2O-Blue
CO2-Grey
Cyclopropane-orange
Helium-Brown
Air-Greybodywithblackandwhiteshoulders

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Entonox-Bluebodywithblueandwhiteshoulders(50%O2.+50%
N2O).

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233.Trueaboutcaudalanesthesiain
children:
a)Averagedistancefromtheskintotheanteriorwallofthesacral

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canalis21mm
b)0.5mL/kgdoseofbupivacaineissufficientforlumberand
sacraldermatomesblock
c)Beyond6-7yearsofage,itisdifficulttogiveandisless
successfulincomparisontoyoungerchildren

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d)2-3cmofepiduralcatheterisadvancesthroughepiduralspace
incontinuosinfusion
e)Distancefromtheupperborderofthesacralhiatustothedural
sacis30?10.4mm
CorrectAnswer-A:C:D:E

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Ans.(A)Averagedistancefromtheskintotheanteriorwallof
thesacralcanalis21mm(C)Beyond6-7yearsofage,itis
difficulttogiveandislesssuccessfulincomparisonto
youngerchildren(D)2-3cmofepiduralcatheterisadvances
throughepiduralspaceincontinuosinfusion(E)Distancefrom

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theupperborderofthesacralhiatustotheduralsacis
30?10.4mm
CaudalAnesthesia
Normallengthofcathetertobeintroducedintotheepiduralspacels
2to3cm,asforanyepiduralblock.

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Dosageprescriptionscheme:
1. With0.5mL/kg,allsacraldermatomesareblocked.
2. With1.0ml/kgallsacralandlumbardermatomesareblocked.

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3. With1.25ml/kg,theupperlimitofanesthesiaisatleastmidthoracic.
Drugused:Thedoseof0.25%bupivacainets0.5-O.75ml/kg

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Extraduralspacebelowsacralhiatusmayrangefrombeingdeepto
excessivelyshallow-itsaveragelengthls10-15cm.
ItsanatomyismoreeasilyappreciatedininfantsandchilDren
Indications:
Useforpattants<8yearsoldtoprovideintraoperativeand

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postoperativeanalgesiaforabdominalandlowerextremitysurgery.
Technique:
Advanceneedleandcatheter2to4mm.

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234.Chestroentgenogramfeature(s)of
stage-2SarcoidosisinScaddingscoring

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system:
a)Bilateralhilarlymphadenopathy
b)Mediastinallymphadenopathy
c)Upperlobeparenchymalinfiltrates
d)Enlargedparatrachealnodes

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e)Pulmonaryfibrosis
CorrectAnswer-A:C
Ans.A,Bilateralhilarlymphadenopathy&C,Upperlobe
parenchymalinfiltrates
StandardscoringsystemdescribedbyScaddingin1961forchest

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roentgenograms.
Stage1-Hilaradenopathyalone,oftenwithrightparatracheal
involvement.
Stage2-Combinationofadenopathyplusinfiltrates.
BHLandparenchymalinfiltrates.

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Patientsmaypresentwithbreathlessnessorcough.
Themajorityofcasesresolvespontaneously.
Stage3revealsinfiltratesalone.
Stage4consistsoffibrosis.
Usuallytheinfiltratesinsarcoidosisarepredominantlyanupperlobe

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process.
Onlyinafewnoninfectiousdiseasesisanupperlobepredominance
noted.

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235.Standardtreatmentofwhole-brain
radiotherapy(WBRT)forbrain

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Metastasis:
a)20grays(Gy)in10fractions
b)30grays(Gy)in10fractions
c)30grays(Gy)in5fractions
d)15grays(Gy)in10fractions

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e)None
CorrectAnswer-B
Ans.B,30grays(Gy)in10fractions
Whole-brainradiotherapy(WBRT)to30grays(Gy)in10fractions-
Standardtreatmentinpatientswithmultiplebrainmetastases.

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Currentstudyinvestigatedthepotentialbenefitofdoseescalation
beyond30Gy.

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236.Defencemechanisminobsessive-
compulsivedisorder(OCD)is/are:
a)Undoing

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b)Reactionformation
c)Suppression
d)Isolationofaffect
e)Projection
CorrectAnswer-A:B:D

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Ans.A,UndoingB,Reactionformation&D,Isolationofaffect
DefenseMechanism:
SynopsisofPsychiatrybyKaplanandSadock11th/160
Displacement-Phobio(Especiallyinchildren)&OCD.
Reactionformation

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Undoing
Inhibition
Isolation
Dissociation

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237.Beck'scognitivetriadofdepression

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includes:
a)Self
b)Future
c)Pastexperience
d)Worldandenvironment

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e)Others
CorrectAnswer-A:B:D
Ans.A,SelfB,Future&D,Worldandenvironment
AaronBeckpostulatedacognitivetriadofdepression.
Consistsof,

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Viewsabouttlwself-anegativeselfprecept.
Aboutenvironment-atendencytoexperiencetheworldashostile
and.demanding.
Aboutfuture-expectationofsufferingandfailure.
Therapyconsistsofmodifyingthesedistortions.

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Cognitivetriad:Beliefsaboutoneself,theworld,andthefuture.

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238.Whichisnotabrainstimulation
technique:
a)Electroconvulsivetherapy
b)Magneticseizuretherapy

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c)Deepbrainstimulation
d)Rapidtranscranialmagneticstimulation
e)Cognitivetherapy
CorrectAnswer-E
Ans.E.Cognitivetherapy

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SynopsisofPsychiatrybyKaplonandSadockp1065-81
BrainStimulationTechnique:
Electricalcurrentsormagneticfieldstoalterneuronalfiring.
Transcranialtechniquesinclude:
Cranialelectricalstimulation(CES)

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Electroconvulsivetherapy(ECT)
Transcranialdirectcurrentstimulation(IDCS,alsodirectcurrent
polarization)
Transcranialmagneticstimulation(TMS)
Magneticseizuretherapy(MST)

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Surgicaltechniques:
Corticalbrainstimulation(CBS).
Deepbrainstimulation(DBS)
Vagusnervestimulation(VNS).

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239.Feature(s)ofdeliriumtremensis/are:

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a)Mostcommoncomplicationinalcoholwithdrawal
b)Auditoryhallucinationmayoccur
c)Visualhallucinationmaybepresent
d)Predominantlylow-voltagefastactivityonEEG
e)Mostseverealcoholwithdrawalsyndrome

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CorrectAnswer-B:C:D:E
Ans.B,AuditoryhallucinationmayoccurC,Visualhallucination
maybepresentD,Predominantlylow-voltagefastactivityon
EEG&E,Mostseverealcoholwithdrawalsyndrome
Deliriumtremens:

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Predominantlylow-voltagefastactivity.
Mostseverealcoholwithdrawalsyndrome.
Visual(andauditory)hallucinations.
Classicsignofalcoholwithdrawalistremulousness,

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240.Personalitytypeassociatedwith

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coronaryarterydisease:
a)A
b)B
c)C
d)D

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e)E
CorrectAnswer-A
Ans.A.A
Psychosocialfactors,includingtypeApersonality,anger,hostility,
andanxiety,havebeenimplicatedinthepathogenesisof

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cardiovasculardisease.
invalidquestionid

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