Download PGI PG PGI 2017 May Solved Question Paper

Download PGIMER (Post Graduate Institute of Medical Education & Research, Chandigarh) PGI 2017 May Solved Question Paper

1.TrueaboutmeiosisI:
a)Sisterchromatidsreplicate
b)Sisterchromatidsseparate
c)Haploiddaughtercells
d)Homologouschromosomesexchangematerial
e)Homologouschromosomesseparate
CorrectAnswer-C:D:E
Ans.is'c'i.e.,Haploiddaughtercells;'d'i.e.,Homologous
chromosomesexchangematerial!&'e'i.e."Homologous
chromosomesseparate
MeiosisIisdividedintofollowingphases:-
1.ProphaseI:
Longestphase.
Itisfurthersubdividedinto:_
1. Leptotene:Diffusechromatinstartscondensingintochromosomes
andchromosomesstartappearinginthisstage.
2. Zygotene:InthisstageHomologouschromosomespairup.This
processiscalled'synapsis'orconjugationandeachpairiscalled
bivalent.
3. Pachytene:Inthisstagetwochromatidsofeachpairseparateandis
calledtetrad.Thenthereoccurs'crossing-over',i.e.,oneorboth
chromatidsofonehomologouschromosomecrossesoverwith
thosefromotherhomologouschromosomeofthatpairforming
synaptonemalcomplex.Thepointofcrossingoverarecalled,
chiasmata.
4. Diplotene:Thetwochromosomesofbivalenttrytomoveapart.
ThereisexchangeofgeneticmaterialbetweenHomologous

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chromosomes
5. Diakinesis:Inthisstagethereorganizedchromosomesmoveapart.
Eachbivalentcannowbeseentocontainfourchromatidslinkedby
acommoncentromere,whilenon-sisterchromatidsarelinkedby
chiasmata.
2.MetaphaseI:Thebivalentsbecomearrangedaroundtheequator
ofthespindle,attachedtotheircentromeres.
3.AnaphaseI:Spindlefibrespullhomologouschromosomes.This
separatesthechromosomeintotwohaploidsets'onesetateach
endofspindle.
4.TelophaseI:Twodaughtercellsareformedeachcontaining23
chromosomes(Haploid),eachconsistingoftwochromatids(2C).

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2.TrueaboutFibrousskeletonofheart?
a)Fibrousringaroundmitralvalve
b)Tendonofinfundibulumisbetweenpulmonary&aorticvalve
c)Trigonumdextrumisbetweenmitral&tricuspidvalve
d)Trigonumsinistrumisbetweenmitralandaorticvalve
e)TendonofTodaroisbetweencentralfibrouspartsto
Eustachianvalve
CorrectAnswer-A:B:D:E
Ans.is'a'i.e.,Fibrousringaroundmitralvalye;'b'i,e.,Tendon
ofinfundibulumisbetweenpulmonary&aorticvalve;'d'i.e.,
Trigonumsinistrumisbetweenmitralandaorticvalve;&'e'
i.e.,TendonofTodaroisbetweencentralfibrouspartsto
Eustachianvalve
Fibrousskeletonofheart:
Fibrousringsurroundingtheorificesofatrioventricular(mitraland
tricuspid)orifices,pulmonaryorificeandaorticorifice,alongwith
someadjoiningmassesoffibroustissue.
Tendonofinfundibulumisfibroustissuebetweenpulmonaryand
aorticring.
Trigonumfibrosumdextrumisfibrosustissuebetweenatrioventricular
rigs(mitralandtricuspid)andaorta.
Trigonumfibrosumsinistrumisfibroustissuebetweentheaorticand
mitralrings.

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3.Tastesensationfromthetongueis/are
carriedby?
a)Facialnerve
b)Glossopharyngealnerve
c)Hypoglossalnerve
d)Vagusnerve
e)Trigeminalnerve
CorrectAnswer-A:B:D
Ans,is'a'i,e.Faeialnerve'b'i,e.Glossopharyngealnerve;&'d'
i,e.Vagusnerve
Tastesensationoftongue:
Anterior2/3rdpart:Chordatympani
Posterior1/3rdpart&circumvallatepapillae:Glossopharyngeal
nerve
Posteriormostpart:InternallaryngealbranchofVagusnerve

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4.Trueaboutepiglottis?
a)Containsserousgland
b)Containsmucoussecretingglands
c)Itisovalshaped
d)Madeupofelasticcartilage
e)Hasbilaterallymphaticsupply
CorrectAnswer-B:D:E
Ans.is'b'i.e.,Containsmucoussecretingglands;'d'i.eMadeup
ofelasticcartilage&'e'i.e',Hasbilaterallymphaticsupply
Epiglottis:
Theepiglottisofelasticcartilagetissuecoveredwithamucous
membrane,attachedtotheentranceofthelarynx.
Theepiglottishastwosurfaces,lingualandalaryngealsurface,
relatedtotheoralcavityandthelarynxrespectively
Theentirelingualsurfaceandtheapicalportionofthelaryngeal
surfacearecoveredbyastratifiedsquamousnon-keratinized
epithelium.
Therestofthelaryngealsurfaceon,whichisinrelationtothe
respiratorysystem'hasrespiratoryepithelium:pseudostratified,
ciliatedcolumnarcellsandmucussecretingGobletcells.
Epiglottishasbilaterallymphaticdrainagetopperdeepcervical
lymphnodes

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5.Trueregardingthyroidglandis?
a)DeepinvestinglayerformBerryligament
b)Condensedfibrouspartofglandformtruecapsule
c)Superiorthyroidarteryliesposterolateraltosuperiorlaryngeal
nerve
d)Recurrentlaryngealnervehasvariablecourseonbothsides
e)SuppliedbyThyrocervicalTrunk
CorrectAnswer-B:E
Ans.Ans.is'b'i.e.,Condensedfibrouspartofglandformtrue
capsule;'e'i.e.,SuppliedbyThyrocervicalTrunk
Thyroidglandhastwocapsule:-
1. Truecapsule-peripheralcondensationoftheconnectivetissueof
thegland.
2. Falsecapsule-derivedfromthepretracheallayerofthedeep
cervicalfascia.ItalsoformsthesuspensoryligamentofBerrywhich
connectsthelobetothecricoidcartilage.
3. Ligamentofberryandfalsecapsulearederivedfrompretracheal
layerofdeepcervicalfascia(notinvestinglayer).
Superiorthyroidarteryisrelatedtoexternallaryngealnerve
(externalbranchofsuperiorlaryngealnerve),butnotdirectlyrelated
tosuperiorlaryngealnerveitself
Recurrentlaryngealnervehasvariablerelationtoinferiorthyroid
arteryonlyonrightside,onleftsideithasconsistentrelation
Bloodsupplyofthyroidglandisthrough:
Superiorthyroidartery-Branchofexternalcarotidartery
Inferiorthyroidartery-BranchofThyrocervicaltrunk
Thyroideaimaartery-Fromthebrachiocephalictrunkorarchof

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aorta

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6.NotTRUEstatementregardingparotid
glandis/are?
a)Deeplobecontainsdeeplymphatics
b)Dividedintosuperficialanddeeplobesbyfacialnerve
c)Parotidductopensoppositetotheseconduppermolar
d)Ectodermalinorigin
e)Auriculotemporalnerveisthemainsensorynerve
CorrectAnswer-A
Ans.is'a'i.e.,Deeplobecontainsdeeplymphatics
Development:
Parotidglandisthefirstsalivaryglandtoappear,inearly6'week.
Itisectodermalinoriginanddevelopsfromthebuccalepithelium
justlateraltotheangleofmouth
Structuresemergingfromparotid
Thefollowingstructuresemergefromtheparotidgland:
Anteriorborder:
Parotidduct
3Terminalbranchesoffacialnerve:
Thezygomaticandbuccalbranches:towardthetemporalregion,
eyelidsandcheek,respectively.
Mandibularbranch:Runalongthebodyofthemandibletowardsthe
mouth
Apex:
5thterminalbranchoffacialnerve:Cervicalbranchcontinuesinto
theneck(toplatysma).
Anterior&posteriordivisionsofretromandibularvein

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Posteriorborder:
Posteriorauricularnerve
Posteriorauricularartery
Posteriorauricularvein
Alongbase:
superficialtemporalartery
temporalbranchoffacialnerve
Auriculotemporalnerve
STRUCTURESWITHINGLAND:
Arteries:
Externalcarotidarteryentersthroughposteromedialsurface
Maxillaryartery
Superficialtemporalvessel
Posteriorauricularartery
Veins:
Theretromandibularveins
FacialNerve
ParotidDuct(Stenson'sduct)
Theductturnsopensintothevestibuleofthemouth(gingivo-buccal
vestibule)oppositethecrownoftheupper2ndmolartooth
Nervesupply:
PARASYMPATHETIC:auriculotemporalnerve
SYMPTHETICSUPPLY-plexusaroundtheexternalcarotidartery.
SENSORYNERVES:auriculotemporalnerve,exceptforparotid
fascia&overlyingskinwhichareinnervatedbyGreatauricular
nerve(C2,C3).

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7.Whichofthefollowingstatement(s)is/are
trueaboutphrenicnerveexcept-
a)Itisprimarymotorsupplytodiaphragm
b)Accessoryphrenicnervejoinsthephrenicnervenearthefirst
rib
c)Formedinfrontofscalenusmediusmuscle
d)Itdescendsposteriortosternocleidomastoid
e)Givessensorysupplytocentraltendonofdiaphragm
CorrectAnswer-C
Ansis.'Ci.e.,Formedinfrontofscalenusmediusmuscle
Liesanteriortoanteriorscalenusmuscle
Phrenicnerveisamixednerve&carriesmotorfibrestothe
diaphragm&sensoryfibresfromthediaphragm,pleura,pericardium
&partoftheperitoneum.
Origin:
Itariseintheneckfromtheant.ramiofthe3rd,4th&5thcervical
nerves
Itisformedatthelateralborderofthescalenusanterior,opposite
themiddleofthesternocleidomastoidattheleveloftheupper
borderofthethyroidcartilage.
Relations:
Itrunsverticallydownwardsontheant.surfaceofthescalenusant.
&inthispartitisrelatedanteriorlyto
1. Prevertebralfascia
2. Inf.bellyofomohyoid
3. Transversecervicalartery

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4. Suprascapularartery
5. Internaljugularvein
6. Sternocleidomastoidmus.
7. Thoracicductonleftside.
Afterleavingtheant.surfaceofthescalenusant.thenerveruns
downwardsonthecervicalpleurabehindthecommencementofthe
brachiocephalicvein.(onleftsidenerveleavesthescalenusant.at
ahigherlevel&crossesinfrontofthe.firstpartofthesubclavian
art.).Hereitcrossestheinternalthoracicartery(eitheranteriorlyor
posteriorly)&entersthethoraxbehindthe1stcostalcartilage.

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8.Allaresuppliedbyanteriorinterosseous
nerveexcept?
a)Flexorcarpiulnaris
b)Brachioradialis
c)Abductorpollicisbrevis
d)Flexorpollicislongus
e)Flexordigitorumsuperficialis
CorrectAnswer-A:B:C:E
Ans.is'a'i'e.,Flexorcarpiulnaris'b'i.e.,Brachioradialis;'c'i.e.,
Abductorpollicisbrevis;&'e'i.e.,Flexordigitorumsuperficial
Theanteriorinterosseousnerve(volarinterosseousnerve)isa
branchofthemediannervethatsuppliesthedeepmusclesonthe
anterioroftheforearm,excepttheulnar(medial)halfoftheflexor
digitorumprofundus.

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9.Truestatementaboutshoulderjoint?
a)Multipennateacromialfibresofdeltoidarepowerfulabductor
b)Axillarynerveinjuryhasnoeffectonabduction
c)Musculotendinouscuffstabilizesshoulderjoint
d)Supraspinatusinitiatesabduction
e)Trapeziusandserratusanterioractsynergisticallyinabduction
CorrectAnswer-A:C:D:E
Ans.is'a'i.e.,Multipennateacromialfibresofdeltoidare
powerfulabductor;'c'i.e.,Musculotendinouscuffstabilizes
shoulderjoint;'d'i.e.,Supraspinatusinitiatesabduction;&'e'
i.e.,Trapeziusandserratusanterioractsynergisticallyin
abduction
TYPEOF
PLANEOF
AXISOF
MUSCLESINVOLVED
MOVEMENT
MOTION
MOTION
PectoralisMajor,Ant.fiber
Saggital
Transverse
Flexion
ofdeltoid,
plane
axis
Coraco-brachialis,Biceps
Latissimus
Saggital
Transverse dorsi,Teresmajor,Post.
Extension
plane
axis
fibers
ofdeltoid,Triceps
Saggital
Abduction
Frontalplane
Deltoid,Supraspinatus
axis
Subscapularis,Pectoralis
Saggital
Major,
Adduction
Frontalplane axis
Latissimusdorsi,Teres
major

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major
Subscapularis,Pectoralis
Internal
Transverse
vertical
Major,
Rotation
plane
axis
Latissimusdorsi,Teres
major
External
Transverse
vertical
Infraspinatus,Teres
Rotation
plane
axis
minor

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10.Whichisattachedmostanteriorlyonthe
intercondylarareaoftibia
intercondylarareaoftibia(areab/wmedial
andlateraltibialplateau)-
a)Anteriorcruciateligament
b)Posteriorcruciateligament
c)Anteriorhornofthelateralmeniscus
d)Anteriorhornofthemedialmeniscus
e)Ligamentumpatellae
CorrectAnswer-D
Ans.is'd'i.e,Anteriorhornofthemedialmeniscus
PROXIMALEND(upperend)
Proximal(upper)endoftibiaincludesmedial&lateral
condyles,formingtibialplateau.
ItalsoincludestibialTuberosity&intercondylararea.
Attachmentsonproximalendare:
Medialcondyle:Semimembranous(posteriorly),capsuleofknee
joint,tibial(medial)collateralligament(deeppart),medialpatellar
retinaculum(anteriorly).
Lateralcondyle:illiotibialtract(anteriorly),capsuleofsuperior
tibiofibularjoint.
TibialTuberosity:Ligamentumpatellae
Intercondylararea(fromanteriortoposterior);
1. Anteriorhornofmedialmeniscus
2. Anteriorcruciateligament(ACL)
3. Anteriorhornoflateralmeniscus

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4. Posteriorhornoflateralmeniscus
5. Posteriorhornofmedialmeniscys
6. Posteriorcruciateligament(PCL)

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11.Trueaboutgasequation-
a)Gasconstantis0-9
b)PV=constant
c)PV=nRT
d)Diffusionisdirectlyrelatedtomolecularweightofgas
e)Oxygenhasmorediffusioncoefficient
CorrectAnswer-C
Ans.C.PV=nRT
Gasequation:
Theidealgaslawisquantitativeexpressionoftheforegoing
principles:PV=nRT.
WherePisthepressure,Visthevolume,nisthenumberofgram
moleculesofthegas,RisthegasconstantandTistheabsolute
temperature.
ValueofRis0.082(R=0.082),whentheunitsemployedare
atmosphere,litresandcentigrade.
Therateofinfusion(D)isdirectlyproportionaltothepressure
gradient(LP)andgasdiffusesfromhigherpressureareastolower
pressureareas.
Partialpressuregradient(gaspressuredifference)isthebasicfactor
whichpromotediffusionofagas.
Rateofdiffusionisdirectlyproportionaltootherfactorsalso,viz.(i)
Surfaceareaofrespiratorymembrane(A);and(ii)Solubilityofgas
concerned(S).
Therateofdiffusionisinverselyproportionalto(i)Thethicknessof
therespiratorymembrane(d);and(ii)Molecularweightofthegas
(MW).

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12.TrueaboutProstaglandins-
a)Derivedfromlipooxygenasepathway
b)FirstproductisPGG2
c)PGE2causesvasoconstriction
d)PGF2acausesbronchoconstriction
e)PG12causesfallinBP
CorrectAnswer-B:D:E
Ans.(B)FirstproductisPGG2(D)PGF2acauses
bronchoconstriction(E)PG12causesfallinBP
Prostaglandins(PG)synthesis:
Prostaglandins(PGs),thromboxanes(TXs),prostacyclin(PGI)and
leukotrienesarecollectivelycalledeicosanoids.
Thesesarederivativesofprostanoicacid.
Theseeicosanoidsarederivedfrom5,8,11,14eicosatetraenoic
acid(arachidonicacid),thefattyacidreleasedfrommembranelipids
bytheactionofphospholipase-A2.

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13.Whichis/arefeature(s)ofprostaglandins-
a)20carbonatomcompound
b)10carbonatomcompound
c)Cyclopentanering
d)-OHgroupat156position
e)Transdoublebondat10thposition
CorrectAnswer-A:C:D
Ans.(A)20carbonatomcompound(C)Cyclopentanering(D)-
OHgroupat156position
(Ref:HarperjP/ep.239-40;Lippincott6h/ep.213-15;Vasudevan
5th/ep.167;Shinde7/ep.64-65;Satyanarayan4th/ep.664)
Prostaglandinsare20carboncompounds,containinga
cyclopentanering.Theyhavehydrox(OH)groupatposition-15and
trans-doublebondatposition-13.

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14.
Whichofthefollowingis/areeffectof
increased2,3-DPGonoxygen-hemoglobin
dissociationcurve?
a)edaffinityofheamoglobintooxygen
b)edaffinityofhaemoglobintooxygen
c)Leftshiftofoxygen-hemoglobindissociationcurve
d)Rightshiftofoxygen-hemoglobindissociationcurve
e)Nochangeinoxygen-hemoglobindissociationcurve
CorrectAnswer-B:D
Ans.(B)edaffinityofhaemoglobintooxygen(D)Rightshift
ofoxygen-hemoglobindissociationcurve
[Ref:Ganong25th/ep.610-41;Guyton's12'h/ep.j56-57;AKlain
6'h/ep.430]
Oxygen-hemoglobindissociationcurveis2,3DPGinRBC.
DPGisanoptionalby-productoftheglycolyticpathway.
DPGbindswithdeoxygenatedhemoglobinbutnotwithoxygenated
hemoglobin.
RaisedDPGconcentrationreleasesoxygenfromoxyhemoglobinby
shiftingthefollowingreversiblereactiontotheright.
Mechanism:
OnemoleculeofDPGbindswithonemoleofdeoxyhemoglobin.
HenceanincreaseinDPGconcentrationshiftstheoxygen-
hemoglobindissociationcurvetotheright.
Thus2,3DPGcausesdelivery(unloading)ofO,tothetissues.
Fetalhemoglobinhasconsiderablylessaffinityfor2,3-DPGthan
doesadulthemoglobinthereforefetalhemoglobinhasagreater

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affinityforoxygenthanadulthemoglobin.
Inhumanblood,theaffinityoffetalhemoglobinfor2,3-DPGisonly
about4O%thatofadulthemoglobin.
Thismakesfetalhemoglobinbehaveasif2,3-DPGlevelsarelow.

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15.Oxygenconsumptionbytheheartis
determinedby?
a)Intramyocardialtension
b)Contractilestateofthemyocardium
c)Initiallengthofthemyocardialmusclefiber
d)Heartrate
e)Basaloxygenconsumptionofmyocardium
CorrectAnswer-A:B:C:D:E
Ans.(A)Intramyocardialtension(B)Contractilestateofthe
myocardium(C)Initiallengthofthemyocardialmusclefiber
(D)Heartrate(E)Basaloxygenconsumptionofmyocardium
[Ref:Ganong25th/ep.550;Guyton's12th/ep.216-17]
Myocardialoxygendemand-Factorsinfluencing:
Thebasalmetabolismofthehearttissuenormallyaccountsof25%
ofmyocardialoxygendemandinrestingindividuals.
Myocytescontraction(cardiaccontraction)istheprimaryfactor
determiningmyocardialoxygenconsumptionabovethebasalleyek
andcardiaccontractionaccountsfor75%ofmyocardialoxygen
consumption.
Myocardialwalltension,
Heartrate(Chronotropy),
Inotropicstate(contractility).
Myocardialwalltensionisdirectlyproportionaltointraventricular
pressure(P)andventricularradius(R)'andinverselyproportionalto
myocardialwallthickness(myocardialmass).
Intraventricularpressure(intracavitarypressure)isdeterminedby

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aorticpressure(i.e.,afterload)andventricularradiusisdetermined
byenddiastolicventricularvolume(i.e.,Preload).

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16.Insulincausesintracellularshiftofwhich
ofthefollowingion?
a)Na+
b)K+
c)Chloride
d)Calcium
e)Bicarbonate
CorrectAnswer-B
Ans.B.K+
[Ref:Ganong25th/ep.433-34;Guyton's12'h/ep.613;AKlain
6,h/ep.748]
InsulinlowersserumK+concentrationi.e.,causeshypokalemia.
ThehypokalemicactionofinsulinisduetostimulationofK+intake
bythecellsmainlyinmuscleandadiposetissue.
InsulinincreasestheactivityofNa+-K+ATPaseincellmembrane,
sothatmoreK+ispumpedintocells.

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17.Hypothalmkpituitaryaxis(HPA)controls
allexcept-
a)Thyroid
b)Parathyroid
c)Pancreas
d)Testis
e)Adrenals
CorrectAnswer-B:C
Ans.(B)Parathyroid(C)Pancreas
[Ref:Ganong25'h/ep.308-14;Harrison'sp.401e-2]
Almostallsecretionbythepituitaryiscontrolledbyeitherhormonal
ornervoussignalsfromthehypothalamus.
Secretionfromtheposteriorpituitaryiscontrolledbynettesignals
thatoriginateinthehypothalamusandterminateintheposterior
pituitary.
Secretionbyanteriorpituitaryiscontrolledbyhormonescalled
hypothalamicreleasingandhypothalamicinhibitoryhormones(or
factors)secretedwithinthehypothalamusandthenconductedtothe
anteriorpituitarythroughhypothalamichypophysealportalvessels.

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18.Truestatementaboutmalereproductive
physiology-
a)SertolicellssecreteMiillerianinhibitingsubstance(MIS)
b)Inhibinisreleasedbysertolicell
c)Primaryspermatocyteisdiploid
d)LHandFSHaresteroidalinnature
e)Inhibinstimulatesfollicle-stimulatinghormone(FSH)
CorrectAnswer-A:B:C
Ans.(A)SertolicellssecreteMiillerianinhibitingsubstance
(MIS)(B)Inhibinisreleasedbysertolicell(C)Primary
spermatocyteisdiploid
HormonesoftheTestes:
Thehormone-secretingcellsinthetestesaretheleydigcellsand
sertolicells.
LeydigcellshavereceptorsforLHandsecretealltheandrogens,
i.e.,testosterone(majorandrogen),dihydrotestosterone(DHT),
androstenedioneanddehydroepiandrosterone(DHEA).
Allofthemhave19carbonatoms.
SertolicellsareunderthecontrolofFSH,i,e.,havereceptorsfor
FSH.WhenstimulatedbyFSH,thesecellssecrete
androgenbindingprotein(ABP),inhibinand,MlS(mullerianinhibiting
substance).Sertolicellsalsocontainaromatase;
theenzymethatconvertsandrogenstoestrogens.
Besidethesehormonalfunction,junctionbetweenadjacentsertoli
cellsformsblood-testisbarrierwhichdoesnotallowharmful
substancestoentertheareawherespermatogenesisisgoingon.

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Sertolicellakohaverec4,torsforandrogens(testosterone)which
stimulatesspermatogenesis.
Hormonalcontroloftesticularfunction.
LHistropicforleydigcellsandthesecretionoftestosteroneisunder
thecontrolofLH.
FSHistropicforsertolicelland,stimulatessertolicellstosecrete
inhibinandandrogenbindingprotein(ABP).
Primaryspermatocyteisdiploid.

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19.Erythropoietinis/areproducedby-
a)Juxtaglomerularcells
b)Interstitialcellsoftheperitubularcapillarybedofthekidneys
c)ParsrectaofPCT
d)Maculadensa
e)Mesangialcell
CorrectAnswer-B
Ans.B.Interstitialcellsoftheperitubularcapillarybedofthe
kidneys
[Ref:Ganong25e/ep.706;Guyton's12e/ep.461;AKlain6e/ep.
68]
Erythropoietinisaglycoproteinhormonewhichstimulateerythrocyte
production.
Inadults,about85%oferythropoietincomesfromthekidney
(interstitialcellsinperitubularcapillarybed)and15%fromliver
(Perivenoushepatocytes).Smallamountisalsoproducedinbrain;
anduterusandoviduct.

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20.Trueaboutcarotidsinus-
a)Chemoreceptor
b)Presentinearlypartofinternalcarotidartery
c)Hasglomuscells
d)Baroreceptor
e)Suppliedbyglossopharyngealnerve
CorrectAnswer-B:D:E
Ans.(B)Presentinearlypartofinternalcarotidartery
(D)Baroreceptor(E)Suppliedbyglossopharyngealnerve
[Ref:Ganong25th/ep.658;Guyton'sl2h/ep.251-52;AKlain6th/ep.
j27-29;Gray,s4p/ep.447]
Carotidsinusisalittlebulgeattherootofinternalcarotidartery,
Isatypeofabaroreceptor.
Itisinnervatedbythesinusnerve,abranchofglossopharyngeal(IX
cranial)nerve.

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21.Stresshyperglycemiaoccursduetoall
except-
a)IncreasedlevelofACTH
b)Increasedlevelofcortisol
c)Decreasedlevelofnorepinephrine
d)Insulinresistance
e)Increasedlevelofepinephrine
CorrectAnswer-C
Ans.C.Decreasedlevelofnorepinephrine
[Ref:Ganong25th/ep.364;Guytan's12'h/ep-598-556;Schwartz
th/ep.17-2a;AKlain6'h/ep.606;Bailey6Love2Ch/ep.4'9;
CSDT1l'h/ep.103-05]
StressHyperglycemia:
Suppressionofinsulinsecretioncoupledwithincreasedsecretionof
glucagon,growthhormone,glucocorticoids(cortisol),and
catecholamines(epinephrine,
norepinephrine)leadstohyperglycemia.

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22.Trueaboutsuccinatedehydrogenase
defect-
a)DeficiencyofcomplexII
b)Tumorigenesis
c)Defectinkrebscycle
d)DefectinETC
e)Mitochondrialencephalopathy
CorrectAnswer-A:B:C:D:E
ANSWER-(A)DeficiencyofcomplexII(B)Tumorigenesis
(C)Defectinkrebscycle(D)DefectinETC(E)Mitochondrial
encephalopathy
Mitochondrialsuccinatedehydrogenase(SDH)catalysesthe
oxidationofsuccinatetofumarateintheKrebscycle(citricacid
cycle).
Succinatedehydrogenasecomplexismadeupoffoursubunits-(i)
SDH-A;(ii)SDH-B;(iii)SDH-C;and(iv)SDH-D.
Functionsofsuccinatedehydrogenaseare:?
1. CatalysesoxidationofsuccinateorfumarateinTCAcycle/citric
acidcycle.
2. TransferselectronsfromsuccinatetocoenzymeQ(atcomplex
II)SuccinatedehydrogenaseactsascomplexIIinETC.
DefectinSDHcausesdefectinmitochondrialETC.Whichleadsto
mitochondria!encephalopathyandmyopathy
(encephalomyopathy)ThisisduetomutationinSDHAsubunit
gene.
MutationinSDH-B,-Cand-Dsubunitscausestumorformation,

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especiallyparaganglioma/pheochromocytoma/carotidbodytumor
Thus,thesesubunitsareregardedasatumorsuppressorgene.

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23.Allaretrueaboutglycosaminoglycans
except?
a)Proteinassociatedwithglycosaminoglycansiscalledcore
proteins
b)Maybeassociatedwithconnectivetissues
c)Highlypositivelycharged
d)Negativelycharged
e)ComponentofECM
CorrectAnswer-C
Ans.is'c'i.e.,Highlypositivelycharged[RefHarper30"/ep.
786]
Proteoglycansarecarbohydratestowhichsmallamountofproteinis
attached.Proteoglycansconsistsof95%ofcarbohydratesand5%
ofprotein.Toknowthestructureofproteoglycans,oneshouldknow
thestructureofglycosaminoglycans.
Glycosaminoglycansareheteropolysaccharide
(heteropolysaccharidesarepolysaccharideswhichcontaintwoor
moredifferentmonosaccharideunitortheirderivatives).
Glycosaminoglycansarelinear(unbranched)polysaccharides,with
repeatingdiasaccharideunits.Eachdisaccharideunitconsistsofan
aminosugarandanacidsugar(sugaracid).
Glycosaminoglyclanswerefirstisolatedfrommucin,thereforethey
arealsocalledmucopolysaccharides.
Theyarenegativelycharged.

---

24.Mechanismsforregulatingenzyme
activityareALLEXCEPT
a)Covalentmodification
b)Allostericactivation
c)Competitiveinhibition
d)Inductionofgenesforenzymesynthesis
e)Repressionofgeneforinhibitionofenzymesynthesis
CorrectAnswer-C
Ans.is(c)Competitiveinhibition[Ref:Harper319`Vep.89-
94;Lippincott6"/ep.62-64;Vasudevan5thiep.42-50;Shinde
Asthenamesuggests,thereiscompetitionbetweeninhibitorand
normalsubstrateforthecatalyticbindingsiteoftheenzyme.Thisis
becauseboththeinhibitorandthenormalsubstratehavesimilar
structuralconfiguration.Therefore,enzymecannotdifferentiate
thesetwoandbothcanbindtotheenzyme.BothESandEI
complexesareformed.ButonlyEScanformproduct.

---

25.Truestatementare-
a)Alllipidarefat
b)Linoleicacidisessentialfattyacid
c)Hydrogenationconvertsunsaturatedfattyacidtosaturated
fattyacid
d)Rancidityoffoodisduetolipidperoxidation
e)Hydrolysisoffatbyacidissaponification.
CorrectAnswer-B:C:D
Ans.is"B"i.e.,Linoleicacidisessentialfattyacid;"C"
Hydrogenationconvertsunsaturatedfattyacidtosaturated
fattyacid;'d'i.e.,Rancidityoffoodisduetolipid
peroxidation[RefLippincott6"Iep.181-1821.
Thethreepolyunsaturatedfattyacids(PUFAs),namely,linoleicacid
linolenicacidandarachidonicacidarecalledessentialfattyacids.
theyarecalledessentialfattyacidsbecausehumanbeingsrequire
thesefattyacidsbutcannotsynthesizethem.
Additionofhydrogenatomstounsaturatedfattyacidrefersto
hydrogenation.Itreducesthenumberofdoublebondsin
unsaturatedfats,Ashydrogenationreducesnumberofdouble
bonds,unsaturatedfattyacidsmaygetconvertedtosaturatedfatty
acid,ifalldoublebondsarereduced.
Theunpleasantodorandtaste,developedbynaturalfatsupon
aging,isreferredtoas"rancidity".Ranciditymaybedueto
hydrolysis(bylipase)oroxidationoffat.

---

26.Truestatement(s)aboutlipiddigestion
andabsorption-
a)Micellesplayanimportantroleinlipidsabsorption
b)Absorptionoflong-chainfattyacidsisgreatestintheupper
partsofthesmallintestine
c)Bileacidhasnoroleinfatabsorption
d)Fattyacidsafterabsorptionarereesterifiedtotriglycerides
intheenterocytes
e)Gastriclipaseisthemajorenzyme
CorrectAnswer-A:B:D
Ans.is'a'i.e.,Micellesplayanimportantroleinlipids
absorption;'b'i.e.,Absorptionoflong-chainfattyacidsis
greatestintheupperpartsofthesmallintestine;&'d'Le.,Fatty
acidsafterabsorptionarereesterifiedtotriglyceridesinthe
enterocytes[RefGanong251h/ep.481-83;Harper..30thlep.
253-54;Guyton12thIep.421-23;Lippincott6th/ep.1761.
Micellesformationistheprocessinwhichdigestedfats(FFAsand
monoglycerides)areincorporatedintomuchsmallerdroplets
(micelles)sothattheycanbeabsorbedmoreefficiently.Thus,
micellesformationhelpsinabsorptionofdigestedfats.
Fatdigestionessentiallybeginsintheduodenumwithentryof
pancreaticandbiliarysecretions.Pancreaticjuicecontainslipase
(pancreaticlipase),themostimportantenzymeforfatdigestion.The
pancreaticlipasedigeststriglycerides(triacylglycerols)intofreefatty
acidsand2-monoglycerides(2-monoacylglycerols).
Afterfatdigestion,fattyacidsandmonoglyceridesareabsorbedin

---

thesmallintestine,especiallyinthejejunumandsomeamountalso
inileum.Insidetheenterocyte,fattyacidsandmonoglycerides
againformtriglycerides.

---

27.Gluconeogenesisisfavouredinfasting
stateby-
a)ActivationofpyruvatecarboxylasebyacetylCoA
b)Increasedconversionofphosphoenolpyruvatetopyruvate
byactivationofpyruvatekinase
c)Increasedfattyacidoxidationinliver
d)Hydrolysisoffructosel,6-bisphosphatebyfructosel,6-
bisphosphatase
e)None
CorrectAnswer-A:C:D
Ans.is'a'i.e.,Activationofpyruvatecarboxylasebyacetyl
CoA;'c'i.e.,Increasedfattyacidoxidationinliver;'d'i.e.,
Hydrolysisoffructose1,6-bisphosphatebyfructose1,6-
bisphosphatase,
[Ref:Satyanarayan4thiep.258-63;Harper30thiep.188;
Lippincott6fVep.117-123;Shinde7m/ep.347]
Theactivationofpyruvatecarboxylaseandreciprocalinhibitionof
PDHcomplexbyacetyl-CoAderivedfromtheoxidationoffattyacids
explaintheactionoffattyacidoxidationinsparingtheoxidationof
pyruvateandinstimulatinggluconeogenesis.
Thereciprocalrelationshipbetweenthesetwoenzymesaltersthe
metabolicfateofpyruvateasthetissuechangesfromcarbohydrate
oxidation(glycolysis)togluconeogenesisduringthetransitionfrom
thefedtofastingstate.
Fructose-2-6-bisphosphateisformedbyphosphorylationoffructose-
6-phosphatebyphosphofructokinase-2.Thisenzymeisa

---

bifunctionalenzymethatalsohasfructose-2,6-bisphosphatase
activitywhichisresponsibleforbreakdownoffructose-2,6-
bisphosphatasebacktofructose-6-phosphate.
Thisbifunctionalenzymeisunderallostericcontroloffructose-6
phosphatewhichstimulatesphosphofructokinase-2activityand
inhibitsfructose-2,6-bisphosphataseactivity.

---

28.AIIaretrueaboutHexose
monophosphatepathway(HMP)except-
a)ProduceNADPHinoxidativephaseofpathway
b)DoesnotproduceATP
c)Occursintestes,ovaries,placentaandadrenalcortex
d)Producesribose5-phosphateinoxidativephaseofpathway
e)Glucose6-phosphatedehydrogenaseenzymeisinvolved
CorrectAnswer-D
Ansis.'d'i.e.,Producesribose5-phosphateinoxidativephase
ofpathway[RefHarper30thiep.196-200;Lippincottelep.145;
Satyanarayan4thIep.270-71]
HMPshuntisamulticyclicprocessinwhich3moleculesofglucose-
6-phosphategiveriseto3moleculesofCO,and3moleculesof5-
carbonsugars(ribulose-5-phosphate).
Thelatterarerearrangedtogenerate2moleculesofglucose-6-
phosphate(throughfructose-6-phosphate)and1molecule
glyceraldehyde-3-phosphate.HMPshuntdoesnotgenerateATP.
HMPshuntoccursinthecytosol.Itishighlyactiveinliver,adipose
tissue,adrenalcortex,lens,cornea,lactating(butnotthe
nonlactating)mammarygland,Gonads(testis,ovary)and
erythrocytes.Activityofthispathwayisminimalinmuscleandbrain,
wherealmostalloftheglucoseisdegradedbyglycolysis.

---

29.Whichofthefollowingisnotapyrimidine
base?
a)Cytosine
b)Uracil
c)Guanine
d)Thymine
e)Adenine
CorrectAnswer-C
Ans.is'c'i.e.,Guanine
PurinesPyrimidines
AdenineCytosine
GuanineUraciI
Thymine
Bothpurines(adenineandguanine)arefoundbothinDNA&RNA.
Amongpyrimidines-
LiCytosineanduracilarefoundinRNA(thymineisnotfoundin
RNA).
CytosineandthyminearefoundinDNA(uracilisnotfoundinDNA).
InDNA,adenineisalwayspairedwiththyminebytwohydrogen
bonds;andguaninealwayspairedwithcytosinebythreehydrogen
bonds.

---

30.Post-translationmodificationofprotein
includesallexcept:
a)Removalofpeptide
b)5'capping
c)Intronsplicing
d)Proteinfolding
e)Covalentmodification
CorrectAnswer-B:C
Ans.isB.,5'capping&`ci.e.,intronsplicing[Ref;
Satyanarayan4thiep.561-62;Harper30`lep426;Lippincott0-
4p.443-441
5'cappingandintronsplicingarepost-transcriptionalmodification
(notpost-translationalmodification.
Thisisthefirstprocessingreaction.5'-endofmRNAiscappedwith
7-methylguansosine.
Thiscaphelpsininitiationoftranslation(proteinsynthesis)and
stabilizesthestructureofmRNAbyprotectingfrom5'-exonuclease
Removalofintrons(splicing):?Eukaryoticgenescontainsome
codingsequenceswhichcodeforproteinandsomeinterveningnon-
codingsequenceswhichdonotcodeforprotein.

---

31.Whichofthefollowingisnottrueabout
transcription
a)SynthesisofprecursorsforthelargeandsmallribosomalRNAs
b)FormationoftRNAtranscript
c)RNApolymeraseIIisresponsibleforthesynthesisof
precursorsforthelargeribosomalRNAs
d)RNApolymeraseIisresponsibleforthesynthesissmall
ribosomalRNAs
e)BindingofRNApolymeraseonDNA
CorrectAnswer-C:D
Ans.is'c'i.e.,RNApolymeraseIIisresponsibleforthe
synthesisofprecursorsforthelargeribosomalRNAs;&'d'i.e.,
RNApolymeraseIisresponsibleforthesynthesissmall
ribosomalRNAs.
[Ref:Harrion19th/ep.427-28;Satyanarayan4thiep.546,566-68]
RNA,eukaryoteshavethreedifferentRNApolymerases:I,II,II
RNApolymeraseI:Itcatalyzesthesynthesisoflargeribosomal
RNA(rRNA),i.e.28SrRNA,18SrRNAand5.8SrRNA.
TheserRNAsarecodedonclass-Igene,i.e.classIgeneis
transcribedbyrRNA.rRNAsarenottranslatedintoprotein.
RNApolymeraseII:?ItcatalyzesthesynthesisofmRNA,small
nuclearRNA(sn-RNA)andmiRNA.Theseproductsarecodedby
classIIgene,i.e.classIIgeneistranscribedbymRNA.ClassII
genedifferfromclassIandIIIinthatoneofitstranscribedproducts
(mRNA)istranslatedintoprotein
RNApolymeraseIII:?ItcatalyzesthesynthesisoftRNAand5S

---

rRNA.TheseproductsarecodedbyclassIIIgene.
BesidesthesethreenuclearRNApolymerases,inaeukaryoticcell,
afourthtypeofRNApolymeraseisfoundinmitochondrialmatrix
knownasmitochondrialRNApolymerase(mtRNAP).Similarto
prokaryoticRNApolymerase,mtRNAPcatalyzesthesynthesisofall
thethreetypesofRNA,i.e.mRNA,tRNAandrRNA

---

32.Trueabouttelomeraseis?
a)DNAdependentRNApolymerase
b)RNAdependentDNApolymerase
c)Reversetranscriptaseenzyme
d)Increasedtelomeraseactivityisseeninsomaticcells
e)Telomeraseincreasesthelongevityofcells
CorrectAnswer-B:C:E
Ans.is'b'i.e.,RNAdependentDNApolymerase,'c'i.e.Reverse
transcriptaseenzyme&`e'i.e.Telomeraseincreasesthe
longevityofcells[RefHarper29th/ep.358&28`"/ep.315,316;
Robbin's8th/ep.40,296]
Telomeraseisareversetranscriptase(RNAdependentDNA
polymerase)andisresponsiblefortelomeresynthesisand
maintainingthelengthoftelomers(replicationofendof
chromosome).Thus,telomeraseprovidelongevitytothecellswhich
containthisenzyme.
Telomeraseisabsentfrommostofthesomaticcellsandhencethey
sufferprogressivelossoftelomeresandtheyexitthecellcycle.
Senscentcellslacktelomerasesotheirtelomeresgetshortenedby
criticallengthandthesecellsremainsinGophase

---

33.Ultravioletradiationexposurecancauses
DNAdamageby-
a)Pyrimidinedimersformation
b)DNAbreakage
c)Thyminedimerformation
d)AcetylationofDNA
e)MethylationofDNA
CorrectAnswer-A:C
Ans.is'a'Pyrimidinedimersformation;&'c'i.e.,Thyminedimer
formation[RefHarper30/ep.761;Lippincott0/ep.412]
UVraysexposureresultsincovalentjoiningoftwoadjacent
pyrimidines(usuallythymine)toformpyrimidinedimers(thymine-
thyminedimersorcyclobutanepyrimidinedimers).Cytosine-
thymineandcytosine-cytosinedimersarealsoformedbutatslower
rates.
Ultravialet(UV)radiations:-Inducedimerizationofadjacent
pyrimidinestoproducepyrimidinedimers.

---

34.TrueaboutDNAphotolyase-
a)RepairdamagecausedbyUVlight
b)Foundonlyinhuman
c)Usevisiblelight
d)Breakspyrimidinedimers
e)None
CorrectAnswer-A:C:D
Ans.is'a'i.e.,RepairdamagecausedbyUVlight;'c'i.e.,Use
visiblelight;&'d'Breakspyrimidinedimer[Ref:PankajNaikp.
496]
NearlyallcellscontainaphotoreactivatingenzymecalledDNA
photolyase.ItisaDNArepairenzymewhichbindtothedamaged
regionofDNAandgetexcitedbylightenergyabsorbedbyN5,N'?-
methenyltetrahydrofolate,whichisboundtothephotolyase.The
processiscalledphotoreactivation.
Theactivationrequiresvisiblelight,preferentiallyfromtheviolet/blue
endofthespectrum.
Theexcitedphotolyasethencleavesthedimerintooriginalbases.
Theseenzymesoccurinalmostalllivingorganismsexposedto
sunlight,theonlyexceptionbeingplacentalmammalslikehumans
andmice.Theircatalyticmechanismemploysthelight-driven
injectionofanelectronintotheDNAlesiontotriggerthecleavageof
cyclobutane-pyrimidinedimers.
PhotolyaseisparticularlyimportantinrepairingUVinduceddamage
inplants.Thephotolyasemechanismisnolongerworkingin
humansandotherplacentalmammalswhoinsteadrelyontheless
efficientnucleotideexcisionrepairmechanism.

---

---

35.TrueaboutDNAGyrase-
a)AtypeoftopoisomeraseI
b)AtypeoftopoisomeraseII
c)ActoncircularDNA
d)Overcometheproblemofsupercoils
e)None
CorrectAnswer-B:C:D
Ans.is'b'i.e.,AtypeoftopoisomeraseIL;"c'i.e.,Acton
circularDNA;'d',Overcometheproblemofsupercoils
[RefLippincottetc401;StayanarayanxlaVep.528J
TopoisomeraseI4Removesnegativesupercoiling.
TopoisomeraseIIRelaxespositivesupercoilsandformsnegative
supercoilingbycondensation.ofchromosome.
TopoisomeraseIIICanintroducesinglestrandbreaksduring
recombinationthatarerequiredforDNAtobeexchanged.

---

36.Correctdyadofdiseaseandtheir
respectiveinheritancepatterninclude?
a)Wilsondisease-autosomalrecessive
b)Cysticfibrosis-autosomaldominant
c)Marfansyndrome-autosomalrecessive
d)Gardnersyndrome-autosomaldominant
e)Duchenemusculardystrophy-X-linkedrecessive
CorrectAnswer-A:D:E
Answer-(A)Wilsondisease-autosomalrecessive(D)Gardner
syndrome-autosomaldominant(E)Duchenemuscular
dystrophy-X-linkedrecessive
Autosomalrecessivedisorders
1)Metabolic-Cysticfibrosis,Phenylketonuria,Galactosemia,
Homocystinuria,Lysosomalstoragedis,alphal-antitrypsin
deficiency,
Wilsondisease,Hemochromatosis,Glycogenstoragedisorders.
Autosomaldominantdisorders
1.GIT-Familialpolyposiscoli,Gardner'ssyndrome
2.Skeletal-Marfansyndrome
X-linkedrecessivedisorders
1)Musculoskeletal-Duchenemusculardystrophy,Becker's
dystrophy

---

37.TrueaboutRASoncogene-
a)TyrosinekinasehasroleinRASactivation
b)Mostcommonformofoncogeneinhumantumors
c)IthasanintrinsicGTPaseactivity
d)Mutationmayresultincarcinomatousgrowth
e)Belongstogrowthfactorcategoryofoncogene
CorrectAnswer-A:B:C:D
Answer-(A)TyrosinekinasehasroleinRASactivation(B)Most
commonformofoncogeneinhumantumors(C)Ithasan
intrinsicGTPaseactivity(D)Mutationmayresultin
carcinomatousgrowth
InnormalcellstheactivatedstateofthisRASproteinistransient
becausenormalRAS-proteinshaveintrinsicGTPaseactivity.
MutationintheRASproteincausespermanentactivationofRAS
proteinwhichmayresultincarcinomatousgrowth.
ActivatedRASraf-landactitesmitogen-activatingkinase(MAP-
kinase)pathway.
PointmutationofRASfamilygenesisthesinglemostcommon
abnormalityofoncogenesinhumantumor.

---

38.Whichis/arenottumorsuppressor
gene(s)
a)TP53
b)RB
c)CD95
d)SKT11
e)RAS
CorrectAnswer-C:E
Answer-C,CD95E,RAS

---

39.TrueaboutDubin-Johnsonsyndrome-
a)Increasedconjugatedbilirubin
b)UsuallyassociatedwithincreasedASTandALT
c)Mutationinuridinediphosphate-glucuronyltransferasepeptide
Al
d)Decreasedbiliaryexcretionofconjugatedbilirubin
e)Autosomaldominantinheritance
CorrectAnswer-A:D
Answer-(A)Increasedconjugatedbilirubin(D)Decreased
biliaryexcretionofconjugatedbilirubin
DuringJohnsonsyndromeisanautosomalrecessivehereditary
disorderpresentingwithconjugatedhyperbilirubinemiaduetodefect
inhepaticexcretoryfunctionacrossthecanalicularmembraneof
hepatocyte.
DJSisatypeofcongenitalconjugatedhyperbilirubinemia.
Conjugatedbilirubinisincreasedbecauseofdefectivebiliary
excretionofbilirubinglucuronidesduetomutationincanalicular
multidrugresistanceprotein2.

---

40.Mostcommontranslocationinacute
promyelocyticleukemia(APML)is
a)t(8:14)
b)t(9:22)
c)t(15:17)
d)t(8:21)
e)t(11:118)
CorrectAnswer-C
Answer-C,t(15:17)
Acutepromyelocyticleukemia(M3bytheFABclassification)is
associatedwithat(15;17)(q22;q11)translocation.
Disseminatedintravascularcoagulationcanoccurinthisdisorder
duetothereleaseofprocoagulantsubstancesfromtheleukemic
cells,especiallyduringtreatment.
Thet(4;11)(q21;q23)translocationisassociatedwithacute
lymphocyticleukemia(ALL)andundifferentiatedleukemia.
Thet(6;9)(p23;q34)translocationisfoundinsubtypesofAMLwith
basophilia(M1,M2,M4).
Burkitt'sleukemia,whichisrelatedtoBurkitt'slymphoma,is
associatedwitht(8;14)(q24;q32).
Thet(8;21)(q22;q22)translocation(choiceD)isseeninM2
leukemia,alsoknownasacutemyeloidleukemia(AML)with
maturation

---

41.Feature(s)ofTurnersyndromeis/are-
a)Monosomyofautosomes
b)Webbingofneck
c)Mentalretardation
d)Shortfourthmetacarpal
e)Streakgonades
CorrectAnswer-B:D:E
Answer-(B)Webbingofneck(D)Shortfourthmetacarpal
(E)Streakgonades
45X0
Lymphademaofdorsumofhand&fat
Looseskinfoldatnapeofneck
Shortstature
ShortNeck(withwebbingofneck)
Anomaliesear
Broadshieldlikechestwithwidelyspacedsmallnipple
Renalanomalies(Horse-shoe,soubleorcleftrenalpelvis)Coartof
aorta

---

42.Mostcommonaneuploidycompatiblewith
lifeis
a)Downsyndrome
b)Turnersyndrome
c)Klinefelter'ssyndrome
d)Patausyndrome
e)None
CorrectAnswer-A
Answer-A,Downsyndrome
Mostcommonaneuploidyinwhichinfantcansurviveistrisomy-21
(Downsyndrome)

---

43.Whichofthefollowingacutephase
protein(s)decreasesduringacute
inflammation
a)Albumin
b)Transferrin
c)Ceruloplasmin
d)C-reactiveprotein
e)Haptoglobin
CorrectAnswer-A:B
Answer-A,AlbuminB,Transferrin
Negativeacutephaseproteins
Theseproteinsaredecreasedduringinflammation.Important
examplesarealbumin,prealbumin,transferrin,transcortin,
transthyretinandretinalbindingprotein

---

44.Whichofthefollowingis/aretrueabout
sideroblasticanaemia
a)Basophilsstipplinginleadpoisoning
b)Erythroidhypoplasiainbonemarrow
c)Pappenheimerbodiesisalwayspresent
d)DimorphicRBC
e)IncreasedMCHC
CorrectAnswer-A:D
Answer-A,BasophilsstipplinginleadpoisoningD,Dimorphic
RBC
Importantfeaturesofsideroblasticanemiaare:-
Ringeedsidetoblastsinbonemarrowprussionbluereaction.
Dimorphicbloodpicture,i.e.amixturemicrocytichypochromicand
macrocyticerythrocytes
Increased:Ironstores,serumferritin,serumiton,transferrin
saturation.
Ineffectiveerythropoiesisbecauseironcannotbeincorporatedinto
erythrocytes.
otherfeature:DecreasedMCVMCHandMCHC;basophiling
stipplinginleadporsonizgAnisopoikilocytosis(varying
sizesandabnormalshapesofRBCs),erthroidhyperplasiainbone
marrow.

---

45.Multiplemyelomamaybeassociatedwith
a)Fanconi'ssyndrome
b)Amyloidosis
c)Mixedcryoglobinemia
d)Castnephropathy
e)Interstitialnephritis
CorrectAnswer-A:B:C:D:E
Answer-A,Fanconi'ssyndromeB,AmyloidosisC,Mixed
cryoglobinemiaD,CastnephropathyE,Interstitialnephritis
Factorscontributingthedamageare:-
BenceJonesproteinuriaandcastnephropathy
Amyioidosis
Lightchainnephropathy,Glomerulopathy,tubule-interstitial
nephritis.
Vasculardisease.
Urinarytractobstruction.
Fanconi'ssyrdrome
TypeIcryoglobulienmiaiscomposedofasinglemono-clonalIg,
usuallyIgM

---

46.Trueaboutautosomalrecessive
polycystickidneydisease(ARPKD)
a)CanbediagnosedinuterobyUSG
b)Hypertensiondevelopsinlatestagesofthedisease
c)Mayproceedtorenalfailurebeforepreschoolage
d)Enlargementofkidney
e)Hematuriaisearlyfeature
CorrectAnswer-A:C:D
Answer-A,CanbediagnosedinuterobyUSGC,Mayproceedto
renalfailurebeforepreschoolageD,Enlargementofkidney
ThepresentationinPolycysticdiseaseofkidneyischaracteristically
bilateral
Thebilateralenlargementcanhardlybemistakenonroutine
examination
USGandCTshowmultiplecystsinbothkidneys
Thediseasemaypresentatanyagebutthemostcommonage
ofpresentationisinthe3rdor4thdecade.
Boththekidneyaregrosslyenlargedandsituatedwithmultiple
cysts.
Childhoodpolycystickidneydiseasehasautosomalrecessive
inheritance.

---

47.Feature(s)oftypeImembranoproliferative
glomerulonephritis(MPGN)-
a)Tramtrackappearanceonlightmicroscopy
b)Subendothelialelectron-densedepositsonelectronmicroscopy
c)Immunofluorescencemicroscopyshowpositiveflorescenceof
IgGandC3ondensedeposit
d)Intramembranousdensedepositonelectronmicroscopy
e)Mesangialhypocellularity
CorrectAnswer-A:B:C
Answer-A,Tramtrackappearanceonlight
microscopyB,Subendothelialelectron-densedepositson
electronmicroscopyC,Immunofluorescencemicroscopyshow
positiveflorescenceofIgGandC3ondensedeposit
Onlightmicroscope,Alltypeshavefollowingsimilarfeatures.
1. TheglomeruliarehypercellularDuetoexocapillaryand
endocapillaryproliferation.
2. Theglomerulihavelobularappearanceaccentuatedbythe
proliferatingmesangialcellsandincreasedmesangialmatrix.
3. Parietalepithelialcrescentinmanycases
4. GBMisthickened,whichismostevidentintheperipheralcapillary
loops.
5. Theglomelularcapillarywallshowsadoublecontourortramtrack
appearancebecauseofduplicationofbasementmembraneasa
resultofnewbasementmembranesynthesis.
6. Withinthebasementmembranethereisinterpositionofcellular
elementsthatgiverisetotheappearanceofsplitbasement

---

membrane.
TypeIandIIMPGNdifferintheirultrastructuralfeatures.
TypeISubendothelialdeposits.
TypeIIIntramembranousdeposition.
TypeIdisease(mostcommon)
Idiopathic
Subacutebacterialendocarditis
TypeIIdisease(Densdepositdisease)
Idiopathic
C3nephriticfactorassociated
Partiallipodystrophy
TypeIIIdisease
Idiopathic
Complementfactordeficiency
Systemiclupuserythematosus
HepatitisC
Mixedcryoglubulinemia

---

48.PAX5is/aremarkerfor?
a)Acutemyeloidleukemia
b)T-celllymphomas
c)Anaplasticlargecelllymphoma
d)Hodgkin'slymphoma
e)B-lymphoblasticlymphoma
CorrectAnswer-D:E
Ans.is'd'i.e.,Hodgkin'slymphoma;&`e'i.e.,B-Lyrnphoblastic
lymphoma
[Ref:Robbins9th(SEA)/ep.590;Harrison19th/ep.699]
Pax5(B-cell-specificactivatorprotein)ismostlyexpressedinB-
lymphocytesandB-celllymphomas.Itisexpressedindeveloping
CNS,someneuroendocrinetumors,andoccasionalmyeloid
leukemia.
Pax5stainingispositiveinmostHodgkinlymphoma,B-cellNHL,
andprecursorB-celllymphoblasticneoplasms.
Lymphoplascytoidlymphoma,smallcellcarcinomasandMerkelcell
carcinomasarealsopositive.
T-celllymphomas,plasmacellneoplasms,multiplemyeloma,and
plasmablasticlymphomasarenegativeforPax5.

---

49.Tumormarkerforlungadenocarcinoma
is/are
a)Positiveforcytokeratin5
b)Positiveforcytokeratin7
c)Positiveforcytokeratin20
d)Transthyretin(TTR)mutation
e)EGFRmutation
CorrectAnswer-B:E
Answer-B,Positiveforcytokeratin7E,EGFRmutation
Adenocarcinoma-AKT1,ALK,BRAF,EGFR,HER-2,K-RAS,MEK-
1,MET,N-RAS
CK7(+)ve-BreastCa,PancreaticCa,CervicalCa,adenocarcinoma
oflung.

---

50.Whichofthefollowingis/areassociated
withsynovialcellsarcoma
a)Translocation(9;22)(q34;q11)
b)SS18-SSX4fusiongenes
c)Translocationt(X;18)(p11;g11)
d)SS18-SSX1fusiongenes
e)None
CorrectAnswer-B:C:D
Answer-B,SS18-SSX4fusiongenesC,Translocationt(X;18)(p1
1;g11)D,SS18-SSX1fusiongenes
Mostsynovialsarcomasshowacharacteristicchromosomal
translocationt(X:18)producingSYT-SSX1or-SSX2fusion
genes.Thespecifictranslocationisassociatedwithpoorprognosis.
Histologichallmarkofbiphasicsynovialsarcomaisthedualliningof
differentiationofthetumorcells(eg.epitheliatlikeandspindlecells)
CalcifiedconcrectionscanbepresentonX-rays

---

51.Truestatementaboutprimary
myelofibrosis
a)Hepatomegalyisthemostcommonmanifestation
b)Drytaponbonemarrowaspiration
c)Onlypotentiallycurativetreatmentisallogeneicstemcell
transplantation
d)Splenomegalyisalmostinvariablypresent
e)Myeloblastsmaybeseeninperipheralblood
CorrectAnswer-B:C:D:E
Answer-B,DrytaponbonemarrowaspirationC,Only
potentiallycurativetreatmentisallogeneicstemcell
transplantationD,Splenomegalyisalmostinvariably
presentE,Myeloblastsmaybeseeninperipheralblood
Thehallmarkofprimarymyelofibrosisisrapiddevelopmentof
obliterativemarrowfibrosis.
Myelofibrosissuppressesbonemarrowhematopoiesis,leadingto
peripheralbloodcytopenias.
Peripheralbloodpictureshowsleukoerythroblastosis(erythroidand
granulocyticprecursorsinperipheralblood),andtear-drop
erythrocytes(dacrocytes).
Bonemarrowbiopsyistheinvestigationofchoice.
Unsuccessfulbonemarrowaspirationalsocalleddrytap.
Allogmeicbonemarrowtransplantationistheonlycurativetreatment
forPMF.

---

52.Newerinclusionin2015WHO
classificationofsquamouscellcarcinoma
oflunginclude(s)
a)Clearcellvariant
b)Papillarycellvariant
c)Adenocarcinomavariant
d)Nonkeratinizingvariant
e)Lymphoepithelioma-likecarcinoma
CorrectAnswer-D
Answer-D,Nonkeratinizingvariant
Oldclassification-
Papillary
Clearcell
Smallcell
Basaloid
NewerClassification-
KeratinizingSCC
NonkeratinizingSCC
BasaloidSCC
Preinvasive:SCCinsitu

---

53.Whichofthefollowingcancause
pulmonaryembolism-
a)Pregnancy
b)OCPuses
c)Mitralregurgitation
d)Leftventricularfailure
e)Excessiveunaccustomedexercise
CorrectAnswer-A:B:D
Answer-(A)Pregnancy(B)OCPuses(D)Leftventricularfailure
PatientFactors
Age
Obesity
Varicoseveins/superficialthrombophlibits
Immobility
Pregnancy
PuerPerium
High-doseoestrogentherapyorOCPuse
Diseaseorsurgicalprocedure-
Traumaorsurgery
Malignancy
Heartfailure
Paralysisoflowerlimb
Infection

---

54.Trueaboutsilicosis-
a)Lowerlobeismorecommonlyinvolved
b)Radiographicallyseenaseggshellclacification
c)Lobarpneumoniaiscommon
d)Associatedwithanincreasedsusceptibilitytotuberculosis
e)Histologicallysilicanodulesconsistsofhyalinisedcenter
surroundedbyconcentriclaminationsofcollagen
CorrectAnswer-B:D:E
Answer-(B)Radiographicallyseenaseggshellclacification
(D)Associatedwithanincreasedsusceptibilitytotuberculosis
(E)Histologicallysilicanodulesconsistsofhyalinisedcenter
surroundedbyconcentriclaminationsofcollagen
Silicosisisalungdiseasecausedbyinhalationofcrystallinesilicon
dioxide(silica).
Silicosisisaslowlyprogressivedisease.
SilicosisisassociatedwithanincreasedsusceptibilitytoT.B.
Silicosisischaracterized-
NodulesintheUpperzonesofthelunghardcollagenousscars
Radiologically,eggshellcalcificationcanbeseeninthelymph
nodes.
Histologically,silicosislesionsconsistofconcentriclayersof
hyalinizedcollagensurroundedbyadensecapsuleofmore
condensedcollagen.

---

55.Truestatementaboutasbestosis-
a)Mayinvolvehilarlymphnode
b)Asbestosisbeginsinthelowerlobes
c)Pleuralplaquesconsistsofcalcifiedhyalinzedcollagenous
tissue
d)HighresolutionCTscanningisthebestimagingmethod
e)Noriskoflungcarcinoma
CorrectAnswer-A:B:C:D
Answer-(A)Mayinvolvehilarlymphnode(B)Asbestosis
beginsinthelowerlobes(C)Pleuralplaquesconsistsof
calcifiedhyalinzedcollagenoustissue(D)HighresolutionCT
scanningisthebestimagingmethod
Asbestosisisaninterstitiallungdiseaseduetoinhalationof
asbestosparticles.
Therearetwodistinctgeometricformsofasbestos:(i)Serpentine
(chrysolite),and(ii)Amphibole(crocidolite).
Bothserpentineandamphibolecancauseallasbestosisrelated
diseaseexceptformesothelioma,whichisusuallyassociatedwith
amphibole.
Pleuralplaquesarethemostcommonmanifestationofasbestos
exposure.
Thereisdiffuseinterstitialfibrosismainlyinvolvinglowerlungfields.
Thelungisinvadeddirectly,andthereisoftenmetastaticspreadto
thehilarlymphnodes.
HighresolutionCTscanningisthebestimagingmethodfor
asbestosis.

---

56.Cancer(s)causedbyviralinfections-
a)Kaposisarcoma
b)Nasopharyngealcarcinoma
c)Hepatocellularcancer
d)Hodgkin'slymphoma
e)All
CorrectAnswer-A:B:C:D
Answer-(A)Kaposisarcoma(B)Nasopharyngealcarcinoma
(C)Hepatocellularcancer(D)Hodgkin'slymphoma
DNAvirusesHerpesviridaeHHV-8Kaposissarcoma
Hepadnaviridae(HBV)hepatocellularcarcinoma
Flaviviridae(HCV)hepatocellularcarcinoma
EBVassociatedmalignancies-
Burkitt'slymphoma
Nasopharynagealcarcinoma
Hodgkin'sdisease

---

57.Smallvesselvasculitisis/are-
a)Kawasakidisease
b)IgAvasculitis
c)Carcinomaassociatedvasculitis
d)Anti-glomerularbasementmembrane(anti-GBM)disease
e)Takayasuarteritis
CorrectAnswer-B:C:D
Answer-(B)IgAvasculitis(C)Carcinomaassociatedvasculitis
(D)Anti-glomerularbasementmembrane(anti-GBM)disease
i)ANCApositive
Wegner'sgranulomatosis,Microscopicpolyangitis,Churgstrauss
sytdrome,Good-posturesyndrome.
ii)ANCAnegative
Henoch-Schonleinpurpura,Bechetssyndrome

---

58.Prolongationofboth-activatedpartial
thromboplastintime(aPTT)and
prothrombintime(PT)maybeseenin
factordeficiencyof-
a)Factor2
b)Factor5
c)Factor10
d)Factor8
e)Factor9
CorrectAnswer-A:B:C
Answer-(A)Factor2(B)Factor5(C)Factor10
Partialthromboplastintime(pTT)
Itteststheintrinsicandcommoncoagulationpathways.So,a
prolongedPTTcanresultsfromdeficiencyoffactorV,VIII(factor
VIIIc,vonwillebrandfactor),IX,X,X,XII,prothrombinorfibrinogen.
Prothrombintime(PT)
Itteststheextrinsicandcommoncoagulationpathways.So,a
prolongedPTcanresultsfromdeficiencyoffactorV,
VII,X,prothrombinorfibrinogen.

---

59.Trueabouthaematologicaldisorder-
a)CryoprecipitateisusedintreatmentinhaemophiliaB
b)BothPTandaPTTareincreasedinDIC
c)Intravenousgammaglobulinisusefulinimmune
thrombocytopenicpurpura
d)HemophiliaC:X-linkeddisorder
e)PlateletcountisdecreasedinDIC
CorrectAnswer-B:C:E
Answer-(B)BothPTandaPTTareincreasedinDIC
(C)Intravenousgammaglobulinisusefulinimmune
thrombocytopenicpurpura(E)Plateletcountisdecreasedin
DIC
1.CryoprecipitateisusedinHemophiliaA-
Itcontainsfbrinogen,factorVIIIcandvWF,andfactorXIII.
UsedinhemophiliaAandvon-Willebranddisease.
2.PT&aPTTareincreasedinDICaldplateletcountisdecreased
Bloodfilmshowsmicroangiopathichaemolyticanaemia.
PT,thrombintime,andActivatedPartialthromboplastintimeallare
prolonged.
3.IVimmunoglobulinisusefulinITP
IVimmunoglobulinisthetreatmentofchoiceforneonatalaswellas
childhoodITP.
4.HemophiliaCiscausedbydeficiencyoffactorXI.
Itisinheritedasanautosomalrecessivepattern.

---

60.Feature(s)ofantiphospholipidsyndrome
is/areexcept-
a)Recurrentthrombosis
b)SLEisassociatedwithprimaryantiphospholipidsyndrome
c)Itincludestwotypesofantibodies-lupusanticoagulantand
anticardiolipinantibody
d)Foetuslossmayoccur
e)Occurd/tdefectin
CorrectAnswer-B:C:E
Answer-(B)SLEisassociatedwithprimaryantiphospholipid
syndrome(C)Itincludestwotypesofantibodies-lupus
anticoagulantandanticardiolipinantibody(E)Occurd/tdefect
in
Inantiphospholipidsyndromethereishypercoagulabititywhich
resultsinrecurrefltvenousandarterialthrombosis.
Peripheralyenoussystetn)DVT
CNSCerebrovascularaccident,sinusthrombosismigraine,
epilepsy.
HematologicalThrombocytopenia,hemolyticanemia.
ObstetricsAbortionin2rd&3rdtrimester(latefetalloss)is
commonbutitmayoccuranytimeinpregnancy;recurrentabortion,
eclampsia.
PulmonaryPulmonaryembolism,pulmonaryhypertension.
CardiacLimbman-Sackendocarditis,MI.
Dermatological>Livedoreticularis,purpura,infarct/ulceration.
OcularAmaurosis,retinalthrombosis.

---

AdrenalInfarction,hemorrhage.
Musculoskeletal>Avascularnecrosisofbone.
CatastrophicantiphospholipidsydromeMultiorganinfarction.

---

61.Longacting13agonist(s)whichis/are
usedasonceadaydrug?
a)Salmeterol
b)Formoterol
c)Olodaterol
d)Vilanterol
e)Indacaterol
CorrectAnswer-C:D:E
Ans.C,OlodaterolD,Vilanterol&E,Indacaterol
Ref:Katzung13'h/ep.j40;Rang6Dale8'h/ep.348
Longactingbeta-1agonist
(8-12hrs)
Giventwicedaily
1. Salmeterol
2. Formoterol
3. Arformoterol
Ultra-longacting
(24hrs)
givenoncedaily
1. Indacaterol
2. Olodaterol
3. Vilanterol

---

62.Drugofchoiceforstrongyloides
stercoralis?
a)Mebendazole
b)Albendazole
c)Ivermectin
d)Levamisole
e)Diethylcarbamazine
CorrectAnswer-C
Ans.C.Ivermectin
Ref:K.D,T,Thlep,850iKatzung13th/ep.909;SatoskarPharma
24'ep.816;RangandDale|th/ep.573
Strongyloid-Ivermectin
Anaerobes-Metronidazole
AtypicalPneumonia(mycoplasma)-Erythromycin
Cholera-Doxycycline
Staphylococci-Penicillin
VRSA-Linezolid
P.Carinii(jiroveci)-Cotrimoxazole
Pseudomonas-
Antipseudomonalbeta-lactam+aminoglycoside
Streptococcus-Penicillin
Toxoplasma-Cotrimoxazole
ToxoplasmainpregnancySpiramycin.
Rheumaticfever-Benzathinepenicillin
TB-INHwithorwithoutrifamPicin
Rickettsia-TetracYclines

---

InfluenzaAandB-Osetamivir
Diphtheria-Penicillin/Erythromycin
Anthrax
Ciprofloxacin/Doxycycline+Pertussis-ErYthromYcin
HSV-AcYclovir
LePtosPirosis
Milder-Oralamoxicillin
Severe-IvPenicillinG
Lyme'sdisease-DoxycYcline
Syphilis-PenicillinG
Pertussis-ErYthromYcin
Actinomycosis-PenicillinG
Lymphogranulomavenereum-AzithromycinorDoxycycline
Legionella-Azithromycinorlevofloxacin
Plague-StrePtomYcin
Listeria-Ampicillin+Gentamicin
MAC-Azithromycin/clarithromycin
GroupB-streptococcus-Ampicillin
UTI-Cotrimoxazole
Endocarditis-Amoxicillin/Clindamycin
Babesiosis-Quinine+Clindamycin
Pvivax-Chloroquine
ChloroquineresistantPvivax-Artemisinincombinationtherapy
(ACT)

---

63.DOCformycoplasmais/are?
a)Doxycycline
b)Ceftriaxone
c)Azithromycin
d)Penicillin
e)Gentamycin
CorrectAnswer-A:C
Ans.A,Doxycycline&C,Azithromycin
Ref:Harrisonrgh/ep.1164
ForM.pneumoniaeinfections:
Azithromycin,clarithromycin,erythromycin,doxycycline,
levofloxacin,moxifloxacin,gemifloxacin(notciprofloxacinor
floxacin).
ForM.Hominis-
Doxycycline,clindamycin

---

64.Whichofthefollowingdyadofanti-HIV
drugandmechanismofactionis/are
correctlymatched?
a)Maraviroc-Entryinhibitor
b)Reltegravir-Intergaseinhibitor
c)Indinavir-Proteaseinhibitor
d)Nevirapine-Nonnucleosidereversetranscriptaseinhibitor
e)Darunavir-Fusioninhibitor
CorrectAnswer-B:C:D
Ans.B,Reltegravir-IntergaseinhibitorC,Indinavir-Protease
inhibitor&D,Nevirapine-Nonnucleosidereversetranscriptase
inhibitor
Antiretroviraldrugs
a)Nucleosidereversetranscriptaseinhibitors(NRTIs)-
Zidovudine,Didanosine,Zalcitabine,Stavudine,Iamivudine,
Abacadr,Emtricitabine
b)Nucleotidereversetranscriptaseinhibitor+Tenofovir
c)NonNucleosidereversetranscriptaseinhibitors(NNRTIS)-
Nevirapine,Efavirenz,Delavirdine,Etravirine,rilpivirine.
d)Proteaseinhibitors-
RitonavirIndinavir,NeIfnavb,Saquinavir,amprenavir,Lopinavir,
Fosamprenavir,Atazanavir,Darunavir,Tipranavir.
e)Fusioninhibitor-Enfuvirtide,Maraviroc.
f)Integraseinhibitors-Raltegravir,Elvitegravir.
g)CCR5receptorinhibitor-Maraviroc

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65.Anti-influenzadrugwhichis/aregiven
throughinhalationroute?
a)Amantadine
b)Oseltamivir
c)Zanamivir
d)Rimantadine
e)None
CorrectAnswer-C
Ans.C.Zanamivir
[Ref:KDT7'/ep.S0l0.3;Park's24't'/e1t.169;Katzung13th/ep.862
63]
Anti-influenzadrugs
Amantadine,rimantadine,oseltamivirandzanamivir.
Onlyzanamivirisgivenbyparenteralroute(intranasdor
intravenous).allothersaregivenorally.
Zanamivirhaslowestoralbioavailabilitylowestt1/2(shortestacting).
Rimantadinehasmaximumplasmaproteinbinding,whileoseltamivir
hasminimumplasmaproteinbinding.
Rimantadinehasmaximummetabolism.

---

66.Truestatement(s)aboutalbendazole?
a)Undergoesfirst-passmetabolismintheliver
b)ActiveagainstbothlarvaandadultofNematodes
c)Absorptionincreaseswithfattymeal
d)Excretedintheurine
e)Thiabendazoleislesstoxicthanalbendazole
CorrectAnswer-A:B:C:D
Ans.A,Undergoesfirst-passmetabolismintheliverB,Active
againstbothlarvaandadultofNematodesC,Absorption
increaseswithfattymeal&D,Excretedintheurine
[Ref:Katzung13't'/ep.90E09;GoodmanandGilmatr'slI't'/ep.
1079;SatoskarPhanna24't'/ep.818]
Albendazole:
Broad-spectrumoralanthelmintic.
Actsbybindingtotubulinandtherebyinhibitingitspolymerization
Afteroraladministration,itiserraticallyabsorbed(increasedwitha
fattymeal)andthenrapidlyundergoesfirst-passmetabolisminthe
livertotheactivemetabolitealbendazolesulfoxide.
excretedintheurine.
Hasamiciilaleffectsinhydatiddisease,cysticercosis,ascariasis,
andhookworminfectionandovicidaleffectsinascariasis,
ancylostomiasis,andtrichuriasis.

---

67.Whichofthefollowingis/arenot5th
generationcephalosporin?
a)Cefoxitin
b)Cefoperazone
c)Ceftolozane
d)Ceftaroline
e)Ceftabiprole
CorrectAnswer-A:B
Ans.A,Cefoxitin&B,Cefoperazone
[Ref:KDT7/ep.26;Ketungp-779;Goodman&Gilman'sp.781;
Pharma241/ep.693]
First
Second
Third
Fourth
Fifth
Cefuroxime
Cefoxitin
Cefotaxime
Cephalothin Cefotetan
Cetizoxime
Ceftobiprole
Cefepime
Parenteral Cefazoline
Cefmetazole Ceftriaxone
Ceftaroline
Cefpirome
Cephapirin
Cefamendole Ceftazidime
Ceftolozane
Cefonicid,
Cefoperazone
ceforanide
Cefixime
Cephalexin
Cefaclor
Cefpodoxime
Cephradine
Cefuroxime proxetil
Oral
Cefadroxil
axetil
Cefdinir
Cephaloridine Cefprozil
Ceftibuten,
Ceftamet

---

68.Whichofthefollowingistrueabout
aminoglycosideassociatedacutekidney
injury?
a)Seeninaround10-20%ofpatientstreatedwiththedrug
b)Mayoccurwithin1weekofinitiationoftreatment
c)Occuronlyafter3weeksoftreatment
d)Interstitialnephritisoccur
e)Usuallydevelopswithin72hoursofinitiationoftreatment
CorrectAnswer-A:B
Ans.A,Seeninaround10-20%ofpatientstreatedwiththe
drug&B,Mayoccurwithin1weekofinitiationoftreatment
[Re/:KDf7e/dp.715;Katzungep.802]
Non-oliguricacutekidneyinjury(AKI)occursin10-30%ofpatients
onaminoglycosidetherapy.
AKTtypicallymanifestsafter5-7daysoftherapy.
Nephrotoxicity:
Neomycinismostnephrotoxic,whilestreptomycinisleast
nephrotoxic.
Nephrotoxicityisincreasedbyadvancedage,liverdisease,
hypokalemia,septicshock,concurrentuseofnephrotoxicdrugs
(amphotericinB,cisplatin,cyclosporine)andprolongedtherapy.

---

69.Whichofthefollowingistrueabout
antifungaldrugs?
a)Echinocandinshaveverylesssideeffects
b)Flucanazoleisfirstlinedrugforinvasiveaspergillosis
c)Oralfluconazolehas100%bioavailability
d)AmphotericinBisfungistatic
e)NephrotoxicityisdoselimitingsideeffectofamphotericinB
CorrectAnswer-A:E
Ans.A,Echinocandinshaveverylesssideeffects&
E,NephrotoxicityisdoselimitingsideeffectofamphotericinB
[RefKDTzh/ep.787-95]
EchinocandinsarewelltoleratedwithmildGIsideeffects.
Fluconazoleisnot1stlinedrugforaspergillosis.
Oralbioavailabilityoffluconazoleis94%.
Amphotericin-Bisfungicidalaswellasfungistatic
Themostimportantdoselimitingtoxicityisnephronicity.
Adverseeffectsincludeinfusionrelatedacutereactions(most
common),nephrotoxicity,anemia,cNStoricityAnd,
hypomagnesemiaInfusionrelatedacutereactioncanbeprevented
bypremedicationslikecorticosteroidsandantihistamines.
Itismanifestedbyazotemia,reducedGFR,RTA,hypokalemia,and
hypomagnesemia.

---

70.Drugsaffectingpurinesynthesis?
a)Azathioprine
b)Methotrexate
c)Fludarabine
d)6-Mercaptopurine
e)Capecitabine
CorrectAnswer-A:B:C:D
Ans,A,AzathioprineB,MethotrexateC,Fludarabine&D,6-
Mercaptopurine
[Ref:KDT7h/ep.858;Katzungp.928,931;Goodman&Gilmin'sI
tth/ep.1336,1346-48;SatoskarPharma24a'/ep.G29.]
Antimetabolites:
Drugsaffectintermediarymetabolismofproliferatingcells.
AllthesedrugsinterferewithnucleicacidsynthesisAct
on.S,phase.
Purineantagonists=Mercaptopurine,Thioguanine,
Azathioprine,FludarabineAndCladribine.
Pyrimidineantagonists=S-Fluorouracil,cytosinearabinoside
(cytarabine),capecitabine,Gemcitabine.
Folateantagonist=Methotrexate,pemetrexed.
Note:Tetrahydrofolateisrequiredforpurinesynthesisandits
formationisinhibitedbymethotrexate.
Methotrexateandpemetrexeddihydrofolatereductase(DHFRcse)
inhibitors.

---

71.Methotrexateaffects?
a)Purinesynthesis
b)Pyrimidinesynthesis
c)ConversionofDHFAtoTHFA
d)Polymerizationofmitotictubule
e)None
CorrectAnswer-A:C
Ans.A,Purinesynthesis&C,ConversionofDHFAtoTHFA
Methotrexateandpemetrexeddihydrofolatereductase(DIlFRcse)
inhibitors.
ThesedrugsalsoinhiUitttrymiapatesynthaseanddenovopurine
synthesis,whichcontributetomethotrexatetoxicity.

---

72.LongactingInsulinis/are?
a)Lispro
b)Detemir
c)Glargine
d)Isophane
e)Glulisine
CorrectAnswer-B:C
Ans.B,Detemir&C,Glargine
[Ref:KDTep-263:satashkarkhanna24e/ep'893]
RapidActingInsulin=Insulinlispro,Insulinaspart,Insulinglulisine.
Shortacting=Regular(soluble)insulin,semilenteinsulin'
Intermediateacting=Insulinzincsuspension(Lente),Neutral
protaminehagedorn(isophaneinsulin)
Longacting=Protaminezincinsulin,Insulinglargine,Insulindetemir

---

73.AmongACEinhibitors,whichofthe
followingis/areprodrug(s)-
a)Perindopril
b)Captopril
c)Lisinopril
d)Ramipril
e)Enalapril
CorrectAnswer-A:D:E
Ans.A,PerindoprilD,Ramipril&E,Enalapril
[RefKDTF/ep'23,501]
AllACEinhibitorsareprodrugsexceptcaptoprilandLisinopril.

---

74.Whichofthefollowinganti-tumordrug
havehighriskofgonadotoxicity?
a)Dactinomycin
b)Cyclophosphamide
c)Busulfan
d)Vinblastine
e)Ifosfamide
CorrectAnswer-B:C:E
Ans.B,CyclophosphamideC,Busulfan&E,Ifosfamide
[ReFK.D-t.P.859;]
Allalkylatingagentsarehighlygonadotoxic.
HighAlkylatingagents=Cyclophosphamide,ifosfamide,busulfan,
chlorambucil,melphalan,procarbazine.
Medium=Carboplatin,doxorubicin
Low=Vincaalkaloids(vincristine,vinblastine),methotrexate,
mercaptopurine,bleomycin,dactinomycin.

---

75.Adrenalinecanbeusedin?
a)Bronchialasthma
b)Allergicdisorder
c)Cardio-pulmonaryresuscitation
d)Anaphylaxis
e)Asanti-analgesicmedicine
CorrectAnswer-B:C:D
Ans.B,AllergicdisorderC,Cardio-pulmonaryresuscitation&
D,Anaphylaxis
Adrenalineisthedrugofchoiceforanaphylaxis(anaphylacticshock)
->anallergichypersensitivityreaction(Type-lhypersensitivity).
1stlinedrugusedincardiopulmonaryresuscitation.

---

76.Drug(s)causingQTintervalprolongation?
a)Amiodarone
b)Cisapride
c)Calciumgluconate
d)Magnesiumtherapy
e)Ketoconazole
CorrectAnswer-A:B
Ans.(A)Amiodarone&(B)Cisapride
[Ref:KDTVh/ep.528;Davison27d/ep.571]
DrugsthatprolongQ-Tinterval(havepotentialtoprecipitate
Torsadesdepointes)
Antiarrhythmics=Quinidine,procainamide,disopyramide,
propafenone,amiodarone
Antimicrobials=Quinine,mefloquine,artemisinin,halofantrine,
sparfloxacin,gatifloxacin
Antihistamines=Terfenadine,astemizole,ebastine
Antidepressants=Amitriptylineandothertricyclics
Antipsychotics=Thioridazine,risperidone
Prokinetic=Cisapride

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77.Whichofthefollowingdrugsisexcreted
mainlybykidney?
a)Tetracycline
b)Rifampicin
c)Digoxin
d)Penicillin
e)Lithium
CorrectAnswer-A:C:D:E
Ans.(A)Tetracycline(C)Digoxin(D)Penicillin&(E)Lithium
[Ref:KDTp.695;Katzung13'h/ep,790]
Lithium=>95%renalexcret
Penicillin=Excretedbythekidney,10%byglomerularfiltrationand
90%bytubularsecretion.
Digoxin=Primarilyexcretedbykidney
Tetracyclines=Primarilyexcretedinurine,exceptfordoxycycline.
Rifampicin=Excretedmainlyinbile,someinurine;Urineand
secretionsmaybecomeorange-red.

---

78.Whichofthefollowingistruestatement(s)
aboutcodeine?
a)Usedasanti-tussiveagent
b)Analgesicpotencyisequivalenttomorphine
c)Causesrespiratorydepression
d)Partlymetabolizedtomorphine
e)Completelymetabolizedtomorphine
CorrectAnswer-A:C:D
Ans.(A)Usedasanti-tussiveagent(C)Causesrespiratory
depression&(D)Partlymetabolizedtomorphine
[Ref:KDT7/ep.474;Katzungljh/ep.545-49]
Codeine:
Codeineisapureopioidagonistwhichislesspotentthanmorphine
(1/l0sanalgesicaction).
Ithaspartialagonisticactivityonopioidreceptorswithalowceiling
effects.
Partlyconvertedtomorphineinthebody.
Itisusedasantitussive(drugsforcough)andantidiarrhealdrugs
Ceusasamedegreeofrespiratorydepressionasmorphine.

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79.Whichofthefollowingis/arefeatureof
drowning?
a)Oedemaaquosuminlung
b)Emphysemaaquosumispresumptiveevidenceofdeathfrom
drowning
c)altaufshaemorrhagesisseensubpleural
d)Gettler'stestisusedtotestchloridecontentofbloodfromboth
sidesoftheheart
e)Lungisballoonedandlightinseawaterdrowning
CorrectAnswer-A:B:C:D
Ans.is'a'i.e.,Oedemaaquosuminlung;'b'i.e.,Emphysema
aquosumispresumptiveevidenceofdeathfromdrowning;'c'
i.e.,Paltaufshaemorrhagesisseensubpleurally;&'d'i.e.,
Gettler'stestisusedtotestchloridecontentofbloodfromboth
sidesoftheheart[RepReddy33'd/ep.369-70;Parikh7"/ep.
192-93]
Theeyesarehalfopenedwithdilatedpupil,congestedconjunctiva
andalmostnilpetechialhamorrhage.
Cutisanserina(gooseskin),i.e.granularappearanceofskinwith
erecthairduetocontractionoferectorpili.
Washerwomanhandandfeed,i.e.bleachedandcorrugated
appearanceofpalmandsoles.
White,fine,lathery,abundantandtenacious(sticky)frothof
noseandmouth.Frothincreasesinamountoncompressionofthe
chest.Frothinthenoseandmouthisalsoseenincertainpoisoning,
e.g.cocaine,organophosphorus,morphine(opioids)and

---

barbiturates.Butthefrothisneithersofinenorsocopicusand
persistentinthesepoisonings.
Weeds,grass,plants,mudorstonesintightlyclenchedhand.Itis
duetocadavericspasmandstronglysuggestthattheperson
wasalivewhendrowned,asitindicatesthestruggleofpersonfor
life.Abradedtipsoffingersandtoes,andsandunderdamagednails
havesamesignificance.
Emphysemaaquosumisseeninwetdrowning.Inthiscondition,the
lungsarecharacterizedbyruptureofaleveolarspaceswith
accumulationofhemolyzedbloodwithwaterandsmallamountof
air.Thisconditionresultsfromviolentrespiratoryeffortswhenthe
victimissubmergedinconsciousstate.
Oedemaaquosumisaconditionoflungcharacterizedby
oedematouschangedueaccumulationofsomewaterinlung.This
conditionresultsduetopassiveentranceofwaterinthelungswhen
thevictimissubmergedinunconsciousstatehavingnoviolenteffort
forrespiration.Itisseeninsubmersionofunconscious

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80.Testusedforbloodstainsdetectionis/are
allexcept
a)Barberio'stest
b)Kastle-meyertest
c)Benzidinetest
d)Acidphosphatasetest
e)Takayamatest
CorrectAnswer-A:D
Ans.is'a'i.e.,Barberio'stest;&'d'i.e.,Acidphosphatase
test[RefReddy33'p.450-51,435-36;Parikh7th/ep.492-93,484-
86]
thesetestsarebasedonH202andperoxidaseenzyme.Tests
are:
Benzidinetest:Greenishbluecolour.
Phenolphthaleintest(kastlemeyertest):Deeppermanganate
colour.
Leucomalachitegreentest:Bluishgreenorpeacockbluecolour.
Guaiacumtest:Bluecolour.
Orthotoludinetest(kohntest):Blueorgreencolour.
Amidopyrinetest:Purplecolour.
Teichmann'shaemincrystaltest.
Takayamahemochromogencrystaltest

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81.Doctorsroleinnotingdyingdeclarationis
to?
a)Ascertaincomposmentis
b)Callthemagistrate
c)Elicitinformationbyleadingquestions
d)Asktheinvestiatingmedialofficertobethere
e)None
CorrectAnswer-A
Ans.is'a'i.e.,Ascertaincomposmentis
Dyingdeclaration
Itisthewrittenorverbalstatementmadebyapersonlikelytodie
becauseofsomeunnaturalactdoneonhisbody,naratingthe
circumstancesortheconditionsresponsibleforhispresentstateof
healthorthecauseandmanneroflikelyunnaturaldeath.
Ideallydyingdeclarationshouldberecordedbyexecutiveor
honorarymagistrate,butcanalsoberecordedbydoctor,village
headman,policeoranyotherperson,ifthereisnotimetocalla
magistrate.Doctorhastocertifythepatienttobecomposmentis
(soundmind).Itisrecordedinpresenceoftwodisinterested
witnesses.Relativesandpoliceofficersarenotallowedtobe
present.Nooathisadministered.
Itcarrieslessweightthandyingdepositionasnocross-examination
ispossible.Ifthepatientdoesnotdieaftertherecordingof
declaration,thedyingdeclarationlosesitsimportancesicenowhe
canbecalledtothecourtandhisevidencecanberecordedafter
cross-examination.

---

---

82.Whichofthefollowingis/aredangerous
injuryinforensicscience?
a)Injurycausingendangertolifeifnottreatedtimely
b)Hearingloss
c)Lossof2-3teeth
d)Synonymouswithgrievousinjury
e)Emasculation
CorrectAnswer-A
Ans.is'a'i.e.,Injurycausingendangertolifeifnottreated
timely[RefReddy33rd/ep.293;Parikh7m/ep.263]
Injuriescanbedividedinto(i)Simple(ii)Grievousand(iii)
dangerous.
Asimpleinjuryisonewhichisneitherextensivenorserious,and
whichwouldhealrapidlywithoutleavinganypermanentdeformityor
disfiguration.
Agrievousinjuryisone(i)Whichisextensiveorserious(ii)Which
doesnothealrapidly,and(iii)Whichleavesapermanentdeformity
ordisfiguration.
1. Emasculation(cuttingofthepenis,castration;orcausinglossof
poweroferectionduetospinalinjury).
2. Permanentprivationofthesightofeithereye.
3. Permanentprivationofthehearingofeitherear.
4. Privationofanymember(part,organ,limb)orjoint.
5. Destructionorpermanentimpairingofpowersofanymemberor
joint.
6. Permanentdisfigurationofheadorface.

---

7. Fractureordislocationofaboneoratooth.
8. Anyhurtwhichendangerslifeorwhichcausesthesufferertobe,
duringthespaceoftwentydaysinseverebodilypain,orunableto
followhisdailyroutine.
9. Section319IPCdefineshurtasbodilypain,disease,orinfirmity,
causedtoanyperson.

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83.Whichofthefollowingfeatures(s)is/are
morecommoninstrangulationratherthan
hanging-
a)Paleface
b)Fracturesoftracheaandlarynx
c)Congestedfaces
d)Transverseligature
e)Bruisesatedgesoftheligaturemark
CorrectAnswer-B:C:D:E
Ans.is'b'i.e.,Fracturesoftracheaandlarynx;'c'i.e.,
Congestedfaces;'d'i.e.,Transverseligature;&`e'i.e.,Bruises
atedgesoftheligaturemark[RefReddy33rdiep.351]

Strangulation
Hanging
1. Nosuspension
2. Compressiononneckisbya
1. Thereissuspensionofbody.
ligature,hands,sticks,
2. Compressiononneckisbyaligature elbow,kneeorfoot.
3. Forceofcompressionistheweighto
3 f
. Itisoutsideforceapplied
body(endogenousorce)
(exogenousforce).
4. Ligaturemarkisabovethethyroidis
4. Markisonorbelowthe
oblique,symmetricalandincomplete. thyroid.Ishorizontal,
5. Knotusuallypresent.
completeandcontinuous(in
6. Usuallynomarkatsiteofknot:In
absenceofligaturemark
fixedknot,markisinverted'V'
thereareotherinjurieson
shaped.
neckdependingupontypeof

---

7. Markusuallysingle.
strangulation).
8. Surfaceofmarkabradedor
5. KnotUsuallyabsent.
contused.
6. Markishorizontal,complete
9. Surfacemayshowpatternofligature andcontinuous.
used.
7. Usuallymultiplemarks.
10. Surfacehard.Mark-yellowishbrown8. Usuallylacerated.
incolour
9. Patternnotseen
10. Soft,duetofrankbleeding.
Black.

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84.SaturatedNaCIisanotusedin
preservationofviscerainwhichofthe
followingpoisoning?
a)Sodiumhydroxide
b)Aconite
c)Carbolicacid
d)Sulphuricacid
e)None
CorrectAnswer-A:B:D
Ans.is'a'i.e.,Sodiumhydroxide;`b'i.e.,Aconite;&'d'i.e.,
Sulphuricacid[RefReddy33"Yep.124;Parikh7TVep.108-09]
1. Saturatedsodiumchloride:Inallcasesofpoisoningexcluding
corrosiveacidsexceptcarbolicacids(phenol),alkalis,corrosive
sublimateandaconite.
2. 30mgpotassiumoxalate(anticoagulant)and10mlsodiumfluoride
(enzymeinhibitor):Bloodinsuspectedpoisoningincludingalcohol
butexcludingoxalicacid,ethyleneglycol,fluoride,carbonmonoxide.
3. Rectifiedspirit:Allexceptincasesofpoisoningby:(i)phenol,
phosphorus,paraldehyde,(ii)kerosene,(iii)formaldehyde,formic
acid,(iv)alcohol,aceticacid(v)chloroform,chloralhydrate,(vi)
ether.
4. 10mg/mlNa/K.flurideand3mgK-oxalate:Forpreservingblood;
flurideisalsoaddedtoCSF,vitreoushumor;andurineifalcohol
estimationisrequired;andalsoinanalysisofcocaine,cyanideand
carbonmonoxide.

---

85.Whichofthefollowingdyadofdisease
andincubationperiodis/arecorrectly
matched?
a)Measles:4-5day
b)Chickenpox:3-20day
c)Bubonicplague:2-5day
d)Leptospirosis:4-20days
e)HeptatisA:45-180day
CorrectAnswer-C:D
Ans.is'c'i.e.,Bubonicplague:2-5days;&d.Leptospirosis;4-
20days[RefPark's24thIep.157;Ananthanarayan9th/e
p.322,512,381;Harrison's19ffi/ep,1/831
BubonicplaguecausedbyYarsiniapestis2-7days
LeptospirosiscausedbyH1N1TypeAinfluenza1-4days1-3

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86.TrueaboutHumanpapillomavirus?
a)Belongstofamilypapovaviridae
b)DNAvirus
c)RNAvirus
d)Enveloped
e)Causesanalwarts
CorrectAnswer-A:B:E
Ans.is'a'i.e.,Belongstofamilypapovaviridae;'b'Le.,DNA
virus&`e'i.e.,Causesanalwarts[Ref:Ananthanarayan9th/e
p.553;Harrison's19thlep.1197-99;Robbins(SEA)9Thlep.326].
HPVisanonenvelopedDNAvirus(dsDWA),belongsto
Papovaviridae.
HPVcausesanogenitalwarts(condylomaaccuminata).

---

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

---

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

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88.Antigenpresentingcell(s)is/are?
a)Skinlangerhanscell
b)T-lymphocytes
c)Macrophages
d)Kuffercell
e)Thymicepithelialcells
CorrectAnswer-A:C:E
Ans.is'a'i.e.,Skinlangerhanscell;'c'i.e.,Macrophages;ie.,
Kuffercell;&`e'i.e.,Thymicepithelialcells[Ref
Ananthanarayan9th/ep.137-38;Greenwood16thlep.133-34]
Importantantigenpresentingcellsaremacrophages,B-cells,
dendriticcellsandLangherhanscells.Dendriticcellsarethemost
potentandeffectiveantigenpresentingcells.
CD4helparTcellsareactivatedonlywhenantigenispresentedby
MHC-classIIofAPC-->MHC-Hrestricted.
CD8cytotoxicT-cellsrecognizeantigenthatispresentedbyMHC-
classI-->MHC-Irestricted.
B-cellsreceptors(i.e.surfaceimmunoglobulin)canbebindto
antigenandactivateB-cellswithoutinvolvementofMHCand
antigenpresentingcellsAntigenprocessingandpresentationby
APCsisnotrequiredforBcells(incontrasttoT-cells).

---

89.DeficiencyofbothTandBlymphocyte
involvedinallexcept?
a)Chronicmucocutaneouscandidiasis
b)Wiskott-Aldrichsyndrome
c)DiGeorgesyndrome
d)AtaxiaTelangiectasia
e)Commonvariableimmunodeficiency
CorrectAnswer-A:C:E
Ans.is'a'i.e.,Chronicmucocutaneouscandidiasis;'c'i.e.,
DiGeorgesyndrome;&`e'i.e.,Commonvariable
immunodeficiency[RefAnanthanarayan9th/ep.174-75;
Robbin's7h/ep.239-401

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90.Dimorphicfungiis/are?
a)Histoplasmacapsulatum
b)Sporothrixschenckii
c)Malasseziafurfur
d)Cryptococcusneoformans
e)Aspergillus
CorrectAnswer-A:B
Ans.is'a'i.e.,Histoplasmacapsulatum;&'b'i.e.,Sporothrix
schenckii[RefAnanthanarayanelep.601,609;Jawetz23'/ep.
6451.
Fungithathavetwogrowthforms,suchasmold(filaments)anda
yeast,whichdevelopunderdifferentgrowthconditions.
Inhosttissuesorculturesat37?Ctheyoccurasyeasts,whileinthe
soilandinculturesat22?Ctheyappearasmoulds.
Yeastsareseenasroundedsinglecellsorasbudding
organisms.CandidaandCryptococcusaretraditionallyclassifiedas
yeasts.
Mostfungicausingsystemicinfectionsaredimorphicfungi
DimorphicFungiareJawetz27th/853
Blastomycosisdermatitidis
Paracoccidioidesbrasiliensis
Coccidioidesposadasii&Coccidioidesimmitis
Histoplasmacapsulatum
Sporotrixschenckii
Penicilliummarneffe

---

91.NontureaboutDonovanosis?
a)CausedbyKlebsiellagranulomatis
b)Associatedwithpseudobuboes
c)CausedbyLeishmaniadonovani
d)DrugofchoiceisMiltefosine
e)Drugofchoiceissodiumstibogluconate
CorrectAnswer-C:D:E
Ans.is'c'i.e.,CausedbyLeishmaniadonovani;'d'i.e.,Drugof
choiceisMiltefosine;&`e'i.e.,Drugofchoiceissodium
stibogluconate[RefAnanthanarayan9th/ep.397;Harrison's
19th/ep.298e1-2;Greenwoodtelep.310;Park's24th/ep.350]
DonovanosisiscausedbyCalymmatobacteriumgranulomatis,a
gramnegativeintracellularbacteria.Incubationperiodof
donovanosisis1to4weeks.Itbeginsasoneormoresubcutaneous
nodulesthaterodethroughskintoproduceanulcer.
AzithromycinistheDOCAlternativesaredoxycycline(2"choice)
andchloramphenicol.Streptomycin,onceused,isnotinuse
now.Note:Calymmatobacteriumgranulomatisisnowcalledas
Klebsiellagranulomatis.

---

92.TrueaboutActinomycosis?
a)Causedbymadurellamycetomatis
b)Causedbyanaerobicormicroaerophilicbacteria
c)Cervicofacialisthemostcommonsiteaffected
d)Sulphurgranulesarepresentinlesion
e)Belongstogrowthfactorcategoryofoncogene
CorrectAnswer-B:C:D:E
Ans.is'b'i.e.,Causedbyanaerobicormicroaerophilicbacteria
;'c'i.e.,Cervicofacialisthemostcommonsiteaffected;`d'
i.e.,Sulphurgranulesarepresentinlesion;&`e'i.e.,Belongsto
growthfactorcategoryofoncogene[RefAnanthanarayan9"'/e
p.391-93,600-01;Greenwood16"/ep.221-22;
Harrison's19th/ep.1088]
Theseareconsideredasatransitionalformbetweenbacteriaand
fungi.
Actinomycesare`gram-positive'non-motile"non-capsulated"non-acid
fast'and'non-sporing'filamentsthatbreakupintobacillaryand
coccoidelements.
Theyareanaerobicormicroaerophilic(Ananthnarayan9th/ep.391-
393)
TwoimportantspeciesareA.israelliandA.bovis.Mostcasesare
duetoAisraelli.
Actinomycesaremembersofnormaloralfloraandareoften
culturedfrombronchi,G.I.tract,andthefemalegenitaltract.
Actinomycosisinhumanbeingsisanendogenousinfection.
Thecriticalstepinthedevelopmentofactinomycosisisdisruptionof

---

mucosalbarrier.

---

93.Trueregardingleptospirosisis?
a)Ratsaretheonlyreservoirs
b)FluoroquinolonesaretheDOC
c)Persontopersontransmissionrare
d)Hepatorenalsyndromeoccursin50%cases
e)None
CorrectAnswer-C
Ans.(c)i.e.Persontopersontransmissionrare
Note:-Weilsyndromedevelopsin5-10%ofinfectedindividual
TreatmentofchoiceforleptospirosisisAmpicillin
Doxycyclineisthedrugofchoiceforchemoprophylaxis.

---

94.Whichistrueaboutsyphilis:
a)VDRLtestdetectsantibodies
b)Jarischherxheimerreaction-IgEmediated
c)Penicillinispreferredtreatmentforprimaryandsecondary
stage
d)RPRcanbedoneforCSF
e)None
CorrectAnswer-A:C
Ans(aandc)VDRLtestdetectsantibodies,Penicillinis
preferredtreatmentforprimaryandsecondarystage
Jarisch:Herxheimerreactionismediatedbyreleaseoflipoproteins,
cytokinesandimmunecomplex.
Evaluationforneurosyphilis:
Pleocytosis,increasedproteinconcentration
CSFVDRLishighlyspecificandwhenreactiveisconsidered
diagnosticofneurosyphilis
PatientwithRPRtitre1:32areathigherriskfordeveloping
neurosyphilis.

---

95.Waterlossof5fi)-l0ffiml/hourincholera
isknowas-
a)Choleragravis
b)Choleramitis
c)Choleramajoris
d)Choleraintermedius
e)Choleratotalis
CorrectAnswer-A
Anwer-Ans.is'a'i.e.,Choleragravis[RefHarrison's
19m/ep,1063;www.ncbi.nlm.nih.gov]
Vibriocholerainfectionmanifestationsrangefromasymptomaticto
milddiarrheatoseverediarrhea.
Massivewaterydiarrhea(knownascholeragravis)maycauseloss
of1000mlwaterperhour.Thiscancausehypotensiveshock&
death.

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96.Organism(s)commonlycausing
infectionincysticfibrosispatients
a)Burkholderiacepacia
b)PseudomonasAeruginosa
c)StaphylococcusAureus
d)BurkholderiaMallei
e)StreptococcusPyogenes
CorrectAnswer-A:B:C
Ans.is'a'i.e.,Burkholderiacepacia;'b'i.e.,Pseudomonas
aeruginosa;&'c'i.e.,Staphylococcusaureus[RefHarrison
19m/ep.1699]
Infectionsseenincysticfibrosisarecausedby-
Burkholderiacepacia
Pseudomonasaeruginosa(mucoidtype)
Atypicalmycobacteria
Non-typeablehemophilusinfluenzae
Staphylococcusaureus(includingMRSA

---

97.Wbichofthefollowingis/areTick-
borne.disease-
a)Murinetyphus
b)Epidemicthyphus
c)Lyme'sdisease
d)Tularemia
e)Trenchfever
CorrectAnswer-C:D
Ans.is'c'i.e.,Lyme'sdisease;&'d'i.e.,Tularemia[RefPark's
24m/ep.817,805;Ananthanarayanlep.407;Greenwood16mle
p.350]
HardtickTicktyphus,viralencephalitis,viralhemorrhagicfever,
KFD,Tularemia,tickparalysis,humanhabesiosis,Lyme'sdisease.
SofttickQfever,relapsingfever,KFD.

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98.Barrelshapedeggsis/areseenin-
a)Hookworm
b)Pinworm
c)Roundworm
d)Whipworn
e)Strongyloidesstercoralis
CorrectAnswer-D
Ans.is'd'i.e.,Whipworm[RefRajeshkarykarte1"/ep.1661
EggsofTrichuris-trichura(whipworm)arebarrel-shapedwith
mucousplugateachpole.Shellisyellowtobrow(bile-stained)and
plugsarecolourless.Theyfloatinsaturatedsolutionofcommonsalt.
Whenfreshlypassed,theycontainunsegmentedovaandarenot
infectivetoman.

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99.Whichofthefollowingistrueabout
malaria-
a)ChloroquineresistanceoccursinIndia
b)Relapsesisusualforvivaxandovalemalaria
c)Sexualcycleoccursinmosquito
d)NotapublicprobleminIndia
e)None
CorrectAnswer-A:B:C
Ans.is'a'i.e.,ChloroquineresistanceoccursinIndia;'b'i.e.,
Relapsesisusualforvivaxandovalemalaria;&'c'i.e.,Sexual
cycleoccursinmosquito[RefKDT7Vep.822;Park24thlep.
272-75]
MalariacontiuestoposeamajorpublichealthprobleminIndia,
especiallyduetoP.falciparum.
Chloroquine-resistantP.falciparummalariainIndiaiswidespread.

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100.Trueabouthumandevelopmentindex
(HDI)-
a)Adultliteracyraterangefrom0to100
b)HDIscorerangeis0-10
c)Lifeexpectancyatbirthrangefrom25yearsto85years
d)GDPpercapitarangefrom25$to50000$
e)HDIscorerangeis0-l
CorrectAnswer-A:C:E
Ans.is'a'i.e.,Adultliteracyraterangefrom0to100;'c'ie.,Life
expectancyatbirthrangefrom25yearsto85years&`e'i.e.,
HDIscorerangeis0-1[RefPark's24thlep.17-18;
AccordingtoHDIcountriesaredivided?
1. Developedcountries(HighHDI0.8)-USA,Canada,Norway
2. Developingcountries(mediumHDI0.5-0.79)-India
3. Underdevelopedcountries(LowHDI0.5)Seiera,Ethopia

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101.VaccinecontraindicatedinAIDS
patient-
a)MMRvaccine
b)HepatitisAvaccine
c)Varicellavaccine
d)Hibvaccine
e)DPTvaccine
CorrectAnswer-A:B:C
Ans.is'a'i.e.,MMRvaccine;'b'i.e.,HepatitisAvaccine;&'c'
i.e.,Varicellavaccine
[RefPark's24thlep.108;CommunityMedicinebyPiyushGupta
1"/ep.428;CommunityMedicinewithRecentAdvancesby
Suryakantha4th/ep.287;O.P.Ghai8thlep.189-90]
Liveattenuatedvaccinesarecontraindicatedinimmunodeficiency
stateslikeHIV.
ImportantexamplesoflivevaccinesareBCG,OPV(Sabinoralpolio
vaccine),measles,mumps,rubella,yellowfever(17Dvaccine),
typhoidoral(typhoral),chickenpox,influenza,plague,epidemic
typhusandhepatitisA.

---

102.TruestatementaboutIPVvaccine-
a)GiventhroughIM/SCroute
b)Giventhroughintradermalroute
c)Doesnotrequirestringentconditions
d)Doseis-0.1ml/dose
e)Doseis-0.5ml/dose
CorrectAnswer-A:C:E
Ans.is'a'i.e.,GiventhroughIM/SCroute;'c'i.e.,Dosenot
requirestringentconditions;&`e'i.e.,Doseis-0.5ml/dose[Ref
Park's24th/ep.221-22;O.P.Ghai8th/ep.192]
IPVisadministeredbyintramuscular(preferred)orsubcutaneous
routes.
Theprimaryorinitialcourseofimmunizationconsistsof4
inoculation(4doses).Thefirst3dosesaregivenatintervalsof1-2
monthsand4thdose6-12monthsafterthethirddose.Firstdose
usuallygivenwhentheinfantis6weeksold.Additionaldosesare
recommendedpriortoschoolentryandthenevery5yearsuntilthe
ageof18.
ItcanbecombinedwithDPT,Hepatitis,and/orH.influenzaetypeB
vaccine.Inthecombinationvaccines,thealumorthepertussis
vaccine,orbothhaveanadjuvanteffect.
ThemajoradvantageofIPVisthatbeinganinactivatedvaccine,it
canbegiveninpregnancyandimmunocompromisedpersons
(personwithlymphoreticularmalignancies,onradiotherapyor
corticosteroid,>50yearsofage).
Theotherimportantadvantageisthatthereisnoriskofvaccine

---

associatedparalyticpolio(VAPP)asvirusisinactive.Vaccinedoes
notrequirestringentconditionsduringstorageandtransportation,
thushavinglongshelflife.Oneortwodosesoflivevaccine(OPV)
canbegivensafelyasboosterafteraninitialcourseofimmunization
withIPV.

---

103.Trueaboutdemographiccycleoflndia
-
a)Enteredintolowstationaryphase
b)Dependencyratio<40Vo
c)YearofBigdivide-l92lA.D
d)Populationpyramidhasabroadbaseandataperingtop
e)FirstregularcensusinIndiawascarriedin1881
CorrectAnswer-C:D:E
Ans.is'c'i.e.,YearofBigdivide-1921A.D;'d'i.e.,Population
pyramidhasabroadbaseandataperingtop;&`e'i.e.,First
regularcensusinIndiawascarriedin1881
[RefPark's24th/ep.513-518;CommunityMedicinebyPiyush
GuptaPlep.610-12;CommunityMedicinewithRecentAdvance
bySuryakantha4th/ep.651-57]
Theproportionofpersonsabove65yearsofageandchildrenbelow
15yearsofageareconsideredtobedependentontheeconomically
productiveagegroup(15-64years).Theratioofcombinedage
group0-14yearsplus65yearsandabovetothe15-65yearsage
groupisknownastotaldependencyratio.
Incountrieswithhighbirthrates(e.g.developingcountrieslike
India),populationpyramidhasabroadbaseandataperingtap/apex
(conicalshape).
Indevelopedcountries,thepyramidgenerallyshowabulgeinthe
middleandnarrowerbase(dumb-bellshaped).CensusinIndia
CensusisveryimportantsourceofhealthinformationinIndia.Itis
carriedatregularintervalof10years.ThefirstcensusinIndiawas

---

takenin1881.LastcensuswasheldinMarch2011.
CensusisunderMinistryofHomeAffairsandheadofcensus
organizationis'RegistrarGeneralandCensusCommissioner'.
Inrecentcensus(2011)Biometrywasincludedfirsttimeever:
Fingerprints,Irisscan,UID(uniqueidentificationnumber)and
photograph.
Thereferraltimeanddateatwhichsnapshotofpopulationistaken
iscalledcensusstop(censusmovement),whichis00.0hrs01
March,i.e.Censusstops.

---

104.Whichofthefollowingis/aretrue
aboutsandfly-
a)Breedonoverheadtanks
b)Smallerthanmosquito
c)Femaleflydoesnotbites
d)Don'tflybychoice
e)None
CorrectAnswer-B:D
Ans.is'b'i.e.,Smallerthanmosquito;&'d'i.e.,Don'tflyby
choice[RefPark24th/ep.812-13]
Size:Sandfliesaresmallerthanmosquitoes.
Wings:Thewingsofthesandflyareup-rightandlanceolatein
shape;thesecondlongitudinalveinbranchestwice,thefirst
branchingtakingplaceinthemiddleofthewing.
Legs:Thelegsofthesandflyarelongercomparedwiththesizeof
thebody.
Hairs:Sandflyisahairyinsect
Hopping:Sandflieshopaboutanddonotflybychoice
Onlyfemalesandfliesbite.Theyrequireabloodmealevery3-4
daysforoviposition.Theyinhabitatholesandcrevicesinwalls,
holesintrees,darkrooms,stablesandstorerooms.
Sandflyconnotfly,itonlyhops.
TheinsecticideofchoiceisDDTassandflieshavenotdeveloped
resistance.DDTissprayeduptoaheightof4-6feetofwalls.

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105.Periodofcornmunicabilityofmeasles
is-
a)3daysbeforeand10daysafterappearanceofrashes
b)3weeksafterappearanceofrashes
c)Iweekbeforeappearanceofrashes
d)4daysbeforeand5daysafterappearanceofrashes
e)Upto3monthsafterappearanceofrashes
CorrectAnswer-D
Ans.is'd'i.e.,4daysbeforeand5daysafterappearanceof
rashestRef:Park24th/ep.157;CommunityMedicinewith
RecentbySuryakantha4th/ep.328]
Chickenpox:1-2daysbeforeto4-5daysafterappearanceof
rash.
Measles:4daysbeforeto5daysafterappearanceofrash.
Rubella:7daysbeforesymptomsto7daysafterappearanceof
rash.
Mumps:4-6daysbeforesymptomsto7daysthereafter.
Influenza:1-2daysbeforeto1-2daysafteronsetofsymptoms.
Diphtheria:14-28daysfromdiseaseonset.
Pertussis:7daysafterexposureto3weeksafterparoxysmalstage.

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106.Whichofthefollowingis/aretrue
aboutnationalironplusinitiotive-
a)Onlyschoolgoingadolescentsarecovered
b)Adolescentsofagegroupl0-19yrarecovered
c)Preschoolchildrenarecoveredthroughaganwadicenter
d)Biannuldewormingthroughalbendazoletablet
e)Screeningoftargetgroupsformoderate/severeanaemia
andreferringthesecasestoanappropriatehealthfacility
CorrectAnswer-B:D:E
Ans.is'b'i.e.,Adolescentsofagegroup10-19yearare
covered;'d'i.e.,Biannuldewormingthroughalbendaz,ole
tablet;&'e'i.e.,Screeningoftargetgroupsformoderate/severe
anaemiaandreferringthesecasestoanappropriatehealth
facility[RefPark's24`5/ep.471;
http://nhm.gov.in/nrhmcomponnets;CommunityMedicineby
PiyushGupta1"/ep.814-15;Suryakantha4thlep.196-97]
Bi-weekly20mgelementalironand100microgram(mcg)folicacid
permlofliquidformulationandageappropriatede-wormingfor
preschoolchildrenof6-59months.
Weeklysupplementationof45mgelementalironand400mcgfolic
acidperchildperdayforchildrenfrom1stto5thgradeingovt.&
Govt.Aidedschools,andatAWCforoutofschoolchildren(6to10
years).
Weeklydoseof100mgelementalironand500mcgfolicacidwith
biannualde-worminginadolescents(10-19years)underWIFS.
Weeklysupplementationforwomaninreproductiveage,Pregnant

---

andlactatingwomen.
Screeningoftargetgroupsformoderate/severeanemiaand
referringthesecasestoanappropriatehealthfacility.

---

107.Whichofthefollowingis/aretrueabout
RevisedNationalTuberculosisControl
Programme(RNTCP)-
a)T.B.ismandatorytonotify
b)SuspiciousTBpatientsarescreenedthrough2sputum
smearexaminations
c)MDR-TBisnotincludedinRNTCP
d)Casefindingisactive
e)CoveredthewholecountrysinceMarch2006
CorrectAnswer-A:B:E
Ans.is'a'i.e.,T.B.ismandatorytonotify;`b'i.e.,SuspiciousTB
patientsarescreenedthrough2sputumsmearexaminations&
'e'i.e.,CoveredthewholecountrysinceMarch2006
[RefPark's24th/ep.427-30;CommunityMedicinebyPiyush
Gupta1"/ep.826-30;Suryakantha4'1*p.921-23;National
HealthProgramsofIndiabyfungalKishore7th/ep.91]
GovernmentofIndiadeclareTBanotifiablediseaseon7thMay
2012withfollowingobjectives:-
TohaveestablishedTBsurveillancesysteminthecountry.
ToextentmechanismofTBtreatmentadherenceandcontact
tracingofpatientstreatedintheprivatesector.
ToensureproperTBdiagnosisandcasemanagementandfurther
acceleratereductionofTBtransmission.
TomitigatetheimpendingdrugresistantTBepidemicinthecountry.

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108.9-valentHPVvaccinecoverswhich
type(s)HPVstrain-
a)6,11
b)16,18
c)31,33
d)41,35
e)42,58
CorrectAnswer-A:B:C
Ans.(A)6,11(B)16,18(C)31,33
The9-valentHPVvaccine,whichprotectsagainstHPVtypes6,11,
16,18,31,33,45,52and58,issafeandeffectiveandwillfurther
reducetheincidenceofHPVinfection,aswellasHPV-related
cancers.
TherearetwotypesofHPVvaccines:-
Quadrivalent:-containingHPVtypes6,11,16,18
Bivalent:-containingHPVtypes16,18

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109.Trueaboutpopulationcoverageof
primaryhealthcenter?
a)20000inplainarea
b)30000inplainarea
c)10000intribalarea
d)20000intribalarea
e)30000intribalarea
CorrectAnswer-B:D
Ans.is'b'i.e.,30000inplainarea;&'d'i.e.,20000tribalarea

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110.Whichofthefollowingistrueaboutpost
exposureprophylaxisinrabies?
a)CategoryI-Bothvaccineandimmunoglobulinaregiven
b)Immunoglobulinnotrequiredifpriorfullvaccinationisreceived
c)Localwoundcleaningisdoneinallcasesofdogwound
d)CategoryI-requiresvaccinationonly
e)Vaccineisstoppedifwithin3daysofbite,dogdies
CorrectAnswer-B:C
Ans.is'b'i.e.,Immunoglobulinnotrequiredifpriorfull
vaccinationisreceived;&'c'i.e.,Localwoundcleaningisdone
inallcasesofdogwound[RefPark's24'h/ep.296-97;
CommunityMedicinebyPiyushGupta1"/ep.3231
Cleansing:Withplentyofsoapandwater,preferablyundera
runningtap.
Suturing:Itshouldnotbedoneimmediately;ifrequiredshouldbe
done24-48hourslater,withminimumpossiblestitches.
CategoryI-touchingorfeedinganimals,licksonintactskinNone
CategoryII-nibblingofuncoveredskin,minorscratchesof
Immediatevaccinationandlocaltreatmentofthewoundabrasions
withoutbleeding
CategoryIII-singleormultipletransdermalbitesorscratches,licks
onbrokenskin;-->Immediatevaccinationandadministrationof
rabies
contaminationofmucouscontactswithbatsimmunoglobulin;
localtreatmentofthewoundmembranewithsalivafromlicks,etc.

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111.Contraindicationofcochlear
implantationis/are-
a)Mondinideformity
b)Intracochlearossification
c)Chronicsuppurativeotitismedia
d)Agenesisofcochlearnerve
e)All
CorrectAnswer-C:D
Answer-(C)Chronicsuppurativeotitismedia(D)Agenesisof
cochlearnerve
Absolute
1. Activemiddleearinfection:ASOM,CSOM,mastoiditis
2. Agenesisofcochleaand/orCochlearnerve
3. Mentalretardion:Patientcannotcooperatewithspeechtraining

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112.Premalignantlesionoforalcavity
includes
a)Lichenplanus
b)Erythroplakia
c)Bowendisease
d)Behchetdisease
e)None
CorrectAnswer-B
Answer-B.Erythroplakia
Premalignantcondition:-Leukoplakia,Erythroplakia,Speckled
erythroplakia,chronichyperplasticcandidiasis.

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113.Whichofthefollowingis/aretrueabout
lefortsfracture
a)Itisfractureofzygomaticbone
b)MaycauseCSFrhinorrhea
c)Type1:completeseparationoffacialbonesformthecranial
bones
d)Classifiedastypes1to5
e)None
CorrectAnswer-B
Answer-B.MaycauseCSFrhinorrhea
LeFortI(transverse)-crosseslowerpartofnasalseptum,maxillary
antraandthepterygoidplates.
LeFortII(pyramidal)-passesthroughtherootofnose,lacrimal
bone,flooroforbit,upperpartofmaxillarysinusandpterygoidplates
LeFortIII(craniofacialdysjunction)-Thereiscompleteseparation
offacialbonesfromthecranialbones.
Clinicalfeaturesofmaxillaryfracture-
Malocclusionofteeth
Mobilityinthemaxilla
CSFrhinorrhoea.

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114.Trueaboutdevelopmentofcochlea
a)Cochleastartdevelopingfrom3rdweekofgestation
b)Semicircularcanalsdevelopaftercochlea
c)Cochleadevelopmentcompletesby20weekofgestation
d)Cochleadevelopmentcompletesat2yearofage
e)All
CorrectAnswer-A:C
Answer-A,Cochleastartdevelopingfrom3rdweekof
gestationC,Cochleadevelopmentcompletesby20weekof
gestation
Developmentofcochleastartsat3weeksandcompletesat20-22
weeksofintrauterinelife.
Semicircularcanaldevelopsearlierthancochlea.

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115.Whichofthefollowingis/aretrueabout
theT-stageofmaxillarysinuscarcinoma
-
a)StageT4a-frontalsinusinvolvement
b)StageT3-ethmoidsinusinvolvement
c)StageT2-sphenoidsinusinvolvement
d)StageT2-boneoftheposteriorwallofmaxillarysinus
e)None
CorrectAnswer-A:B
Answer-(A)StageT4a-frontalsinusinvolvement(B)StageT3-
ethmoidsinusinvolvement
T4a-Tumourinvadesanteriororbitalcontents,skinofcheek,
pterygoidplates,infratemporalfossa,cribiformplates,sphenoidor
frontalsinus.
T3-Tumourinvadesanyofthefollowing-boneoftheposteriorwall
ofmaxillarysinus,subcutaneoustissues,floorormedialwallorbit,
pterygoidfossaandethmoidsinuses.
T2-Tumourcausingboneerosionordestructionincludingextension
intothehardpalateandmiddlenasalmeatus,exceptextensionto
posteriorwallofmaxillarysinusandpterygoidplates.

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116.Trueaboutforeignbodiesofairpassage
inchildrenexcept-
a)Vegetableforeignbodiesarenotcommon
b)Trachealobstructioncancausessuddendeath
c)Morecommoninrightbronchus
d)Morecommoninchildrenoflessthan4yrofage
e)CTscanofchestisdoneinallcases
CorrectAnswer-A:B:E
Answer-(A)Vegetableforeignbodiesarenotcommon
(B)Trachealobstructioncancausessuddendeath(C)More
commoninrightbronchus
Themostcommonagegroupis6monthsto4years.
Mostcommonforeignbodyaspiratedisnuts(peanuts).
Mostairwayforeignbodieslodgeinabronchus(rightmorethan
left).
Thechildpresentswithacuteonsetofcough-(most-common),
Chockinggagging,wheezing,respiratorydistress,aphonia,drooling
andstridor.
Bronchoscopyisdiagnosticaswellastherapeutic.

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117.Deformitiesoccurringinleprosypatients
is/are-
a)Faciesleonina
b)Lowsetear
c)Saddlenose
d)Lagophthalmos
e)Microganthia
CorrectAnswer-A:C:D
Answer-(A)Faciesleonina(C)Saddlenose(D)Lagophthalmos
Face-
Maskface,faciesleonina,Saddlenose,saggingface,
lagophthalmos,lossofeyebrows,perforatednose,depressednose,
eardeformities.

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118.Whichofthefollowingis/aretrueabout
schwartzsign-
a)Signofinactivedisease
b)Indicationforsurgery
c)Morecommonduringpregnancy
d)Reddishhueoverthepromontory
e)Seenintheearlystagesoftheotoscelerosis
CorrectAnswer-B:C:D:E
Answer-(B)Indicationforsurgery(C)Morecommonduring
pregnancy(D)Reddishhueoverthepromontory(E)Seeninthe
earlystagesoftheotoscelerosis
Schwartzsign(Flemingo'sflushsign)-
In10%ofcasesflamingo-pinkblushisseenthroughthetympanic
membranecalledasSchwartzsign
Itisseeninearlyandactivestageofthedisease.
Thesignischaracterizedbypinkblushseenthroughthetympanic
membranecausedbyreddishhueoverpromontoryduetoincreased
vascularityofthepromontory.
ThissignindicatesactiveostosclerosisusuallyduringPregnancy
Itseemsthatthesurgeryremainsatherapeuticoption,whenthe
activephaseofthediseaseisstabilizedevenfollowingashort
courseofpharmacologicaltherapy.

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119.Allaretrueaboutcentralretinalartery
occlusion(CRAO)except
a)Mostcommonlyoccursduetothromboembolus
b)Anteriorchamberparacentesisisusedfortreatment
c)Suddenpainfullossofvision
d)Occursduetoobstructionofretinalarteryattheleveloflamina
cribrosa
e)Macularareashowscherry-redspot
CorrectAnswer-C
Answer-C.Suddenpainfullossofvision
Patientnoticessuddenpainlesslossofvision.
Patients'swithapatentcilioretinalarterymayretaincentralvisionas
themaculaisspared.
Emboliarethemostcommoncauseofretinalarteryocclusion.
Obstructionoccursattheleveloflaminacribrosa.
Thelargerretinalarteriesareconstuictedandlooklikethinthreads
whilethesmallervesselsarescarcelyvisible.
Thefundusappearsmilkywhitebecauseofretinaledema.
Thereischerry-redspotatthemacula.
Bloodcolumnwithintheretinalveinsissegmented(Cattletracking)

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120.Nottrueaboutbluesclera
a)Seeninosteogenesisimpertca
b)DoesnotseeninEhlers-danlossyndrome
c)Bluecolourisproducedbyunderlyinguvealpigment
d)Seeninmarfan'ssyndrome
e)Scleraisthin
CorrectAnswer-B
Answer-B.DoesnotseeninEhlers-danlossyndrome
BlueScleraischaracterizedbymarked,generalizedblue
discolourationofscleraduetothinning,Theuvealpigmentshines
throughthethinscleraandproducesthebluecolour.
CausesofblueSclera:
Pseudoxanthomaelasticum
Osteogenesisimperfecta
Ehlers-Danlossyndrome
Marfan'ssyndrome
Alkaptonuria
Hypophosphatasia
Juvenilepaget'sdisease
Normalinnewborns
VanderHoeve'ssyndrome

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121.Cornealulcerisdefinedas
a)Erosionofepitheliumonly
b)Erosionofendotheliumonly
c)Erosionofepithelium+underlyinginflammation
d)Lossofendotheliumwithlossofcornealsensation
e)None
CorrectAnswer-C
Answer-C.Erosionofepithelium+underlyinginflammation
Cornealulcerreferstodiscontinuationinnormalepithelialsurfaceof
corneaassociatedwithnecrosisofthesurroundingcornealtissue

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122.Postoperativeendophthalmitisin
cataractsurgerycanbepreventedby
useof
a)Pre-operativeoralantibiotics
b)Intra-operativeIVantibiotics
c)Useofpovidone-iodinesolutiontopaintthelidsbeforesurgery
d)Cleaningandsterilizationofoperationtheatre
e)Postoptopicalantibiotics
CorrectAnswer-C:D:E
Answer-C,Useofpovidone-iodinesolutiontopaintthelids
beforesurgeryD,Cleaningandsterilizationofoperation
theatreE,Postoptopicalantibiotics
Thepre-operativetopicalantibioticshouldbestarted3dayspriorto
surgery.
Preferredantibioticsarefourthgenerationfluoroquinolones
(gatifloxacin,moxifloxacin).
Thetopicalantisepticpovidoneiodine5%instilledasasingledrop
l0-30minutesbeforesurgeryisoneofthemosteffectivemeasure
todecreasethisbacterialflora.
Methodofprophylaxysisagainstpostoperativeendophthalmitisisby
useofprovidonesolutionontheskinandinconjunctivalsac.
Post-operativelytopicalantibiotics(eyedrops)aregivenalongwith
steroidsforl0-14days.

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

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124.Whichofthefollowingstatement(s)
is/aretrueabouteyelidglands-
a)Mollaremodifiedsebaceous
b)Tarsalglandsaremeibomianglands
c)Glandofzeisaresweatgland
d)Meibomianglandsaremodifiedsebaceousglands
e)Externalhordeolumisanacutesuppurativeinflammationof
glandofZeis
CorrectAnswer-B:D:E
Answer-(B)Tarsalglandsaremeibomianglands(D)Meibomian
glandsaremodifiedsebaceousglands(E)Externalhordeolum
isanacutesuppurativeinflammationofglandofZeis
Aneyelidisathinfoldofskinthatcoversandprotectstheanterior
surfaceofeyeball.
Eyelidcontainsmanyglandsas-
1. Meibomianglands-Thesearealsoknownastarsalglands
2. GlandsofZeis:Thesearesebaceousglands
3. GlandsofMoll-Thesearemodifiedsweatglands
4. AccessorylacrimalglandsofWolfring
Stye(Hordeolumexternum)-
Onsetisacute
EffectedglandisZeis'sgland
Typeofinflammationsuppurative
C/F-Acutepainandhardswelling
Treatment-
Hotfomentation,antibiotics

---

---

125.Trueaboutinferioropthalmicvein-
a)Smallerthansuperiorophthalmicvein
b)Connectedtothepterygoidvenousplexus
c)Formedatlateralwallandflooroforbit
d)Passthroughsuperiororbitalfissure
e)Emptiesintosuperiorophthalmicvein
CorrectAnswer-A:B:D:E
Answer-(A)Smallerthansuperiorophthalmicvein
(B)Connectedtothepterygoidvenousplexus(D)Passthrough
superiororbitalfissure(E)Emptiesintosuperiorophthalmic
vein
1. Theinferiorophthalamicveinbeginsasavenousnetworknearthe
anteriorpartoforbitalfloornearmedialwalloforbit.
2. ItissmallerthanSuperiorophthalamicvein.
Dividedintotwobranches-
1. Inferiororbitalfissuretojoinpterygoidvenousplexus
2. Superiororbitalfissuretodrainintoeithersuperiorophthalmicvein
orintocavernoussinus.

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126.Whichofthefollowingcanbe
ophthalmiccomplicationofDMexcept-
a)Papillopathy
b)Snowflakecataract
c)Retinopathy
d)Rhegmatogenousretinaldetachment
e)Cystoidmacularoedema
CorrectAnswer-D
Answer-D.Rhegmatogenousretinaldetachment
Ocularmanifestationsofdiabeticretinopathyare-
1)Non-proliferativediabeticretinopathy(NPDR)-
Microaneurysms
Retinalhemorrhage
Retinaledema(Retinalthickening)-macularedema.
2)Proliferativediabeticretinopathy(PDR)
HallmarkofPDRistheoccuranceofneovascularization
3)Diabeticmaculopathy
Cataract(Snowflakesnowstorm)
Myopia(whenthereissuddenincreaseinbloodsugarlevel)
Rarelyhypermetropia
Cranialnervepalsy:3rd(mostcommon),4th,5th,7th.
Diabeticpapillopathy

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127.Whichofthefollowingis/aretrueabout
secondarycataract-
a)Treatmentofthickenedcapsulecanbedonebydiscissionwith
cystitome
b)TreatmentbyNd-YAGlaserposteriorcapsulotomy
c)Morecommonafterintracapsularcatractextractionthan
extracapsularcataractextraction
d)Posteriorcapsularopacification(PCO)
e)Anteriorsubcapsularcataract
CorrectAnswer-A:B:D
Answer-(A)Treatmentofthickenedcapsulecanbedoneby
discissionwithcystitome(B)TreatmentbyNd-YAGlaser
posteriorcapsulotomy(D)Posteriorcapsularopacification
(PCO)
Opacificationoftheposteriorcapsuleiscausedbypostoperative
proliferationofcellsinthecapsularbagandisthemostcommon
complicationofECCE.
Aftercataract,ifthin,canbeclearedcentrallybyNd:YAGlaser
capsulotomy.
Discissionwithcystitomeorzeigler'sknifemayalsobeused.

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128.Whichofthefollowingis/aretrueabout
mediallongitudinalfasciculus(MLF)and
itslesionexcept-
a)Unilaterallesionresultinadductionpalsyofoppositeeye
b)MLFconnectssixthcranialnervenucleusofonesidewiththe
thirdcranialnervenucleusoftheotherside
c)MLFisresponsibleforconjugateeyemovements
d)Itisanintegralcomponentofsaccadiceyemovements
e)Abductingnystagmusoftheeyecontralateraltothe
CorrectAnswer-A
Answer-A.Unilaterallesionresultinadductionpalsyof
oppositeeye
Voluntaryhorizontalgazeinonedirectionbeginswiththe
contralateralfrontaleyefields
Contralateralparamedianpontinereticularformation(PPRF),which
istheorganizingcenterforlateralgazeinthebrainstem
Medialrectusmuscleweaknessimpsilateraltothesideofthelesion
withparesisofadductionoradductionlag.

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129.Truestatementaboutdiabetic
ketoacidosisis/are?
a)Ph<7.3
b)Ketonemia
c)Absenturinaryketonebodies
d)Glucoselevel>300mg/dl
e)Bicarbonate<15meq/1
CorrectAnswer-A:B:D:E
Answer-A,B,D,E,Ph<7.3,Ketonemia,Glucoselevel>
300mg/dl,Bicarbonate<15meq/1
KetoacidosisisrareintypeIIdiabeteswhereinsulinlevelsalthough
functionallyinadequatearestillsufficienttopreventketonebody
formation.
ArterialpHis7.25-7.35,7.0-7.24&<7.0inmild,moderate&
severeDKA.
Diabeticketoacidosisischaracterizedby-
1. Hyperglycemia,
2. Ketosis(ketonemia)andketonuria
3. Acidosis
Ketonesareanearlyindicatorofdiabeticketoacidosisandshould
bemeasuredinindividlualwithtypeIdiabetesmellitus.
Whentheplasmaglucoseisconsistently>16.7mmol/L(300mg/dl).
Hyperketonemiaandacidosis-
Hormonesensitivelipaseisinhibitedbyinsulinandactivatedby
counterregulatoryhormones.
TheserumbicarbonatelevelinD.K.A.istypicallydecreasedtoless

---

than15meq/l.

---

130.ComponentsofAPACHE-11score
include(s)-
a)Age
b)Glassgowcommascale
c)Pa02
d)Alanineaminotransferase(ALT)
e)Serumlactate
CorrectAnswer-A:B:C
Answer-A,AgeB,GlassgowcommascaleC,Pa02
APACHEIIscoreincludesAge,GCS,Physiologicalparameters(BP,
RespiratoryRate,Pa02)andchronicmedicalconditions.
APACHEIISCORE(AcutePhysiologicalAndChronicHealth
EvaluationSystem)
TheAPACHEIIscoringsystemisthemostcommonlyusedseverity
ofillnessscoringsysteminNorthAmerica
TheAPACHEIIscoreisrecordedasthesumoftheAcute
physiologyscore(Vitalsigns,oxygenation,laboratoryvalues),GCS,
AgeandChronichealthpointsasdetailedinthefollowingtable.

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131.Whichofthefollowingdyadsare
correct
a)Pulsusparadoxus-aorticregurgitation
b)Pulsusbisferiens-mitralstenosis
c)Water-hammerpulse-aorticregurgitation
d)Pulsusparvusettardus-aorticstenosis
e)Collapsingpulse-aorticregurgitation
CorrectAnswer-C:D:E
Answer-C,Water-hammerpulse-aorticregurgitationD,Pulsus
parvusettardus-aorticstenosisE,Collapsingpulse-aortic
regurgitation

---

---

132.Whichofthefollowingis/aretrueabout
jugularvenouspressure(JVP)waveform
a)awaveoccurjustafterelectrocardiographicPwave
b)Prominentxandydescentsisseeninconstrictivepericarditis
c)Canonawavesoccurinatrioventricular(AV)dissociation
d)vwaveoccurinearlysystoleofcardiaccycle
e)Prominentxdescentbutanabsentydescentisseenincardiac
temponade
CorrectAnswer-A:B:C:E
Answer-A,awaveoccurjustafterelectrocardiographicP
waveB,Prominentxandydescentsisseeninconstrictive
pericarditisC,Canonawavesoccurinatrioventricular(AV)
dissociationE,Prominentxdescentbutanabsentydescentis
seenincardiactemponade
Atrialcontractionproducesthefirstpressurepeakcalledtheawave.
Thecwaveisthetransmittedmanifestationoftheriseinatrial
pressureproducedbythebulgingofthetricuspidvalveintotheatria
duringisovolumetricventricularcontraction.
Thevwavemirrorstheriseinatrialpressurebeforethetricuspid
valveopensduringdiastole.
a-xdescent-Constrictivepericalditis,Cardiactemponade,
Restrictivecardiomyopathy
v-ydescent-Ticuspidregurgitation,Constrictivepericarditis

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133.Exudativepleuraleffusionis/areseenin
allexcept-
a)Cirrhosis
b)Carcinoma
c)Bacterialpneumonia
d)Tuberculosis
e)Congestiveheartfailure
CorrectAnswer-A:E
Answer-(A)Cirrhosis(E)Congestiveheartfailure
Collagenvasculardisease-
Rheumatoidarthritis
SLE
Druginducedlupus
Sjogren'ssyndrome
Wegener'sgranulomatosis
Churgstrausssyndrome
Infectiousdisease-
Bacterialinfection
Tuberculosis
Gastrointestinalinfections-
Esophagealperforation
Pancreaticdisease
Intraabdominalabscesses
Diaphragmatichernia
Neoplastic-
Metastatic

---

Mesothelioma

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134.Neurofibromatosistype1is/are
associatedwith-
a)Caf?-au-laitspots
b)Cataracts
c)Axillaryfreckling
d)Facialnervepalsy
e)Opticnervemeningioma
CorrectAnswer-A:C
Answer-(A)Caf?-au-laitspots(C)Axillaryfreckling
FeaturesofNeurofibromatosis1are:cafeaulaitspots,
neurofibromasorplexiformneuroma,freckling,opticgliomaand
Lischnodules.

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135.Feature(s)ofvitaminAtoxicityinclude(s)
-
a)Hypercalcemia
b)Yellowskin
c)Anorexia
d)Poorwoundhealing
e)Papilledemaandhepatomegaly
CorrectAnswer-A:B:C:E
Answer-(A)Hypercalcemia(B)Yellowskin(C)Anorexia
(E)Papilledemaandhepatomegaly
HypervitaminosisAcanleadtoruptureoflysosomalmembrane.
Acutetoxicity-Pseudotumourcerebri(headache,dizziness,
vomiting,drowsiness,blurredvision)
Chronictoxicity-anorexia,weightloss,nausea,boneandjointpain,
boneabnormalitiesandbonyswelling.

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136.Whichofthefollowingcanoccurin
COPD-
a)Hypoxemia
b)Hypercarbia
c)Decreasedgasexchangeinterminalbronchioles
d)Acidosis
e)Hypocarbia
CorrectAnswer-A:B:C:D
Answer-A,B,C,D,Hypoxemia,Hypercarbia,Decreasedgas
exchangeinterminalbronchioles,Acidosis
ThemostcommonsymptomsofCOPDaresputumproduction,
shortnessofbreath,andaproductivecough.
Emphysemaischaracteriredbydestructionofgas-exchangingair
spacesi.e.therespiratorybronchioles,alveolarductsandalveoli.
Lowoxygenlevels(hypoxia)thenhighcarbondioxidelevelinthe
blood(hypercapnia/hypercarbia)
Thereisadevelopmentofrespiratoryacidosisalocalled
hpyercapnicacidosis.

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137.Trueaboutventilatorassociated
pneumonia(VAP)-
a)2ndmostcommonnosocomialinfectionintheintensivecare
unit
b)Colonizationofthepharynxwithbacteriaisriskfactor
c)Highestriskoccurinthefirst5days
d)Gastricacidmayplayaroleinprotectionagainstnosocomial
pneumonias
e)Developsonlyafter1weekonmechanicalventilation
CorrectAnswer-A:B:C:D
Answer-(A)2ndmostcommonnosocomialinfectioninthe
intensivecareunit(B)Colonizationofthepharynxwithbacteria
isriskfactor(C)Highestriskoccurinthefirst5days
(D)Gastricacidmayplayaroleinprotectionagainst
nosocomialpneumonias
Ventilatorassociatedpenumoniais2dmostcommonnosocomial
infectionafterurinarytractinfection.
Ventilator-associatedpneumonia(VAP)ispneumoniathatdevelops
48hoursorlongeraftermechanicalventilationisgivenbymeans
ofanendotrachealtubeortracheostomy.
VAPresultsfromtheinvasionofthelowerrespiratorytractandLung
parenchymabymicroorganism.
RiskforVAPisgreatestduringthefirst5daysofmechanical
vantilation.
EarlyonsetVAPisdefinedaspneumoniathatoccurswithin4days.
Gastricacidmayplayaroleinprotectionagainstnosocomial

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pneumonias.

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138.Clinicalpresentationofpituitary
apoplexyinclude(s)allexcept-
a)Ophthalmoplegia
b)Visualimpairment
c)Fever
d)Severeheadache
e)Hypertension
CorrectAnswer-E
Answer-E.Hypertension
1. Severehypoglycemic
2. Severeheadache(usuallyretroorbital)
3. Impairedconsciousness
4. Fever
5. Visualdisturbances(visualfielddefect,visualacuity)
6. Ophthalmoplegia(ocularparesis)Causingdiplopia
7. Hypotension&shock
8. Nausea/vomiting
9. Meningealsign

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139.Whichofthefollowingstatement(s)
is/aretrueaboutmyastheniaGraviswith
muscle-specifictyrosinekinase(MuSK)
antibodiesthananti-AChRAb-
a)Diseaseonsetisearlierwithfemalepredominance
b)Neckandfacialmuscleweaknessaremorecommon
c)Moreproximalmuscleinvolvement
d)Associatedwiththymichyperplasia
e)Poorresponsewithacetylcholineesterase(AChE)inhibitors
CorrectAnswer-A:B:C:E
Answer-(A)Diseaseonsetisearlierwithfemalepredominance
(B)Neckandfacialmuscleweaknessaremorecommon
(C)Moreproximalmuscleinvolvement(E)Poorresponsewith
acetylcholineesterase(AChE)inhibitors
Featuresare-
1. Onsetisearlierwithfemalepredominance
2. Thymushistologyisusuallynormal
3. Selectivefacial,bulbarneckorrespiratorymuscleweakness
4. Involvementofproximalmuscles
5. Relativesparingofocularmuscles
6. Poorresponsetoacetylcholinesteraseinhibitors(anticholinesterase)

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140.Whichofthefollowingis/arefeature(s)of
hypomagnesemia
a)Tremors
b)Improvementseenwithcalciumsupplementation
c)Atheroidmovements
d)Seizure
e)Bradycardia
CorrectAnswer-A:B:C:D
Answer-(A)Tremors(B)Improvementseenwithcalcium
supplementation(C)Atheroidmovements(D)Seizure
Clinicalfeaturesaremostly:
1. Neuromuscular&CNShyperirritability:Tetany,Seizura,tremer,
muscleweakness,ataxia,nystagmus,vertigo,atheroidmovement,
depression,irritability,deliriumandpsychosis.
2. Cardiacarrhythmias:Sinustachycardia,othersupraventricular
tachycardia,andventriculararrhythmias.

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141.Inflammatoryodontogeniccystis/are
a)Periapicalcyst
b)Residualcyst
c)Paradentalcyst
d)Eruptioncyst
e)Dentigerouscyst
CorrectAnswer-A:B:C
Answer-A,PeriapicalcystB,ResidualcystC,Paradentalcyst
Residualcyst
Paradentalcyst
Periapicalryst

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142.Mostaccuratemethodforthediagnosis
GastroesophagealRefluxDisease
(GERD)is
a)Histologicalstudy
b)Manometry
c)24-hourpHrecordingandelectricalimpedancemeasurement
d)Bariumswallowstudies
e)UpperGIendoscopy
CorrectAnswer-C
Answer-C.24-hourpHrecordingandelectricalimpedance
measurement
ThemostsensitivetestfordiagnosisofGERDis24-hambulatory
pHmonitoring.
Endoscopyisindicatedinpatientswithrefluxsymptomsrefractoryto
antisecretorytherapy;inthosewithalarmingsymptomssuchas
dysphagia,weightloss,orgastrointestinalbleeding;andinthose
withrecurrentdyspepsiaaftertreatmentthatisnotclearlydueto
refluxonclinicalgroundsalone

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143.Allaretrueaboutbilateralbreastcancer
except
a)Bilateralityiscommonwhenthetumorintheprimarybreastis
lobularcarcinoma
b)About5%bilateralcancersaresynchronousand20%bilateral
cancersaremetachronous
c)Morecommoninwomenof>50yearofage
d)BRCAmutationcancersareassociatedhigherprevalenceof
bilateralbreastcancer
e)Usuallyb/1iffamilialbreastcancerpresent
CorrectAnswer-B:C
Answer-B,About5%bilateralcancersaresynchronousand
20%bilateralcancersaremetachronousC,Morecommonin
womenof>50yearofage
BRCAmutationisariskfactorforbilateralbreastcancer.
Riskfactorsforbilateralbreastcancerare-
Youngageatdiagnosis(<50yearsofage).
multicentricdisease
Lobularinvasivecarcinoma.
Radiationexposure
Familialorhereditarybreastcancer.
Bilateralbreastcancerare-
Synchronous(simultaneous)
Metachronous(sequential)
Metachronousbilateralbreastcancerismorecommonthan
synchronous.

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144.Onlysimplecholecystectomyis
adequateinwhichstageofgallbladder
cancer
a)StageIA
b)StageIB
c)StageIII
d)StageIV
e)None
CorrectAnswer-A
Answer-A.StageIA
AccordingtoTNMstaging,SimplecholecystectomyisdoneforT1a
whichisincludedinstage-I.
T1a-simplecholecystectomy
T1b,II&III-Extendedcholecystectomy
IV-Palliativetreatment

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145.Whichofthefollowingis/aretrueabout
Gastriclymphoma
a)AssociatedwithH.pyloriinfection
b)MajoritybelongstoB-cellHodgkinlymphomas
c)Endoscopicultrasoundisperformedtodeterminethedepthof
gastricwallinvasion
d)Secondmostcommontumorofstomach
e)Diagnosisismadeonbasisofendoscopicbiopsy
CorrectAnswer-A:C:D:E
Answer-A,AssociatedwithH.pyloriinfectionC,Endoscopic
ultrasoundisperformedtodeterminethedepthofgastricwall
invasionD,Secondmostcommontumorof
stomachE,Diagnosisismadeonbasisofendoscopicbiopsy
Thestomachisthemostcommonsiteforextranodallymphoma.
B-celllyphomasofmucosa-associatedlymphoidtissue(MALT
lymphoma).
Lymphomaisthesecondmostcommonprimarycancerofthe
stomach.
Majorityofcases(80%)areassociatedwithchronicgastritisandH.
Pyloriinfection.
Itismostprevalentissixthdecadeoflife.
MALTomasexpressB-cellmarkersCD19andCD20.
Diagnosisismadebyendoscopicbiopsy.
Endoscopicultrasoundisusefultodeterminethedepthofgastric
wallinvasion.
Gastriclymphomasarechemosensitiveandchemotherapyaloneor

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alongwithsurgeryisusedforthetreatmentofgastriclymphoma.

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146.Notincludedinsurgicalsafetychecklist
a)Signin
b)Signout
c)Timein
d)Timeout
e)Preanestheticcheckup
CorrectAnswer-C:E
Answer-C,TimeinE,Preanestheticcheckup

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147.Suspicionofmalignancyinthyroid
noduleisindicatedbyallexcept-
a)Femalegender
b)Dysphagia
c)Age20-40years
d)Increasingpain
e)Rapidlyenlargingsize
CorrectAnswer-A:B:C:E
Answer-(A)Femalegender(B)Dysphagia(C)Age20-40years
(E)Rapidlyenlargingsize
Themostcommonpresentingsignofthyroidcancerisathyroid
nodule.
SolitaryorMultiplethyroidnodules
NeckNodes
Hoarsevoiceofrecentonset
Mediastinaladenopathy
Boneorlungmetastasis
Gender:Female>Males.
Age:
Morecommonatyoungadults.
MTCusuallydiagnosedafter60.
Ahistoryofarapidlyenlargingthyroidnoduleusuallyindicates
hemorrhage,andthisoccurinbothbenignandmalignantdisease.

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148.Allaretrueaboutsuccinate
dehydrogenasedeficientgastrointestinal
stromaltumor(SDH-deficientGIST)
except
a)Morecommoninchildrenandyoungadult
b)NegativeforDOG-1
c)Mostcommonlocationisstomach
d)AssociatedwithCarney-Stratakissyndrome
e)Absentc-kitmutation
CorrectAnswer-B
Answer-B.NegativeforDOG-1
Succinatedehydrogenase(SDH)deficient-GastrointestinalStromal
Tumors(GIST)-
Pathologicalfeatures-
SDHdeficient-GISTsdonothavec-KITmutation-->absenceofc-
KITmutation.
TheystronglyexpressKITandDOG1/Ano-1,butdonothaveKIT
mutation.
Clinicalfeatures-
TheymaYbeassociatedwith:-
1. Carneystratakissyndrome-ParagangliomawithfamilialGIST
2. Carneytriad
Thesetumorshavetendencytoappearinchildrenandyoungadults
Theyoccurexclusivelyinstomach.

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149.Whichofthefollowingis/aretrueabout
appendicitis-
a)Bothdiarrheaandconstipationmaypresent
b)Nauseaandvomitingusuallypresent
c)Painoninternalrotationofflexedhip
d)Painonflexionandexternalrotationofhip
e)Initiallypainislocatedintheperiumbilicalregion
CorrectAnswer-A:B:C:E
Answer-A,Bothdiarrheaandconstipationmay
presentB,NauseaandvomitingusuallypresentC,Painon
internalrotationofflexedhipE,Initiallypainislocatedinthe
periumbilicalregion
Clinicalfeatures-
AbdominalPain(mostcommon)isfrequentlynoticedinthe
periumbilicalregion.
Anorexia
Nauseaandvomiting
Diarrheaorconstipation
SignsinAppendicitis-
Rovsingsign
Obturatorsign
Psoassign
Dunphysign
Marklesign
McBurney'ssign

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150.Allaretruestatementabouthernias
except
a)Femoralherniahasthehighestriskofstrangulationofgroin
hernias
b)Directinguinalherniacausemoresymptomsthanindirect
c)Directinguinalherniaismostcommoninchildren
d)Indirectinguinalherniaoccurduetopatentprocessusvaginalis
e)Indirectinguinalherniaoccurthroughadefectinfascia
transversalis
CorrectAnswer-B:C
Answer-B,Directinguinalherniacausemoresymptomsthan
indirectC,Directinguinalherniaismostcommoninchildren
Afemoralherniahasthehighestriskofincarcerationand
strangulationofgroinhernias.

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151.Mediastinalmass(s)whichis/aremore
commoninposteriormediastinum
a)Lymphoma
b)Thymoma
c)Neurogenictumor
d)Enterogenouscyst
e)Thyroidcarcinoma
CorrectAnswer-C:D
Answer-C,NeurogenictumorD,Enterogenouscyst
MostcommontumorsintheposteriormediastinumareNeurogenic
tumors.
Posteriormediastinalmassesinclude-
Lymphnodeenlargement
Neuroentericcyst(Enterogenouscyst)
Anteriormeningocele

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152.Trueaboutundescendedtestis
a)U/LmorecommonthanB/L
b)Missingtestisonpalpationmaybeduetoagenesis
c)10%bilateral
d)Undescendedtestismaybeassociatedwithabsentkidney
e)Stephenfowlertechniqueinvolvesrenalarteryligation
CorrectAnswer-A:B:C:D
Answer-A,U/LmorecommonthanB/LB,Missingtestison
palpationmaybeduetoagenesisC,10%
bilateralD,Undescendedtestismaybeassociatedwithabsent
kidney
Cryptorchidismisthemostcommoncongenitalabnormalityofthe
genitourinarytract.
Cryptorchidismmeanshiddentestis.
Anabsenttestismaybeduetoagenesisoratrophysecondaryto
intrauterinevascularcompromisealsoknownasthe"vanishing
testissyndrome".
Bilaterallyabsenttestesisanorchiawhichis10%cases.
MorecommononRightSide.
Complicationsofundescendedtestes
Torsioncanbeseeninincompletetesticulardescent
Sterilityisseeninbilateralcases(especiallyintra-abdominaltestes)
Incompletetesticulardescentpredisposestomalignantdisease;
cancerismorecommoninanincompletelydescendedtestes-
orchidopexymayormaynotdiminishtherisk.
Atrophyofaninguinaltestesbeforepubertymaypossiblybecaused
byrecurrentminortrauma.

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153.Trueabouttorsionoftestisisallexcept
a)Presentswithsuddenpainintestis
b)Commonlyassociatedwithpyuria
c)DopplerU/Sshowsdecreasedbloodflowtothetestis
d)Simultaneousorchipexyoftheothersideshouldalsobedone
e)All
CorrectAnswer-B
Answer-B.Commonlyassociatedwithpyuria
Pyuriaisassociatedwithepidydimo-orchitis,notwithtorsionof
testis.
Torsionisthetwistingofthetestisonthespermaticcord,resultingin
strangulationofthebloodsupplyandinfarctionoftestis.
Itisseencommonlyinadolescents(10-25yrs)
Symptoms-4itpresentsassuddenagonisingpaininthegroinand
thelowerabdomen.Nauseaandvomittingareverycommon.
ColourDopplerdetectsthedecreasedbloodflowtotestisin
torsion

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154.Condition(s)associatedwithesophageal
carcinoma
a)Achalsia
b)Post-cricoidweb
c)Schatzki'sring
d)Paterson-Kellysyndrome
e)Lyeingestion
CorrectAnswer-A:B:D:E
Answer-A,AchalsiaB,Post-cricoidwebD,Paterson-Kelly
syndromeE,Lyeingestion
rmportantriskfactorsforSCCcarcinomaare:_
i)AlcoholandCigarettesmoking.
1. Mucosaldamagefromphysicalagents-Hottea,Lyeingestion,
Radiationinducedstrictures,Chronicachlasia.
2. otheringestedcarcinogens-Nitrates,Smokedopiates,Fungal
toxinsinpickledvegetables
3. Plummer-vinson-PatersolKellysyndrome(Esophageal(post
cricoid)Web+glossitis+Irondeficiency).
4. Tylosisplamarisetplantaris(congenitalhyperkeratosisandpittingof
palmsandsoles)
5. Dietarydeficienciesofmolybednum,Zinc,VitaminA.
6. Celiacsprue

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155.Trueaboutpseudocyst
a)Pancreaticfluidcollection
b)Maybeasymptomatic
c)Well-definedwall
d)Fluidcollectionisalwaysinfectiousinnature
e)Richinpancreaticenzymes
CorrectAnswer-A:B:C:E
Answer-A,PancreaticfluidcollectionB,Maybe
asymptomaticC,Well-definedwallE,Richinpancreatic
enzymes
Pancreaticpseudocystisthemostcommoncomplicationofboth
acuteandchronicpancreatitis.
Itisnotatruecystasitswalldoesnothaveanepitheliallining.
Fluidofthecystisrichinpancteaticamylase.
Mostcommonsiteforpseudopancreaticcystisthebodyandtailof
pancreas.
Clinicalfeatures-
Pancreaticpseudocystsshowawidevarietyofclinicalpresentations
rangingfromcompletelyasymptomaticlesionstomanysymptoms.
AbdominalpainisMCsymptom.
Investigations-
CECTabdomenisinvestigationofchoicefordiagnosisofa
pancreaticpseudocyst.

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156.Hyperamylasemiais/areseeninall
except
a)Pancreaticpseudocyst
b)Cysticfibrosis
c)Macroamylasemia
d)Parotitis
e)Chronicpancreatitis
CorrectAnswer-B
Answer-B.Cysticfibrosis
Pancreatitis
1. Acute
2. Chronic
Pancreaticpseudocyst
Pancreaticnecorsis
Pancreatictrauma
Pancreaticcarcinoma
cysticfibrosis

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157.Raisedintracranialpressure(ICP)in
headinjuryis/aremanagedby
a)Furosemide
b)Mannitol
c)DecompressivecraniectomyishelpfulindecreasingICPbutdo
notaffectneurologicaloutcome
d)Glucosefreefluid
e)Hypotonicsolution
CorrectAnswer-A:B:C:D
Answer-A,FurosemideB,MannitolC,Decompressive
craniectomyishelpfulindecreasingICPbutdonotaffect
neurologicaloutcomeD,Glucosefreefluid
A)Initial
Optimiseelectrolytebalance
Sedation
Seizurecontrol
B)Middle(Intermediate)
Mannitol/furosemide/hyperventilationastemporisingmeasures
Heavysedation
C)Last(Final)
Inductionofthiopentonecoma
Decompressivecraniectomy
HyperglycemiacanaggrevateincreaseICP,thusglucosefreefluid
shouldbeused.
Decompressivecraniectomy-Decompressivecraniectomyisthe
surgicalremovalalargeportionofthecranialvaulttoallow

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fortheedematousintracranialcontentstoexpandandsubsequently
reduceICP.

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158.Indicationsofsurgeryintuberculosis
include(s)-
a)Streakyhemoptysis
b)Tubercularempyema
c)Persistentbronchopleuralfistula
d)Chroniccough
e)AFB+yebacilliinsputum
CorrectAnswer-B:C
Answer-(B)Tubercularempyema(C)Persistentbronchopleural
fistula
Destroyedlung
1. Persistentbronchopleuralfutula
2. Life-threateninghemoptysis(intractablehemorrhage)
3. Aspergillomainatuberculouscavity
4. Postsurgicalcomplication
5. Performanceofdiagnosticprocedure
6. Tubercularemryerna

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159.Trueabouttuberculosis-
a)Cavitatorylesionsuggestsinactivedisease
b)Rasmussenaneurysmisacomplication
c)Highgradefever
d)Tubercularbronchiectasisoccurinlowerlobes
e)All
CorrectAnswer-B
Answer-B.Rasmussenaneurysmisacomplication
Cavitationisasignofactivedisease,andisconsideredasasignof
reactivation
FeverinTBisusuallylow-gradeandintermittent.
Rasmussen'saneurysmisaninflammatorypseudoaneurysmal
dilatationofabranchofpulmonaryarteryadjacenttoatuberculous
cavityandlifethreateningcomplicationofcavitytuberculosis.
Tuberculosiscausesupperlobebronchiectasis.

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160.TrueaboutMeckel'sdiverticulum-
a)Causesvolvulusofintestine
b)Duetopersistentremnantofthevitellointestinalduct
c)Commonlyfoundonthemesentericsideoftheileum
d)Causesmelena
e)Causeshaemoptysis
CorrectAnswer-A:B:D
Answer-(A)Causesvolvulusofintestine(B)Duetopersistent
remnantofthevitellointestinalduct(D)Causesmelena
Meckel'sdiverticulumisthepersistentproximalpartofthe
vitellointestinalductwhichnormallydisappearsduringintrauterine
life.
BleedinginMeckel'sdiverticulumisusuallytheresultofulcerationin
ilealmucosa
Hemorrhagemaypresentasrectalbleedingormelana.
Volvulusoftheintestinearoundthefibrousbandattachingthe
diverticulumtotheumbilicus.
Mesodiverticularbandisaremnantofleftvitellineartery.

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161.Differenceb/wfullthicknessandpartial
thicknessgrafts-
a)Partialthicknessgrafthavegoodcosmeticappearance
b)Fullthicknessgraftaregoodforlargearea
c)Edemaundergraftmaycausegraftfailure
d)Thingraftsurvivetransplantationmorereliably
e)Minimalcontractioninfullthicknessgraft
CorrectAnswer-C:D:E
Answer-(C)Edemaundergraftmaycausegraftfailure(D)Thin
graftsurvivetransplantationmorereliably(E)Minimal
contractioninfullthicknessgraft
Typeof
Advantages
Disadvantages
Graft
-Leastresemblesoriginal
skin.
ThinSplit
-BestSurvival
-Leastresistancetotrauma.
Thickness -HealsRaqidly
-PoorSensation
-MaximalSecondary
-Contraction
-Morequalitiesofnarmal
skin.
ThickSplit
-Lowergraftsurvival
-LessContraction
Thickness
-Slowerhealing.
-LooksBetter
-FairSensation
-Mostresemblesnormal
skin.
-Poorestsurvival.
-Donorsitemustbeclosed

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-Donorsitemustbeclosed
Full
-MinimalSecondary
surgically.
Thickness contraction
-Resistanttotrauma
-Donorsitesarelimited.
-GoodSensation
-Aestheticallypleasing
Edemaandnecrotictissueundergraftmayhampergraft
acceptance.

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162.Feature(s)ofsuperficialpartialthickness
burn(seconddegree)is/are-
a)Hairseasilypluckable
b)Severepain
c)Thrombosedvessel
d)Leatheryskin
e)Blisteringofskin
CorrectAnswer-B:E
Answer-(B)Severepain(E)Blisteringofskin
thesesuperfcialdermalburnsinvolvetheupperlayersofdermis
Blistersareseen
Erythematous
Blanchtotouch
Quitepainful
Healwithoutscarringin1to2weeks

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163.Trueabouthypertrophicscar-
a)Treatedwithtriamcinolone
b)Resultsfromaprolongedinflammatoryphaseofwoundhealing
c)Mostcommoninpigmentedskin
d)Growbeyondmargin
e)Improvespontaneouslywithtime
CorrectAnswer-A:B:E
Answer-(A)Treatedwithtriamcinolone(B)Resultsfroma
prolongedinflammatoryphaseofwoundhealing(E)Improve
spontaneouslywithtime
Hypertrophicscarsarecharacterizedbyerythematous,pruritic,
raisedfibrouslesionsthattypicallydonotexpandbeyondthe
boundariesoftheinitialinjuryandmayundergopartialspontaneous
resolution.
Itresultsfromaprolongedinflammatorypheseofwoundhealingand
fromunfavourablescarsiting.
Hypertrophicscarsarecommonafterthermalinjuriesandother
injuriesthatinvolvethedeepdermis.
IntralesionalinjectionofTriamcinoloneisalsothet/tofchoicefor
intractablehypertrophicscars.

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164.Allaretrueaboutbasalcellcarcinoma
EXCEPT:
a)Translucent
b)Retentioncyst
c)Cystofsubmandibulargland
d)Cystofminorsalivarygland
e)All
CorrectAnswer-A
Answer-A.Translucent
Mostcommonsiteisuppereyelid
Usuallyaslow-growing,locallyinvasivemalignanttumourof
pluripotentialepithelialcellsarisingfrombasalepidermisandhair
follicles,henceaffectingthepilosebaceousskin.
Basalcellcarcinomasusuallypresentaspearlypapulescontaining
prominentdilatedsubepidermalbloodvessels(telangiectasias)

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165.Trueaboutendemicgoiter-
a)Sizemayincreaseduringpregnancy
b)Usuallyhypothyroid
c)Sameasmultinodulargoiter
d)Canturnmalignant
e)None
CorrectAnswer-A:B:D
Answer-(A)Sizemayincreaseduringpregnancy(B)Usually
hypothyroid(D)Canturnmalignant
EndemicGoiteristhepresenceofagoitercausedbynutritional
deficiencyofIodine.
Effectofpregnancy-
Increasedendocrinedemandtheiodinemetabolismischaracterized
bythetendencytodevelopanendogenousiodinedeficiency(ID).
Diffusethyroidglandhypertrophycanbevisiblyobservedasagoiter
oftheneck.
EndemicGoiterisultimatelycausedbyreducedthyroidhormone
levelsitisaccompaniedbytheclinicalsyndromeofhypothyroidism.
Irregular,nodulargoitersduetorepeatedboutsofiodinedeficiency
mayprogresstothyroidfollicularcarcinoma.

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166.Trueaboutsurgicalapproachinthyroid
surgery-
a)Incisionismade1cmbelowcricoidcartilage
b)Usuallyverticalincisionisused
c)Thoracicductmaybedamaged
d)Forlobectomythyroidisdissectedattheisthmus
e)Strapmusclesaredividedifgreaterexposureisneeded
CorrectAnswer-A:C:D:E
Answer-(A)Incisionismade1cmbelowcricoidcartilage(C)
Thoracicductmaybedamaged(D)Forlobectomythyroidis
dissectedattheisthmus(E)Strapmusclesaredividedif
greaterexposureisneeded
Kochertransversecollarincision,typically4to5cminlength,is
placedinorparalleltoanaturalskincrease1cmbelowthecricoid
cartilage.
Thesubcutaneoustissuesandplatysmaareincisedsharply.
TheRLNbmostvulnerabletoinjuryinthevicinityoftheligamentof
Bery.
Ifalobectomyistobeperformed,theisthmusisdividedflushtiththe
tracheaonthecontralateralsideandsutureligated.

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167.Trueaboutneurogenicclaudication-
a)Lowbackpainispresent
b)Fixedwalkingdistance
c)Painimmediatelyrelievedbyrest
d)Shinyskinoffoot
e)Painrelievedbyleaningforward
CorrectAnswer-A:C:E
Answer-(A)Lowbackpainispresent(C)Painimmediately
relievedbyrest(E)Painrelievedbyleaningforward
Neurogenicclaudicationischaracterizedbylowbackpainradiating
tolowerlimbs(glutealregion,bockofthigh&leg).
Thesesymptomsareespeciallypresentwhenstandinguprightor
walkingandusuallyrelievedwithleaningforwardorsittingdown

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168.Trueaboutbluntabdominaltrauma-
a)Liveristhemostcommonorganaffected
b)AbdominalpelvicCTscanningishelpfulforevaluatingintra-
abdominalandretroperitonealinjuries
c)>100,000redcells/?Linperitoneallavageisconsidered
positiveandisindicationforexploratorylaparotomy
d)Morethan2m1offreebloodintheabdominalcavityis
indicationforexploratorylaparotomy
e)FAST-USGisusedforinitialevaluation
CorrectAnswer-A:C:E
Answer-(A)Liveristhemostcommonorganaffected(C)>
100,000redcells/?Linperitoneallavageisconsideredpositive
andisindicationforexploratorylaparotomy(E)FAST-USGis
usedforinitialevaluation
Blunttrauma:Inblunttraumatheorgansmostcommonly
injuredarethesolidorgans:
Spleen(MC)
Liver
Kidney
Thepresenceof>100,000redcells/plor>500whitecells/plis
deemedpositive(thisisequivalentto2OmLoffreebloodinthe
abdominalcavity).
PositiveDPLisanindicationforemergencyexploratorylaprotomy.
Hemodynamicallystablepatientssustainingblunttraumaare
adequatelyevaluatedbyabdominalultrasoundorCT.

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169.Congenitaladrenalhyperplasiaisdueto
deficiencyofenzyme?
a)3?-Hydrorysteroiddehydrogenasedeficiency
b)5?reductase
c)l7?-Hydrorylasedeficienry
d)2l-Hydroxylasedeficiency
e)Aromatase
CorrectAnswer-A:C:D
Ans.(a)3?-Hydrorysteroiddehydrogenasedeficiency;(C)l7?-
Hydrorylasedeficienry(d)2l-Hydroxylasedeficiency
Congenitaladrenalhyperplasia(CAH)
GroupofARdisorder
MCadrenaldisorderinchildhood
Mostcommon21-hydroxylasedeficiency
In21a-hyroxylesedeficiency
Thereisdeficiencyofmineralocorticoids&glucocorticoid.
Thisleadstohypoglycemia,hyponatremia

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170.Whichofthefollowingis/aretrueabout
developmentalmilestonesof2yearsold
child-
a)Canwalkup&downstairswithalternatingfeet
b)Walksupanddownstairs,onestepatatime
c)Ridestricycle
d)Knowsageandsex
e)WeightquadruplesofbirthweightAchildishavingWilson
disease
CorrectAnswer-B:E
Ans.is'b'i.e.,Walksupanddownstairs,onestepatatime;'e'
i.e.,WeightquadruplesofbirthweightAchildishavingWilson
disease
GROSSMOTORMILESTONES:
Age
Milestone
3months Neckholding
5months Rollsover
6months Sittingsupported
8months Sittingwithoutsupport
9months Standswithsupport
12months Standswithoutsupport,Walksbutfalls
15months Walksalone,Creepsupstairs
18months Runs,exploresdrawers
2years
Walksupstairs(babysteps),Jumps
3years
Walksupstairs(alternatefeet),ridestricycle

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4years
Hopsononefoot,walksdownstairs(alternatefeet)
FINEMOTORMILESTONES:
Age
Milestone
4months Bidextrousreach
6months Unidextrousreach
9months Immaturepincergrasp
12months Maturepincergrasp
15months Imitatesscribbling,towerof2blocks
18months Scribbles,towerof3blocks
2years
Towerof6blocks,vertical&circularstroke
3years
Towerof9blocks,copiescircle
4years
Copiescross,bridgewithblocks
5years
Copiestriangle

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171.Whichofthefollowingstatement(s)
is/arenotcorrect-
a)Kayser-fleischer(KF)ringmaybepresentineye
b)Serumceruloplasminis<20mg/dl
c)Hepaticcopperis>250?g/gdryweightofliver
d)Insymptomaticpatients,the24hrurinarycopperexcretionis
lessthan40?g/day
e)Liverbiopsyisofvaluefordeterminingtheextentandseverity
ofliverdisease
CorrectAnswer-D
Ans.(d)Insymptomaticpatients,the24hrurinarycopper
excretionislessthan40?g/day
Wilson'sdisease(Hepatolenticulardegeneration)
DIAGNOSIS:
Thegoldstandardfordiagnosisisliverbiopsywithquantitative
copperassay->concentrationofcopperinaliverbiopsysample>
200?g/gdryweight.
Othertestsare?
1. Serumceruloplasminlevel->low(20mg/dl)
2. KFrings
3. Urinecopperexcretion->increased(>100?g/day)
4. DNAHaplotypeanalysis.

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172.Allaretrueaboutwilmstumorexcept-
a)Painlessabdominalmass
b)Mostlyasymptomatic
c)Swellingisballotable
d)StageI-tumourconfinedtokidney
e)CompletelyexcisionistreatmentofchoiceinstageI&II
CorrectAnswer-E
Ans.(e)CompletelyexcisionistreatmentofchoiceinstageI&
II
PresentationofWilm'stumor:
Asymptomaticabdominalmass(mostcommon)
Abdominelswelling(rcnallump)inwilm'stumorisballottable.
Abdominalpain(30%)
Hypertension(25%)
Heamaturia(10-25%)
Fever(20%)
Anorexiaandvomiting
Stages Features
StageI Tumorislimitedtokidenyandcompletelyexcised
Tumorbeyondkidney&completelyexcised.Regional
StageII extensionconfinedtoflank
Residualnon-hematogenoustumorconfinedtothe
abdomen.Lymphnodeinvolvementofhilus,periaortic
chains,orbeyond;diffuseperitonealimplantsoftumor,
StageIII tumorextendsbeyondsurgicalmarginsmicroscopicallyor
macroscopically;tumornotcompletelyremovablebecause
oflocalinfiltrationintovitalstructures

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oflocalinfiltrationintovitalstructures
Stage
DepositsbeyondstageIII(e.g.,lung,liver,bone,brain)
IV
StageV Bilateralrenalinvolvementatdiagnosis.
Treatment-
1.Fortumourconfinedtorenalcapsule-
RadicalnephrectomyfollowedbychemotherapywithantinomycinD
andVincristine
2.Fortumourbeyondrenalcapsule
Nephrectomyfollowedbylocalradiotherapyandchemotherapy
TheidealtimingofradiotherapyforWilmsTumouraftersurgeryis
within10days.
3.BilateralWilm'stumour-
Radicalnephrectomyonlargersideoftumourandpartial
nephrectomyonsmallersideoftumour.

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173.Syndrome(s)relatedtopaediatricbrain
tumors-
a)Tuberoussclerosis
b)Neurofibromatosis-2
c)Cokaynesyndrome
d)Fanconisyndrome
e)Turcotsyndrome
CorrectAnswer-A:B:E
Ans.is'a'i.e.,Tuberoussclerosis'b'i.e.,Neurofibromatosis-
2;'e'i.e.,Turcotsyndrome
FamilialSyndromesAssociatedwithPaediatricBrainTumors:
NeurofibromatosistypeI
Neurofibromatosistype2
vonHippel-Lindausyndrome
Tuberoussclerosis
Bilateralretinoblastoma
Li-Fraumenisyndrome
Cowdensyndrome
Turcotsyndrome
Gorlinsyndrome
Nevoidbasalcellcarcinoma

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174.A5-month-oldinfanthasmassive
hepatomegaly.Whichofthefollowing
condition(s)presentswithmassive
hepatomegaly
a)TypeIglycogenstoragedisorder
b)Biliaryatresia
c)Gaucher'sdisease
d)Biliarycirrhosis
e)Noneoftheabove
CorrectAnswer-A:D
Ans.is'a'i.e.,TypeIglycogenstoragedisorder;'d'i.e.,Biliary
cirrhosis
Causesofmassivehepatomegaly:
Chroniccongestivehepatomegalyeg..,
VSDwithheartfailure(chronic).
Cardiomyopathywithcongestiveheartfailure.
Constrictivepericarditis.
Chronicextrahepaticcholestasise.g.,congenitalbiliaryatresia.
Malaria,kala-azarforlongduration.
Glycogenstoragedisease
Congenitalhepaticfibrosis
Amoebicliverabscess.
Hepatomaorsecondarymalignantdeposits.
Cystsofliver.
Biliarycirrhosis.

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175.Trueaboutbenignidiopathicneonatal
seizures
a)Calledas5ddayfits
b)Seizureoftenoccurlaterinlife
c)Statusepilepticusmayoccur
d)Familyhistoryisusuallypresent
e)Morecommoninpreterm
CorrectAnswer-A:C
Ans.is'a'i.e.,Calledas5thdayfits;'c'i.e.,Statusepilepticus
mayoccur
BenignNeonatalSeizures(5thdayfits)
Increasinglyrecognizedsyndromecharacterizedbyseizuresinthe
neonatalorinfantileperiod.
2forms:Familialandnonfamilial.
Quitesevere,andstatusepilepticusiscommon.
Nonfamilialformischaracterizedby:
Idiopathic,self-Limitedseizureinpreviouslynormalneonates.
Mostcommonlyoccuratday5
Familialseizures:
Mostfrequentlyhavetheironsetduringthefirstweekoflife,but
onsetmayoccuraslateasearlyinfancy.
Theseseizuresmayrecurforseveralmonthsbeforeresolving.
Thefamilyhistoryrevealsbenignneonatalseizuresinotherfamily
members.
Prognosisisfavourableinbothsyndrome,butseizuresmay
occasionallyoccurlaterinlifeinthefamilialform.

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---

176.Complication(s)ofH.typeoftracheo-
esophagealfistulais/are
a)Dysphagia
b)Aspirationpneumonia
c)Hematemesis
d)Paroxysmsofcoughingorcyanosiswithfeeding
e)Deathusuallyoccurininfancy
CorrectAnswer-B:D
Ans.b)Aspirationpneumonia;d)Paroxysmsofcoughingor
cyanosiswithfeeding
H-Type{Type-E)TEF:
Itaccountsfor4-5%ofallcongenitalTEF'
Commonclinicalfeaturesare:
Recurrentrespiratorysymptom
Paroxysmsofcoughingandcyanosisduringfeeding'
Aspirationduringfeedingwithcyanosis
Abdominaldistension.
Dysphagiaisnotpresentbecauseofpatencyofesophagus
Theremaybeassociatedanomalies
VACTERL(vertebral,anorectal,cardiac,tracheal,esophageal,
renal,radial'limb)syndrome

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177.Achildispresentedwithmediastinal
mass,swellingofface,dyspnea&
stridor,Nextlineofmanagementis/are
a)Administrationofoxygenwithventimask
b)Tracheostomy
c)Biopsyofmassandfineneedleaspirationcytology
d)Mediastinalradiation
e)Rasburicase
CorrectAnswer-A:B:C
Ans.is.a,i,e.,Administrationofoxygenwithventimask;'b'i.e.,
Tracheostomy`c'Biopsyofmassandfineneedleaspiration
cytology
Thisisacaseofsuperiorvena-cavasyndromeorsuperior
mediastinalcompressionsyndrome.
Itisamedicalemergencyandrequiresimmediatediagnostic
evaluationandtherapy.
Nextlineofmanagementinthegivenpatientincludes:-
Inclinedpositionifpossible
Oxygenwithventimask
Tracheostomy
Biopsyandaspirationcytology
Furosemide

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178.CauseoflowerGIbleedinchildrenof
age>2yearofage
a)TB
b)Meckel'sdiverticulum
c)Aspirin
d)Esophagealvarices
e)Itisbleedingfromasitedistaltoligamentoftreitz
CorrectAnswer-A:B:C:E
Ans.is'a'i.e.,TB;"b'i.e.,Meckel'sdiverticulum'c'i.e.,Aspirin;
'e'i.e.,Itisbleedingfromasitedistaltoligamentoftreitz
LowerGIbleedingisdefinedasbleedingfromasitedistalto
ligamentoftreitz.
In>2years:
Infectiouscolitis
Inflammatoryboweldisease
Tuberculosis
Pseudomembranecolitis
Cowmilkproteinallergy
Uncommon:Amebiasis,cytomegalovirus,neutropeniccolitis
Fissure,Arteriovenousmalformation
Polyposissyndrome
Solitaryrectalulcersyndrome
Meckel'sdiverticulum
Rectalvaricesorcolopathy
NSAIDS
Haemorrhoids;Coagulopathy

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Henochschonleinpurpura

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179.Inponsetitechniquelastdeformityinto
getcorrectedinCTEV-
a)Equinus
b)Talipus
c)Varus
d)Cavus
e)Alldeformitycorrectedsimultaneously
CorrectAnswer-A
Ans(a)Equinus
Ponseti'stechnique
Thisinvolvesfirstcorrectingthecavusdeformitythentheadduction
andheelvarusandfinallytheequinusdeformity.
ThistechniqueisnowmostlyacceptedtechniqueforCTEV
correctionasitisbasedonbetterunderstandingofthe
pathoanatomyofthedeformedfoot.
Thesuccessofreductionis90-98Percent.

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180.Trueaboutganglioncyst?
a)Mostcommoninyoungmale
b)Containsynovialfluid
c)Arisefromextensorretinaculum
d)Itusuallyarisefromthelunotriquetraljoint
e)Surgicaltreatmentisexcisionofcyst
CorrectAnswer-B:E
Ans.is'b'i.e',Containsynovialfluid;'e'i.e.,Surgicaltreatmentis
excisionofcyst
Aganglionisthecommonestcysticswellingattheback(Dorsal
aspect)ofthewrist.
Unilocularcyst
Arisesduetoleakageofsynovialfluidfromajointortendonsheath.
Filledwithmucinousfluidandlinedbyfibroustissue
Usuallydevelopsonthedorsalsurfaceofthescapho-lunate
ligament.
Palmarwristgangliausuallyarisefromthevolarscapholunateor
scapho-trapezio-trapezoidjoint.
Morecommoninyoung(20-40years)female.
Nocommunicationbetweenthejointcavityortendonsheathandthe
interiorofcyst.
Painlesssmallswellingsometimesitmaycausepain.
Treatment:
Notrequired.
ForpainNSAIDs
Swellingincreaseinsizeitmaybeaspiratedorsurgicallyexcised.

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181.Trueaboutosteomalacia?
a)Morecommoninmale
b)LowPTH
c)Increasealkalinephosphatase
d)Decreasedcalciumlevel
e)Looser'szoneonX-ray
CorrectAnswer-C:D:E
Ans.(c)Increasealkalinephosphatase;(d)Decreasedcalcium
level;(e)Looser'szoneonX-ray
Osteomalacia
Looser'szone(pseudofractures)areradiolucentzonesoccurringat
thesitesofstressinosteomalacia(commonlyatpubicrami)
Osteomalaciaismorecommoninwomenwholivein"purdah"&lack
exposuretosunlight
Serumcalcium&phosphateislow&alkalinephosphataseishigh
Muscularweakness(Thepatientfeelsveryweak.Hemaydifficulty
inclimbingup&downthestairs)

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182.Testforanteriorcruciateligamentis/are
a)Lachmanntest
b)Apley'sgrindingtest
c)Pivotshifttest
d)Anteriordrawer
e)KT-1000kneearthrometerisanobjectiveinstrumentforACL
reconstruction
CorrectAnswer-A:C:D:E
Ans.is'a'i.e.,Lachmanntest'c'i.e.,Pivotshifttest;'d'i.e.,
Anteriordrawer&'e'i.e.,KT-1000kneearthrometerisan
objectiveinstrumentforACLreconstruction
FollowingtestsareusedforACLinjury:-
Lachman'stest
Pivotshifttest
Anteriordrawertest
Jerktest
Flexion-rotationdrawertest
Loose'stest

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183.Trueaboutankylosingspondylitis:
a)Romanuslesionmaybefound
b)Ifleftuntreated,spinefusionmayoccur
c)Predilectionofthejointsoftheaxialskeleton
d)Bonyerosionsdonotoccur
e)all
CorrectAnswer-A:B:C
Ans.a.Romanuslesionmaybefound;b.Ifleftuntreated,spine
fusionmayoccur;c.Predilectionofthejointsoftheaxial
skeleton
Ankylosingspondylitis(marie-strumpelldisease)
Ankylosingspondylitisisachronicprogressiveinflammatorydisease
ofthesacroiliacjointsandtheaxialskeleton.
rototypeofseronegative(absenceofrheumatoidfactor)
spondyloarthropathies.
Inflammatorydisorderofunknowncause.
Usuallybeginsinthesecondorthirddecadewithamedianageof
23,in5%symptomsbeginafter40.
Maletofemaleratiois2-3:1
StrongcorrelationwithHLA-B270-95%ofcase
9sarepositiveforHLA-B27.
Jointsinvolvedinankylosingspondylitis
Ankylosingspondylitisprimarilyaffectsaxialskeleton.
Thediseaseusuallybeginsinthesacro-iliacjointsandusually
extendsupwardstoinvolvethelumbar,thoracic,andoftencervical
spine.
Intheworstcasesthehipsorshouldersarealsoaffected.Hipjoint

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isthemostcommonlyaffectedperipheraljoint.
Rarelyknee(Ebenzar4th/e593)andankle(Apley's9thle67)are
alsoinvolved.Pathology
Enthesitisi.e.inflammationoftheinsertionpointsoftendons,
ligamentsorjointcapsuleonboneisoneofthehallmarksofthis
entityofdisease.
Primarilyaffectsaxial(spinal)skeletonandsacroiliitisisoftenthe
earliestmanifestationofA.S..
Involvementofcostovertebraljointsfrequentlyoccur,leadingto
diminishedchestexpansion(normal_5cm)
Peripheraljointse.g.shoulders,andhipsarealsoinvolvedin1/3rd
patients.
Extraarticularmanifestationslikeacuteanterioruveitis(in5%);rarely
aorticvalvedisease,carditisandpulmonaryfibrosisalsooccur.
Pathologicalchangesproceedinthreestages?
Inflammationwithgranulationtissueformationanderosionof
adjacentbone.
Fibrosisofgranulationtissue
Ossificationofthefibroustissue,leadingtoankylosisofthejoint.
Radiologicalfeaturesofankylosingspondylitis
Radiographicevidenceofsacroiliacjointisthemostconsistent
findinginankylosingspondylitisandiscrucialfordiagnosis.The
findingsare:-
SclerosisofthearticulatingsurfacesofSIjoints
Wideningofthesacroiliacjointspace
Bonyankylosisofthesacroiliacjoints
Calcificationofthesacroiliacligamentandsacro-tuberousligaments
Evidenceofenthesopathy-calcificationattheattachmentofthe
muscles,tendonsandligaments,particularlyaroundthepelvisand
aroundtheheel.
X-rayoflumbarspinemayshow:-
Squaringofvertebrae:Thenormalanteriorconcavityofthe
vertebralbodyislostbecauseofcalcificationoftheanterior
longitudinalligament.
ftLossofthelumbarlordosis.
Bridging`osteophytes'(syndesmophytes)
Bamboospineappearance

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184.Trueaboutavascularnecrosisoffemur
a)Affectedsidehipallowsweightbearing
b)Asymptomaticcasesmayoccur
c)Radionucleotidescanshowincreaseduptakeduetonewbone
formationintheareaaroundtheinfarct
d)Trendelenburgsigninnegative
e)Noneoftheabove
CorrectAnswer-A:B:C
Ans.is'a'i.e.,Affectedsideofhipallowwt.bearing;'b'i.e.,
Asymptomaticcasesmayoccur&'c'i.e.,Radionucleotidescan
showincreaseduptakeduetonewboneformationinthearea
aroundtheinfarct
CausesofAVN
ldiopathic(mostcommon)
Infection-septicarthritis,osteomyelitis
Hematologicalmalignancies-leukemia,lymphoma
Alcohol,corticosteroids
SLE
Pregnancy
Cassionsdisease
Hyperlipidemia
Perthesdiseas
Ionisingradiation
CLINICALFEATURES:
Pain
Deceaserangeofmotionespeciallyinternalrotationfollowedby
abduction.

---

SectoralsignorDifferentialrotation:-Internalrotationispossiblein
extendedpositionofhip,butasseenasthehipisflexedto900no
internalrotationispossible.ThisisthecharacteristicsignofAVN.
Trendelenburg'stestpositive
Radiologicalfindings:
MRIisthemostreliablewayofdiagnosingmarrowchangesand
boneischaemia

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185.Trueaboutpectusexcavatum
a)Morecommoninfemale
b)Inseverecases,mitralvalveprolapsemayoccur
c)Maybepresentatbirth
d)Seeninmarfansyndrome
e)Impairmentofrespiratoryfunction
CorrectAnswer-B:C:D:E
Ans.is'b'i.e.,Inseverecases,mitralvalveprolapsemayoccur;
'c'i.e.,Maybepresentatbirth;'d'i.e.,SeeninMarfansyndrome
i'e'i.e.,Impairmentofrespiratoryfunction
PectusExcavatum
Alsocalledfunnelchest'isthemostcommonchestwalldeformity.
Malesareaffectedmorethanfemales(4:1).
Pectusexcavatumarisesfromimbalancedorexcessivegrowthof
thelowercostalcartilages.
Typicallythedefectisdiagnosedwithinthefirstyroflifeand
worsensovertime.
Depressionmayrangefrommildlydepressedsternumtosternal
depressionabuttingthevertebralcolumnwithdisplacementsof
mediastinalstructures.
OtherconditionsassociatedwithPectusExcavatum:
Scoliosis
Marfan'ssyndrome
Mitralvalveprolapse
Congenitalheartdiseases

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186.Apersonhasinjuryondorsalsurfaceof
proximalinterphalangealjointofright
middlefinger.Whichofthefollowingcan
occur
a)Ruptureoflateralligament
b)Buttonholedeformity
c)Malletfinger
d)Lacerationofthecentralslipoftheextensor
e)Noneoftheabove
CorrectAnswer-A:B:D
Ans.is'a'i.e.,Ruptureoflateralligament;'b'i.e.,Buttonhole
deformity;'d'i.e.,Lacerationofthecentralskipoftheextensor
Injurytodorsalsurfaceofproximalinterphalangealjoint(zone
II)maycause:-
Ruptureofcentralslipofextensorexpansion-causingButtonhole
deformity.
ThisresultsinlossofactiveextensionofthePIPjointandpersistent
flexionofthePIPjoint.
AnteriordislocationofPIPjointmaycauseruptureofbothcentral
clipaswellaslateralligament.

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187.Pregnancyaggravateswhichofthe
followingcondition(s)-
a)Hypertension
b)Anaemia
c)Rheumatoidarthritis
d)Acne
e)All
CorrectAnswer-A:B
Ans.is'a'i.e.,Hypertension;&'b'i.e.Anaemia
Importantmedicalconditionswhichareaggravatedin
pregnancy
Congenitalheartdiseases
Rheumaticheartdiseases
Non-rheumaticvalvularheartdisease
Anemia
Pulmonaryhypertension
Renalfailure
Hypertension

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188.Truestatementregardingmagnesium
sulphateuseineclampsia&pre-
eclampsiais/are?
a)Usedforthetreatmentofhypertension
b)Canbeusedcontinuousintravenousaswellasintermittent
intramuscular
c)In>95%ofcasessuccessfullycontrolsseizuresofeclampsia
d)Toxicitycanbetreatedbystoppingfurtheradministrationand
givingcalciumgluconate
e)Administrationiscontinuedfor24hoursafterdelivery
CorrectAnswer-B:C:D:E
Ans.is'b'i.e.,Canbeusedcontinuousintravenousaswellas
intermittentintramuscular,'c'i.e.,In>95%ofcases
successfullycontrolsseizuresofeclampsia,'d'i.e.,Toxicity
canbetreatedbystoppingfurtheradministrationandgiving
calciumgluconate&`e'i.e.,Administrationiscontinuedfor24
hoursafterdelivery
MAGNESIUMSUPHATEINECLAMPSIA&PRE-
ECLAMPSIA:
Indicatedtopreventseizuresassociatedwithpre-eclampsia,andfor
controlofseizureswitheclampsia
In>95%ofcasessuccessfullycontrolsseizuresofeclampsia.
Dose:4-5g(dilutedin250mLNS/D5W)IVincombinationwith
either:
Upto10g(10mLofundiluted50%solution)dividedand
administeredIMintoeachbuttockor

---

AfterinitialIVdose,1-3g/hrIV.
MgSO4iscontinued24hoursafterdeliverytopreventpost-partum
eclampsia
Monitoring:
Throughouttheadministrationofmagnesium,thepatientneeds
continuousclinicalmonitoringformagnesiumtoxicity
Toxicityismanifestedbylossofdeeptendonreflexes(patellar),
decreaseinrespiratoryrate,oliguriaandalteredmentalstatus.
Comparatively,lossofdeeptendonreflexesappearstobethe
earliestofallthesignsanditoccurswhenthemagnesiumlevel
exceeds5mmol/L.
ToxicityofMgSO4ismonitoredby:
Urinaryoutput,
Respiratoryrate,
Kneejerk

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189.Finding(s)ofatrophicvaginitisis/are
a)LowpHofvagina
b)Occurduetoestrogendeficiency
c)Frequentintercourseisuseful
d)Intercoursecausespainlessbleeding
e)Estradiolvaginalringishelpful
CorrectAnswer-B:E
Ans.b)Occurduetoestrogendeficiency;e)Estradiolvaginal
ringishelpful
AtrophicVaginitis
Alsocalledsenilevaginitis,isthethinningofvaginalwalldueto
decreasedestrogenlevels.
Mostcommonaftermenopause,butmayalsodevelopaftersurgical
removalofovaries.
Thereisatrophyofvulvovaginalstructure'
TheacidityofvaginaisdecreasedcausingincreaseinpH.
Importantclinicalfeaturesare:-
Dryvagina
Thinningofvaginalwall
Shorteningandtighteningofvaginalcanal
Dyspareunia
Spotting(bleeding)afterintercourse
Purulent,oftenbloodtingeddischarge
Painorburningwithurination
FrequentUTIs
Urinaryincontinence
Treatmentincludes:

---

Intravaginalapplicationofestrogencream,estradiolvaginalringand
Systemicestrogentherapy

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190.Feature(s)ofHELLPsyndrome
a)Lowplatelets
b)IncreasedASTandALT
c)Decreasedlactatedehydrogenase
d)Increasedconjugatedbilirubin
e)Hemolysis
CorrectAnswer-A:B:E
Ans.a)Lowplatelets;b)IncreasedASTandALT;e)Hemolysis
HELLPsyndromeisanacronymforHemolysis(H),Elevated
liverenzymes(EL)andLowPlateletcount(LP)of<
1,00,000/mm3
ClinicalFeatures:
Manifestedbynausea,vomiting,epigastricorrightupperquadrant
pain,alongwithbiochemicalandhaematologicalchanges.
Parenchymalnecrosisofliveriauseselevationinhepaticenzymes
(ASTandALT>70IU/LandLDH>600IU/L)
Theremaybesubcapsularhematomaformation(whichmayneed
CTscanning)andabnormalperipheralsmear.
Eventuallylivermavrupturetocausesuddenhypotension,dueto
hemoperitoneum

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191.Riskfactorsforabruptioplacentais/are
a)Traumaticseparationoftheplacenta
b)Mutigravida
c)Diabetes
d)Gestationalhypertension
e)Submucousfibroid
CorrectAnswer-A:B:D:E
Ans.a)Traumaticseparationoftheplacenta;b)Mutigravida;d)
Gestationalhypertension;e)Submucousfibroid
ETIOLOGY:
PrimarycauseofAPisuncertain
Severalassociatedconditionsidentified:
Increaseinage&parity:1.3-1.5%
Pre-eclamsia:2.1-4%
Chronichypertension:1.8-3%
Pretermrupturedmembranes:2.4-4.9%
Multifetalgestation:2.1%
Cigarettesmoking:1.4-1.9%
Cocaineabuse:NA
Folicaciddeficiency
Priorabruption:10-25%
Uterineleiomyoma:NA
Hydromnios:2%

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192.Allis/aretrueaboutHIVinpregnancy
except
a)Verticaltransmissiontotheneonateisabout15-30%
b)HAARTtherapyofpregnantwomanreduceschanceof
transmissiontoneonates
c)Zidovudinetherapyshouldbegiventoneonates
d)Electivecaesareansectionreducestheriskofvertical
transmission
e)ZidovudineisgiveninplaceofstavudineinHAARTtherapyif
motherisanaemic
CorrectAnswer-E
Ans.(e)ZidovudineisgiveninplaceofstavudineinHAART
therapyifmotherisanaemic
ManagementofHIVinpregnancy:
Antepartum:-
Mostpatientswillbeasymptomatic.
Patientrequiresobstericcare+HIVcare.ConsultHIVspecialist.
MTPoptionisoffered.
Nutritionalsupplementincludingmicronutrients.
Routineantenatalinvestigation+BaselineCBC,LFT,RFT.
InvestigationsofSTDs,TB,Toxoplasmosis,Cytomegalovirus.
CD4count&vitalloadineachtrimester.IfCD4count<200,
prophylacticAntibioticsareindicated.
Counselagainstunprotectedcoitus.
USG-Routine+Fetalwellbeingassessment.
Avoidinvasiveprocedures.

---

AntiRetroviralTherapy(ART)
ACTG076regimen:-(AIDSClinicalTrialGroup)
Zidovudine(AZT)
Reductionoftransmission:-25.5%to8.3%
CDCThairegimen:-
Zidovudine(AZT)
Reductionoftransmission:-50%
HIVNET012regimen:-
Nevirapine
Reductionoftransmission:-47%
PETRAstudy:-Zidovudine(AZT)+Lamuvidine(3TC)
Reductionoftransmission:-69%
INTRAPARTUMMANAGEMENT
ElectiveLSCSreducesperinataltransmissionupto50-80%.
DuringDelivery:-
AvoidARM
AvoidVaginaltears
AvoidInstrumentaldelivery
RestrictEpisiotomy
Avoidfetalscalpelectrode/fetalbloodsampling
POSTPARTUMMANAGEMENT:
Washnewbornafterbirth,especiallyface.
Mouthsuctionisavoided
Avoidhypothermia
AntiRetroviralTherapy(ART)
Allvaccinestoasymptomaticchildren&onlyinactivatedvaccinesto
symptomaticchildren
Newborntesting
ELISATESTfalsepositiveupto18months
Beforethattoconsidernewbornpositive2testsmustbepositive
fromHIV1culture,p-24antigen,PCR

---

193.Truestatementaboutvacuumextraction
ofbaby-
a)Pressureismaintainedb/w5kg/cm2to8kg/cm2
b)Donewhencervixisfullydilated
c)Centreofcupshouldbeplaced1cminfrontofposterior
fontanelle
d)Cuprimshouldbeplaced3cmfromtheanteriorfontanelle
e)Alltheabove
CorrectAnswer-B:D
Ans.(b)Donewhencervixisfullydilated;(d)Cuprimshouldbe
placed3cmfromtheanteriorfontanelle
INDICATIONSOFVENTOUSEDELIVERY:
Fetalheartrateabnormalities
LowfetalscalppH
Non-progressivelabourin2ndstage
Maternalexhaustion
Cervixshouldbefulldilated.
Thepressureiskeptbetween0.2kg/cm2,to0.8kg/cm2
Theflexionpointisfoundalongthesagittalsuture,approximately3
cminfrontoftheposteriorfontanelandapproximately6cmfromthe
anteriorfontanelBecausecupdiametersrangefrom5to6cm,when
properlyplaced,thecuprimlies3cmfromtheanteriorfontanel

---

194.Truestatementaboutprimary
dysmenorrhea-
a)Painstarts2-3daybeforemenstruationandstopsafter1dayof
menstruation
b)Painbeginsafewhoursbeforeorjustaftertheonsetofa
menstrualperiodandmaylast48to72hours
c)MaybeassociatedwithPsychologicalfactors
d)GnRHantagonistsarealwaysusedin1stlinetreatment
e)All
CorrectAnswer-B:C
Ans.is'b'i.e.,Painbeginsafewhoursbeforeorjustafterthe
onsetofamenstrualperiodandmaylast48to72hours;&'c'
i.e.,Maybeassociatedwithpsychologicalfactors
Primarydysmenorrheaoccursduringovulatorycyclesandusually
appearswithin6to12monthsofthemenarche.
Painindysmenorrheabeginsafewhoursbeforeorjustafterthe
onsetofmenstruationandusuallylasts48-72hours.
AssociatedSymptoms
Nauseaandvomiting
Fatigue
Diarrhoea
Lowerbackache
Headache
Behaviouralandpsychological
Treatment
NSAIDsarethedrugsofchoicefortreatmentofprimary

---

dysmenorrhea,
OCPs

---

195.Whichofthefollowingstatement(s)is
trueaboutabdominalincisioninwomen
forvarioussurgicalprocedures-
a)Paramedian:bestincision
b)Transverseincisionshouldbeonlyusedinexceptionalcases
c)Cherneyincisionisusefulinuro-gynaecologicalprocedures
d)Marylandincisionprovideimprovedaccesstothepelvicside
wall
e)Rutherford-morrisonisparticularlyusefulforapproaching
ovarianmasses
CorrectAnswer-C:D:E
Ans.is'c'i.e.,Cherneyincisionisusefulinuro-gynaecological
procedures;'d'i.e.,Maylardincisionprovideimprovedaccess
tothepelvicsidewall;&'e'i.e.,Rutherford-Morrisonis
particularlyusefulforapproachingovarianmasses.
Factsaboutabdominalincisionsinobstetrics
MostcommonlypreferredincisionsMidlineverticalincisionor
suprapubictransverseincision(Pfannenstielincision).
Paramedianormidlinetransverseincisionarenotusedexceptin
exceptionalsituations..Maylardincisionprovideimprovedaccessto
pelvicsidewall.
Cherneyincisionisusefulfor:
Oncologicalsurgery
Complexurogynaecologicalprocedures(ifincisionisplacedlower).
Rutherford-Morrisonisparticularlyusefulforreachingtheovarian
massesinpregnancy(especiallyin2ndhalf).

---

---

196.Ahighgradesquamousintraepithelial
lesionisnotedwithpap,next
managementincludes?
a)Warthim'shysterectomy
b)Localexcision
c)Colposcolicstudyandbiopsy
d)HPVDNAtesting
e)Liquidbasedcytology
CorrectAnswer-C
Ans'is'c'i.e.,Colposcolicstudyandbiopsy
Forhighgradeintraepitheliallesions(HSIL),firststepistodo
colposcopyandbiopsy.
Moderatetoseveredysplasia(CIN-II&CIN-III)(HSIL):
Treatmentoptionsare:
Localdestructivemethods
Cryosurgery
Fulguration/electrocoagulation.
Laserablation
Excisionofabnormaltissue
Coldknifeconisation
Laserconisation
LLETZ
LEEP
NETZ
Surgery:
Therapeuticconisation

---

Hysterectomy
Hysterectomywithremovalofvaginalcuffifcarcinomainsitu
extendsintovaginalvault

---

197.Screeningtestusedinfirsttrimesterfor
aneuploidy?
a)PAPP-A&estradiol
b)PAPP-A&AFP
c)PAPP-A&betaHCG
d)BetaHCG&inhibin
e)Estradiol&AFP
CorrectAnswer-C
Ans.is'c'i.e.,PAPP-A&betaHCG
1sttrimesteraneuploidyscreening:
Humanchorionicgonadotropin(eitherintactorfree(-hCG).
Pregnancy-associatedplasmaproteinA(PAPP-A).
FetalDownsyndromein1sttrimester:
Higherserumfreebeta-hCGlevel.
LowerPAPP-Alevels.
Trisomy18&13:
LoweredlevelsofbothHCGPAPPP-A.
2ndtrimesteranalytes:
Serumintegratedscreening.
Accuracyofaneuploidydetection:
Greateroncombinationwith,
SonographicNTmeasurement.

---

198.Absolutecontraindicationofmedical
abortion?
a)RHD
b)Ectopicpregnancy
c)Hypersensitivitytoprostaglandins
d)Corticosteroidtherapy
e)Porphyria
CorrectAnswer-B:C:E
Ans.is'b'i.e.,Ectopicpregnancy;'c'i.e.,Hypersensitivityto
prostaglandins;&'e'i.e.,porphyria
Absolutecontraindicationofmedicalabortion:
Allergiestomifepristone/misoprostol
Inheritedporphyria
Chronicadrenalfailure
Knownorsuggestedectopicpregnancy
Undiagnosedadnexalmass

---

199.Vaginalprolapsefollowingabdominal
hysterectomyis/arecausedbydamage
of
a)LevelIsupport
b)LevelIIsupport
c)LevelIIIsupport
d)Urogenitaldiaphragm
e)Alltheabove
CorrectAnswer-E
Ans.e)Alltheabove
Vaginalprolapsecanbedividedinto:-
LevelI:damagecausesuterinedescent,enterocele,vaultdescent'
LevelII:damagecausecystocele,rectocele
LevelIII:damagecausesurethrocele,gapingintroitusanddeficient
perineum
Themiddlepartofvaginaissupportedbytheurogenitaldiaphragm

---

200.Contraindicationofcombinedoral
contraceptive(COC)include(s)-
a)Severehypertension
b)Ischemicheartdisease
c)Pre-menstrualtension
d)Activeliverdisease
e)All
CorrectAnswer-A:B:C:D
Aps.is'a'i.e.,Severehypertensiorr;'b'i.e.,Ischemicheart
disease;&'d'i.c',Activeliverdisease
ContraindicationsofOCPs(WHOguidelines)
Absolute:
Thromboembolismevent,cerebrovascularaccident,coronaryartery
disease,
Breastcancer,
DM(>20yearsduration)
Impendingmajorsurgery
Hyperlipidaemia
Pregnancy
Lactation(<6weekspostpartum)
Activeliverdisease,hepatoma
Uncontrolledhypertensionorwithvasculardiseases
>35yearsoldandheavysmoker(>20cigarettes/day)
Migrainewithaura
Diabeticnephropathy/neuropathy/retinopathy
Structuralheartdiseasewithpulmonaryhypertension,AForSABE.

---

Relative:
Lactation(6weeks-6months)
Controlledhypertension
Undiagnosedvaginalbleeding
Migrainewithoutaura
Gallbladderdisease
Age>35yearsandlightsmoker(<20cigarettes/day)
DMwithvascularcomplications.

---

201.Chronicuseofcombineoral
contraceptive(COC)helpsinallexcept
a)Dysmenorrhea
b)Breakthroughbleeding
c)Menorrhagia
d)Migraine
e)Anaemia
CorrectAnswer-B:D
Ans.b)Breakthroughbleeding&d)Migraine
OCPS
ADVANTAGES:
Controlsfertility
TreatsMenorrhagia&polymenorrhoea.
Relievedysmenorrhoeaandpremenstrualtension
Preventsanaemia
Lowerschancesof
Fibrocysticdisease
Ovariancyst
Ovarian,uterine&anorectalmalignancy
PID
Ectopicpregnancy
Usefulinacne,PCODandendometriosis
PreventRA
NoncontraceptivebenefitsofOCPs:
Cyclestabilization
Cureofmenstrualdisorder-usefulinmenorrhagia&polymenorrhea

---

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

---

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

---

203.Whichofthefollowingstatement(s)
is/aretrueaboutcystsinovaryexcept-
a)Follicularcystisleastcommonamongfunctionalcyst
b)CorpuslutealcystsareoftenassociatedwithPregnancy
c)Dermoidcystaregermcelltumor
d)FibromaofovaryisassociatedwithMeig'ssyndrome
e)Thecaleutincystisseeninassociationwithhydatiformmole
andGnRHanalogueuse
CorrectAnswer-A
Ans.a)Follicularcystisleastcommonamongfunctionalcyst
Functionalovariancysts:
Benignmassintheovary
Thesecystsare:-
Follicularcyst:Mostcommonfunctionalovariancyst.Itisofsmall
size,rarelyislargerthan8cm.
Corpusluteumcyst:Maybeassociatedwithpregnancyandpersist
upto14weeksasnormalphysiologicalstructure.
Thecaluteincysts:Leastcommonoffunctionalovariancysts.
Usuallybilateralandoccurwithpregnancy,includingmolar
pregnancies.associatedwithmultiplegestations,molar
pregnancies,choriocarcinoma,diabetes,Rhsensitization,
clomiphenecitrateuse,humanmenopausalgonadotropin-human
chorionicgonadotropinovulationinduction,andtheuseofGnRH
analogues.
Allteratomas,includingbenignmatureteratoma(dermoidcyst),are
germcelltumors.

---

Combinationofanovarianfibromawithascitesandhydrothorax
(usuallyrightsided)isknownasMeig'ssyndrome.

---

204.Dermatologicmanifestationoflithium
is/are-
a)Rash
b)Psoriasisexacerbation
c)Acneiformeruptions
d)Pustulardermatoses
e)Pemphigus
CorrectAnswer-B:C:D
Ans.(B)Psoriasisexacerbation(C)Acneiformeruptions
(D)Pustulardermatoses
[Ref.NeenaKhannap.45;KDT7e/ep.449]
Dermatologicalsideeffectsoflithium
Acneiformeruptions
ExacerbationOfPsoriasis
DLE
Pustulardermatosis
Alopecia,thinning&dryingofhair
Itchingskin

---

205.Subepidermalblistersis/areseenin-
a)Pemphigusvulgaris
b)Pemphigusvegetans
c)Pemphigoid
d)Dermatitishepetiformis
e)Pemphigusfoliaceus
CorrectAnswer-C:D
Ans.(C)Pemphigoid(D)Dermatitishepetiformis
[RelNeenal(hanna5e/ep.76]
Subepidermal(Dermo-epidermal)
Functional(AtBasallamina)
Junctionalepidermolysisbullosa
Bullouspemphigoid
Toxicepidermalnecrolysis
Dermolytic(BelowBasallamina)
Epidermolysisbullosaacquisita
Epidermolysisbullosadystrophica
DermatitisHerpetiformis
Deepburns
Porphyriacutaneatarda

---

206.Desmogleinisassociatedwith?
a)Arrhythomogenicrightventricularcardiomyopathy
b)Hypertrichosis
c)Pemphigusvulgaris
d)Psoriasis
e)Keratodermawithwoolyhair
CorrectAnswer-A:C:E
Ans.(A)Arrhythomogenicrightventricularcardiomyopathy
(C)Pemphigusvulgaris(E)Keratodermawithwoolyhair
Desmoglein:
Pemphigusfoliaceus,
pemphigusvulgaris(mucocutaneoustype)paraneoplastic
pemphigus
Staphylococcalscaldedskinsyndrome
Bullousimpetigo
Striatepalmoplantarkeratoderma

---

207.Drugsknowntotriggermalignant
hyperthermia-
a)Halothane
b)Succinylcholine
c)Pancuronium
d)Fentanyl
e)Propofol
CorrectAnswer-A:B
Ans.(A)Halothane(B)Succinylcholine
[RefMorganAnaesthesia5th/ep.1187-9A;AiayYadavp.13j-35;
Miterp.1187-89;Leel3'h/ep.353;Wylle'sAflaesthesiflVh/cp.I65-
67]
DrugscausingMalignanthyperthermia(MH):
Succinylcholine
Halothane
Isoflurane
Enflurane
Sevoflurane
Desflurane
Methoxyflurane
MAOinhibitors
TCA
Phenothiazines
Lignocaine

---

208.Whenwillyoususpectmalignant
hyperthermiainpostappendectomy
patientshiftedtoICUwithhighfever&-
a)Hypotonia
b)Seizure
c)Masseterspasm
d)Metabolicacidosis
e)Hypokalemia
CorrectAnswer-B:C:D
Ans.(B)Seizure(C)Masseterspasm(D)Metabolicacidosis
[Ref:MorganAnaesthesia5'h/ep.1187-90;AjayYadavSe/ep.133-
35;MillerThlep,1187-89;Leel3'h/ep.35i;Wylie'sAnesthesiaVh/e
p.j65,367]
Malignanthyperthermia:
Theconditionoccursduringorimmediatelyafteranaesthesiaand
maybeprecipitatedbypotentinhalationagents(enflurane,
halothane,isoflurane),orsuxamethonium.
Clinicalfeaturesare:-
MassetersPasmIfapatientdevelopsseveremasseterspasm
aftersuxamethonium,thereisasignificantpossibilityofmalignant
hyperthermia.
Tachycardiaandarrhythmias
Riseinend-tidalCO,(firstsign)
Increasedtemperature&unexpectedchangeinBP.
Seizuresagitationandmusclerigidity

---

209.Whichofthefollowingis/areusedin
bupivacainetoxicity-
a)CaC12
b)Bretylium
c)Intralipids
d)Esmolol
e)Epinephrine
CorrectAnswer-B:C:E
Ans.(B)Bretylium(C)Intralipids(E)Epinephrine
[Re!.MorganAnaesthesiaSth/ep.273-74;Ajayyadav5'h/ep.144;
Miller6th/ep.933;Leel3th/ep.384;BarashAnaesthesia6,h/ep.
545]
Managementofbupivacainetoxicity
Ensureadequateoxygenation,whetherbyfacemaskorby
intubation.
Anticonvulsantssuchasbenzodiazepinesandbarbituratesarethe
drugofchoiceforseizurecontrol.
Propofolcanalsobeused.
Succinylcholineissometimesalsousedtoterminatethe
neuromusculareffectsofseizures.
ForunresPonsivebupivacainetoxicity,intravenouslipidor
cardiopulmonarybypassmaybeconsidered.
Forarrhythmias,amiodaroneistheDOC.Bretyliumandesmololcan
alsobeused.

---

210.Anaesthesiausedforinductionis/are-
a)Propofol
b)Thiopentone
c)Ketamine
d)Diazepam
e)Midazolam
CorrectAnswer-A:B:C:E
Ans.(A)Propofol(B)Thiopentone(C)Ketamine(E)Midazolam
[Ref:MorganAnaesthesia5th/ep.175-82;AjayYadavS,h/ep.92;
Leel3th/ep.155]
Intravenousinducingagents:
Thiopentone
Methohexitone
Propofol
Etomidate
Ketamine
Benzodiazepines

---

211.Whichofthefollowingcriteriais/are
usedforsettingmechanicalventilatorfor
adultinICU-
a)Age
b)Gender
c)Weight
d)Height
e)Underlyingconditionofpatient
CorrectAnswer-B:C:D:E
Ans.(B)Gender(C)Weight(D)Height(E)Underlyingcondition
ofpatient
[Ref:MorganAnaesthesia5th/ep.1288;emedicine.medscape.com]
Mainlydependsonidealbodyweight(IBW),whichiscalculated
basedongenderandheight.
WomenIBW(lbs)=105+5(Heightininches-60)
MenIBW(lbs)=106+6(Heightininches-60)
Settingsalsodependatypesoflungdisease,i.e.whetherthe
patientisnormalorwithrestrictivediseaseorwithobstructivelung
disease

---

212.Trueaboutendotrachealtube-
a)Noncuffedtubeisusedinpediatricagegroup
b)MadeofPVC&disposable
c)Canbeputeitheroralornasalaccordingtodifferentsituations
d)CuffedPVCtubes-lowpressure,lowvolume
e)Moretendencytogotorightbronchusthereby
CorrectAnswer-A:B:C:E
Ans.(A)Noncuffedtubeisusedinpediatricagegroup
(B)MadeofPVC&disposable(C)Canbeputeitheroralor
nasalaccordingtodifferentsituations(E)Moretendencytogo
torightbronchusthereby
[Ref:MorganAnaesthesiap.320-25;AjayYedav5'h/ep.43-46;Lee
l3th/ep.205-09]
Endotrachealtubesaremainlyoftwotypes.
CuffedEndotrachealTube:
CuffPressureshouldnotexceed30cmH2O(22mmHg)toprevent
ischemicdamagetotrachealmucosa.
Twotypes,basedoncuffpressureandvolume.
LowPressure,Highvolume:-
Inthiscuffhashighvolume&lowpressure.
Becauseoflowpressurethesetubesproducelesstrachealinjury,
thereforesuitableforprolongedsurgeries.0
Morecommonlyusedthanhighpressurelowvolumetube.
Thesetubesaremadeupofpolyvinylchloride
Highpressure,lowvolume:
Madeupofredrubber.
UncuffedEndotrachealTube:

---

Inchildren(lessthanl0yearsofage)uncuffedtubesshouldbeused
andthereshouldbeslightteakoninspiratorypressureof30cmIIrO

---

213.Trueaboutendotrachealintubation-
a)HeadtraumapatientpresentingwithaGCSscore8orless
shouldbeintubated
b)Doneinpatientswithincreasedriskofaspiration
c)Canbeusedinpatientwithfullstomach
d)Incervicalinjury,patientneckisstabilizedbeforeintuvation
e)Doneinpatientswhoneedanaesthesia
CorrectAnswer-A:B:C:D:E
Ans.(A)HeadtraumapatientpresentingwithaGCSscore8or
lessshouldbeintubated(B)Doneinpatientswithincreased
riskofaspiration(C)Canbeusedinpatientwithfullstomach
(D)Incervicalinjury,patientneckisstabilizedbeforeintuvation
(E)Doneinpatientswhoneedanaesthesia
[RefLeel3tt'/ep.208;MillerVh/ep./586;CSDTl4th/ep.814]
Endotrachealintubationisusedtomaintainapatentairwayin
operationtheateraswellasoutsidetheoperationtheater:-
IndicationsforEndotrachealIntubationintheoperatingroom
include:
Theneedtodeliverpositivepressureventilation.
Protectionofrespiratorytractfromaspirationofgastriccontents.
Surgicalprocedureinvolvingtheheadandneckorinnon-supine
positionsthatprecludemanualairwaysupport.
Almostallsituationsinvolvingneuromuscularparalysis.
Somenon-operativeindicationsare:
Tracheobronchialtoilet(pulmonarytoilet).
Profounddisturbanceinconsciousnesswiththeinabilitytoprotect
theairways.

---

---

214.Whichofthefollowingis/arefeature(s)of
epiduralanaesthesiathanspinal
anaesthesia-
a)Smallersizeofneedleisused
b)Drugusedislessinconcentration
c)Lesschanceofspinalheadache
d)Onsetofactionisdelayed
e)Densityofanaestheticagentislessinepiduralthanspinal
CorrectAnswer-B:C:D:E
Ans.(B)Drugusedislessinconcentration(C)Lesschanceof
spinalheadache(D)Onsetofactionisdelayed(E)Densityof
anaestheticagentislessinepiduralthanspinal
[RefMorganAnaesthesiap.959,969;AjayYadav5'h/ep.162;
MillerVh/ep.1626]
Epiduralanaesthesia:
Sloweronsetofaction
Lessreliable
Difficult
DurationcanbeprolongedbyrepeatedlyinjectingLAbyanepidural
catheter.
Canbeusedforupperabdominal,thoracic&necksurgeryaswellin
additiontosurgeriesperformedbyspinalanaesthesia.
PDPHisunlikelybecauseduraisnotpierced->so,thereisnoCSF
leakage.
Epiduralneedlesarelargerthanspinalneedles.

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215.Feature(s)ofcrohn'sdiseaseis/are-
a)Pipestemcolon
b)Pseudosacculation
c)Lossofhaustrasion
d)Cobblestoneappearance
e)Stringsignofkantor
CorrectAnswer-B:D:E
Ans.(B)Pseudosacculation(D)Cobblestoneappearance
(E)Stringsignofkantor
RadiologicalfindingsofCDare:-
EarliestchangesareaPhthouslesionsorerosions(centralflecksof
bariumsurroundedbyatranslucenthalo).Theselesionsarealso
knownasTargetlesionsorBull'seye.
StringsignofKantor:-Greatlynarrowedterminalileumdueto
inflammationandfibrosis.
'Creeping-faf"sign(OnCT):-Inflammatorychangesintheadjacent
mesentericfat.
Combsign:-Prominentvasarectaofmesentericvessels.
Discontinuousinvolvement(Skipareasarepresent).
Cobblestoneappearance
Raspberryrosethornappearance
Pseudosacculation

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216.Neoadjuvantchemotherapystandsfor-
a)Chemotherapyalongwithsurgery
b)Chemotherapybeforesurgery
c)Chemotherapyaftersurgery
d)Chemotherapyalongwithradiationtherapy
e)Chemotherapyafterradiationtherapy
CorrectAnswer-B
Ans.B.Chemotherapybeforesurgery
[Ref:Katzung13th/ep.919-20;chemoth.com/neoadjuvant-
chemotherapy]
NeoadiuvantchemotherapyreferstoCombinationofChemotherapy
andsurgery/radiotherapyinwhichchemotherapyisgivenpriorto
surgery/radiotherapy.

---

217.Trueaboutconcomitant
chemoradiotherapy-
a)Chemotherapyandradiotherapybothgivensimultaneously
b)Radiotherapyactslocoregionallyandchemotherapyacts
againstdistantmicrometastases
c)Radiotherapyactsassensitizingagent
d)Chemotherapymayactassensitizingagent
e)None
CorrectAnswer-A:B:D
Ans.(A)Chemotherapyandradiotherapybothgiven
simultaneously(B)Radiotherapyactslocoregionallyand
chemotherapyactsagainstdistantmicrometastases
(D)Chemotherapymayactassensitizingagent
Concomitantchemoradiotherapy
Radiotherapyandchemotherapyaregivensimultaneously.
Threeclinicalrationalessupporttheuseofchemotherapydelivered
concurrentlywithradiation.
First,concomitantchemoradiotherapycanbeusedwithorgan-
preservingintent,resultinginimprovedcosmesisandfunction
comparedwithsurgicalresectionwithorwithoutadjuvanttreatment.
Second,chemotherapycanactasaradiosensitizer,improvingthe
probabilityoflocalcontroland,insomecases,survival,byaidingthe
destructionofradioresistantclones.
Third,chemotherapygivenaspartofconcurrentchemoradiation
mayactsystemicallyandpotentiallyeradicatedistant
micrometastases.

---

---

218.Whichofthefollowingis/aretrueabout
brachytherapythanteletherapy-
a)Moreeffectiveincarcinomacervix
b)Sameproportionofradiationisdeliveredtoboth-tumour&
normaltissue
c)Betterthanteletherapyforlarge&bulkytumour
d)Deliverhigherdoseofradiationtotumour
e)Lessdamagetonormaltissue
CorrectAnswer-A:D:E
Ans.(A)Moreeffectiveincarcinomacervix(D)Betterthan
teletherapyforlarge&bulkytumour(E)Lessdamagetonormal
tissue
Advantageofbrachytherapyisthatitdelivershighradiationdoseto
tumorlocallywithhighlocalcontrol.
Damagetonormaltissueislessastheirisrapidfall-offofradiation
aroundthesource.
Thistechniqueisparticularlyusefulintreatingcancersofcemix,
uterus,vaginaandcertainHandNcancers.
Itcanalsobeusedtotreatbreast,brain,skin,esophageal,soft
tissue,lung,bladderandprostatecancer.

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219.Featuresofstrontium89incomparison
tophosphorus-32-
a)Longert-1/2
b)Deeperpenetration
c)EmitsbetarayswhileP-32emitsalpharays
d)Lessertoxicity
e)None
CorrectAnswer-A:D
Ans.(A)Longert-1/2(D)Lessertoxicity
[ReJ:ReviewofRadiologybySumerSethiCh/ep.184;Harrison
l9h/ep.363e-3;Bonica'sManagementofPuinbyScottFishmanp'
655]
Half-lifeofP-32is14.3daysandstrontium-89is50.5days.
SofttissuepenetrationofP-32is8mmandstrontium-89is2.4mm.
BothP-32andStrontium-89emitB-rays.
P-32ismoderatelytoxicwhereasstrontiumhaslowtoxicity.

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220.Maximumscoreinminimentalstatus
examinationis-
a)10
b)15
c)20
d)25
e)30
CorrectAnswer-E
Ans.E.30
[Ref:KaplanandSadockp.2537]
Themini-mentalstatusexaminationoffersaquickandsimplewayto
quantifycognitivefunctionandsteenforcognitiveImpairment.
Ithelpstoconfirmthepresenceofcognitiveimpairmentandtofollow
theprogressionofdementia.
Ittestsindividual'sorientation,attention,calculation,recall,
language,andmotorskills.Eachsectionofthetestinvolvesa
relatedseriesofquestionsorcommands.
TheindIVIdualreceivesonepointforeachcorrectanswer.The
individualcanreceiveamaximumscoreof30points,i.e.,
MMSEis30pointprogrammetoevaluatecognitivefunction.

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221.Trueaboutgeneralizedanxietydisorder
?
a)Insomnia
b)Clearhistoryofpasttraumaticevent
c)Excessiveanxietyandworry
d)Benzodiazepinesisdrugsofchoice
e)None
CorrectAnswer-A:C:D
Ans.(A)Insomnia(C)Excessiveanxietyandworry
(D)Benzodiazepinesisdrugsofchoice
[Ref:NirajAhujap.90-91;KaplanandSadock11'h/ep.409]
Generalizedanxietydisorder:
Characterizedbyexcessiveanxietyandworrywhicharepersistent
&generalizedandnotrestrictedtoanyspecificsituationorobject.
Excessiveanxietyworryoccurforatleast6months.
Worryisdifficulttocontrolandisassociatedwithatleastthree
symptomsfromthefollowing:
Selflessnessorfeelingkeyedup
Difficultyconcentrating
Muscletension
Easilyfatigued
Irritability
Sleepdisturbance
Anxietyandworrycausesignificantdistressandimpairmentis
social,occupational,orotherdailyfunctioning.
Treatment:

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Benzodiazepine-Drugofchoice.

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222.Essentialcriteriaformajordepression
areallexcept-
a)Delusionofgrandeur
b)Lossofpleasure
c)Insomnia
d)Hypersomnia
e)Anorexia
CorrectAnswer-A
Ans.A.Delusionofgrandeur
[RefNirajAhaiap.7l-72;KeplarnandSadsckp.357]
Diagnosticcriteriaformajordepression
5ormoreofthefollowingsymptomsshouldbepresentmostofthe
dayforatleast2weeks:-
Depressedmood
Lossofinterestorpleasureinallactivities.
Decrease/increaseappetiteorloss/gainofweight.
Insomniaorhypersomnia(Increasedordecreasedsleep).
Psychomotorretardationoragitation(decreasedorincreased
psychomotoractivity).
Fatigueorlossofenergy(weaknessorlethargy).
Feelingsofworthlessnessorexcessiveguilt.
Diminishedconcentration
Recurrentthoughtsofdeathorrecurrentsuicidalideationorsuicidal
attempt.

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223.TruematchofEEGpatterninsleepEEG-
a)K-complexisseeninstageIofNREMsleep
b)Wakingstateshowalphawave
c)Alpha-waveoccurinonsetofsleep
d)ThetawaveisthepredominantwaveinstageIofNREMsleep
e)StageIII-NREMsleepshowshighamplitudeslowwaves
CorrectAnswer-B:D:E
Ans.(B)Wakingstateshowalphawave(D)Thetawaveisthe
predominantwaveinstageIofNREMsleep(E)StageIII-NREM
sleepshowshighamplitudeslowwaves
[RefNirajAhajap.132-34;Kaplan&Sedaockp.534]
Fullawakeandalertstate=Betarhythm
Awake,eyesclosedandmindwanderingbutwithlessattentiveness
=Alpha-rhythm
Stage1NREM=Thetarhythm
Stage2NREM=Sleepspindles,Kcomplex
Stage3&4NREM(Deepsleep)=Deltarhythm
REMsleep=Betarhythmandsometimesalsoreappearanceof
alpharhythm-.

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224.Naltrexoneis/areusedfor-
a)Alcoholdependence
b)Opioiddependence
c)Cocainedependence
d)Cannabistoxicity
e)None
CorrectAnswer-A:B:C
Ans.(A)Alcoholdependence(B)Opioiddependence
(C)Cocainedependence
[Ref:Katzungp.56-t;NiruiAhuia7h/ep.42,44,132;Pharmacology
bySatoskarp.165]
Naltrexone:
Antagonistonallopioidreceptors)
Morepotentthannaloxone.
Givenorally.
Usedasamaintenancedrugforopioidaddicts-opioidblockade
therapyofpostaddict.
Usedtodecreasecravinginchronicalcoholism.

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225.Whichofthefollowingis/arefeature(s)of
nicotinewithdrawal-
a)Weightloss
b)Irritability
c)Impairedconcentration
d)Anxiety
e)Insomnia
CorrectAnswer-B:C:D:E
Ans.(B)Irritability(C)Impairedconcentration(D)Anxiety
(E)Insomnia
Diagnosticcriteria{iaofnicotinewithdrawal:
Fourormoreofthefollowingsignsshouldbetherewithin24hours
ofwithdrawal
Dysphoriaordepressedmood
Anxiety
Decreasedheartrate(bradycardia)
Insomnia
Difficultyconcentrating
IncreasedaPPetiteorweightgain
Irritability,frustrationoranger
Restlessness.
invalidquestionid

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