Download PGI PG PGI 2017 May Solved Question Paper

1.TrueaboutmeiosisI:
a)Sisterchromatidsreplicate
b)Sisterchromatidsseparate
c)Haploiddaughtercells
d)Homologouschromosomesexchangematerial

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e)Homologouschromosomesseparate
CorrectAnswer-C:D:E
Ans.is'c'i.e.,Haploiddaughtercells;'d'i.e.,Homologous
chromosomesexchangematerial!&'e'i.e."Homologous
chromosomesseparate

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MeiosisIisdividedintofollowingphases:-
1.ProphaseI:
Longestphase.
Itisfurthersubdividedinto:_
1. Leptotene:Diffusechromatinstartscondensingintochromosomes

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andchromosomesstartappearinginthisstage.
2. Zygotene:InthisstageHomologouschromosomespairup.This
processiscalled'synapsis'orconjugationandeachpairiscalled
bivalent.
3. Pachytene:Inthisstagetwochromatidsofeachpairseparateandis

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calledtetrad.Thenthereoccurs'crossing-over',i.e.,oneorboth
chromatidsofonehomologouschromosomecrossesoverwith
thosefromotherhomologouschromosomeofthatpairforming
synaptonemalcomplex.Thepointofcrossingoverarecalled,
chiasmata.

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4. Diplotene:Thetwochromosomesofbivalenttrytomoveapart.
ThereisexchangeofgeneticmaterialbetweenHomologous

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chromosomes
5. Diakinesis:Inthisstagethereorganizedchromosomesmoveapart.
Eachbivalentcannowbeseentocontainfourchromatidslinkedby

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acommoncentromere,whilenon-sisterchromatidsarelinkedby
chiasmata.
2.MetaphaseI:Thebivalentsbecomearrangedaroundtheequator
ofthespindle,attachedtotheircentromeres.
3.AnaphaseI:Spindlefibrespullhomologouschromosomes.This

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separatesthechromosomeintotwohaploidsets'onesetateach
endofspindle.
4.TelophaseI:Twodaughtercellsareformedeachcontaining23
chromosomes(Haploid),eachconsistingoftwochromatids(2C).

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2.TrueaboutFibrousskeletonofheart?

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a)Fibrousringaroundmitralvalve
b)Tendonofinfundibulumisbetweenpulmonary&aorticvalve
c)Trigonumdextrumisbetweenmitral&tricuspidvalve
d)Trigonumsinistrumisbetweenmitralandaorticvalve
e)TendonofTodaroisbetweencentralfibrouspartsto

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Eustachianvalve
CorrectAnswer-A:B:D:E
Ans.is'a'i.e.,Fibrousringaroundmitralvalye;'b'i,e.,Tendon
ofinfundibulumisbetweenpulmonary&aorticvalve;'d'i.e.,
Trigonumsinistrumisbetweenmitralandaorticvalve;&'e'

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i.e.,TendonofTodaroisbetweencentralfibrouspartsto
Eustachianvalve
Fibrousskeletonofheart:
Fibrousringsurroundingtheorificesofatrioventricular(mitraland
tricuspid)orifices,pulmonaryorificeandaorticorifice,alongwith

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someadjoiningmassesoffibroustissue.
Tendonofinfundibulumisfibroustissuebetweenpulmonaryand
aorticring.
Trigonumfibrosumdextrumisfibrosustissuebetweenatrioventricular
rigs(mitralandtricuspid)andaorta.

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Trigonumfibrosumsinistrumisfibroustissuebetweentheaorticand
mitralrings.

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3.Tastesensationfromthetongueis/are
carriedby?
a)Facialnerve

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b)Glossopharyngealnerve
c)Hypoglossalnerve
d)Vagusnerve
e)Trigeminalnerve
CorrectAnswer-A:B:D

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Ans,is'a'i,e.Faeialnerve'b'i,e.Glossopharyngealnerve;&'d'
i,e.Vagusnerve
Tastesensationoftongue:
Anterior2/3rdpart:Chordatympani
Posterior1/3rdpart&circumvallatepapillae:Glossopharyngeal

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nerve
Posteriormostpart:InternallaryngealbranchofVagusnerve

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4.Trueaboutepiglottis?
a)Containsserousgland
b)Containsmucoussecretingglands

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c)Itisovalshaped
d)Madeupofelasticcartilage
e)Hasbilaterallymphaticsupply
CorrectAnswer-B:D:E
Ans.is'b'i.e.,Containsmucoussecretingglands;'d'i.eMadeup

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ofelasticcartilage&'e'i.e',Hasbilaterallymphaticsupply
Epiglottis:
Theepiglottisofelasticcartilagetissuecoveredwithamucous
membrane,attachedtotheentranceofthelarynx.
Theepiglottishastwosurfaces,lingualandalaryngealsurface,

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relatedtotheoralcavityandthelarynxrespectively
Theentirelingualsurfaceandtheapicalportionofthelaryngeal
surfacearecoveredbyastratifiedsquamousnon-keratinized
epithelium.
Therestofthelaryngealsurfaceon,whichisinrelationtothe

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respiratorysystem'hasrespiratoryepithelium:pseudostratified,
ciliatedcolumnarcellsandmucussecretingGobletcells.
Epiglottishasbilaterallymphaticdrainagetopperdeepcervical
lymphnodes

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5.Trueregardingthyroidglandis?

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a)DeepinvestinglayerformBerryligament
b)Condensedfibrouspartofglandformtruecapsule
c)Superiorthyroidarteryliesposterolateraltosuperiorlaryngeal
nerve
d)Recurrentlaryngealnervehasvariablecourseonbothsides

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e)SuppliedbyThyrocervicalTrunk
CorrectAnswer-B:E
Ans.Ans.is'b'i.e.,Condensedfibrouspartofglandformtrue
capsule;'e'i.e.,SuppliedbyThyrocervicalTrunk
Thyroidglandhastwocapsule:-

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1. Truecapsule-peripheralcondensationoftheconnectivetissueof
thegland.
2. Falsecapsule-derivedfromthepretracheallayerofthedeep
cervicalfascia.ItalsoformsthesuspensoryligamentofBerrywhich
connectsthelobetothecricoidcartilage.

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3. Ligamentofberryandfalsecapsulearederivedfrompretracheal
layerofdeepcervicalfascia(notinvestinglayer).
Superiorthyroidarteryisrelatedtoexternallaryngealnerve
(externalbranchofsuperiorlaryngealnerve),butnotdirectlyrelated
tosuperiorlaryngealnerveitself

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Recurrentlaryngealnervehasvariablerelationtoinferiorthyroid
arteryonlyonrightside,onleftsideithasconsistentrelation
Bloodsupplyofthyroidglandisthrough:
Superiorthyroidartery-Branchofexternalcarotidartery
Inferiorthyroidartery-BranchofThyrocervicaltrunk

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Thyroideaimaartery-Fromthebrachiocephalictrunkorarchof

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aorta

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6.NotTRUEstatementregardingparotid
glandis/are?
a)Deeplobecontainsdeeplymphatics

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b)Dividedintosuperficialanddeeplobesbyfacialnerve
c)Parotidductopensoppositetotheseconduppermolar
d)Ectodermalinorigin
e)Auriculotemporalnerveisthemainsensorynerve
CorrectAnswer-A

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Ans.is'a'i.e.,Deeplobecontainsdeeplymphatics
Development:
Parotidglandisthefirstsalivaryglandtoappear,inearly6'week.
Itisectodermalinoriginanddevelopsfromthebuccalepithelium
justlateraltotheangleofmouth

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Structuresemergingfromparotid
Thefollowingstructuresemergefromtheparotidgland:
Anteriorborder:
Parotidduct
3Terminalbranchesoffacialnerve:

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Thezygomaticandbuccalbranches:towardthetemporalregion,
eyelidsandcheek,respectively.
Mandibularbranch:Runalongthebodyofthemandibletowardsthe
mouth
Apex:

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5thterminalbranchoffacialnerve:Cervicalbranchcontinuesinto
theneck(toplatysma).
Anterior&posteriordivisionsofretromandibularvein

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Posteriorborder:
Posteriorauricularnerve

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Posteriorauricularartery
Posteriorauricularvein
Alongbase:
superficialtemporalartery
temporalbranchoffacialnerve

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Auriculotemporalnerve
STRUCTURESWITHINGLAND:
Arteries:
Externalcarotidarteryentersthroughposteromedialsurface
Maxillaryartery

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Superficialtemporalvessel
Posteriorauricularartery
Veins:
Theretromandibularveins
FacialNerve

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ParotidDuct(Stenson'sduct)
Theductturnsopensintothevestibuleofthemouth(gingivo-buccal
vestibule)oppositethecrownoftheupper2ndmolartooth
Nervesupply:
PARASYMPATHETIC:auriculotemporalnerve

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

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7.Whichofthefollowingstatement(s)is/are

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trueaboutphrenicnerveexcept-
a)Itisprimarymotorsupplytodiaphragm
b)Accessoryphrenicnervejoinsthephrenicnervenearthefirst
rib
c)Formedinfrontofscalenusmediusmuscle

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d)Itdescendsposteriortosternocleidomastoid
e)Givessensorysupplytocentraltendonofdiaphragm
CorrectAnswer-C
Ansis.'Ci.e.,Formedinfrontofscalenusmediusmuscle
Liesanteriortoanteriorscalenusmuscle

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Phrenicnerveisamixednerve&carriesmotorfibrestothe
diaphragm&sensoryfibresfromthediaphragm,pleura,pericardium
&partoftheperitoneum.
Origin:
Itariseintheneckfromtheant.ramiofthe3rd,4th&5thcervical

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nerves
Itisformedatthelateralborderofthescalenusanterior,opposite
themiddleofthesternocleidomastoidattheleveloftheupper
borderofthethyroidcartilage.
Relations:

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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

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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

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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

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Theanteriorinterosseousnerve(volarinterosseousnerve)isa
branchofthemediannervethatsuppliesthedeepmusclesonthe
anterioroftheforearm,excepttheulnar(medial)halfoftheflexor
digitorumprofundus.

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9.Truestatementaboutshoulderjoint?

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a)Multipennateacromialfibresofdeltoidarepowerfulabductor
b)Axillarynerveinjuryhasnoeffectonabduction
c)Musculotendinouscuffstabilizesshoulderjoint
d)Supraspinatusinitiatesabduction
e)Trapeziusandserratusanterioractsynergisticallyinabduction

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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

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abduction
TYPEOF
PLANEOF
AXISOF
MUSCLESINVOLVED

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MOVEMENT
MOTION
MOTION
PectoralisMajor,Ant.fiber
Saggital

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Transverse
Flexion
ofdeltoid,
plane
axis

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Coraco-brachialis,Biceps
Latissimus
Saggital
Transverse dorsi,Teresmajor,Post.
Extension

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plane
axis
fibers
ofdeltoid,Triceps
Saggital

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Abduction
Frontalplane
Deltoid,Supraspinatus
axis
Subscapularis,Pectoralis

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Saggital
Major,
Adduction
Frontalplane axis
Latissimusdorsi,Teres

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major

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major
Subscapularis,Pectoralis
Internal
Transverse

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vertical
Major,
Rotation
plane
axis

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Latissimusdorsi,Teres
major
External
Transverse
vertical

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Infraspinatus,Teres
Rotation
plane
axis
minor

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10.Whichisattachedmostanteriorlyonthe
intercondylarareaoftibia
intercondylarareaoftibia(areab/wmedial
andlateraltibialplateau)-
a)Anteriorcruciateligament

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b)Posteriorcruciateligament
c)Anteriorhornofthelateralmeniscus
d)Anteriorhornofthemedialmeniscus
e)Ligamentumpatellae
CorrectAnswer-D

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Ans.is'd'i.e,Anteriorhornofthemedialmeniscus
PROXIMALEND(upperend)
Proximal(upper)endoftibiaincludesmedial&lateral
condyles,formingtibialplateau.
ItalsoincludestibialTuberosity&intercondylararea.

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Attachmentsonproximalendare:
Medialcondyle:Semimembranous(posteriorly),capsuleofknee
joint,tibial(medial)collateralligament(deeppart),medialpatellar
retinaculum(anteriorly).
Lateralcondyle:illiotibialtract(anteriorly),capsuleofsuperior

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tibiofibularjoint.
TibialTuberosity:Ligamentumpatellae
Intercondylararea(fromanteriortoposterior);
1. Anteriorhornofmedialmeniscus
2. Anteriorcruciateligament(ACL)

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3. Anteriorhornoflateralmeniscus

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

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11.Trueaboutgasequation-

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a)Gasconstantis0-9
b)PV=constant
c)PV=nRT
d)Diffusionisdirectlyrelatedtomolecularweightofgas
e)Oxygenhasmorediffusioncoefficient

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CorrectAnswer-C
Ans.C.PV=nRT
Gasequation:
Theidealgaslawisquantitativeexpressionoftheforegoing
principles:PV=nRT.

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WherePisthepressure,Visthevolume,nisthenumberofgram
moleculesofthegas,RisthegasconstantandTistheabsolute
temperature.
ValueofRis0.082(R=0.082),whentheunitsemployedare
atmosphere,litresandcentigrade.

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Therateofinfusion(D)isdirectlyproportionaltothepressure
gradient(LP)andgasdiffusesfromhigherpressureareastolower
pressureareas.
Partialpressuregradient(gaspressuredifference)isthebasicfactor
whichpromotediffusionofagas.

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Rateofdiffusionisdirectlyproportionaltootherfactorsalso,viz.(i)
Surfaceareaofrespiratorymembrane(A);and(ii)Solubilityofgas
concerned(S).
Therateofdiffusionisinverselyproportionalto(i)Thethicknessof
therespiratorymembrane(d);and(ii)Molecularweightofthegas

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(MW).

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12.TrueaboutProstaglandins-
a)Derivedfromlipooxygenasepathway
b)FirstproductisPGG2
c)PGE2causesvasoconstriction

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d)PGF2acausesbronchoconstriction
e)PG12causesfallinBP
CorrectAnswer-B:D:E
Ans.(B)FirstproductisPGG2(D)PGF2acauses
bronchoconstriction(E)PG12causesfallinBP

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Prostaglandins(PG)synthesis:
Prostaglandins(PGs),thromboxanes(TXs),prostacyclin(PGI)and
leukotrienesarecollectivelycalledeicosanoids.
Thesesarederivativesofprostanoicacid.
Theseeicosanoidsarederivedfrom5,8,11,14eicosatetraenoic

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acid(arachidonicacid),thefattyacidreleasedfrommembranelipids
bytheactionofphospholipase-A2.

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13.Whichis/arefeature(s)ofprostaglandins-
a)20carbonatomcompound
b)10carbonatomcompound

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c)Cyclopentanering
d)-OHgroupat156position
e)Transdoublebondat10thposition
CorrectAnswer-A:C:D
Ans.(A)20carbonatomcompound(C)Cyclopentanering(D)-

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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

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trans-doublebondatposition-13.

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14.
Whichofthefollowingis/areeffectof
increased2,3-DPGonoxygen-hemoglobin
dissociationcurve?

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a)edaffinityofheamoglobintooxygen
b)edaffinityofhaemoglobintooxygen
c)Leftshiftofoxygen-hemoglobindissociationcurve
d)Rightshiftofoxygen-hemoglobindissociationcurve
e)Nochangeinoxygen-hemoglobindissociationcurve

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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]

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Oxygen-hemoglobindissociationcurveis2,3DPGinRBC.
DPGisanoptionalby-productoftheglycolyticpathway.
DPGbindswithdeoxygenatedhemoglobinbutnotwithoxygenated
hemoglobin.
RaisedDPGconcentrationreleasesoxygenfromoxyhemoglobinby

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shiftingthefollowingreversiblereactiontotheright.
Mechanism:
OnemoleculeofDPGbindswithonemoleofdeoxyhemoglobin.
HenceanincreaseinDPGconcentrationshiftstheoxygen-
hemoglobindissociationcurvetotheright.

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Thus2,3DPGcausesdelivery(unloading)ofO,tothetissues.
Fetalhemoglobinhasconsiderablylessaffinityfor2,3-DPGthan
doesadulthemoglobinthereforefetalhemoglobinhasagreater

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affinityforoxygenthanadulthemoglobin.
Inhumanblood,theaffinityoffetalhemoglobinfor2,3-DPGisonly

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about4O%thatofadulthemoglobin.
Thismakesfetalhemoglobinbehaveasif2,3-DPGlevelsarelow.

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15.Oxygenconsumptionbytheheartis
determinedby?
a)Intramyocardialtension

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b)Contractilestateofthemyocardium
c)Initiallengthofthemyocardialmusclefiber
d)Heartrate
e)Basaloxygenconsumptionofmyocardium
CorrectAnswer-A:B:C:D:E

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Ans.(A)Intramyocardialtension(B)Contractilestateofthe
myocardium(C)Initiallengthofthemyocardialmusclefiber
(D)Heartrate(E)Basaloxygenconsumptionofmyocardium
[Ref:Ganong25th/ep.550;Guyton's12th/ep.216-17]
Myocardialoxygendemand-Factorsinfluencing:

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Thebasalmetabolismofthehearttissuenormallyaccountsof25%
ofmyocardialoxygendemandinrestingindividuals.
Myocytescontraction(cardiaccontraction)istheprimaryfactor
determiningmyocardialoxygenconsumptionabovethebasalleyek
andcardiaccontractionaccountsfor75%ofmyocardialoxygen

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consumption.
Myocardialwalltension,
Heartrate(Chronotropy),
Inotropicstate(contractility).
Myocardialwalltensionisdirectlyproportionaltointraventricular

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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

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d)Calcium
e)Bicarbonate
CorrectAnswer-B
Ans.B.K+
[Ref:Ganong25th/ep.433-34;Guyton's12'h/ep.613;AKlain

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6,h/ep.748]
InsulinlowersserumK+concentrationi.e.,causeshypokalemia.
ThehypokalemicactionofinsulinisduetostimulationofK+intake
bythecellsmainlyinmuscleandadiposetissue.
InsulinincreasestheactivityofNa+-K+ATPaseincellmembrane,

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sothatmoreK+ispumpedintocells.

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17.Hypothalmkpituitaryaxis(HPA)controls
allexcept-
a)Thyroid
b)Parathyroid

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c)Pancreas
d)Testis
e)Adrenals
CorrectAnswer-B:C
Ans.(B)Parathyroid(C)Pancreas

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[Ref:Ganong25'h/ep.308-14;Harrison'sp.401e-2]
Almostallsecretionbythepituitaryiscontrolledbyeitherhormonal
ornervoussignalsfromthehypothalamus.
Secretionfromtheposteriorpituitaryiscontrolledbynettesignals
thatoriginateinthehypothalamusandterminateintheposterior

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pituitary.
Secretionbyanteriorpituitaryiscontrolledbyhormonescalled
hypothalamicreleasingandhypothalamicinhibitoryhormones(or
factors)secretedwithinthehypothalamusandthenconductedtothe
anteriorpituitarythroughhypothalamichypophysealportalvessels.

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18.Truestatementaboutmalereproductive
physiology-
a)SertolicellssecreteMiillerianinhibitingsubstance(MIS)
b)Inhibinisreleasedbysertolicell
c)Primaryspermatocyteisdiploid

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d)LHandFSHaresteroidalinnature
e)Inhibinstimulatesfollicle-stimulatinghormone(FSH)
CorrectAnswer-A:B:C
Ans.(A)SertolicellssecreteMiillerianinhibitingsubstance
(MIS)(B)Inhibinisreleasedbysertolicell(C)Primary

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spermatocyteisdiploid
HormonesoftheTestes:
Thehormone-secretingcellsinthetestesaretheleydigcellsand
sertolicells.
LeydigcellshavereceptorsforLHandsecretealltheandrogens,

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i.e.,testosterone(majorandrogen),dihydrotestosterone(DHT),
androstenedioneanddehydroepiandrosterone(DHEA).
Allofthemhave19carbonatoms.
SertolicellsareunderthecontrolofFSH,i,e.,havereceptorsfor
FSH.WhenstimulatedbyFSH,thesecellssecrete

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androgenbindingprotein(ABP),inhibinand,MlS(mullerianinhibiting
substance).Sertolicellsalsocontainaromatase;
theenzymethatconvertsandrogenstoestrogens.
Besidethesehormonalfunction,junctionbetweenadjacentsertoli
cellsformsblood-testisbarrierwhichdoesnotallowharmful

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substancestoentertheareawherespermatogenesisisgoingon.

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Sertolicellakohaverec4,torsforandrogens(testosterone)which
stimulatesspermatogenesis.
Hormonalcontroloftesticularfunction.
LHistropicforleydigcellsandthesecretionoftestosteroneisunder

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thecontrolofLH.
FSHistropicforsertolicelland,stimulatessertolicellstosecrete
inhibinandandrogenbindingprotein(ABP).
Primaryspermatocyteisdiploid.

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19.Erythropoietinis/areproducedby-

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a)Juxtaglomerularcells
b)Interstitialcellsoftheperitubularcapillarybedofthekidneys
c)ParsrectaofPCT
d)Maculadensa
e)Mesangialcell

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CorrectAnswer-B
Ans.B.Interstitialcellsoftheperitubularcapillarybedofthe
kidneys
[Ref:Ganong25e/ep.706;Guyton's12e/ep.461;AKlain6e/ep.
68]

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Erythropoietinisaglycoproteinhormonewhichstimulateerythrocyte
production.
Inadults,about85%oferythropoietincomesfromthekidney
(interstitialcellsinperitubularcapillarybed)and15%fromliver
(Perivenoushepatocytes).Smallamountisalsoproducedinbrain;

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anduterusandoviduct.

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20.Trueaboutcarotidsinus-
a)Chemoreceptor
b)Presentinearlypartofinternalcarotidartery
c)Hasglomuscells

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d)Baroreceptor
e)Suppliedbyglossopharyngealnerve
CorrectAnswer-B:D:E
Ans.(B)Presentinearlypartofinternalcarotidartery
(D)Baroreceptor(E)Suppliedbyglossopharyngealnerve

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[Ref:Ganong25th/ep.658;Guyton'sl2h/ep.251-52;AKlain6th/ep.
j27-29;Gray,s4p/ep.447]
Carotidsinusisalittlebulgeattherootofinternalcarotidartery,
Isatypeofabaroreceptor.
Itisinnervatedbythesinusnerve,abranchofglossopharyngeal(IX

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cranial)nerve.

---

21.Stresshyperglycemiaoccursduetoall
except-
a)IncreasedlevelofACTH
b)Increasedlevelofcortisol

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c)Decreasedlevelofnorepinephrine
d)Insulinresistance
e)Increasedlevelofepinephrine
CorrectAnswer-C
Ans.C.Decreasedlevelofnorepinephrine

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[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

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glucagon,growthhormone,glucocorticoids(cortisol),and
catecholamines(epinephrine,
norepinephrine)leadstohyperglycemia.

---

22.Trueaboutsuccinatedehydrogenase
defect-

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a)DeficiencyofcomplexII
b)Tumorigenesis
c)Defectinkrebscycle
d)DefectinETC
e)Mitochondrialencephalopathy

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CorrectAnswer-A:B:C:D:E
ANSWER-(A)DeficiencyofcomplexII(B)Tumorigenesis
(C)Defectinkrebscycle(D)DefectinETC(E)Mitochondrial
encephalopathy
Mitochondrialsuccinatedehydrogenase(SDH)catalysesthe

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oxidationofsuccinatetofumarateintheKrebscycle(citricacid
cycle).
Succinatedehydrogenasecomplexismadeupoffoursubunits-(i)
SDH-A;(ii)SDH-B;(iii)SDH-C;and(iv)SDH-D.
Functionsofsuccinatedehydrogenaseare:?

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1. CatalysesoxidationofsuccinateorfumarateinTCAcycle/citric
acidcycle.
2. TransferselectronsfromsuccinatetocoenzymeQ(atcomplex
II)SuccinatedehydrogenaseactsascomplexIIinETC.
DefectinSDHcausesdefectinmitochondrialETC.Whichleadsto

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mitochondria!encephalopathyandmyopathy
(encephalomyopathy)ThisisduetomutationinSDHAsubunit
gene.
MutationinSDH-B,-Cand-Dsubunitscausestumorformation,

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especiallyparaganglioma/pheochromocytoma/carotidbodytumor

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Thus,thesesubunitsareregardedasatumorsuppressorgene.

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23.Allaretrueaboutglycosaminoglycans
except?
a)Proteinassociatedwithglycosaminoglycansiscalledcore
proteins

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b)Maybeassociatedwithconnectivetissues
c)Highlypositivelycharged
d)Negativelycharged
e)ComponentofECM
CorrectAnswer-C

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Ans.is'c'i.e.,Highlypositivelycharged[RefHarper30"/ep.
786]
Proteoglycansarecarbohydratestowhichsmallamountofproteinis
attached.Proteoglycansconsistsof95%ofcarbohydratesand5%
ofprotein.Toknowthestructureofproteoglycans,oneshouldknow

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thestructureofglycosaminoglycans.
Glycosaminoglycansareheteropolysaccharide
(heteropolysaccharidesarepolysaccharideswhichcontaintwoor
moredifferentmonosaccharideunitortheirderivatives).
Glycosaminoglycansarelinear(unbranched)polysaccharides,with

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repeatingdiasaccharideunits.Eachdisaccharideunitconsistsofan
aminosugarandanacidsugar(sugaracid).
Glycosaminoglyclanswerefirstisolatedfrommucin,thereforethey
arealsocalledmucopolysaccharides.
Theyarenegativelycharged.

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---

24.Mechanismsforregulatingenzyme
activityareALLEXCEPT
a)Covalentmodification
b)Allostericactivation
c)Competitiveinhibition

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d)Inductionofgenesforenzymesynthesis
e)Repressionofgeneforinhibitionofenzymesynthesis
CorrectAnswer-C
Ans.is(c)Competitiveinhibition[Ref:Harper319`Vep.89-
94;Lippincott6"/ep.62-64;Vasudevan5thiep.42-50;Shinde

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Asthenamesuggests,thereiscompetitionbetweeninhibitorand
normalsubstrateforthecatalyticbindingsiteoftheenzyme.Thisis
becauseboththeinhibitorandthenormalsubstratehavesimilar
structuralconfiguration.Therefore,enzymecannotdifferentiate
thesetwoandbothcanbindtotheenzyme.BothESandEI

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complexesareformed.ButonlyEScanformproduct.

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25.Truestatementare-
a)Alllipidarefat
b)Linoleicacidisessentialfattyacid
c)Hydrogenationconvertsunsaturatedfattyacidtosaturated

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fattyacid
d)Rancidityoffoodisduetolipidperoxidation
e)Hydrolysisoffatbyacidissaponification.
CorrectAnswer-B:C:D
Ans.is"B"i.e.,Linoleicacidisessentialfattyacid;"C"

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Hydrogenationconvertsunsaturatedfattyacidtosaturated
fattyacid;'d'i.e.,Rancidityoffoodisduetolipid
peroxidation[RefLippincott6"Iep.181-1821.
Thethreepolyunsaturatedfattyacids(PUFAs),namely,linoleicacid
linolenicacidandarachidonicacidarecalledessentialfattyacids.

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theyarecalledessentialfattyacidsbecausehumanbeingsrequire
thesefattyacidsbutcannotsynthesizethem.
Additionofhydrogenatomstounsaturatedfattyacidrefersto
hydrogenation.Itreducesthenumberofdoublebondsin
unsaturatedfats,Ashydrogenationreducesnumberofdouble

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bonds,unsaturatedfattyacidsmaygetconvertedtosaturatedfatty
acid,ifalldoublebondsarereduced.
Theunpleasantodorandtaste,developedbynaturalfatsupon
aging,isreferredtoas"rancidity".Ranciditymaybedueto
hydrolysis(bylipase)oroxidationoffat.

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---

26.Truestatement(s)aboutlipiddigestion
andabsorption-
a)Micellesplayanimportantroleinlipidsabsorption
b)Absorptionoflong-chainfattyacidsisgreatestintheupper
partsofthesmallintestine

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c)Bileacidhasnoroleinfatabsorption
d)Fattyacidsafterabsorptionarereesterifiedtotriglycerides
intheenterocytes
e)Gastriclipaseisthemajorenzyme
CorrectAnswer-A:B:D

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Ans.is'a'i.e.,Micellesplayanimportantroleinlipids
absorption;'b'i.e.,Absorptionoflong-chainfattyacidsis
greatestintheupperpartsofthesmallintestine;&'d'Le.,Fatty
acidsafterabsorptionarereesterifiedtotriglyceridesinthe
enterocytes[RefGanong251h/ep.481-83;Harper..30thlep.

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253-54;Guyton12thIep.421-23;Lippincott6th/ep.1761.
Micellesformationistheprocessinwhichdigestedfats(FFAsand
monoglycerides)areincorporatedintomuchsmallerdroplets
(micelles)sothattheycanbeabsorbedmoreefficiently.Thus,
micellesformationhelpsinabsorptionofdigestedfats.

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Fatdigestionessentiallybeginsintheduodenumwithentryof
pancreaticandbiliarysecretions.Pancreaticjuicecontainslipase
(pancreaticlipase),themostimportantenzymeforfatdigestion.The
pancreaticlipasedigeststriglycerides(triacylglycerols)intofreefatty
acidsand2-monoglycerides(2-monoacylglycerols).

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Afterfatdigestion,fattyacidsandmonoglyceridesareabsorbedin

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thesmallintestine,especiallyinthejejunumandsomeamountalso
inileum.Insidetheenterocyte,fattyacidsandmonoglycerides
againformtriglycerides.

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27.Gluconeogenesisisfavouredinfasting

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stateby-
a)ActivationofpyruvatecarboxylasebyacetylCoA
b)Increasedconversionofphosphoenolpyruvatetopyruvate
byactivationofpyruvatekinase
c)Increasedfattyacidoxidationinliver

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d)Hydrolysisoffructosel,6-bisphosphatebyfructosel,6-
bisphosphatase
e)None
CorrectAnswer-A:C:D
Ans.is'a'i.e.,Activationofpyruvatecarboxylasebyacetyl

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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]

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Theactivationofpyruvatecarboxylaseandreciprocalinhibitionof
PDHcomplexbyacetyl-CoAderivedfromtheoxidationoffattyacids
explaintheactionoffattyacidoxidationinsparingtheoxidationof
pyruvateandinstimulatinggluconeogenesis.
Thereciprocalrelationshipbetweenthesetwoenzymesaltersthe

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metabolicfateofpyruvateasthetissuechangesfromcarbohydrate
oxidation(glycolysis)togluconeogenesisduringthetransitionfrom
thefedtofastingstate.
Fructose-2-6-bisphosphateisformedbyphosphorylationoffructose-
6-phosphatebyphosphofructokinase-2.Thisenzymeisa

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---

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

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inhibitsfructose-2,6-bisphosphataseactivity.

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28.AIIaretrueaboutHexose
monophosphatepathway(HMP)except-
a)ProduceNADPHinoxidativephaseofpathway
b)DoesnotproduceATP

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c)Occursintestes,ovaries,placentaandadrenalcortex
d)Producesribose5-phosphateinoxidativephaseofpathway
e)Glucose6-phosphatedehydrogenaseenzymeisinvolved
CorrectAnswer-D
Ansis.'d'i.e.,Producesribose5-phosphateinoxidativephase

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ofpathway[RefHarper30thiep.196-200;Lippincottelep.145;
Satyanarayan4thIep.270-71]
HMPshuntisamulticyclicprocessinwhich3moleculesofglucose-
6-phosphategiveriseto3moleculesofCO,and3moleculesof5-
carbonsugars(ribulose-5-phosphate).

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Thelatterarerearrangedtogenerate2moleculesofglucose-6-
phosphate(throughfructose-6-phosphate)and1molecule
glyceraldehyde-3-phosphate.HMPshuntdoesnotgenerateATP.
HMPshuntoccursinthecytosol.Itishighlyactiveinliver,adipose
tissue,adrenalcortex,lens,cornea,lactating(butnotthe

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nonlactating)mammarygland,Gonads(testis,ovary)and
erythrocytes.Activityofthispathwayisminimalinmuscleandbrain,
wherealmostalloftheglucoseisdegradedbyglycolysis.

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29.Whichofthefollowingisnotapyrimidine
base?

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a)Cytosine
b)Uracil
c)Guanine
d)Thymine
e)Adenine

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CorrectAnswer-C
Ans.is'c'i.e.,Guanine
PurinesPyrimidines
AdenineCytosine
GuanineUraciI

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Thymine
Bothpurines(adenineandguanine)arefoundbothinDNA&RNA.
Amongpyrimidines-
LiCytosineanduracilarefoundinRNA(thymineisnotfoundin
RNA).

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CytosineandthyminearefoundinDNA(uracilisnotfoundinDNA).
InDNA,adenineisalwayspairedwiththyminebytwohydrogen
bonds;andguaninealwayspairedwithcytosinebythreehydrogen
bonds.

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30.Post-translationmodificationofprotein

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includesallexcept:
a)Removalofpeptide
b)5'capping
c)Intronsplicing
d)Proteinfolding

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e)Covalentmodification
CorrectAnswer-B:C
Ans.isB.,5'capping&`ci.e.,intronsplicing[Ref;
Satyanarayan4thiep.561-62;Harper30`lep426;Lippincott0-
4p.443-441

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5'cappingandintronsplicingarepost-transcriptionalmodification
(notpost-translationalmodification.
Thisisthefirstprocessingreaction.5'-endofmRNAiscappedwith
7-methylguansosine.
Thiscaphelpsininitiationoftranslation(proteinsynthesis)and

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stabilizesthestructureofmRNAbyprotectingfrom5'-exonuclease
Removalofintrons(splicing):?Eukaryoticgenescontainsome
codingsequenceswhichcodeforproteinandsomeinterveningnon-
codingsequenceswhichdonotcodeforprotein.

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31.Whichofthefollowingisnottrueabout

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transcription
a)SynthesisofprecursorsforthelargeandsmallribosomalRNAs
b)FormationoftRNAtranscript
c)RNApolymeraseIIisresponsibleforthesynthesisof
precursorsforthelargeribosomalRNAs

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

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synthesisofprecursorsforthelargeribosomalRNAs;&'d'i.e.,
RNApolymeraseIisresponsibleforthesynthesissmall
ribosomalRNAs.
[Ref:Harrion19th/ep.427-28;Satyanarayan4thiep.546,566-68]
RNA,eukaryoteshavethreedifferentRNApolymerases:I,II,II

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RNApolymeraseI:Itcatalyzesthesynthesisoflargeribosomal
RNA(rRNA),i.e.28SrRNA,18SrRNAand5.8SrRNA.
TheserRNAsarecodedonclass-Igene,i.e.classIgeneis
transcribedbyrRNA.rRNAsarenottranslatedintoprotein.
RNApolymeraseII:?ItcatalyzesthesynthesisofmRNA,small

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nuclearRNA(sn-RNA)andmiRNA.Theseproductsarecodedby
classIIgene,i.e.classIIgeneistranscribedbymRNA.ClassII
genedifferfromclassIandIIIinthatoneofitstranscribedproducts
(mRNA)istranslatedintoprotein
RNApolymeraseIII:?ItcatalyzesthesynthesisoftRNAand5S

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---

rRNA.TheseproductsarecodedbyclassIIIgene.
BesidesthesethreenuclearRNApolymerases,inaeukaryoticcell,
afourthtypeofRNApolymeraseisfoundinmitochondrialmatrix
knownasmitochondrialRNApolymerase(mtRNAP).Similarto
prokaryoticRNApolymerase,mtRNAPcatalyzesthesynthesisofall

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thethreetypesofRNA,i.e.mRNA,tRNAandrRNA

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32.Trueabouttelomeraseis?
a)DNAdependentRNApolymerase
b)RNAdependentDNApolymerase
c)Reversetranscriptaseenzyme

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d)Increasedtelomeraseactivityisseeninsomaticcells
e)Telomeraseincreasesthelongevityofcells
CorrectAnswer-B:C:E
Ans.is'b'i.e.,RNAdependentDNApolymerase,'c'i.e.Reverse
transcriptaseenzyme&`e'i.e.Telomeraseincreasesthe

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longevityofcells[RefHarper29th/ep.358&28`"/ep.315,316;
Robbin's8th/ep.40,296]
Telomeraseisareversetranscriptase(RNAdependentDNA
polymerase)andisresponsiblefortelomeresynthesisand
maintainingthelengthoftelomers(replicationofendof

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chromosome).Thus,telomeraseprovidelongevitytothecellswhich
containthisenzyme.
Telomeraseisabsentfrommostofthesomaticcellsandhencethey
sufferprogressivelossoftelomeresandtheyexitthecellcycle.
Senscentcellslacktelomerasesotheirtelomeresgetshortenedby

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criticallengthandthesecellsremainsinGophase

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33.Ultravioletradiationexposurecancauses
DNAdamageby-
a)Pyrimidinedimersformation
b)DNAbreakage

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c)Thyminedimerformation
d)AcetylationofDNA
e)MethylationofDNA
CorrectAnswer-A:C
Ans.is'a'Pyrimidinedimersformation;&'c'i.e.,Thyminedimer

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formation[RefHarper30/ep.761;Lippincott0/ep.412]
UVraysexposureresultsincovalentjoiningoftwoadjacent
pyrimidines(usuallythymine)toformpyrimidinedimers(thymine-
thyminedimersorcyclobutanepyrimidinedimers).Cytosine-
thymineandcytosine-cytosinedimersarealsoformedbutatslower

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rates.
Ultravialet(UV)radiations:-Inducedimerizationofadjacent
pyrimidinestoproducepyrimidinedimers.

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34.TrueaboutDNAphotolyase-
a)RepairdamagecausedbyUVlight

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b)Foundonlyinhuman
c)Usevisiblelight
d)Breakspyrimidinedimers
e)None
CorrectAnswer-A:C:D

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Ans.is'a'i.e.,RepairdamagecausedbyUVlight;'c'i.e.,Use
visiblelight;&'d'Breakspyrimidinedimer[Ref:PankajNaikp.
496]
NearlyallcellscontainaphotoreactivatingenzymecalledDNA
photolyase.ItisaDNArepairenzymewhichbindtothedamaged

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regionofDNAandgetexcitedbylightenergyabsorbedbyN5,N'?-
methenyltetrahydrofolate,whichisboundtothephotolyase.The
processiscalledphotoreactivation.
Theactivationrequiresvisiblelight,preferentiallyfromtheviolet/blue
endofthespectrum.

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Theexcitedphotolyasethencleavesthedimerintooriginalbases.
Theseenzymesoccurinalmostalllivingorganismsexposedto
sunlight,theonlyexceptionbeingplacentalmammalslikehumans
andmice.Theircatalyticmechanismemploysthelight-driven
injectionofanelectronintotheDNAlesiontotriggerthecleavageof

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cyclobutane-pyrimidinedimers.
PhotolyaseisparticularlyimportantinrepairingUVinduceddamage
inplants.Thephotolyasemechanismisnolongerworkingin
humansandotherplacentalmammalswhoinsteadrelyontheless
efficientnucleotideexcisionrepairmechanism.

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---

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35.TrueaboutDNAGyrase-
a)AtypeoftopoisomeraseI
b)AtypeoftopoisomeraseII
c)ActoncircularDNA
d)Overcometheproblemofsupercoils

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e)None
CorrectAnswer-B:C:D
Ans.is'b'i.e.,AtypeoftopoisomeraseIL;"c'i.e.,Acton
circularDNA;'d',Overcometheproblemofsupercoils
[RefLippincottetc401;StayanarayanxlaVep.528J

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TopoisomeraseI4Removesnegativesupercoiling.
TopoisomeraseIIRelaxespositivesupercoilsandformsnegative
supercoilingbycondensation.ofchromosome.
TopoisomeraseIIICanintroducesinglestrandbreaksduring
recombinationthatarerequiredforDNAtobeexchanged.

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

---

36.Correctdyadofdiseaseandtheir
respectiveinheritancepatterninclude?
a)Wilsondisease-autosomalrecessive
b)Cysticfibrosis-autosomaldominant
c)Marfansyndrome-autosomalrecessive

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d)Gardnersyndrome-autosomaldominant
e)Duchenemusculardystrophy-X-linkedrecessive
CorrectAnswer-A:D:E
Answer-(A)Wilsondisease-autosomalrecessive(D)Gardner
syndrome-autosomaldominant(E)Duchenemuscular

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dystrophy-X-linkedrecessive
Autosomalrecessivedisorders
1)Metabolic-Cysticfibrosis,Phenylketonuria,Galactosemia,
Homocystinuria,Lysosomalstoragedis,alphal-antitrypsin
deficiency,

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Wilsondisease,Hemochromatosis,Glycogenstoragedisorders.
Autosomaldominantdisorders
1.GIT-Familialpolyposiscoli,Gardner'ssyndrome
2.Skeletal-Marfansyndrome
X-linkedrecessivedisorders

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1)Musculoskeletal-Duchenemusculardystrophy,Becker's
dystrophy

---

37.TrueaboutRASoncogene-
a)TyrosinekinasehasroleinRASactivation
b)Mostcommonformofoncogeneinhumantumors

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c)IthasanintrinsicGTPaseactivity
d)Mutationmayresultincarcinomatousgrowth
e)Belongstogrowthfactorcategoryofoncogene
CorrectAnswer-A:B:C:D
Answer-(A)TyrosinekinasehasroleinRASactivation(B)Most

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commonformofoncogeneinhumantumors(C)Ithasan
intrinsicGTPaseactivity(D)Mutationmayresultin
carcinomatousgrowth
InnormalcellstheactivatedstateofthisRASproteinistransient
becausenormalRAS-proteinshaveintrinsicGTPaseactivity.

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MutationintheRASproteincausespermanentactivationofRAS
proteinwhichmayresultincarcinomatousgrowth.
ActivatedRASraf-landactitesmitogen-activatingkinase(MAP-
kinase)pathway.
PointmutationofRASfamilygenesisthesinglemostcommon

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abnormalityofoncogenesinhumantumor.

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38.Whichis/arenottumorsuppressor
gene(s)
a)TP53
b)RB

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c)CD95
d)SKT11
e)RAS
CorrectAnswer-C:E
Answer-C,CD95E,RAS

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---

39.TrueaboutDubin-Johnsonsyndrome-
a)Increasedconjugatedbilirubin
b)UsuallyassociatedwithincreasedASTandALT
c)Mutationinuridinediphosphate-glucuronyltransferasepeptide
Al

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

d)Decreasedbiliaryexcretionofconjugatedbilirubin
e)Autosomaldominantinheritance
CorrectAnswer-A:D
Answer-(A)Increasedconjugatedbilirubin(D)Decreased
biliaryexcretionofconjugatedbilirubin

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DuringJohnsonsyndromeisanautosomalrecessivehereditary
disorderpresentingwithconjugatedhyperbilirubinemiaduetodefect
inhepaticexcretoryfunctionacrossthecanalicularmembraneof
hepatocyte.
DJSisatypeofcongenitalconjugatedhyperbilirubinemia.

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Conjugatedbilirubinisincreasedbecauseofdefectivebiliary
excretionofbilirubinglucuronidesduetomutationincanalicular
multidrugresistanceprotein2.

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40.Mostcommontranslocationinacute
promyelocyticleukemia(APML)is

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

a)t(8:14)
b)t(9:22)
c)t(15:17)
d)t(8:21)
e)t(11:118)

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

CorrectAnswer-C
Answer-C,t(15:17)
Acutepromyelocyticleukemia(M3bytheFABclassification)is
associatedwithat(15;17)(q22;q11)translocation.
Disseminatedintravascularcoagulationcanoccurinthisdisorder

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duetothereleaseofprocoagulantsubstancesfromtheleukemic
cells,especiallyduringtreatment.
Thet(4;11)(q21;q23)translocationisassociatedwithacute
lymphocyticleukemia(ALL)andundifferentiatedleukemia.
Thet(6;9)(p23;q34)translocationisfoundinsubtypesofAMLwith

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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

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maturation

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41.Feature(s)ofTurnersyndromeis/are-
a)Monosomyofautosomes
b)Webbingofneck
c)Mentalretardation

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d)Shortfourthmetacarpal
e)Streakgonades
CorrectAnswer-B:D:E
Answer-(B)Webbingofneck(D)Shortfourthmetacarpal
(E)Streakgonades

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45X0
Lymphademaofdorsumofhand&fat
Looseskinfoldatnapeofneck
Shortstature
ShortNeck(withwebbingofneck)

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Anomaliesear
Broadshieldlikechestwithwidelyspacedsmallnipple
Renalanomalies(Horse-shoe,soubleorcleftrenalpelvis)Coartof
aorta

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42.Mostcommonaneuploidycompatiblewith

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lifeis
a)Downsyndrome
b)Turnersyndrome
c)Klinefelter'ssyndrome
d)Patausyndrome

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e)None
CorrectAnswer-A
Answer-A,Downsyndrome
Mostcommonaneuploidyinwhichinfantcansurviveistrisomy-21
(Downsyndrome)

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43.Whichofthefollowingacutephase
protein(s)decreasesduringacute
inflammation
a)Albumin
b)Transferrin

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c)Ceruloplasmin
d)C-reactiveprotein
e)Haptoglobin
CorrectAnswer-A:B
Answer-A,AlbuminB,Transferrin

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Negativeacutephaseproteins
Theseproteinsaredecreasedduringinflammation.Important
examplesarealbumin,prealbumin,transferrin,transcortin,
transthyretinandretinalbindingprotein

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44.Whichofthefollowingis/aretrueabout

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sideroblasticanaemia
a)Basophilsstipplinginleadpoisoning
b)Erythroidhypoplasiainbonemarrow
c)Pappenheimerbodiesisalwayspresent
d)DimorphicRBC

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e)IncreasedMCHC
CorrectAnswer-A:D
Answer-A,BasophilsstipplinginleadpoisoningD,Dimorphic
RBC
Importantfeaturesofsideroblasticanemiaare:-

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Ringeedsidetoblastsinbonemarrowprussionbluereaction.
Dimorphicbloodpicture,i.e.amixturemicrocytichypochromicand
macrocyticerythrocytes
Increased:Ironstores,serumferritin,serumiton,transferrin
saturation.

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Ineffectiveerythropoiesisbecauseironcannotbeincorporatedinto
erythrocytes.
otherfeature:DecreasedMCVMCHandMCHC;basophiling
stipplinginleadporsonizgAnisopoikilocytosis(varying
sizesandabnormalshapesofRBCs),erthroidhyperplasiainbone

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marrow.

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45.Multiplemyelomamaybeassociatedwith
a)Fanconi'ssyndrome
b)Amyloidosis
c)Mixedcryoglobinemia

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d)Castnephropathy
e)Interstitialnephritis
CorrectAnswer-A:B:C:D:E
Answer-A,Fanconi'ssyndromeB,AmyloidosisC,Mixed
cryoglobinemiaD,CastnephropathyE,Interstitialnephritis

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Factorscontributingthedamageare:-
BenceJonesproteinuriaandcastnephropathy
Amyioidosis
Lightchainnephropathy,Glomerulopathy,tubule-interstitial
nephritis.

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Vasculardisease.
Urinarytractobstruction.
Fanconi'ssyrdrome
TypeIcryoglobulienmiaiscomposedofasinglemono-clonalIg,
usuallyIgM

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46.Trueaboutautosomalrecessive
polycystickidneydisease(ARPKD)
a)CanbediagnosedinuterobyUSG
b)Hypertensiondevelopsinlatestagesofthedisease
c)Mayproceedtorenalfailurebeforepreschoolage

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d)Enlargementofkidney
e)Hematuriaisearlyfeature
CorrectAnswer-A:C:D
Answer-A,CanbediagnosedinuterobyUSGC,Mayproceedto
renalfailurebeforepreschoolageD,Enlargementofkidney

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ThepresentationinPolycysticdiseaseofkidneyischaracteristically
bilateral
Thebilateralenlargementcanhardlybemistakenonroutine
examination
USGandCTshowmultiplecystsinbothkidneys

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Thediseasemaypresentatanyagebutthemostcommonage
ofpresentationisinthe3rdor4thdecade.
Boththekidneyaregrosslyenlargedandsituatedwithmultiple
cysts.
Childhoodpolycystickidneydiseasehasautosomalrecessive

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inheritance.

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47.Feature(s)oftypeImembranoproliferative
glomerulonephritis(MPGN)-
a)Tramtrackappearanceonlightmicroscopy
b)Subendothelialelectron-densedepositsonelectronmicroscopy

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c)Immunofluorescencemicroscopyshowpositiveflorescenceof
IgGandC3ondensedeposit
d)Intramembranousdensedepositonelectronmicroscopy
e)Mesangialhypocellularity
CorrectAnswer-A:B:C

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Answer-A,Tramtrackappearanceonlight
microscopyB,Subendothelialelectron-densedepositson
electronmicroscopyC,Immunofluorescencemicroscopyshow
positiveflorescenceofIgGandC3ondensedeposit
Onlightmicroscope,Alltypeshavefollowingsimilarfeatures.

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1. TheglomeruliarehypercellularDuetoexocapillaryand
endocapillaryproliferation.
2. Theglomerulihavelobularappearanceaccentuatedbythe
proliferatingmesangialcellsandincreasedmesangialmatrix.
3. Parietalepithelialcrescentinmanycases

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4. GBMisthickened,whichismostevidentintheperipheralcapillary
loops.
5. Theglomelularcapillarywallshowsadoublecontourortramtrack
appearancebecauseofduplicationofbasementmembraneasa
resultofnewbasementmembranesynthesis.

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6. Withinthebasementmembranethereisinterpositionofcellular
elementsthatgiverisetotheappearanceofsplitbasement

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membrane.
TypeIandIIMPGNdifferintheirultrastructuralfeatures.
TypeISubendothelialdeposits.

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TypeIIIntramembranousdeposition.
TypeIdisease(mostcommon)
Idiopathic
Subacutebacterialendocarditis
TypeIIdisease(Densdepositdisease)

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Idiopathic
C3nephriticfactorassociated
Partiallipodystrophy
TypeIIIdisease
Idiopathic

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Complementfactordeficiency
Systemiclupuserythematosus
HepatitisC
Mixedcryoglubulinemia

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48.PAX5is/aremarkerfor?

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a)Acutemyeloidleukemia
b)T-celllymphomas
c)Anaplasticlargecelllymphoma
d)Hodgkin'slymphoma
e)B-lymphoblasticlymphoma

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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-

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lymphocytesandB-celllymphomas.Itisexpressedindeveloping
CNS,someneuroendocrinetumors,andoccasionalmyeloid
leukemia.
Pax5stainingispositiveinmostHodgkinlymphoma,B-cellNHL,
andprecursorB-celllymphoblasticneoplasms.

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Lymphoplascytoidlymphoma,smallcellcarcinomasandMerkelcell
carcinomasarealsopositive.
T-celllymphomas,plasmacellneoplasms,multiplemyeloma,and
plasmablasticlymphomasarenegativeforPax5.

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49.Tumormarkerforlungadenocarcinoma

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is/are
a)Positiveforcytokeratin5
b)Positiveforcytokeratin7
c)Positiveforcytokeratin20
d)Transthyretin(TTR)mutation

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e)EGFRmutation
CorrectAnswer-B:E
Answer-B,Positiveforcytokeratin7E,EGFRmutation
Adenocarcinoma-AKT1,ALK,BRAF,EGFR,HER-2,K-RAS,MEK-
1,MET,N-RAS

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CK7(+)ve-BreastCa,PancreaticCa,CervicalCa,adenocarcinoma
oflung.

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50.Whichofthefollowingis/areassociated
withsynovialcellsarcoma
a)Translocation(9;22)(q34;q11)

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b)SS18-SSX4fusiongenes
c)Translocationt(X;18)(p11;g11)
d)SS18-SSX1fusiongenes
e)None
CorrectAnswer-B:C:D

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Answer-B,SS18-SSX4fusiongenesC,Translocationt(X;18)(p1
1;g11)D,SS18-SSX1fusiongenes
Mostsynovialsarcomasshowacharacteristicchromosomal
translocationt(X:18)producingSYT-SSX1or-SSX2fusion
genes.Thespecifictranslocationisassociatedwithpoorprognosis.

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Histologichallmarkofbiphasicsynovialsarcomaisthedualliningof
differentiationofthetumorcells(eg.epitheliatlikeandspindlecells)
CalcifiedconcrectionscanbepresentonX-rays

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51.Truestatementaboutprimary
myelofibrosis

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a)Hepatomegalyisthemostcommonmanifestation
b)Drytaponbonemarrowaspiration
c)Onlypotentiallycurativetreatmentisallogeneicstemcell
transplantation
d)Splenomegalyisalmostinvariablypresent

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e)Myeloblastsmaybeseeninperipheralblood
CorrectAnswer-B:C:D:E
Answer-B,DrytaponbonemarrowaspirationC,Only
potentiallycurativetreatmentisallogeneicstemcell
transplantationD,Splenomegalyisalmostinvariably

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presentE,Myeloblastsmaybeseeninperipheralblood
Thehallmarkofprimarymyelofibrosisisrapiddevelopmentof
obliterativemarrowfibrosis.
Myelofibrosissuppressesbonemarrowhematopoiesis,leadingto
peripheralbloodcytopenias.

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Peripheralbloodpictureshowsleukoerythroblastosis(erythroidand
granulocyticprecursorsinperipheralblood),andtear-drop
erythrocytes(dacrocytes).
Bonemarrowbiopsyistheinvestigationofchoice.
Unsuccessfulbonemarrowaspirationalsocalleddrytap.

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Allogmeicbonemarrowtransplantationistheonlycurativetreatment
forPMF.

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52.Newerinclusionin2015WHO
classificationofsquamouscellcarcinoma
oflunginclude(s)

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a)Clearcellvariant
b)Papillarycellvariant
c)Adenocarcinomavariant
d)Nonkeratinizingvariant
e)Lymphoepithelioma-likecarcinoma

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CorrectAnswer-D
Answer-D,Nonkeratinizingvariant
Oldclassification-
Papillary
Clearcell

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Smallcell
Basaloid
NewerClassification-
KeratinizingSCC
NonkeratinizingSCC

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BasaloidSCC
Preinvasive:SCCinsitu

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53.Whichofthefollowingcancause
pulmonaryembolism-
a)Pregnancy

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b)OCPuses
c)Mitralregurgitation
d)Leftventricularfailure
e)Excessiveunaccustomedexercise
CorrectAnswer-A:B:D

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Answer-(A)Pregnancy(B)OCPuses(D)Leftventricularfailure
PatientFactors
Age
Obesity
Varicoseveins/superficialthrombophlibits

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Immobility
Pregnancy
PuerPerium
High-doseoestrogentherapyorOCPuse
Diseaseorsurgicalprocedure-

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Traumaorsurgery
Malignancy
Heartfailure
Paralysisoflowerlimb
Infection

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54.Trueaboutsilicosis-
a)Lowerlobeismorecommonlyinvolved
b)Radiographicallyseenaseggshellclacification
c)Lobarpneumoniaiscommon
d)Associatedwithanincreasedsusceptibilitytotuberculosis

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e)Histologicallysilicanodulesconsistsofhyalinisedcenter
surroundedbyconcentriclaminationsofcollagen
CorrectAnswer-B:D:E
Answer-(B)Radiographicallyseenaseggshellclacification
(D)Associatedwithanincreasedsusceptibilitytotuberculosis

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(E)Histologicallysilicanodulesconsistsofhyalinisedcenter
surroundedbyconcentriclaminationsofcollagen
Silicosisisalungdiseasecausedbyinhalationofcrystallinesilicon
dioxide(silica).
Silicosisisaslowlyprogressivedisease.

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SilicosisisassociatedwithanincreasedsusceptibilitytoT.B.
Silicosisischaracterized-
NodulesintheUpperzonesofthelunghardcollagenousscars
Radiologically,eggshellcalcificationcanbeseeninthelymph
nodes.

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Histologically,silicosislesionsconsistofconcentriclayersof
hyalinizedcollagensurroundedbyadensecapsuleofmore
condensedcollagen.

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55.Truestatementaboutasbestosis-
a)Mayinvolvehilarlymphnode

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b)Asbestosisbeginsinthelowerlobes
c)Pleuralplaquesconsistsofcalcifiedhyalinzedcollagenous
tissue
d)HighresolutionCTscanningisthebestimagingmethod
e)Noriskoflungcarcinoma

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CorrectAnswer-A:B:C:D
Answer-(A)Mayinvolvehilarlymphnode(B)Asbestosis
beginsinthelowerlobes(C)Pleuralplaquesconsistsof
calcifiedhyalinzedcollagenoustissue(D)HighresolutionCT
scanningisthebestimagingmethod

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Asbestosisisaninterstitiallungdiseaseduetoinhalationof
asbestosparticles.
Therearetwodistinctgeometricformsofasbestos:(i)Serpentine
(chrysolite),and(ii)Amphibole(crocidolite).
Bothserpentineandamphibolecancauseallasbestosisrelated

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diseaseexceptformesothelioma,whichisusuallyassociatedwith
amphibole.
Pleuralplaquesarethemostcommonmanifestationofasbestos
exposure.
Thereisdiffuseinterstitialfibrosismainlyinvolvinglowerlungfields.

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Thelungisinvadeddirectly,andthereisoftenmetastaticspreadto
thehilarlymphnodes.
HighresolutionCTscanningisthebestimagingmethodfor
asbestosis.

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56.Cancer(s)causedbyviralinfections-

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a)Kaposisarcoma
b)Nasopharyngealcarcinoma
c)Hepatocellularcancer
d)Hodgkin'slymphoma
e)All

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CorrectAnswer-A:B:C:D
Answer-(A)Kaposisarcoma(B)Nasopharyngealcarcinoma
(C)Hepatocellularcancer(D)Hodgkin'slymphoma
DNAvirusesHerpesviridaeHHV-8Kaposissarcoma
Hepadnaviridae(HBV)hepatocellularcarcinoma

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Flaviviridae(HCV)hepatocellularcarcinoma
EBVassociatedmalignancies-
Burkitt'slymphoma
Nasopharynagealcarcinoma
Hodgkin'sdisease

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57.Smallvesselvasculitisis/are-
a)Kawasakidisease
b)IgAvasculitis
c)Carcinomaassociatedvasculitis
d)Anti-glomerularbasementmembrane(anti-GBM)disease

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e)Takayasuarteritis
CorrectAnswer-B:C:D
Answer-(B)IgAvasculitis(C)Carcinomaassociatedvasculitis
(D)Anti-glomerularbasementmembrane(anti-GBM)disease
i)ANCApositive

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Wegner'sgranulomatosis,Microscopicpolyangitis,Churgstrauss
sytdrome,Good-posturesyndrome.
ii)ANCAnegative
Henoch-Schonleinpurpura,Bechetssyndrome

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58.Prolongationofboth-activatedpartial

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thromboplastintime(aPTT)and
prothrombintime(PT)maybeseenin
factordeficiencyof-
a)Factor2
b)Factor5

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c)Factor10
d)Factor8
e)Factor9
CorrectAnswer-A:B:C
Answer-(A)Factor2(B)Factor5(C)Factor10

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Partialthromboplastintime(pTT)
Itteststheintrinsicandcommoncoagulationpathways.So,a
prolongedPTTcanresultsfromdeficiencyoffactorV,VIII(factor
VIIIc,vonwillebrandfactor),IX,X,X,XII,prothrombinorfibrinogen.
Prothrombintime(PT)

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Itteststheextrinsicandcommoncoagulationpathways.So,a
prolongedPTcanresultsfromdeficiencyoffactorV,
VII,X,prothrombinorfibrinogen.

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59.Trueabouthaematologicaldisorder-
a)CryoprecipitateisusedintreatmentinhaemophiliaB

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b)BothPTandaPTTareincreasedinDIC
c)Intravenousgammaglobulinisusefulinimmune
thrombocytopenicpurpura
d)HemophiliaC:X-linkeddisorder
e)PlateletcountisdecreasedinDIC

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CorrectAnswer-B:C:E
Answer-(B)BothPTandaPTTareincreasedinDIC
(C)Intravenousgammaglobulinisusefulinimmune
thrombocytopenicpurpura(E)Plateletcountisdecreasedin
DIC

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1.CryoprecipitateisusedinHemophiliaA-
Itcontainsfbrinogen,factorVIIIcandvWF,andfactorXIII.
UsedinhemophiliaAandvon-Willebranddisease.
2.PT&aPTTareincreasedinDICaldplateletcountisdecreased
Bloodfilmshowsmicroangiopathichaemolyticanaemia.

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PT,thrombintime,andActivatedPartialthromboplastintimeallare
prolonged.
3.IVimmunoglobulinisusefulinITP
IVimmunoglobulinisthetreatmentofchoiceforneonatalaswellas
childhoodITP.

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4.HemophiliaCiscausedbydeficiencyoffactorXI.
Itisinheritedasanautosomalrecessivepattern.

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60.Feature(s)ofantiphospholipidsyndrome
is/areexcept-
a)Recurrentthrombosis

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b)SLEisassociatedwithprimaryantiphospholipidsyndrome
c)Itincludestwotypesofantibodies-lupusanticoagulantand
anticardiolipinantibody
d)Foetuslossmayoccur
e)Occurd/tdefectin

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CorrectAnswer-B:C:E
Answer-(B)SLEisassociatedwithprimaryantiphospholipid
syndrome(C)Itincludestwotypesofantibodies-lupus
anticoagulantandanticardiolipinantibody(E)Occurd/tdefect
in

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Inantiphospholipidsyndromethereishypercoagulabititywhich
resultsinrecurrefltvenousandarterialthrombosis.
Peripheralyenoussystetn)DVT
CNSCerebrovascularaccident,sinusthrombosismigraine,
epilepsy.

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HematologicalThrombocytopenia,hemolyticanemia.
ObstetricsAbortionin2rd&3rdtrimester(latefetalloss)is
commonbutitmayoccuranytimeinpregnancy;recurrentabortion,
eclampsia.
PulmonaryPulmonaryembolism,pulmonaryhypertension.

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CardiacLimbman-Sackendocarditis,MI.
Dermatological>Livedoreticularis,purpura,infarct/ulceration.
OcularAmaurosis,retinalthrombosis.

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AdrenalInfarction,hemorrhage.
Musculoskeletal>Avascularnecrosisofbone.

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CatastrophicantiphospholipidsydromeMultiorganinfarction.

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61.Longacting13agonist(s)whichis/are
usedasonceadaydrug?
a)Salmeterol
b)Formoterol

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c)Olodaterol
d)Vilanterol
e)Indacaterol
CorrectAnswer-C:D:E
Ans.C,OlodaterolD,Vilanterol&E,Indacaterol

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Ref:Katzung13'h/ep.j40;Rang6Dale8'h/ep.348
Longactingbeta-1agonist
(8-12hrs)
Giventwicedaily
1. Salmeterol

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2. Formoterol
3. Arformoterol
Ultra-longacting
(24hrs)
givenoncedaily

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1. Indacaterol
2. Olodaterol
3. Vilanterol

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62.Drugofchoiceforstrongyloides
stercoralis?

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a)Mebendazole
b)Albendazole
c)Ivermectin
d)Levamisole
e)Diethylcarbamazine

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CorrectAnswer-C
Ans.C.Ivermectin
Ref:K.D,T,Thlep,850iKatzung13th/ep.909;SatoskarPharma
24'ep.816;RangandDale|th/ep.573
Strongyloid-Ivermectin

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Anaerobes-Metronidazole
AtypicalPneumonia(mycoplasma)-Erythromycin
Cholera-Doxycycline
Staphylococci-Penicillin
VRSA-Linezolid

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P.Carinii(jiroveci)-Cotrimoxazole
Pseudomonas-
Antipseudomonalbeta-lactam+aminoglycoside
Streptococcus-Penicillin
Toxoplasma-Cotrimoxazole

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ToxoplasmainpregnancySpiramycin.
Rheumaticfever-Benzathinepenicillin
TB-INHwithorwithoutrifamPicin
Rickettsia-TetracYclines

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InfluenzaAandB-Osetamivir

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Diphtheria-Penicillin/Erythromycin
Anthrax
Ciprofloxacin/Doxycycline+Pertussis-ErYthromYcin
HSV-AcYclovir
LePtosPirosis

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Milder-Oralamoxicillin
Severe-IvPenicillinG
Lyme'sdisease-DoxycYcline
Syphilis-PenicillinG
Pertussis-ErYthromYcin

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Actinomycosis-PenicillinG
Lymphogranulomavenereum-AzithromycinorDoxycycline
Legionella-Azithromycinorlevofloxacin
Plague-StrePtomYcin
Listeria-Ampicillin+Gentamicin

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MAC-Azithromycin/clarithromycin
GroupB-streptococcus-Ampicillin
UTI-Cotrimoxazole
Endocarditis-Amoxicillin/Clindamycin
Babesiosis-Quinine+Clindamycin

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Pvivax-Chloroquine
ChloroquineresistantPvivax-Artemisinincombinationtherapy
(ACT)

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63.DOCformycoplasmais/are?
a)Doxycycline

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b)Ceftriaxone
c)Azithromycin
d)Penicillin
e)Gentamycin
CorrectAnswer-A:C

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Ans.A,Doxycycline&C,Azithromycin
Ref:Harrisonrgh/ep.1164
ForM.pneumoniaeinfections:
Azithromycin,clarithromycin,erythromycin,doxycycline,
levofloxacin,moxifloxacin,gemifloxacin(notciprofloxacinor

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floxacin).
ForM.Hominis-
Doxycycline,clindamycin

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64.Whichofthefollowingdyadofanti-HIV
drugandmechanismofactionis/are

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correctlymatched?
a)Maraviroc-Entryinhibitor
b)Reltegravir-Intergaseinhibitor
c)Indinavir-Proteaseinhibitor
d)Nevirapine-Nonnucleosidereversetranscriptaseinhibitor

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e)Darunavir-Fusioninhibitor
CorrectAnswer-B:C:D
Ans.B,Reltegravir-IntergaseinhibitorC,Indinavir-Protease
inhibitor&D,Nevirapine-Nonnucleosidereversetranscriptase
inhibitor

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

Antiretroviraldrugs
a)Nucleosidereversetranscriptaseinhibitors(NRTIs)-
Zidovudine,Didanosine,Zalcitabine,Stavudine,Iamivudine,
Abacadr,Emtricitabine
b)Nucleotidereversetranscriptaseinhibitor+Tenofovir

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c)NonNucleosidereversetranscriptaseinhibitors(NNRTIS)-
Nevirapine,Efavirenz,Delavirdine,Etravirine,rilpivirine.
d)Proteaseinhibitors-
RitonavirIndinavir,NeIfnavb,Saquinavir,amprenavir,Lopinavir,
Fosamprenavir,Atazanavir,Darunavir,Tipranavir.

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e)Fusioninhibitor-Enfuvirtide,Maraviroc.
f)Integraseinhibitors-Raltegravir,Elvitegravir.
g)CCR5receptorinhibitor-Maraviroc

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65.Anti-influenzadrugwhichis/aregiven
throughinhalationroute?

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a)Amantadine
b)Oseltamivir
c)Zanamivir
d)Rimantadine
e)None

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CorrectAnswer-C
Ans.C.Zanamivir
[Ref:KDT7'/ep.S0l0.3;Park's24't'/e1t.169;Katzung13th/ep.862
63]
Anti-influenzadrugs

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Amantadine,rimantadine,oseltamivirandzanamivir.
Onlyzanamivirisgivenbyparenteralroute(intranasdor
intravenous).allothersaregivenorally.
Zanamivirhaslowestoralbioavailabilitylowestt1/2(shortestacting).
Rimantadinehasmaximumplasmaproteinbinding,whileoseltamivir

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hasminimumplasmaproteinbinding.
Rimantadinehasmaximummetabolism.

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66.Truestatement(s)aboutalbendazole?
a)Undergoesfirst-passmetabolismintheliver
b)ActiveagainstbothlarvaandadultofNematodes

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c)Absorptionincreaseswithfattymeal
d)Excretedintheurine
e)Thiabendazoleislesstoxicthanalbendazole
CorrectAnswer-A:B:C:D
Ans.A,Undergoesfirst-passmetabolismintheliverB,Active

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againstbothlarvaandadultofNematodesC,Absorption
increaseswithfattymeal&D,Excretedintheurine
[Ref:Katzung13't'/ep.90E09;GoodmanandGilmatr'slI't'/ep.
1079;SatoskarPhanna24't'/ep.818]
Albendazole:

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Broad-spectrumoralanthelmintic.
Actsbybindingtotubulinandtherebyinhibitingitspolymerization
Afteroraladministration,itiserraticallyabsorbed(increasedwitha
fattymeal)andthenrapidlyundergoesfirst-passmetabolisminthe
livertotheactivemetabolitealbendazolesulfoxide.

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excretedintheurine.
Hasamiciilaleffectsinhydatiddisease,cysticercosis,ascariasis,
andhookworminfectionandovicidaleffectsinascariasis,
ancylostomiasis,andtrichuriasis.

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67.Whichofthefollowingis/arenot5th

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generationcephalosporin?
a)Cefoxitin
b)Cefoperazone
c)Ceftolozane
d)Ceftaroline

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e)Ceftabiprole
CorrectAnswer-A:B
Ans.A,Cefoxitin&B,Cefoperazone
[Ref:KDT7/ep.26;Ketungp-779;Goodman&Gilman'sp.781;
Pharma241/ep.693]

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First
Second
Third
Fourth
Fifth

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Cefuroxime
Cefoxitin
Cefotaxime
Cephalothin Cefotetan
Cetizoxime

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Ceftobiprole
Cefepime
Parenteral Cefazoline
Cefmetazole Ceftriaxone
Ceftaroline

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Cefpirome
Cephapirin
Cefamendole Ceftazidime
Ceftolozane
Cefonicid,

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Cefoperazone
ceforanide
Cefixime
Cephalexin
Cefaclor

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Cefpodoxime
Cephradine
Cefuroxime proxetil
Oral
Cefadroxil

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axetil
Cefdinir
Cephaloridine Cefprozil
Ceftibuten,
Ceftamet

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68.Whichofthefollowingistrueabout
aminoglycosideassociatedacutekidney
injury?
a)Seeninaround10-20%ofpatientstreatedwiththedrug
b)Mayoccurwithin1weekofinitiationoftreatment

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c)Occuronlyafter3weeksoftreatment
d)Interstitialnephritisoccur
e)Usuallydevelopswithin72hoursofinitiationoftreatment
CorrectAnswer-A:B
Ans.A,Seeninaround10-20%ofpatientstreatedwiththe

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drug&B,Mayoccurwithin1weekofinitiationoftreatment
[Re/:KDf7e/dp.715;Katzungep.802]
Non-oliguricacutekidneyinjury(AKI)occursin10-30%ofpatients
onaminoglycosidetherapy.
AKTtypicallymanifestsafter5-7daysoftherapy.

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Nephrotoxicity:
Neomycinismostnephrotoxic,whilestreptomycinisleast
nephrotoxic.
Nephrotoxicityisincreasedbyadvancedage,liverdisease,
hypokalemia,septicshock,concurrentuseofnephrotoxicdrugs

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(amphotericinB,cisplatin,cyclosporine)andprolongedtherapy.

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69.Whichofthefollowingistrueabout
antifungaldrugs?
a)Echinocandinshaveverylesssideeffects
b)Flucanazoleisfirstlinedrugforinvasiveaspergillosis

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c)Oralfluconazolehas100%bioavailability
d)AmphotericinBisfungistatic
e)NephrotoxicityisdoselimitingsideeffectofamphotericinB
CorrectAnswer-A:E
Ans.A,Echinocandinshaveverylesssideeffects&

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E,NephrotoxicityisdoselimitingsideeffectofamphotericinB
[RefKDTzh/ep.787-95]
EchinocandinsarewelltoleratedwithmildGIsideeffects.
Fluconazoleisnot1stlinedrugforaspergillosis.
Oralbioavailabilityoffluconazoleis94%.

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Amphotericin-Bisfungicidalaswellasfungistatic
Themostimportantdoselimitingtoxicityisnephronicity.
Adverseeffectsincludeinfusionrelatedacutereactions(most
common),nephrotoxicity,anemia,cNStoricityAnd,
hypomagnesemiaInfusionrelatedacutereactioncanbeprevented

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bypremedicationslikecorticosteroidsandantihistamines.
Itismanifestedbyazotemia,reducedGFR,RTA,hypokalemia,and
hypomagnesemia.

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70.Drugsaffectingpurinesynthesis?
a)Azathioprine

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b)Methotrexate
c)Fludarabine
d)6-Mercaptopurine
e)Capecitabine
CorrectAnswer-A:B:C:D

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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:

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Drugsaffectintermediarymetabolismofproliferatingcells.
AllthesedrugsinterferewithnucleicacidsynthesisAct
on.S,phase.
Purineantagonists=Mercaptopurine,Thioguanine,
Azathioprine,FludarabineAndCladribine.

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Pyrimidineantagonists=S-Fluorouracil,cytosinearabinoside
(cytarabine),capecitabine,Gemcitabine.
Folateantagonist=Methotrexate,pemetrexed.
Note:Tetrahydrofolateisrequiredforpurinesynthesisandits
formationisinhibitedbymethotrexate.

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Methotrexateandpemetrexeddihydrofolatereductase(DHFRcse)
inhibitors.

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71.Methotrexateaffects?
a)Purinesynthesis
b)Pyrimidinesynthesis

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c)ConversionofDHFAtoTHFA
d)Polymerizationofmitotictubule
e)None
CorrectAnswer-A:C
Ans.A,Purinesynthesis&C,ConversionofDHFAtoTHFA

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Methotrexateandpemetrexeddihydrofolatereductase(DIlFRcse)
inhibitors.
ThesedrugsalsoinhiUitttrymiapatesynthaseanddenovopurine
synthesis,whichcontributetomethotrexatetoxicity.

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72.LongactingInsulinis/are?

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a)Lispro
b)Detemir
c)Glargine
d)Isophane
e)Glulisine

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CorrectAnswer-B:C
Ans.B,Detemir&C,Glargine
[Ref:KDTep-263:satashkarkhanna24e/ep'893]
RapidActingInsulin=Insulinlispro,Insulinaspart,Insulinglulisine.
Shortacting=Regular(soluble)insulin,semilenteinsulin'

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Intermediateacting=Insulinzincsuspension(Lente),Neutral
protaminehagedorn(isophaneinsulin)
Longacting=Protaminezincinsulin,Insulinglargine,Insulindetemir

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73.AmongACEinhibitors,whichofthe
followingis/areprodrug(s)-

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a)Perindopril
b)Captopril
c)Lisinopril
d)Ramipril
e)Enalapril

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CorrectAnswer-A:D:E
Ans.A,PerindoprilD,Ramipril&E,Enalapril
[RefKDTF/ep'23,501]
AllACEinhibitorsareprodrugsexceptcaptoprilandLisinopril.

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74.Whichofthefollowinganti-tumordrug

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havehighriskofgonadotoxicity?
a)Dactinomycin
b)Cyclophosphamide
c)Busulfan
d)Vinblastine

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e)Ifosfamide
CorrectAnswer-B:C:E
Ans.B,CyclophosphamideC,Busulfan&E,Ifosfamide
[ReFK.D-t.P.859;]
Allalkylatingagentsarehighlygonadotoxic.

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HighAlkylatingagents=Cyclophosphamide,ifosfamide,busulfan,
chlorambucil,melphalan,procarbazine.
Medium=Carboplatin,doxorubicin
Low=Vincaalkaloids(vincristine,vinblastine),methotrexate,
mercaptopurine,bleomycin,dactinomycin.

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75.Adrenalinecanbeusedin?
a)Bronchialasthma
b)Allergicdisorder
c)Cardio-pulmonaryresuscitation
d)Anaphylaxis

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e)Asanti-analgesicmedicine
CorrectAnswer-B:C:D
Ans.B,AllergicdisorderC,Cardio-pulmonaryresuscitation&
D,Anaphylaxis
Adrenalineisthedrugofchoiceforanaphylaxis(anaphylacticshock)

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->anallergichypersensitivityreaction(Type-lhypersensitivity).
1stlinedrugusedincardiopulmonaryresuscitation.

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76.Drug(s)causingQTintervalprolongation?
a)Amiodarone
b)Cisapride

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c)Calciumgluconate
d)Magnesiumtherapy
e)Ketoconazole
CorrectAnswer-A:B
Ans.(A)Amiodarone&(B)Cisapride

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[Ref:KDTVh/ep.528;Davison27d/ep.571]
DrugsthatprolongQ-Tinterval(havepotentialtoprecipitate
Torsadesdepointes)
Antiarrhythmics=Quinidine,procainamide,disopyramide,
propafenone,amiodarone

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Antimicrobials=Quinine,mefloquine,artemisinin,halofantrine,
sparfloxacin,gatifloxacin
Antihistamines=Terfenadine,astemizole,ebastine
Antidepressants=Amitriptylineandothertricyclics
Antipsychotics=Thioridazine,risperidone

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Prokinetic=Cisapride

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77.Whichofthefollowingdrugsisexcreted
mainlybykidney?
a)Tetracycline
b)Rifampicin

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c)Digoxin
d)Penicillin
e)Lithium
CorrectAnswer-A:C:D:E
Ans.(A)Tetracycline(C)Digoxin(D)Penicillin&(E)Lithium

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[Ref:KDTp.695;Katzung13'h/ep,790]
Lithium=>95%renalexcret
Penicillin=Excretedbythekidney,10%byglomerularfiltrationand
90%bytubularsecretion.
Digoxin=Primarilyexcretedbykidney

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Tetracyclines=Primarilyexcretedinurine,exceptfordoxycycline.
Rifampicin=Excretedmainlyinbile,someinurine;Urineand
secretionsmaybecomeorange-red.

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78.Whichofthefollowingistruestatement(s)
aboutcodeine?

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a)Usedasanti-tussiveagent
b)Analgesicpotencyisequivalenttomorphine
c)Causesrespiratorydepression
d)Partlymetabolizedtomorphine
e)Completelymetabolizedtomorphine

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CorrectAnswer-A:C:D
Ans.(A)Usedasanti-tussiveagent(C)Causesrespiratory
depression&(D)Partlymetabolizedtomorphine
[Ref:KDT7/ep.474;Katzungljh/ep.545-49]
Codeine:

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Codeineisapureopioidagonistwhichislesspotentthanmorphine
(1/l0sanalgesicaction).
Ithaspartialagonisticactivityonopioidreceptorswithalowceiling
effects.
Partlyconvertedtomorphineinthebody.

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Itisusedasantitussive(drugsforcough)andantidiarrhealdrugs
Ceusasamedegreeofrespiratorydepressionasmorphine.

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79.Whichofthefollowingis/arefeatureof
drowning?
a)Oedemaaquosuminlung

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b)Emphysemaaquosumispresumptiveevidenceofdeathfrom
drowning
c)altaufshaemorrhagesisseensubpleural
d)Gettler'stestisusedtotestchloridecontentofbloodfromboth
sidesoftheheart

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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.,

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Gettler'stestisusedtotestchloridecontentofbloodfromboth
sidesoftheheart[RepReddy33'd/ep.369-70;Parikh7"/ep.
192-93]
Theeyesarehalfopenedwithdilatedpupil,congestedconjunctiva
andalmostnilpetechialhamorrhage.

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Cutisanserina(gooseskin),i.e.granularappearanceofskinwith
erecthairduetocontractionoferectorpili.
Washerwomanhandandfeed,i.e.bleachedandcorrugated
appearanceofpalmandsoles.
White,fine,lathery,abundantandtenacious(sticky)frothof

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noseandmouth.Frothincreasesinamountoncompressionofthe
chest.Frothinthenoseandmouthisalsoseenincertainpoisoning,
e.g.cocaine,organophosphorus,morphine(opioids)and

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barbiturates.Butthefrothisneithersofinenorsocopicusand
persistentinthesepoisonings.

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Weeds,grass,plants,mudorstonesintightlyclenchedhand.Itis
duetocadavericspasmandstronglysuggestthattheperson
wasalivewhendrowned,asitindicatesthestruggleofpersonfor
life.Abradedtipsoffingersandtoes,andsandunderdamagednails
havesamesignificance.

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Emphysemaaquosumisseeninwetdrowning.Inthiscondition,the
lungsarecharacterizedbyruptureofaleveolarspaceswith
accumulationofhemolyzedbloodwithwaterandsmallamountof
air.Thisconditionresultsfromviolentrespiratoryeffortswhenthe
victimissubmergedinconsciousstate.

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Oedemaaquosumisaconditionoflungcharacterizedby
oedematouschangedueaccumulationofsomewaterinlung.This
conditionresultsduetopassiveentranceofwaterinthelungswhen
thevictimissubmergedinunconsciousstatehavingnoviolenteffort
forrespiration.Itisseeninsubmersionofunconscious

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80.Testusedforbloodstainsdetectionis/are
allexcept
a)Barberio'stest
b)Kastle-meyertest
c)Benzidinetest

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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-

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86]
thesetestsarebasedonH202andperoxidaseenzyme.Tests
are:
Benzidinetest:Greenishbluecolour.
Phenolphthaleintest(kastlemeyertest):Deeppermanganate

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colour.
Leucomalachitegreentest:Bluishgreenorpeacockbluecolour.
Guaiacumtest:Bluecolour.
Orthotoludinetest(kohntest):Blueorgreencolour.
Amidopyrinetest:Purplecolour.

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Teichmann'shaemincrystaltest.
Takayamahemochromogencrystaltest

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81.Doctorsroleinnotingdyingdeclarationis
to?
a)Ascertaincomposmentis

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b)Callthemagistrate
c)Elicitinformationbyleadingquestions
d)Asktheinvestiatingmedialofficertobethere
e)None
CorrectAnswer-A

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Ans.is'a'i.e.,Ascertaincomposmentis
Dyingdeclaration
Itisthewrittenorverbalstatementmadebyapersonlikelytodie
becauseofsomeunnaturalactdoneonhisbody,naratingthe
circumstancesortheconditionsresponsibleforhispresentstateof

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healthorthecauseandmanneroflikelyunnaturaldeath.
Ideallydyingdeclarationshouldberecordedbyexecutiveor
honorarymagistrate,butcanalsoberecordedbydoctor,village
headman,policeoranyotherperson,ifthereisnotimetocalla
magistrate.Doctorhastocertifythepatienttobecomposmentis

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(soundmind).Itisrecordedinpresenceoftwodisinterested
witnesses.Relativesandpoliceofficersarenotallowedtobe
present.Nooathisadministered.
Itcarrieslessweightthandyingdepositionasnocross-examination
ispossible.Ifthepatientdoesnotdieaftertherecordingof

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declaration,thedyingdeclarationlosesitsimportancesicenowhe
canbecalledtothecourtandhisevidencecanberecordedafter
cross-examination.

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82.Whichofthefollowingis/aredangerous
injuryinforensicscience?

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a)Injurycausingendangertolifeifnottreatedtimely
b)Hearingloss
c)Lossof2-3teeth
d)Synonymouswithgrievousinjury
e)Emasculation

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CorrectAnswer-A
Ans.is'a'i.e.,Injurycausingendangertolifeifnottreated
timely[RefReddy33rd/ep.293;Parikh7m/ep.263]
Injuriescanbedividedinto(i)Simple(ii)Grievousand(iii)
dangerous.

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Asimpleinjuryisonewhichisneitherextensivenorserious,and
whichwouldhealrapidlywithoutleavinganypermanentdeformityor
disfiguration.
Agrievousinjuryisone(i)Whichisextensiveorserious(ii)Which
doesnothealrapidly,and(iii)Whichleavesapermanentdeformity

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ordisfiguration.
1. Emasculation(cuttingofthepenis,castration;orcausinglossof
poweroferectionduetospinalinjury).
2. Permanentprivationofthesightofeithereye.
3. Permanentprivationofthehearingofeitherear.

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4. Privationofanymember(part,organ,limb)orjoint.
5. Destructionorpermanentimpairingofpowersofanymemberor
joint.
6. Permanentdisfigurationofheadorface.

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7. Fractureordislocationofaboneoratooth.

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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

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c)Congestedfaces
d)Transverseligature
e)Bruisesatedgesoftheligaturemark
CorrectAnswer-B:C:D:E
Ans.is'b'i.e.,Fracturesoftracheaandlarynx;'c'i.e.,

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Congestedfaces;'d'i.e.,Transverseligature;&`e'i.e.,Bruises
atedgesoftheligaturemark[RefReddy33rdiep.351]

Strangulation
Hanging

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1. Nosuspension
2. Compressiononneckisbya
1. Thereissuspensionofbody.
ligature,hands,sticks,
2. Compressiononneckisbyaligature elbow,kneeorfoot.

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3. Forceofcompressionistheweighto
3 f
. Itisoutsideforceapplied
body(endogenousorce)
(exogenousforce).

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4. Ligaturemarkisabovethethyroidis
4. Markisonorbelowthe
oblique,symmetricalandincomplete. thyroid.Ishorizontal,
5. Knotusuallypresent.
completeandcontinuous(in

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6. Usuallynomarkatsiteofknot:In
absenceofligaturemark
fixedknot,markisinverted'V'
thereareotherinjurieson
shaped.

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neckdependingupontypeof

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7. Markusuallysingle.
strangulation).
8. Surfaceofmarkabradedor
5. KnotUsuallyabsent.

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contused.
6. Markishorizontal,complete
9. Surfacemayshowpatternofligature andcontinuous.
used.
7. Usuallymultiplemarks.

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10. Surfacehard.Mark-yellowishbrown8. Usuallylacerated.
incolour
9. Patternnotseen
10. Soft,duetofrankbleeding.
Black.

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84.SaturatedNaCIisanotusedin
preservationofviscerainwhichofthe
followingpoisoning?
a)Sodiumhydroxide
b)Aconite

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c)Carbolicacid
d)Sulphuricacid
e)None
CorrectAnswer-A:B:D
Ans.is'a'i.e.,Sodiumhydroxide;`b'i.e.,Aconite;&'d'i.e.,

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Sulphuricacid[RefReddy33"Yep.124;Parikh7TVep.108-09]
1. Saturatedsodiumchloride:Inallcasesofpoisoningexcluding
corrosiveacidsexceptcarbolicacids(phenol),alkalis,corrosive
sublimateandaconite.
2. 30mgpotassiumoxalate(anticoagulant)and10mlsodiumfluoride

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(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)

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ether.
4. 10mg/mlNa/K.flurideand3mgK-oxalate:Forpreservingblood;
flurideisalsoaddedtoCSF,vitreoushumor;andurineifalcohol
estimationisrequired;andalsoinanalysisofcocaine,cyanideand
carbonmonoxide.

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85.Whichofthefollowingdyadofdisease
andincubationperiodis/arecorrectly
matched?
a)Measles:4-5day
b)Chickenpox:3-20day

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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-

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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?

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a)Belongstofamilypapovaviridae
b)DNAvirus
c)RNAvirus
d)Enveloped
e)Causesanalwarts

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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

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Papovaviridae.
HPVcausesanogenitalwarts(condylomaaccuminata).

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87.AllaretrueaboutEbolavirusinfection
except?
a)Airdroplerismostcommonmodeoftransmission

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b)Haemorrhagicmanifestationmayoccur
c)Thaiforesttype-mostcommonspeciesinepidemics
d)presentsassuddenonsetoffeverandsorethroat
e)Casefatalityratemaybehighas70%
CorrectAnswer-A:C

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Ans.is'a'i.e.,Airdroplerismostcommonmodeof
transmission&'c'i.e.,Thaiforesttype-mostcommonspecies
inepidemics]RefPark24m/ep.374]
Thevirusistransmittedthroughdirectcontactwithblood,organs,
bodysecretionsorotherbodyfluidsofinfectedanimalslike

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chimpanzees,gorillas,monkeys,fruitbatsetc.
Humantohumantransmissionisthroughbloodorbodyfluidsofan
infectedsymptomaticpersonorthroughexposuretoobjects(sucha
needle)thathavebeencontaminatedwithinfectedsecretions.
Itisnottransmittedthroughair,water,orfood.

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Thevirusistransmittedthroughdirectcontactwithblood,organs,
bodysecretionsorotherbodyfluidsofinfectedanimalslike
chimpanzees,gorillas,monkeys,fruitbatsetc.
Humantohumantransmissionisthroughbloodorbodyfluidsofan
infectedsymptomaticpersonorthroughexposuretoobjects(such

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asneedle)thathavebeencontaminatedwithinfectedsecretions
Itisnottransmittedthroughair,water,orfood
Theillnessischaracterizedbysuddenonsetoffever,intense

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weakness,musclepain,headache,sorethroat,vomiting,diarrhea,
rash,impairedkidneyandliverfunctionandinsomebothinternal

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andexternalbleeding.
ThevirusfamilyFiloviridaeincludesthreegenera:Cuevavirus,
Marburgvirus,andEbolavirus.
WithinthegenusEbolavirus,fivespecieshavebeenidentified:
Zaire,Bundibugyo,Sudan,RestonandTalForest.

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Thefirstthree,Bundibugyoebolavirus,Zaireebolavirus,and
Sudanebolavirushavebeenassociatedwithlargeoutbreaksin
Africa.

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88.Antigenpresentingcell(s)is/are?
a)Skinlangerhanscell

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b)T-lymphocytes
c)Macrophages
d)Kuffercell
e)Thymicepithelialcells
CorrectAnswer-A:C:E

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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

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potentandeffectiveantigenpresentingcells.
CD4helparTcellsareactivatedonlywhenantigenispresentedby
MHC-classIIofAPC-->MHC-Hrestricted.
CD8cytotoxicT-cellsrecognizeantigenthatispresentedbyMHC-
classI-->MHC-Irestricted.

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B-cellsreceptors(i.e.surfaceimmunoglobulin)canbebindto
antigenandactivateB-cellswithoutinvolvementofMHCand
antigenpresentingcellsAntigenprocessingandpresentationby
APCsisnotrequiredforBcells(incontrasttoT-cells).

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89.DeficiencyofbothTandBlymphocyte

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involvedinallexcept?
a)Chronicmucocutaneouscandidiasis
b)Wiskott-Aldrichsyndrome
c)DiGeorgesyndrome
d)AtaxiaTelangiectasia

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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;

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Robbin's7h/ep.239-401

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90.Dimorphicfungiis/are?
a)Histoplasmacapsulatum
b)Sporothrixschenckii
c)Malasseziafurfur

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d)Cryptococcusneoformans
e)Aspergillus
CorrectAnswer-A:B
Ans.is'a'i.e.,Histoplasmacapsulatum;&'b'i.e.,Sporothrix
schenckii[RefAnanthanarayanelep.601,609;Jawetz23'/ep.

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6451.
Fungithathavetwogrowthforms,suchasmold(filaments)anda
yeast,whichdevelopunderdifferentgrowthconditions.
Inhosttissuesorculturesat37?Ctheyoccurasyeasts,whileinthe
soilandinculturesat22?Ctheyappearasmoulds.

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Yeastsareseenasroundedsinglecellsorasbudding
organisms.CandidaandCryptococcusaretraditionallyclassifiedas
yeasts.
Mostfungicausingsystemicinfectionsaredimorphicfungi
DimorphicFungiareJawetz27th/853

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Blastomycosisdermatitidis
Paracoccidioidesbrasiliensis
Coccidioidesposadasii&Coccidioidesimmitis
Histoplasmacapsulatum
Sporotrixschenckii

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Penicilliummarneffe

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91.NontureaboutDonovanosis?
a)CausedbyKlebsiellagranulomatis
b)Associatedwithpseudobuboes
c)CausedbyLeishmaniadonovani

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d)DrugofchoiceisMiltefosine
e)Drugofchoiceissodiumstibogluconate
CorrectAnswer-C:D:E
Ans.is'c'i.e.,CausedbyLeishmaniadonovani;'d'i.e.,Drugof
choiceisMiltefosine;&`e'i.e.,Drugofchoiceissodium

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stibogluconate[RefAnanthanarayan9th/ep.397;Harrison's
19th/ep.298e1-2;Greenwoodtelep.310;Park's24th/ep.350]
DonovanosisiscausedbyCalymmatobacteriumgranulomatis,a
gramnegativeintracellularbacteria.Incubationperiodof
donovanosisis1to4weeks.Itbeginsasoneormoresubcutaneous

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nodulesthaterodethroughskintoproduceanulcer.
AzithromycinistheDOCAlternativesaredoxycycline(2"choice)
andchloramphenicol.Streptomycin,onceused,isnotinuse
now.Note:Calymmatobacteriumgranulomatisisnowcalledas
Klebsiellagranulomatis.

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92.TrueaboutActinomycosis?
a)Causedbymadurellamycetomatis
b)Causedbyanaerobicormicroaerophilicbacteria
c)Cervicofacialisthemostcommonsiteaffected
d)Sulphurgranulesarepresentinlesion

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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

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growthfactorcategoryofoncogene[RefAnanthanarayan9"'/e
p.391-93,600-01;Greenwood16"/ep.221-22;
Harrison's19th/ep.1088]
Theseareconsideredasatransitionalformbetweenbacteriaand
fungi.

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Actinomycesare`gram-positive'non-motile"non-capsulated"non-acid
fast'and'non-sporing'filamentsthatbreakupintobacillaryand
coccoidelements.
Theyareanaerobicormicroaerophilic(Ananthnarayan9th/ep.391-
393)

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TwoimportantspeciesareA.israelliandA.bovis.Mostcasesare
duetoAisraelli.
Actinomycesaremembersofnormaloralfloraandareoften
culturedfrombronchi,G.I.tract,andthefemalegenitaltract.
Actinomycosisinhumanbeingsisanendogenousinfection.

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Thecriticalstepinthedevelopmentofactinomycosisisdisruptionof

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mucosalbarrier.

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93.Trueregardingleptospirosisis?
a)Ratsaretheonlyreservoirs
b)FluoroquinolonesaretheDOC

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c)Persontopersontransmissionrare
d)Hepatorenalsyndromeoccursin50%cases
e)None
CorrectAnswer-C
Ans.(c)i.e.Persontopersontransmissionrare

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Note:-Weilsyndromedevelopsin5-10%ofinfectedindividual
TreatmentofchoiceforleptospirosisisAmpicillin
Doxycyclineisthedrugofchoiceforchemoprophylaxis.

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94.Whichistrueaboutsyphilis:
a)VDRLtestdetectsantibodies

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b)Jarischherxheimerreaction-IgEmediated
c)Penicillinispreferredtreatmentforprimaryandsecondary
stage
d)RPRcanbedoneforCSF
e)None

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CorrectAnswer-A:C
Ans(aandc)VDRLtestdetectsantibodies,Penicillinis
preferredtreatmentforprimaryandsecondarystage
Jarisch:Herxheimerreactionismediatedbyreleaseoflipoproteins,
cytokinesandimmunecomplex.

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Evaluationforneurosyphilis:
Pleocytosis,increasedproteinconcentration
CSFVDRLishighlyspecificandwhenreactiveisconsidered
diagnosticofneurosyphilis
PatientwithRPRtitre1:32areathigherriskfordeveloping

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neurosyphilis.

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95.Waterlossof5fi)-l0ffiml/hourincholera
isknowas-
a)Choleragravis
b)Choleramitis

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c)Choleramajoris
d)Choleraintermedius
e)Choleratotalis
CorrectAnswer-A
Anwer-Ans.is'a'i.e.,Choleragravis[RefHarrison's

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19m/ep,1063;www.ncbi.nlm.nih.gov]
Vibriocholerainfectionmanifestationsrangefromasymptomaticto
milddiarrheatoseverediarrhea.
Massivewaterydiarrhea(knownascholeragravis)maycauseloss
of1000mlwaterperhour.Thiscancausehypotensiveshock&

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death.

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96.Organism(s)commonlycausing
infectionincysticfibrosispatients
a)Burkholderiacepacia
b)PseudomonasAeruginosa

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c)StaphylococcusAureus
d)BurkholderiaMallei
e)StreptococcusPyogenes
CorrectAnswer-A:B:C
Ans.is'a'i.e.,Burkholderiacepacia;'b'i.e.,Pseudomonas

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aeruginosa;&'c'i.e.,Staphylococcusaureus[RefHarrison
19m/ep.1699]
Infectionsseenincysticfibrosisarecausedby-
Burkholderiacepacia
Pseudomonasaeruginosa(mucoidtype)

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Atypicalmycobacteria
Non-typeablehemophilusinfluenzae
Staphylococcusaureus(includingMRSA

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97.Wbichofthefollowingis/areTick-
borne.disease-

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a)Murinetyphus
b)Epidemicthyphus
c)Lyme'sdisease
d)Tularemia
e)Trenchfever

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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,

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KFD,Tularemia,tickparalysis,humanhabesiosis,Lyme'sdisease.
SofttickQfever,relapsingfever,KFD.

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98.Barrelshapedeggsis/areseenin-
a)Hookworm
b)Pinworm

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c)Roundworm
d)Whipworn
e)Strongyloidesstercoralis
CorrectAnswer-D
Ans.is'd'i.e.,Whipworm[RefRajeshkarykarte1"/ep.1661

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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

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d)NotapublicprobleminIndia
e)None
CorrectAnswer-A:B:C
Ans.is'a'i.e.,ChloroquineresistanceoccursinIndia;'b'i.e.,
Relapsesisusualforvivaxandovalemalaria;&'c'i.e.,Sexual

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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

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d)GDPpercapitarangefrom25$to50000$
e)HDIscorerangeis0-l
CorrectAnswer-A:C:E
Ans.is'a'i.e.,Adultliteracyraterangefrom0to100;'c'ie.,Life
expectancyatbirthrangefrom25yearsto85years&`e'i.e.,

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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

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d)Hibvaccine
e)DPTvaccine
CorrectAnswer-A:B:C
Ans.is'a'i.e.,MMRvaccine;'b'i.e.,HepatitisAvaccine;&'c'
i.e.,Varicellavaccine

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[RefPark's24thlep.108;CommunityMedicinebyPiyushGupta
1"/ep.428;CommunityMedicinewithRecentAdvancesby
Suryakantha4th/ep.287;O.P.Ghai8thlep.189-90]
Liveattenuatedvaccinesarecontraindicatedinimmunodeficiency
stateslikeHIV.

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ImportantexamplesoflivevaccinesareBCG,OPV(Sabinoralpolio
vaccine),measles,mumps,rubella,yellowfever(17Dvaccine),
typhoidoral(typhoral),chickenpox,influenza,plague,epidemic
typhusandhepatitisA.

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102.TruestatementaboutIPVvaccine-

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a)GiventhroughIM/SCroute
b)Giventhroughintradermalroute
c)Doesnotrequirestringentconditions
d)Doseis-0.1ml/dose
e)Doseis-0.5ml/dose

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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

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routes.
Theprimaryorinitialcourseofimmunizationconsistsof4
inoculation(4doses).Thefirst3dosesaregivenatintervalsof1-2
monthsand4thdose6-12monthsafterthethirddose.Firstdose
usuallygivenwhentheinfantis6weeksold.Additionaldosesare

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recommendedpriortoschoolentryandthenevery5yearsuntilthe
ageof18.
ItcanbecombinedwithDPT,Hepatitis,and/orH.influenzaetypeB
vaccine.Inthecombinationvaccines,thealumorthepertussis
vaccine,orbothhaveanadjuvanteffect.

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ThemajoradvantageofIPVisthatbeinganinactivatedvaccine,it
canbegiveninpregnancyandimmunocompromisedpersons
(personwithlymphoreticularmalignancies,onradiotherapyor
corticosteroid,>50yearsofage).
Theotherimportantadvantageisthatthereisnoriskofvaccine

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

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103.Trueaboutdemographiccycleoflndia
-
a)Enteredintolowstationaryphase
b)Dependencyratio<40Vo
c)YearofBigdivide-l92lA.D

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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

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regularcensusinIndiawascarriedin1881
[RefPark's24th/ep.513-518;CommunityMedicinebyPiyush
GuptaPlep.610-12;CommunityMedicinewithRecentAdvance
bySuryakantha4th/ep.651-57]
Theproportionofpersonsabove65yearsofageandchildrenbelow

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15yearsofageareconsideredtobedependentontheeconomically
productiveagegroup(15-64years).Theratioofcombinedage
group0-14yearsplus65yearsandabovetothe15-65yearsage
groupisknownastotaldependencyratio.
Incountrieswithhighbirthrates(e.g.developingcountrieslike

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India),populationpyramidhasabroadbaseandataperingtap/apex
(conicalshape).
Indevelopedcountries,thepyramidgenerallyshowabulgeinthe
middleandnarrowerbase(dumb-bellshaped).CensusinIndia
CensusisveryimportantsourceofhealthinformationinIndia.Itis

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carriedatregularintervalof10years.ThefirstcensusinIndiawas

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takenin1881.LastcensuswasheldinMarch2011.
CensusisunderMinistryofHomeAffairsandheadofcensus
organizationis'RegistrarGeneralandCensusCommissioner'.
Inrecentcensus(2011)Biometrywasincludedfirsttimeever:

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Fingerprints,Irisscan,UID(uniqueidentificationnumber)and
photograph.
Thereferraltimeanddateatwhichsnapshotofpopulationistaken
iscalledcensusstop(censusmovement),whichis00.0hrs01
March,i.e.Censusstops.

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104.Whichofthefollowingis/aretrue
aboutsandfly-
a)Breedonoverheadtanks
b)Smallerthanmosquito
c)Femaleflydoesnotbites

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d)Don'tflybychoice
e)None
CorrectAnswer-B:D
Ans.is'b'i.e.,Smallerthanmosquito;&'d'i.e.,Don'tflyby
choice[RefPark24th/ep.812-13]

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Size:Sandfliesaresmallerthanmosquitoes.
Wings:Thewingsofthesandflyareup-rightandlanceolatein
shape;thesecondlongitudinalveinbranchestwice,thefirst
branchingtakingplaceinthemiddleofthewing.
Legs:Thelegsofthesandflyarelongercomparedwiththesizeof

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thebody.
Hairs:Sandflyisahairyinsect
Hopping:Sandflieshopaboutanddonotflybychoice
Onlyfemalesandfliesbite.Theyrequireabloodmealevery3-4
daysforoviposition.Theyinhabitatholesandcrevicesinwalls,

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holesintrees,darkrooms,stablesandstorerooms.
Sandflyconnotfly,itonlyhops.
TheinsecticideofchoiceisDDTassandflieshavenotdeveloped
resistance.DDTissprayeduptoaheightof4-6feetofwalls.

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105.Periodofcornmunicabilityofmeasles

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is-
a)3daysbeforeand10daysafterappearanceofrashes
b)3weeksafterappearanceofrashes
c)Iweekbeforeappearanceofrashes
d)4daysbeforeand5daysafterappearanceofrashes

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e)Upto3monthsafterappearanceofrashes
CorrectAnswer-D
Ans.is'd'i.e.,4daysbeforeand5daysafterappearanceof
rashestRef:Park24th/ep.157;CommunityMedicinewith
RecentbySuryakantha4th/ep.328]

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Chickenpox:1-2daysbeforeto4-5daysafterappearanceof
rash.
Measles:4daysbeforeto5daysafterappearanceofrash.
Rubella:7daysbeforesymptomsto7daysafterappearanceof
rash.

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Mumps:4-6daysbeforesymptomsto7daysthereafter.
Influenza:1-2daysbeforeto1-2daysafteronsetofsymptoms.
Diphtheria:14-28daysfromdiseaseonset.
Pertussis:7daysafterexposureto3weeksafterparoxysmalstage.

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106.Whichofthefollowingis/aretrue

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aboutnationalironplusinitiotive-
a)Onlyschoolgoingadolescentsarecovered
b)Adolescentsofagegroupl0-19yrarecovered
c)Preschoolchildrenarecoveredthroughaganwadicenter
d)Biannuldewormingthroughalbendazoletablet

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e)Screeningoftargetgroupsformoderate/severeanaemia
andreferringthesecasestoanappropriatehealthfacility
CorrectAnswer-B:D:E
Ans.is'b'i.e.,Adolescentsofagegroup10-19yearare
covered;'d'i.e.,Biannuldewormingthroughalbendaz,ole

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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]

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Bi-weekly20mgelementalironand100microgram(mcg)folicacid
permlofliquidformulationandageappropriatede-wormingfor
preschoolchildrenof6-59months.
Weeklysupplementationof45mgelementalironand400mcgfolic
acidperchildperdayforchildrenfrom1stto5thgradeingovt.&

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Govt.Aidedschools,andatAWCforoutofschoolchildren(6to10
years).
Weeklydoseof100mgelementalironand500mcgfolicacidwith
biannualde-worminginadolescents(10-19years)underWIFS.
Weeklysupplementationforwomaninreproductiveage,Pregnant

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andlactatingwomen.
Screeningoftargetgroupsformoderate/severeanemiaand
referringthesecasestoanappropriatehealthfacility.

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107.Whichofthefollowingis/aretrueabout
RevisedNationalTuberculosisControl

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Programme(RNTCP)-
a)T.B.ismandatorytonotify
b)SuspiciousTBpatientsarescreenedthrough2sputum
smearexaminations
c)MDR-TBisnotincludedinRNTCP

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d)Casefindingisactive
e)CoveredthewholecountrysinceMarch2006
CorrectAnswer-A:B:E
Ans.is'a'i.e.,T.B.ismandatorytonotify;`b'i.e.,SuspiciousTB
patientsarescreenedthrough2sputumsmearexaminations&

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'e'i.e.,CoveredthewholecountrysinceMarch2006
[RefPark's24th/ep.427-30;CommunityMedicinebyPiyush
Gupta1"/ep.826-30;Suryakantha4'1*p.921-23;National
HealthProgramsofIndiabyfungalKishore7th/ep.91]
GovernmentofIndiadeclareTBanotifiablediseaseon7thMay

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2012withfollowingobjectives:-
TohaveestablishedTBsurveillancesysteminthecountry.
ToextentmechanismofTBtreatmentadherenceandcontact
tracingofpatientstreatedintheprivatesector.
ToensureproperTBdiagnosisandcasemanagementandfurther

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acceleratereductionofTBtransmission.
TomitigatetheimpendingdrugresistantTBepidemicinthecountry.

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108.9-valentHPVvaccinecoverswhich
type(s)HPVstrain-
a)6,11

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b)16,18
c)31,33
d)41,35
e)42,58
CorrectAnswer-A:B:C

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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.

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TherearetwotypesofHPVvaccines:-
Quadrivalent:-containingHPVtypes6,11,16,18
Bivalent:-containingHPVtypes16,18

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109.Trueaboutpopulationcoverageof
primaryhealthcenter?

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a)20000inplainarea
b)30000inplainarea
c)10000intribalarea
d)20000intribalarea
e)30000intribalarea

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CorrectAnswer-B:D
Ans.is'b'i.e.,30000inplainarea;&'d'i.e.,20000tribalarea

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110.Whichofthefollowingistrueaboutpost
exposureprophylaxisinrabies?
a)CategoryI-Bothvaccineandimmunoglobulinaregiven

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b)Immunoglobulinnotrequiredifpriorfullvaccinationisreceived
c)Localwoundcleaningisdoneinallcasesofdogwound
d)CategoryI-requiresvaccinationonly
e)Vaccineisstoppedifwithin3daysofbite,dogdies
CorrectAnswer-B:C

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Ans.is'b'i.e.,Immunoglobulinnotrequiredifpriorfull
vaccinationisreceived;&'c'i.e.,Localwoundcleaningisdone
inallcasesofdogwound[RefPark's24'h/ep.296-97;
CommunityMedicinebyPiyushGupta1"/ep.3231
Cleansing:Withplentyofsoapandwater,preferablyundera

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runningtap.
Suturing:Itshouldnotbedoneimmediately;ifrequiredshouldbe
done24-48hourslater,withminimumpossiblestitches.
CategoryI-touchingorfeedinganimals,licksonintactskinNone
CategoryII-nibblingofuncoveredskin,minorscratchesof

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Immediatevaccinationandlocaltreatmentofthewoundabrasions
withoutbleeding
CategoryIII-singleormultipletransdermalbitesorscratches,licks
onbrokenskin;-->Immediatevaccinationandadministrationof
rabies

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contaminationofmucouscontactswithbatsimmunoglobulin;
localtreatmentofthewoundmembranewithsalivafromlicks,etc.

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111.Contraindicationofcochlear
implantationis/are-
a)Mondinideformity

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b)Intracochlearossification
c)Chronicsuppurativeotitismedia
d)Agenesisofcochlearnerve
e)All
CorrectAnswer-C:D

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Answer-(C)Chronicsuppurativeotitismedia(D)Agenesisof
cochlearnerve
Absolute
1. Activemiddleearinfection:ASOM,CSOM,mastoiditis
2. Agenesisofcochleaand/orCochlearnerve

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3. Mentalretardion:Patientcannotcooperatewithspeechtraining

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112.Premalignantlesionoforalcavity
includes
a)Lichenplanus
b)Erythroplakia

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c)Bowendisease
d)Behchetdisease
e)None
CorrectAnswer-B
Answer-B.Erythroplakia

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Premalignantcondition:-Leukoplakia,Erythroplakia,Speckled
erythroplakia,chronichyperplasticcandidiasis.

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113.Whichofthefollowingis/aretrueabout
lefortsfracture
a)Itisfractureofzygomaticbone

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b)MaycauseCSFrhinorrhea
c)Type1:completeseparationoffacialbonesformthecranial
bones
d)Classifiedastypes1to5
e)None

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CorrectAnswer-B
Answer-B.MaycauseCSFrhinorrhea
LeFortI(transverse)-crosseslowerpartofnasalseptum,maxillary
antraandthepterygoidplates.
LeFortII(pyramidal)-passesthroughtherootofnose,lacrimal

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bone,flooroforbit,upperpartofmaxillarysinusandpterygoidplates
LeFortIII(craniofacialdysjunction)-Thereiscompleteseparation
offacialbonesfromthecranialbones.
Clinicalfeaturesofmaxillaryfracture-
Malocclusionofteeth

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Mobilityinthemaxilla
CSFrhinorrhoea.

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114.Trueaboutdevelopmentofcochlea
a)Cochleastartdevelopingfrom3rdweekofgestation
b)Semicircularcanalsdevelopaftercochlea

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c)Cochleadevelopmentcompletesby20weekofgestation
d)Cochleadevelopmentcompletesat2yearofage
e)All
CorrectAnswer-A:C
Answer-A,Cochleastartdevelopingfrom3rdweekof

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gestationC,Cochleadevelopmentcompletesby20weekof
gestation
Developmentofcochleastartsat3weeksandcompletesat20-22
weeksofintrauterinelife.
Semicircularcanaldevelopsearlierthancochlea.

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115.Whichofthefollowingis/aretrueabout
theT-stageofmaxillarysinuscarcinoma
-
a)StageT4a-frontalsinusinvolvement
b)StageT3-ethmoidsinusinvolvement

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c)StageT2-sphenoidsinusinvolvement
d)StageT2-boneoftheposteriorwallofmaxillarysinus
e)None
CorrectAnswer-A:B
Answer-(A)StageT4a-frontalsinusinvolvement(B)StageT3-

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ethmoidsinusinvolvement
T4a-Tumourinvadesanteriororbitalcontents,skinofcheek,
pterygoidplates,infratemporalfossa,cribiformplates,sphenoidor
frontalsinus.
T3-Tumourinvadesanyofthefollowing-boneoftheposteriorwall

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ofmaxillarysinus,subcutaneoustissues,floorormedialwallorbit,
pterygoidfossaandethmoidsinuses.
T2-Tumourcausingboneerosionordestructionincludingextension
intothehardpalateandmiddlenasalmeatus,exceptextensionto
posteriorwallofmaxillarysinusandpterygoidplates.

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116.Trueaboutforeignbodiesofairpassage
inchildrenexcept-
a)Vegetableforeignbodiesarenotcommon
b)Trachealobstructioncancausessuddendeath
c)Morecommoninrightbronchus

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d)Morecommoninchildrenoflessthan4yrofage
e)CTscanofchestisdoneinallcases
CorrectAnswer-A:B:E
Answer-(A)Vegetableforeignbodiesarenotcommon
(B)Trachealobstructioncancausessuddendeath(C)More

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commoninrightbronchus
Themostcommonagegroupis6monthsto4years.
Mostcommonforeignbodyaspiratedisnuts(peanuts).
Mostairwayforeignbodieslodgeinabronchus(rightmorethan
left).

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Thechildpresentswithacuteonsetofcough-(most-common),
Chockinggagging,wheezing,respiratorydistress,aphonia,drooling
andstridor.
Bronchoscopyisdiagnosticaswellastherapeutic.

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117.Deformitiesoccurringinleprosypatients

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is/are-
a)Faciesleonina
b)Lowsetear
c)Saddlenose
d)Lagophthalmos

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e)Microganthia
CorrectAnswer-A:C:D
Answer-(A)Faciesleonina(C)Saddlenose(D)Lagophthalmos
Face-
Maskface,faciesleonina,Saddlenose,saggingface,

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lagophthalmos,lossofeyebrows,perforatednose,depressednose,
eardeformities.

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118.Whichofthefollowingis/aretrueabout
schwartzsign-
a)Signofinactivedisease

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b)Indicationforsurgery
c)Morecommonduringpregnancy
d)Reddishhueoverthepromontory
e)Seenintheearlystagesoftheotoscelerosis
CorrectAnswer-B:C:D:E

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Answer-(B)Indicationforsurgery(C)Morecommonduring
pregnancy(D)Reddishhueoverthepromontory(E)Seeninthe
earlystagesoftheotoscelerosis
Schwartzsign(Flemingo'sflushsign)-
In10%ofcasesflamingo-pinkblushisseenthroughthetympanic

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membranecalledasSchwartzsign
Itisseeninearlyandactivestageofthedisease.
Thesignischaracterizedbypinkblushseenthroughthetympanic
membranecausedbyreddishhueoverpromontoryduetoincreased
vascularityofthepromontory.

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ThissignindicatesactiveostosclerosisusuallyduringPregnancy
Itseemsthatthesurgeryremainsatherapeuticoption,whenthe
activephaseofthediseaseisstabilizedevenfollowingashort
courseofpharmacologicaltherapy.

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119.Allaretrueaboutcentralretinalartery

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occlusion(CRAO)except
a)Mostcommonlyoccursduetothromboembolus
b)Anteriorchamberparacentesisisusedfortreatment
c)Suddenpainfullossofvision
d)Occursduetoobstructionofretinalarteryattheleveloflamina

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cribrosa
e)Macularareashowscherry-redspot
CorrectAnswer-C
Answer-C.Suddenpainfullossofvision
Patientnoticessuddenpainlesslossofvision.

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Patients'swithapatentcilioretinalarterymayretaincentralvisionas
themaculaisspared.
Emboliarethemostcommoncauseofretinalarteryocclusion.
Obstructionoccursattheleveloflaminacribrosa.
Thelargerretinalarteriesareconstuictedandlooklikethinthreads

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whilethesmallervesselsarescarcelyvisible.
Thefundusappearsmilkywhitebecauseofretinaledema.
Thereischerry-redspotatthemacula.
Bloodcolumnwithintheretinalveinsissegmented(Cattletracking)

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120.Nottrueaboutbluesclera

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a)Seeninosteogenesisimpertca
b)DoesnotseeninEhlers-danlossyndrome
c)Bluecolourisproducedbyunderlyinguvealpigment
d)Seeninmarfan'ssyndrome
e)Scleraisthin

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CorrectAnswer-B
Answer-B.DoesnotseeninEhlers-danlossyndrome
BlueScleraischaracterizedbymarked,generalizedblue
discolourationofscleraduetothinning,Theuvealpigmentshines
throughthethinscleraandproducesthebluecolour.

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CausesofblueSclera:
Pseudoxanthomaelasticum
Osteogenesisimperfecta
Ehlers-Danlossyndrome
Marfan'ssyndrome

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Alkaptonuria
Hypophosphatasia
Juvenilepaget'sdisease
Normalinnewborns
VanderHoeve'ssyndrome

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121.Cornealulcerisdefinedas
a)Erosionofepitheliumonly
b)Erosionofendotheliumonly
c)Erosionofepithelium+underlyinginflammation
d)Lossofendotheliumwithlossofcornealsensation

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e)None
CorrectAnswer-C
Answer-C.Erosionofepithelium+underlyinginflammation
Cornealulcerreferstodiscontinuationinnormalepithelialsurfaceof
corneaassociatedwithnecrosisofthesurroundingcornealtissue

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122.Postoperativeendophthalmitisin
cataractsurgerycanbepreventedby
useof
a)Pre-operativeoralantibiotics
b)Intra-operativeIVantibiotics

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c)Useofpovidone-iodinesolutiontopaintthelidsbeforesurgery
d)Cleaningandsterilizationofoperationtheatre
e)Postoptopicalantibiotics
CorrectAnswer-C:D:E
Answer-C,Useofpovidone-iodinesolutiontopaintthelids

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beforesurgeryD,Cleaningandsterilizationofoperation
theatreE,Postoptopicalantibiotics
Thepre-operativetopicalantibioticshouldbestarted3dayspriorto
surgery.
Preferredantibioticsarefourthgenerationfluoroquinolones

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(gatifloxacin,moxifloxacin).
Thetopicalantisepticpovidoneiodine5%instilledasasingledrop
l0-30minutesbeforesurgeryisoneofthemosteffectivemeasure
todecreasethisbacterialflora.
Methodofprophylaxysisagainstpostoperativeendophthalmitisisby

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useofprovidonesolutionontheskinandinconjunctivalsac.
Post-operativelytopicalantibiotics(eyedrops)aregivenalongwith
steroidsforl0-14days.

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123.Allaretrueaboutcongenitalptosis
except

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a)Stimulusdeprivationamblyopiamayoccuriftreatmentis
delayed
b)Lidlagondowngaze
c)Prominenceoflidcrease
d)Lossoflidcrease

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e)Associatedwithweaknessofthelevatorpalpebraesuperioris
CorrectAnswer-C
Answer-C.Prominenceoflidcrease
Ptosisisdroopingofuppereyelid.
Congenitalmyogenisptosis-

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Itisthemostcommontypeofptosis.
Associatedwithcongenitalweaknessoflevatorpalpebraesperioris.
Characterisedbydroopingofeyelidswithabsentlidcreseandlid
lagondowngaze.

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124.Whichofthefollowingstatement(s)

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is/aretrueabouteyelidglands-
a)Mollaremodifiedsebaceous
b)Tarsalglandsaremeibomianglands
c)Glandofzeisaresweatgland
d)Meibomianglandsaremodifiedsebaceousglands

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e)Externalhordeolumisanacutesuppurativeinflammationof
glandofZeis
CorrectAnswer-B:D:E
Answer-(B)Tarsalglandsaremeibomianglands(D)Meibomian
glandsaremodifiedsebaceousglands(E)Externalhordeolum

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isanacutesuppurativeinflammationofglandofZeis
Aneyelidisathinfoldofskinthatcoversandprotectstheanterior
surfaceofeyeball.
Eyelidcontainsmanyglandsas-
1. Meibomianglands-Thesearealsoknownastarsalglands

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2. GlandsofZeis:Thesearesebaceousglands
3. GlandsofMoll-Thesearemodifiedsweatglands
4. AccessorylacrimalglandsofWolfring
Stye(Hordeolumexternum)-
Onsetisacute

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EffectedglandisZeis'sgland
Typeofinflammationsuppurative
C/F-Acutepainandhardswelling
Treatment-
Hotfomentation,antibiotics

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125.Trueaboutinferioropthalmicvein-
a)Smallerthansuperiorophthalmicvein
b)Connectedtothepterygoidvenousplexus
c)Formedatlateralwallandflooroforbit
d)Passthroughsuperiororbitalfissure

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e)Emptiesintosuperiorophthalmicvein
CorrectAnswer-A:B:D:E
Answer-(A)Smallerthansuperiorophthalmicvein
(B)Connectedtothepterygoidvenousplexus(D)Passthrough
superiororbitalfissure(E)Emptiesintosuperiorophthalmic

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vein
1. Theinferiorophthalamicveinbeginsasavenousnetworknearthe
anteriorpartoforbitalfloornearmedialwalloforbit.
2. ItissmallerthanSuperiorophthalamicvein.
Dividedintotwobranches-

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1. Inferiororbitalfissuretojoinpterygoidvenousplexus
2. Superiororbitalfissuretodrainintoeithersuperiorophthalmicvein
orintocavernoussinus.

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126.Whichofthefollowingcanbe
ophthalmiccomplicationofDMexcept-

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a)Papillopathy
b)Snowflakecataract
c)Retinopathy
d)Rhegmatogenousretinaldetachment
e)Cystoidmacularoedema

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CorrectAnswer-D
Answer-D.Rhegmatogenousretinaldetachment
Ocularmanifestationsofdiabeticretinopathyare-
1)Non-proliferativediabeticretinopathy(NPDR)-
Microaneurysms

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Retinalhemorrhage
Retinaledema(Retinalthickening)-macularedema.
2)Proliferativediabeticretinopathy(PDR)
HallmarkofPDRistheoccuranceofneovascularization
3)Diabeticmaculopathy

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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

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c)Morecommonafterintracapsularcatractextractionthan
extracapsularcataractextraction
d)Posteriorcapsularopacification(PCO)
e)Anteriorsubcapsularcataract
CorrectAnswer-A:B:D

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Answer-(A)Treatmentofthickenedcapsulecanbedoneby
discissionwithcystitome(B)TreatmentbyNd-YAGlaser
posteriorcapsulotomy(D)Posteriorcapsularopacification
(PCO)
Opacificationoftheposteriorcapsuleiscausedbypostoperative

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proliferationofcellsinthecapsularbagandisthemostcommon
complicationofECCE.
Aftercataract,ifthin,canbeclearedcentrallybyNd:YAGlaser
capsulotomy.
Discissionwithcystitomeorzeigler'sknifemayalsobeused.

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128.Whichofthefollowingis/aretrueabout
mediallongitudinalfasciculus(MLF)and
itslesionexcept-
a)Unilaterallesionresultinadductionpalsyofoppositeeye
b)MLFconnectssixthcranialnervenucleusofonesidewiththe

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thirdcranialnervenucleusoftheotherside
c)MLFisresponsibleforconjugateeyemovements
d)Itisanintegralcomponentofsaccadiceyemovements
e)Abductingnystagmusoftheeyecontralateraltothe
CorrectAnswer-A

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Answer-A.Unilaterallesionresultinadductionpalsyof
oppositeeye
Voluntaryhorizontalgazeinonedirectionbeginswiththe
contralateralfrontaleyefields
Contralateralparamedianpontinereticularformation(PPRF),which

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istheorganizingcenterforlateralgazeinthebrainstem
Medialrectusmuscleweaknessimpsilateraltothesideofthelesion
withparesisofadductionoradductionlag.

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129.Truestatementaboutdiabetic
ketoacidosisis/are?

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a)Ph<7.3
b)Ketonemia
c)Absenturinaryketonebodies
d)Glucoselevel>300mg/dl
e)Bicarbonate<15meq/1

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CorrectAnswer-A:B:D:E
Answer-A,B,D,E,Ph<7.3,Ketonemia,Glucoselevel>
300mg/dl,Bicarbonate<15meq/1
KetoacidosisisrareintypeIIdiabeteswhereinsulinlevelsalthough
functionallyinadequatearestillsufficienttopreventketonebody

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formation.
ArterialpHis7.25-7.35,7.0-7.24&<7.0inmild,moderate&
severeDKA.
Diabeticketoacidosisischaracterizedby-
1. Hyperglycemia,

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2. Ketosis(ketonemia)andketonuria
3. Acidosis
Ketonesareanearlyindicatorofdiabeticketoacidosisandshould
bemeasuredinindividlualwithtypeIdiabetesmellitus.
Whentheplasmaglucoseisconsistently>16.7mmol/L(300mg/dl).

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Hyperketonemiaandacidosis-
Hormonesensitivelipaseisinhibitedbyinsulinandactivatedby
counterregulatoryhormones.
TheserumbicarbonatelevelinD.K.A.istypicallydecreasedtoless

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than15meq/l.

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130.ComponentsofAPACHE-11score
include(s)-
a)Age
b)Glassgowcommascale
c)Pa02

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d)Alanineaminotransferase(ALT)
e)Serumlactate
CorrectAnswer-A:B:C
Answer-A,AgeB,GlassgowcommascaleC,Pa02
APACHEIIscoreincludesAge,GCS,Physiologicalparameters(BP,

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RespiratoryRate,Pa02)andchronicmedicalconditions.
APACHEIISCORE(AcutePhysiologicalAndChronicHealth
EvaluationSystem)
TheAPACHEIIscoringsystemisthemostcommonlyusedseverity
ofillnessscoringsysteminNorthAmerica

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TheAPACHEIIscoreisrecordedasthesumoftheAcute
physiologyscore(Vitalsigns,oxygenation,laboratoryvalues),GCS,
AgeandChronichealthpointsasdetailedinthefollowingtable.

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131.Whichofthefollowingdyadsare

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correct
a)Pulsusparadoxus-aorticregurgitation
b)Pulsusbisferiens-mitralstenosis
c)Water-hammerpulse-aorticregurgitation
d)Pulsusparvusettardus-aorticstenosis

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e)Collapsingpulse-aorticregurgitation
CorrectAnswer-C:D:E
Answer-C,Water-hammerpulse-aorticregurgitationD,Pulsus
parvusettardus-aorticstenosisE,Collapsingpulse-aortic
regurgitation

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132.Whichofthefollowingis/aretrueabout
jugularvenouspressure(JVP)waveform

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a)awaveoccurjustafterelectrocardiographicPwave
b)Prominentxandydescentsisseeninconstrictivepericarditis
c)Canonawavesoccurinatrioventricular(AV)dissociation
d)vwaveoccurinearlysystoleofcardiaccycle
e)Prominentxdescentbutanabsentydescentisseenincardiac

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temponade
CorrectAnswer-A:B:C:E
Answer-A,awaveoccurjustafterelectrocardiographicP
waveB,Prominentxandydescentsisseeninconstrictive
pericarditisC,Canonawavesoccurinatrioventricular(AV)

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dissociationE,Prominentxdescentbutanabsentydescentis
seenincardiactemponade
Atrialcontractionproducesthefirstpressurepeakcalledtheawave.
Thecwaveisthetransmittedmanifestationoftheriseinatrial
pressureproducedbythebulgingofthetricuspidvalveintotheatria

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duringisovolumetricventricularcontraction.
Thevwavemirrorstheriseinatrialpressurebeforethetricuspid
valveopensduringdiastole.
a-xdescent-Constrictivepericalditis,Cardiactemponade,
Restrictivecardiomyopathy

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v-ydescent-Ticuspidregurgitation,Constrictivepericarditis

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133.Exudativepleuraleffusionis/areseenin
allexcept-
a)Cirrhosis
b)Carcinoma

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c)Bacterialpneumonia
d)Tuberculosis
e)Congestiveheartfailure
CorrectAnswer-A:E
Answer-(A)Cirrhosis(E)Congestiveheartfailure

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Collagenvasculardisease-
Rheumatoidarthritis
SLE
Druginducedlupus
Sjogren'ssyndrome

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Wegener'sgranulomatosis
Churgstrausssyndrome
Infectiousdisease-
Bacterialinfection
Tuberculosis

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Gastrointestinalinfections-
Esophagealperforation
Pancreaticdisease
Intraabdominalabscesses
Diaphragmatichernia

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Neoplastic-
Metastatic

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Mesothelioma

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134.Neurofibromatosistype1is/are
associatedwith-

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a)Caf?-au-laitspots
b)Cataracts
c)Axillaryfreckling
d)Facialnervepalsy
e)Opticnervemeningioma

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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

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d)Poorwoundhealing
e)Papilledemaandhepatomegaly
CorrectAnswer-A:B:C:E
Answer-(A)Hypercalcemia(B)Yellowskin(C)Anorexia
(E)Papilledemaandhepatomegaly

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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

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d)Acidosis
e)Hypocarbia
CorrectAnswer-A:B:C:D
Answer-A,B,C,D,Hypoxemia,Hypercarbia,Decreasedgas
exchangeinterminalbronchioles,Acidosis

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ThemostcommonsymptomsofCOPDaresputumproduction,
shortnessofbreath,andaproductivecough.
Emphysemaischaracteriredbydestructionofgas-exchangingair
spacesi.e.therespiratorybronchioles,alveolarductsandalveoli.
Lowoxygenlevels(hypoxia)thenhighcarbondioxidelevelinthe

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blood(hypercapnia/hypercarbia)
Thereisadevelopmentofrespiratoryacidosisalocalled
hpyercapnicacidosis.

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137.Trueaboutventilatorassociated
pneumonia(VAP)-

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a)2ndmostcommonnosocomialinfectionintheintensivecare
unit
b)Colonizationofthepharynxwithbacteriaisriskfactor
c)Highestriskoccurinthefirst5days
d)Gastricacidmayplayaroleinprotectionagainstnosocomial

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pneumonias
e)Developsonlyafter1weekonmechanicalventilation
CorrectAnswer-A:B:C:D
Answer-(A)2ndmostcommonnosocomialinfectioninthe
intensivecareunit(B)Colonizationofthepharynxwithbacteria

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isriskfactor(C)Highestriskoccurinthefirst5days
(D)Gastricacidmayplayaroleinprotectionagainst
nosocomialpneumonias
Ventilatorassociatedpenumoniais2dmostcommonnosocomial
infectionafterurinarytractinfection.

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Ventilator-associatedpneumonia(VAP)ispneumoniathatdevelops
48hoursorlongeraftermechanicalventilationisgivenbymeans
ofanendotrachealtubeortracheostomy.
VAPresultsfromtheinvasionofthelowerrespiratorytractandLung
parenchymabymicroorganism.

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RiskforVAPisgreatestduringthefirst5daysofmechanical
vantilation.
EarlyonsetVAPisdefinedaspneumoniathatoccurswithin4days.
Gastricacidmayplayaroleinprotectionagainstnosocomial

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pneumonias.

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138.Clinicalpresentationofpituitary
apoplexyinclude(s)allexcept-
a)Ophthalmoplegia
b)Visualimpairment
c)Fever

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d)Severeheadache
e)Hypertension
CorrectAnswer-E
Answer-E.Hypertension
1. Severehypoglycemic

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2. Severeheadache(usuallyretroorbital)
3. Impairedconsciousness
4. Fever
5. Visualdisturbances(visualfielddefect,visualacuity)
6. Ophthalmoplegia(ocularparesis)Causingdiplopia

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7. Hypotension&shock
8. Nausea/vomiting
9. Meningealsign

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139.Whichofthefollowingstatement(s)
is/aretrueaboutmyastheniaGraviswith

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muscle-specifictyrosinekinase(MuSK)
antibodiesthananti-AChRAb-
a)Diseaseonsetisearlierwithfemalepredominance
b)Neckandfacialmuscleweaknessaremorecommon
c)Moreproximalmuscleinvolvement

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d)Associatedwiththymichyperplasia
e)Poorresponsewithacetylcholineesterase(AChE)inhibitors
CorrectAnswer-A:B:C:E
Answer-(A)Diseaseonsetisearlierwithfemalepredominance
(B)Neckandfacialmuscleweaknessaremorecommon

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(C)Moreproximalmuscleinvolvement(E)Poorresponsewith
acetylcholineesterase(AChE)inhibitors
Featuresare-
1. Onsetisearlierwithfemalepredominance
2. Thymushistologyisusuallynormal

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3. Selectivefacial,bulbarneckorrespiratorymuscleweakness
4. Involvementofproximalmuscles
5. Relativesparingofocularmuscles
6. Poorresponsetoacetylcholinesteraseinhibitors(anticholinesterase)

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140.Whichofthefollowingis/arefeature(s)of

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hypomagnesemia
a)Tremors
b)Improvementseenwithcalciumsupplementation
c)Atheroidmovements
d)Seizure

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e)Bradycardia
CorrectAnswer-A:B:C:D
Answer-(A)Tremors(B)Improvementseenwithcalcium
supplementation(C)Atheroidmovements(D)Seizure
Clinicalfeaturesaremostly:

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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

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e)Dentigerouscyst
CorrectAnswer-A:B:C
Answer-A,PeriapicalcystB,ResidualcystC,Paradentalcyst
Residualcyst
Paradentalcyst

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Periapicalryst

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142.Mostaccuratemethodforthediagnosis
GastroesophagealRefluxDisease
(GERD)is
a)Histologicalstudy

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b)Manometry
c)24-hourpHrecordingandelectricalimpedancemeasurement
d)Bariumswallowstudies
e)UpperGIendoscopy
CorrectAnswer-C

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Answer-C.24-hourpHrecordingandelectricalimpedance
measurement
ThemostsensitivetestfordiagnosisofGERDis24-hambulatory
pHmonitoring.
Endoscopyisindicatedinpatientswithrefluxsymptomsrefractoryto

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antisecretorytherapy;inthosewithalarmingsymptomssuchas
dysphagia,weightloss,orgastrointestinalbleeding;andinthose
withrecurrentdyspepsiaaftertreatmentthatisnotclearlydueto
refluxonclinicalgroundsalone

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143.Allaretrueaboutbilateralbreastcancer

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except
a)Bilateralityiscommonwhenthetumorintheprimarybreastis
lobularcarcinoma
b)About5%bilateralcancersaresynchronousand20%bilateral
cancersaremetachronous

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c)Morecommoninwomenof>50yearofage
d)BRCAmutationcancersareassociatedhigherprevalenceof
bilateralbreastcancer
e)Usuallyb/1iffamilialbreastcancerpresent
CorrectAnswer-B:C

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Answer-B,About5%bilateralcancersaresynchronousand
20%bilateralcancersaremetachronousC,Morecommonin
womenof>50yearofage
BRCAmutationisariskfactorforbilateralbreastcancer.
Riskfactorsforbilateralbreastcancerare-

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Youngageatdiagnosis(<50yearsofage).
multicentricdisease
Lobularinvasivecarcinoma.
Radiationexposure
Familialorhereditarybreastcancer.

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Bilateralbreastcancerare-
Synchronous(simultaneous)
Metachronous(sequential)
Metachronousbilateralbreastcancerismorecommonthan
synchronous.

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144.Onlysimplecholecystectomyis
adequateinwhichstageofgallbladder
cancer
a)StageIA
b)StageIB

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c)StageIII
d)StageIV
e)None
CorrectAnswer-A
Answer-A.StageIA

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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

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gastricwallinvasion
d)Secondmostcommontumorofstomach
e)Diagnosisismadeonbasisofendoscopicbiopsy
CorrectAnswer-A:C:D:E
Answer-A,AssociatedwithH.pyloriinfectionC,Endoscopic

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ultrasoundisperformedtodeterminethedepthofgastricwall
invasionD,Secondmostcommontumorof
stomachE,Diagnosisismadeonbasisofendoscopicbiopsy
Thestomachisthemostcommonsiteforextranodallymphoma.
B-celllyphomasofmucosa-associatedlymphoidtissue(MALT

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lymphoma).
Lymphomaisthesecondmostcommonprimarycancerofthe
stomach.
Majorityofcases(80%)areassociatedwithchronicgastritisandH.
Pyloriinfection.

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Itismostprevalentissixthdecadeoflife.
MALTomasexpressB-cellmarkersCD19andCD20.
Diagnosisismadebyendoscopicbiopsy.
Endoscopicultrasoundisusefultodeterminethedepthofgastric
wallinvasion.

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Gastriclymphomasarechemosensitiveandchemotherapyaloneor

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alongwithsurgeryisusedforthetreatmentofgastriclymphoma.

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146.Notincludedinsurgicalsafetychecklist
a)Signin

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b)Signout
c)Timein
d)Timeout
e)Preanestheticcheckup
CorrectAnswer-C:E

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Answer-C,TimeinE,Preanestheticcheckup

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147.Suspicionofmalignancyinthyroid
noduleisindicatedbyallexcept-
a)Femalegender
b)Dysphagia

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c)Age20-40years
d)Increasingpain
e)Rapidlyenlargingsize
CorrectAnswer-A:B:C:E
Answer-(A)Femalegender(B)Dysphagia(C)Age20-40years

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(E)Rapidlyenlargingsize
Themostcommonpresentingsignofthyroidcancerisathyroid
nodule.
SolitaryorMultiplethyroidnodules
NeckNodes

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Hoarsevoiceofrecentonset
Mediastinaladenopathy
Boneorlungmetastasis
Gender:Female>Males.
Age:

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Morecommonatyoungadults.
MTCusuallydiagnosedafter60.
Ahistoryofarapidlyenlargingthyroidnoduleusuallyindicates
hemorrhage,andthisoccurinbothbenignandmalignantdisease.

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148.Allaretrueaboutsuccinate

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dehydrogenasedeficientgastrointestinal
stromaltumor(SDH-deficientGIST)
except
a)Morecommoninchildrenandyoungadult
b)NegativeforDOG-1

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c)Mostcommonlocationisstomach
d)AssociatedwithCarney-Stratakissyndrome
e)Absentc-kitmutation
CorrectAnswer-B
Answer-B.NegativeforDOG-1

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Succinatedehydrogenase(SDH)deficient-GastrointestinalStromal
Tumors(GIST)-
Pathologicalfeatures-
SDHdeficient-GISTsdonothavec-KITmutation-->absenceofc-
KITmutation.

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TheystronglyexpressKITandDOG1/Ano-1,butdonothaveKIT
mutation.
Clinicalfeatures-
TheymaYbeassociatedwith:-
1. Carneystratakissyndrome-ParagangliomawithfamilialGIST

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2. Carneytriad
Thesetumorshavetendencytoappearinchildrenandyoungadults
Theyoccurexclusivelyinstomach.

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149.Whichofthefollowingis/aretrueabout
appendicitis-

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a)Bothdiarrheaandconstipationmaypresent
b)Nauseaandvomitingusuallypresent
c)Painoninternalrotationofflexedhip
d)Painonflexionandexternalrotationofhip
e)Initiallypainislocatedintheperiumbilicalregion

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CorrectAnswer-A:B:C:E
Answer-A,Bothdiarrheaandconstipationmay
presentB,NauseaandvomitingusuallypresentC,Painon
internalrotationofflexedhipE,Initiallypainislocatedinthe
periumbilicalregion

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Clinicalfeatures-
AbdominalPain(mostcommon)isfrequentlynoticedinthe
periumbilicalregion.
Anorexia
Nauseaandvomiting

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Diarrheaorconstipation
SignsinAppendicitis-
Rovsingsign
Obturatorsign
Psoassign

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Dunphysign
Marklesign
McBurney'ssign

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150.Allaretruestatementabouthernias
except

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a)Femoralherniahasthehighestriskofstrangulationofgroin
hernias
b)Directinguinalherniacausemoresymptomsthanindirect
c)Directinguinalherniaismostcommoninchildren
d)Indirectinguinalherniaoccurduetopatentprocessusvaginalis

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e)Indirectinguinalherniaoccurthroughadefectinfascia
transversalis
CorrectAnswer-B:C
Answer-B,Directinguinalherniacausemoresymptomsthan
indirectC,Directinguinalherniaismostcommoninchildren

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Afemoralherniahasthehighestriskofincarcerationand
strangulationofgroinhernias.

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151.Mediastinalmass(s)whichis/aremore
commoninposteriormediastinum
a)Lymphoma

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b)Thymoma
c)Neurogenictumor
d)Enterogenouscyst
e)Thyroidcarcinoma
CorrectAnswer-C:D

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Answer-C,NeurogenictumorD,Enterogenouscyst
MostcommontumorsintheposteriormediastinumareNeurogenic
tumors.
Posteriormediastinalmassesinclude-
Lymphnodeenlargement

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Neuroentericcyst(Enterogenouscyst)
Anteriormeningocele

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152.Trueaboutundescendedtestis
a)U/LmorecommonthanB/L
b)Missingtestisonpalpationmaybeduetoagenesis

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

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palpationmaybeduetoagenesisC,10%
bilateralD,Undescendedtestismaybeassociatedwithabsent
kidney
Cryptorchidismisthemostcommoncongenitalabnormalityofthe
genitourinarytract.

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

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MorecommononRightSide.
Complicationsofundescendedtestes
Torsioncanbeseeninincompletetesticulardescent
Sterilityisseeninbilateralcases(especiallyintra-abdominaltestes)
Incompletetesticulardescentpredisposestomalignantdisease;

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cancerismorecommoninanincompletelydescendedtestes-
orchidopexymayormaynotdiminishtherisk.
Atrophyofaninguinaltestesbeforepubertymaypossiblybecaused
byrecurrentminortrauma.

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153.Trueabouttorsionoftestisisallexcept

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a)Presentswithsuddenpainintestis
b)Commonlyassociatedwithpyuria
c)DopplerU/Sshowsdecreasedbloodflowtothetestis
d)Simultaneousorchipexyoftheothersideshouldalsobedone
e)All

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CorrectAnswer-B
Answer-B.Commonlyassociatedwithpyuria
Pyuriaisassociatedwithepidydimo-orchitis,notwithtorsionof
testis.
Torsionisthetwistingofthetestisonthespermaticcord,resultingin

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strangulationofthebloodsupplyandinfarctionoftestis.
Itisseencommonlyinadolescents(10-25yrs)
Symptoms-4itpresentsassuddenagonisingpaininthegroinand
thelowerabdomen.Nauseaandvomittingareverycommon.
ColourDopplerdetectsthedecreasedbloodflowtotestisin

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torsion

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154.Condition(s)associatedwithesophageal
carcinoma
a)Achalsia
b)Post-cricoidweb

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c)Schatzki'sring
d)Paterson-Kellysyndrome
e)Lyeingestion
CorrectAnswer-A:B:D:E
Answer-A,AchalsiaB,Post-cricoidwebD,Paterson-Kelly

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syndromeE,Lyeingestion
rmportantriskfactorsforSCCcarcinomaare:_
i)AlcoholandCigarettesmoking.
1. Mucosaldamagefromphysicalagents-Hottea,Lyeingestion,
Radiationinducedstrictures,Chronicachlasia.

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2. otheringestedcarcinogens-Nitrates,Smokedopiates,Fungal
toxinsinpickledvegetables
3. Plummer-vinson-PatersolKellysyndrome(Esophageal(post
cricoid)Web+glossitis+Irondeficiency).
4. Tylosisplamarisetplantaris(congenitalhyperkeratosisandpittingof

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palmsandsoles)
5. Dietarydeficienciesofmolybednum,Zinc,VitaminA.
6. Celiacsprue

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155.Trueaboutpseudocyst
a)Pancreaticfluidcollection

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b)Maybeasymptomatic
c)Well-definedwall
d)Fluidcollectionisalwaysinfectiousinnature
e)Richinpancreaticenzymes
CorrectAnswer-A:B:C:E

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Answer-A,PancreaticfluidcollectionB,Maybe
asymptomaticC,Well-definedwallE,Richinpancreatic
enzymes
Pancreaticpseudocystisthemostcommoncomplicationofboth
acuteandchronicpancreatitis.

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Itisnotatruecystasitswalldoesnothaveanepitheliallining.
Fluidofthecystisrichinpancteaticamylase.
Mostcommonsiteforpseudopancreaticcystisthebodyandtailof
pancreas.
Clinicalfeatures-

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Pancreaticpseudocystsshowawidevarietyofclinicalpresentations
rangingfromcompletelyasymptomaticlesionstomanysymptoms.
AbdominalpainisMCsymptom.
Investigations-
CECTabdomenisinvestigationofchoicefordiagnosisofa

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pancreaticpseudocyst.

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156.Hyperamylasemiais/areseeninall
except
a)Pancreaticpseudocyst
b)Cysticfibrosis

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c)Macroamylasemia
d)Parotitis
e)Chronicpancreatitis
CorrectAnswer-B
Answer-B.Cysticfibrosis

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Pancreatitis
1. Acute
2. Chronic
Pancreaticpseudocyst
Pancreaticnecorsis

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Pancreatictrauma
Pancreaticcarcinoma
cysticfibrosis

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157.Raisedintracranialpressure(ICP)in
headinjuryis/aremanagedby

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a)Furosemide
b)Mannitol
c)DecompressivecraniectomyishelpfulindecreasingICPbutdo
notaffectneurologicaloutcome
d)Glucosefreefluid

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e)Hypotonicsolution
CorrectAnswer-A:B:C:D
Answer-A,FurosemideB,MannitolC,Decompressive
craniectomyishelpfulindecreasingICPbutdonotaffect
neurologicaloutcomeD,Glucosefreefluid

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A)Initial
Optimiseelectrolytebalance
Sedation
Seizurecontrol
B)Middle(Intermediate)

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Mannitol/furosemide/hyperventilationastemporisingmeasures
Heavysedation
C)Last(Final)
Inductionofthiopentonecoma
Decompressivecraniectomy

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HyperglycemiacanaggrevateincreaseICP,thusglucosefreefluid
shouldbeused.
Decompressivecraniectomy-Decompressivecraniectomyisthe
surgicalremovalalargeportionofthecranialvaulttoallow

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fortheedematousintracranialcontentstoexpandandsubsequently

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reduceICP.

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158.Indicationsofsurgeryintuberculosis
include(s)-
a)Streakyhemoptysis
b)Tubercularempyema

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c)Persistentbronchopleuralfistula
d)Chroniccough
e)AFB+yebacilliinsputum
CorrectAnswer-B:C
Answer-(B)Tubercularempyema(C)Persistentbronchopleural

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fistula
Destroyedlung
1. Persistentbronchopleuralfutula
2. Life-threateninghemoptysis(intractablehemorrhage)
3. Aspergillomainatuberculouscavity

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4. Postsurgicalcomplication
5. Performanceofdiagnosticprocedure
6. Tubercularemryerna

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159.Trueabouttuberculosis-
a)Cavitatorylesionsuggestsinactivedisease

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b)Rasmussenaneurysmisacomplication
c)Highgradefever
d)Tubercularbronchiectasisoccurinlowerlobes
e)All
CorrectAnswer-B

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Answer-B.Rasmussenaneurysmisacomplication
Cavitationisasignofactivedisease,andisconsideredasasignof
reactivation
FeverinTBisusuallylow-gradeandintermittent.
Rasmussen'saneurysmisaninflammatorypseudoaneurysmal

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dilatationofabranchofpulmonaryarteryadjacenttoatuberculous
cavityandlifethreateningcomplicationofcavitytuberculosis.
Tuberculosiscausesupperlobebronchiectasis.

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160.TrueaboutMeckel'sdiverticulum-
a)Causesvolvulusofintestine

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b)Duetopersistentremnantofthevitellointestinalduct
c)Commonlyfoundonthemesentericsideoftheileum
d)Causesmelena
e)Causeshaemoptysis
CorrectAnswer-A:B:D

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Answer-(A)Causesvolvulusofintestine(B)Duetopersistent
remnantofthevitellointestinalduct(D)Causesmelena
Meckel'sdiverticulumisthepersistentproximalpartofthe
vitellointestinalductwhichnormallydisappearsduringintrauterine
life.

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BleedinginMeckel'sdiverticulumisusuallytheresultofulcerationin
ilealmucosa
Hemorrhagemaypresentasrectalbleedingormelana.
Volvulusoftheintestinearoundthefibrousbandattachingthe
diverticulumtotheumbilicus.

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Mesodiverticularbandisaremnantofleftvitellineartery.

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161.Differenceb/wfullthicknessandpartial
thicknessgrafts-
a)Partialthicknessgrafthavegoodcosmeticappearance
b)Fullthicknessgraftaregoodforlargearea

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c)Edemaundergraftmaycausegraftfailure
d)Thingraftsurvivetransplantationmorereliably
e)Minimalcontractioninfullthicknessgraft
CorrectAnswer-C:D:E
Answer-(C)Edemaundergraftmaycausegraftfailure(D)Thin

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graftsurvivetransplantationmorereliably(E)Minimal
contractioninfullthicknessgraft
Typeof
Advantages
Disadvantages

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Graft
-Leastresemblesoriginal
skin.
ThinSplit
-BestSurvival

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-Leastresistancetotrauma.
Thickness -HealsRaqidly
-PoorSensation
-MaximalSecondary
-Contraction

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-Morequalitiesofnarmal
skin.
ThickSplit
-Lowergraftsurvival
-LessContraction

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Thickness
-Slowerhealing.
-LooksBetter
-FairSensation
-Mostresemblesnormal

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skin.
-Poorestsurvival.
-Donorsitemustbeclosed

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-Donorsitemustbeclosed
Full

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-MinimalSecondary
surgically.
Thickness contraction
-Resistanttotrauma
-Donorsitesarelimited.

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-GoodSensation
-Aestheticallypleasing
Edemaandnecrotictissueundergraftmayhampergraft
acceptance.

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162.Feature(s)ofsuperficialpartialthickness

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burn(seconddegree)is/are-
a)Hairseasilypluckable
b)Severepain
c)Thrombosedvessel
d)Leatheryskin

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e)Blisteringofskin
CorrectAnswer-B:E
Answer-(B)Severepain(E)Blisteringofskin
thesesuperfcialdermalburnsinvolvetheupperlayersofdermis
Blistersareseen

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Erythematous
Blanchtotouch
Quitepainful
Healwithoutscarringin1to2weeks

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163.Trueabouthypertrophicscar-

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

a)Treatedwithtriamcinolone
b)Resultsfromaprolongedinflammatoryphaseofwoundhealing
c)Mostcommoninpigmentedskin
d)Growbeyondmargin
e)Improvespontaneouslywithtime

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CorrectAnswer-A:B:E
Answer-(A)Treatedwithtriamcinolone(B)Resultsfroma
prolongedinflammatoryphaseofwoundhealing(E)Improve
spontaneouslywithtime
Hypertrophicscarsarecharacterizedbyerythematous,pruritic,

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raisedfibrouslesionsthattypicallydonotexpandbeyondthe
boundariesoftheinitialinjuryandmayundergopartialspontaneous
resolution.
Itresultsfromaprolongedinflammatorypheseofwoundhealingand
fromunfavourablescarsiting.

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Hypertrophicscarsarecommonafterthermalinjuriesandother
injuriesthatinvolvethedeepdermis.
IntralesionalinjectionofTriamcinoloneisalsothet/tofchoicefor
intractablehypertrophicscars.

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164.Allaretrueaboutbasalcellcarcinoma

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EXCEPT:
a)Translucent
b)Retentioncyst
c)Cystofsubmandibulargland
d)Cystofminorsalivarygland

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e)All
CorrectAnswer-A
Answer-A.Translucent
Mostcommonsiteisuppereyelid
Usuallyaslow-growing,locallyinvasivemalignanttumourof

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pluripotentialepithelialcellsarisingfrombasalepidermisandhair
follicles,henceaffectingthepilosebaceousskin.
Basalcellcarcinomasusuallypresentaspearlypapulescontaining
prominentdilatedsubepidermalbloodvessels(telangiectasias)

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165.Trueaboutendemicgoiter-

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a)Sizemayincreaseduringpregnancy
b)Usuallyhypothyroid
c)Sameasmultinodulargoiter
d)Canturnmalignant
e)None

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CorrectAnswer-A:B:D
Answer-(A)Sizemayincreaseduringpregnancy(B)Usually
hypothyroid(D)Canturnmalignant
EndemicGoiteristhepresenceofagoitercausedbynutritional
deficiencyofIodine.

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Effectofpregnancy-
Increasedendocrinedemandtheiodinemetabolismischaracterized
bythetendencytodevelopanendogenousiodinedeficiency(ID).
Diffusethyroidglandhypertrophycanbevisiblyobservedasagoiter
oftheneck.

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EndemicGoiterisultimatelycausedbyreducedthyroidhormone
levelsitisaccompaniedbytheclinicalsyndromeofhypothyroidism.
Irregular,nodulargoitersduetorepeatedboutsofiodinedeficiency
mayprogresstothyroidfollicularcarcinoma.

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166.Trueaboutsurgicalapproachinthyroid

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surgery-
a)Incisionismade1cmbelowcricoidcartilage
b)Usuallyverticalincisionisused
c)Thoracicductmaybedamaged
d)Forlobectomythyroidisdissectedattheisthmus

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e)Strapmusclesaredividedifgreaterexposureisneeded
CorrectAnswer-A:C:D:E
Answer-(A)Incisionismade1cmbelowcricoidcartilage(C)
Thoracicductmaybedamaged(D)Forlobectomythyroidis
dissectedattheisthmus(E)Strapmusclesaredividedif

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greaterexposureisneeded
Kochertransversecollarincision,typically4to5cminlength,is
placedinorparalleltoanaturalskincrease1cmbelowthecricoid
cartilage.
Thesubcutaneoustissuesandplatysmaareincisedsharply.

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TheRLNbmostvulnerabletoinjuryinthevicinityoftheligamentof
Bery.
Ifalobectomyistobeperformed,theisthmusisdividedflushtiththe
tracheaonthecontralateralsideandsutureligated.

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167.Trueaboutneurogenicclaudication-

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a)Lowbackpainispresent
b)Fixedwalkingdistance
c)Painimmediatelyrelievedbyrest
d)Shinyskinoffoot
e)Painrelievedbyleaningforward

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CorrectAnswer-A:C:E
Answer-(A)Lowbackpainispresent(C)Painimmediately
relievedbyrest(E)Painrelievedbyleaningforward
Neurogenicclaudicationischaracterizedbylowbackpainradiating
tolowerlimbs(glutealregion,bockofthigh&leg).

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Thesesymptomsareespeciallypresentwhenstandinguprightor
walkingandusuallyrelievedwithleaningforwardorsittingdown

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168.Trueaboutbluntabdominaltrauma-
a)Liveristhemostcommonorganaffected
b)AbdominalpelvicCTscanningishelpfulforevaluatingintra-

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abdominalandretroperitonealinjuries
c)>100,000redcells/?Linperitoneallavageisconsidered
positiveandisindicationforexploratorylaparotomy
d)Morethan2m1offreebloodintheabdominalcavityis
indicationforexploratorylaparotomy

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e)FAST-USGisusedforinitialevaluation
CorrectAnswer-A:C:E
Answer-(A)Liveristhemostcommonorganaffected(C)>
100,000redcells/?Linperitoneallavageisconsideredpositive
andisindicationforexploratorylaparotomy(E)FAST-USGis

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usedforinitialevaluation
Blunttrauma:Inblunttraumatheorgansmostcommonly
injuredarethesolidorgans:
Spleen(MC)
Liver

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Kidney
Thepresenceof>100,000redcells/plor>500whitecells/plis
deemedpositive(thisisequivalentto2OmLoffreebloodinthe
abdominalcavity).
PositiveDPLisanindicationforemergencyexploratorylaprotomy.

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Hemodynamicallystablepatientssustainingblunttraumaare
adequatelyevaluatedbyabdominalultrasoundorCT.

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169.Congenitaladrenalhyperplasiaisdueto
deficiencyofenzyme?
a)3?-Hydrorysteroiddehydrogenasedeficiency

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b)5?reductase
c)l7?-Hydrorylasedeficienry
d)2l-Hydroxylasedeficiency
e)Aromatase
CorrectAnswer-A:C:D

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Ans.(a)3?-Hydrorysteroiddehydrogenasedeficiency;(C)l7?-
Hydrorylasedeficienry(d)2l-Hydroxylasedeficiency
Congenitaladrenalhyperplasia(CAH)
GroupofARdisorder
MCadrenaldisorderinchildhood

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Mostcommon21-hydroxylasedeficiency
In21a-hyroxylesedeficiency
Thereisdeficiencyofmineralocorticoids&glucocorticoid.
Thisleadstohypoglycemia,hyponatremia

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170.Whichofthefollowingis/aretrueabout

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developmentalmilestonesof2yearsold
child-
a)Canwalkup&downstairswithalternatingfeet
b)Walksupanddownstairs,onestepatatime
c)Ridestricycle

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d)Knowsageandsex
e)WeightquadruplesofbirthweightAchildishavingWilson
disease
CorrectAnswer-B:E
Ans.is'b'i.e.,Walksupanddownstairs,onestepatatime;'e'

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i.e.,WeightquadruplesofbirthweightAchildishavingWilson
disease
GROSSMOTORMILESTONES:
Age
Milestone

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3months Neckholding
5months Rollsover
6months Sittingsupported
8months Sittingwithoutsupport
9months Standswithsupport

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12months Standswithoutsupport,Walksbutfalls
15months Walksalone,Creepsupstairs
18months Runs,exploresdrawers
2years
Walksupstairs(babysteps),Jumps

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3years
Walksupstairs(alternatefeet),ridestricycle

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4years
Hopsononefoot,walksdownstairs(alternatefeet)
FINEMOTORMILESTONES:

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Age
Milestone
4months Bidextrousreach
6months Unidextrousreach
9months Immaturepincergrasp

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12months Maturepincergrasp
15months Imitatesscribbling,towerof2blocks
18months Scribbles,towerof3blocks
2years
Towerof6blocks,vertical&circularstroke

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3years
Towerof9blocks,copiescircle
4years
Copiescross,bridgewithblocks
5years

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Copiestriangle

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171.Whichofthefollowingstatement(s)
is/arenotcorrect-
a)Kayser-fleischer(KF)ringmaybepresentineye
b)Serumceruloplasminis<20mg/dl

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c)Hepaticcopperis>250?g/gdryweightofliver
d)Insymptomaticpatients,the24hrurinarycopperexcretionis
lessthan40?g/day
e)Liverbiopsyisofvaluefordeterminingtheextentandseverity
ofliverdisease

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CorrectAnswer-D
Ans.(d)Insymptomaticpatients,the24hrurinarycopper
excretionislessthan40?g/day
Wilson'sdisease(Hepatolenticulardegeneration)
DIAGNOSIS:

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Thegoldstandardfordiagnosisisliverbiopsywithquantitative
copperassay->concentrationofcopperinaliverbiopsysample>
200?g/gdryweight.
Othertestsare?
1. Serumceruloplasminlevel->low(20mg/dl)

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2. KFrings
3. Urinecopperexcretion->increased(>100?g/day)
4. DNAHaplotypeanalysis.

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172.Allaretrueaboutwilmstumorexcept-
a)Painlessabdominalmass

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b)Mostlyasymptomatic
c)Swellingisballotable
d)StageI-tumourconfinedtokidney
e)CompletelyexcisionistreatmentofchoiceinstageI&II
CorrectAnswer-E

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Ans.(e)CompletelyexcisionistreatmentofchoiceinstageI&
II
PresentationofWilm'stumor:
Asymptomaticabdominalmass(mostcommon)
Abdominelswelling(rcnallump)inwilm'stumorisballottable.

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Abdominalpain(30%)
Hypertension(25%)
Heamaturia(10-25%)
Fever(20%)
Anorexiaandvomiting

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Stages Features
StageI Tumorislimitedtokidenyandcompletelyexcised
Tumorbeyondkidney&completelyexcised.Regional
StageII extensionconfinedtoflank
Residualnon-hematogenoustumorconfinedtothe

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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.

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Treatment-
1.Fortumourconfinedtorenalcapsule-
RadicalnephrectomyfollowedbychemotherapywithantinomycinD
andVincristine
2.Fortumourbeyondrenalcapsule

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Nephrectomyfollowedbylocalradiotherapyandchemotherapy
TheidealtimingofradiotherapyforWilmsTumouraftersurgeryis
within10days.
3.BilateralWilm'stumour-
Radicalnephrectomyonlargersideoftumourandpartial

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nephrectomyonsmallersideoftumour.

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173.Syndrome(s)relatedtopaediatricbrain
tumors-
a)Tuberoussclerosis
b)Neurofibromatosis-2

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c)Cokaynesyndrome
d)Fanconisyndrome
e)Turcotsyndrome
CorrectAnswer-A:B:E
Ans.is'a'i.e.,Tuberoussclerosis'b'i.e.,Neurofibromatosis-

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2;'e'i.e.,Turcotsyndrome
FamilialSyndromesAssociatedwithPaediatricBrainTumors:
NeurofibromatosistypeI
Neurofibromatosistype2
vonHippel-Lindausyndrome

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Tuberoussclerosis
Bilateralretinoblastoma
Li-Fraumenisyndrome
Cowdensyndrome
Turcotsyndrome

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Gorlinsyndrome
Nevoidbasalcellcarcinoma

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174.A5-month-oldinfanthasmassive
hepatomegaly.Whichofthefollowing
condition(s)presentswithmassive

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hepatomegaly
a)TypeIglycogenstoragedisorder
b)Biliaryatresia
c)Gaucher'sdisease
d)Biliarycirrhosis

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e)Noneoftheabove
CorrectAnswer-A:D
Ans.is'a'i.e.,TypeIglycogenstoragedisorder;'d'i.e.,Biliary
cirrhosis
Causesofmassivehepatomegaly:

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Chroniccongestivehepatomegalyeg..,
VSDwithheartfailure(chronic).
Cardiomyopathywithcongestiveheartfailure.
Constrictivepericarditis.
Chronicextrahepaticcholestasise.g.,congenitalbiliaryatresia.

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Malaria,kala-azarforlongduration.
Glycogenstoragedisease
Congenitalhepaticfibrosis
Amoebicliverabscess.
Hepatomaorsecondarymalignantdeposits.

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Cystsofliver.
Biliarycirrhosis.

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175.Trueaboutbenignidiopathicneonatal
seizures
a)Calledas5ddayfits

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b)Seizureoftenoccurlaterinlife
c)Statusepilepticusmayoccur
d)Familyhistoryisusuallypresent
e)Morecommoninpreterm
CorrectAnswer-A:C

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Ans.is'a'i.e.,Calledas5thdayfits;'c'i.e.,Statusepilepticus
mayoccur
BenignNeonatalSeizures(5thdayfits)
Increasinglyrecognizedsyndromecharacterizedbyseizuresinthe
neonatalorinfantileperiod.

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2forms:Familialandnonfamilial.
Quitesevere,andstatusepilepticusiscommon.
Nonfamilialformischaracterizedby:
Idiopathic,self-Limitedseizureinpreviouslynormalneonates.
Mostcommonlyoccuratday5

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Familialseizures:
Mostfrequentlyhavetheironsetduringthefirstweekoflife,but
onsetmayoccuraslateasearlyinfancy.
Theseseizuresmayrecurforseveralmonthsbeforeresolving.
Thefamilyhistoryrevealsbenignneonatalseizuresinotherfamily

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members.
Prognosisisfavourableinbothsyndrome,butseizuresmay
occasionallyoccurlaterinlifeinthefamilialform.

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176.Complication(s)ofH.typeoftracheo-
esophagealfistulais/are

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a)Dysphagia
b)Aspirationpneumonia
c)Hematemesis
d)Paroxysmsofcoughingorcyanosiswithfeeding
e)Deathusuallyoccurininfancy

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CorrectAnswer-B:D
Ans.b)Aspirationpneumonia;d)Paroxysmsofcoughingor
cyanosiswithfeeding
H-Type{Type-E)TEF:
Itaccountsfor4-5%ofallcongenitalTEF'

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Commonclinicalfeaturesare:
Recurrentrespiratorysymptom
Paroxysmsofcoughingandcyanosisduringfeeding'
Aspirationduringfeedingwithcyanosis
Abdominaldistension.

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Dysphagiaisnotpresentbecauseofpatencyofesophagus
Theremaybeassociatedanomalies
VACTERL(vertebral,anorectal,cardiac,tracheal,esophageal,
renal,radial'limb)syndrome

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177.Achildispresentedwithmediastinal

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mass,swellingofface,dyspnea&
stridor,Nextlineofmanagementis/are
a)Administrationofoxygenwithventimask
b)Tracheostomy
c)Biopsyofmassandfineneedleaspirationcytology

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d)Mediastinalradiation
e)Rasburicase
CorrectAnswer-A:B:C
Ans.is.a,i,e.,Administrationofoxygenwithventimask;'b'i.e.,
Tracheostomy`c'Biopsyofmassandfineneedleaspiration

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cytology
Thisisacaseofsuperiorvena-cavasyndromeorsuperior
mediastinalcompressionsyndrome.
Itisamedicalemergencyandrequiresimmediatediagnostic
evaluationandtherapy.

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Nextlineofmanagementinthegivenpatientincludes:-
Inclinedpositionifpossible
Oxygenwithventimask
Tracheostomy
Biopsyandaspirationcytology

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Furosemide

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178.CauseoflowerGIbleedinchildrenof
age>2yearofage
a)TB
b)Meckel'sdiverticulum

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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;

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'e'i.e.,Itisbleedingfromasitedistaltoligamentoftreitz
LowerGIbleedingisdefinedasbleedingfromasitedistalto
ligamentoftreitz.
In>2years:
Infectiouscolitis

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Inflammatoryboweldisease
Tuberculosis
Pseudomembranecolitis
Cowmilkproteinallergy
Uncommon:Amebiasis,cytomegalovirus,neutropeniccolitis

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Fissure,Arteriovenousmalformation
Polyposissyndrome
Solitaryrectalulcersyndrome
Meckel'sdiverticulum
Rectalvaricesorcolopathy

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NSAIDS
Haemorrhoids;Coagulopathy

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Henochschonleinpurpura

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179.Inponsetitechniquelastdeformityinto
getcorrectedinCTEV-

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a)Equinus
b)Talipus
c)Varus
d)Cavus
e)Alldeformitycorrectedsimultaneously

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CorrectAnswer-A
Ans(a)Equinus
Ponseti'stechnique
Thisinvolvesfirstcorrectingthecavusdeformitythentheadduction
andheelvarusandfinallytheequinusdeformity.

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ThistechniqueisnowmostlyacceptedtechniqueforCTEV
correctionasitisbasedonbetterunderstandingofthe
pathoanatomyofthedeformedfoot.
Thesuccessofreductionis90-98Percent.

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180.Trueaboutganglioncyst?

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a)Mostcommoninyoungmale
b)Containsynovialfluid
c)Arisefromextensorretinaculum
d)Itusuallyarisefromthelunotriquetraljoint
e)Surgicaltreatmentisexcisionofcyst

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CorrectAnswer-B:E
Ans.is'b'i.e',Containsynovialfluid;'e'i.e.,Surgicaltreatmentis
excisionofcyst
Aganglionisthecommonestcysticswellingattheback(Dorsal
aspect)ofthewrist.

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Unilocularcyst
Arisesduetoleakageofsynovialfluidfromajointortendonsheath.
Filledwithmucinousfluidandlinedbyfibroustissue
Usuallydevelopsonthedorsalsurfaceofthescapho-lunate
ligament.

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Palmarwristgangliausuallyarisefromthevolarscapholunateor
scapho-trapezio-trapezoidjoint.
Morecommoninyoung(20-40years)female.
Nocommunicationbetweenthejointcavityortendonsheathandthe
interiorofcyst.

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Painlesssmallswellingsometimesitmaycausepain.
Treatment:
Notrequired.
ForpainNSAIDs
Swellingincreaseinsizeitmaybeaspiratedorsurgicallyexcised.

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181.Trueaboutosteomalacia?
a)Morecommoninmale
b)LowPTH
c)Increasealkalinephosphatase
d)Decreasedcalciumlevel

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e)Looser'szoneonX-ray
CorrectAnswer-C:D:E
Ans.(c)Increasealkalinephosphatase;(d)Decreasedcalcium
level;(e)Looser'szoneonX-ray
Osteomalacia

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Looser'szone(pseudofractures)areradiolucentzonesoccurringat
thesitesofstressinosteomalacia(commonlyatpubicrami)
Osteomalaciaismorecommoninwomenwholivein"purdah"&lack
exposuretosunlight
Serumcalcium&phosphateislow&alkalinephosphataseishigh

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Muscularweakness(Thepatientfeelsveryweak.Hemaydifficulty
inclimbingup&downthestairs)

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182.Testforanteriorcruciateligamentis/are
a)Lachmanntest
b)Apley'sgrindingtest

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c)Pivotshifttest
d)Anteriordrawer
e)KT-1000kneearthrometerisanobjectiveinstrumentforACL
reconstruction
CorrectAnswer-A:C:D:E

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Ans.is'a'i.e.,Lachmanntest'c'i.e.,Pivotshifttest;'d'i.e.,
Anteriordrawer&'e'i.e.,KT-1000kneearthrometerisan
objectiveinstrumentforACLreconstruction
FollowingtestsareusedforACLinjury:-
Lachman'stest

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Pivotshifttest
Anteriordrawertest
Jerktest
Flexion-rotationdrawertest
Loose'stest

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183.Trueaboutankylosingspondylitis:
a)Romanuslesionmaybefound
b)Ifleftuntreated,spinefusionmayoccur
c)Predilectionofthejointsoftheaxialskeleton
d)Bonyerosionsdonotoccur

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e)all
CorrectAnswer-A:B:C
Ans.a.Romanuslesionmaybefound;b.Ifleftuntreated,spine
fusionmayoccur;c.Predilectionofthejointsoftheaxial
skeleton

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Ankylosingspondylitis(marie-strumpelldisease)
Ankylosingspondylitisisachronicprogressiveinflammatorydisease
ofthesacroiliacjointsandtheaxialskeleton.
rototypeofseronegative(absenceofrheumatoidfactor)
spondyloarthropathies.

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

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9sarepositiveforHLA-B27.
Jointsinvolvedinankylosingspondylitis
Ankylosingspondylitisprimarilyaffectsaxialskeleton.
Thediseaseusuallybeginsinthesacro-iliacjointsandusually
extendsupwardstoinvolvethelumbar,thoracic,andoftencervical

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spine.
Intheworstcasesthehipsorshouldersarealsoaffected.Hipjoint

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isthemostcommonlyaffectedperipheraljoint.
Rarelyknee(Ebenzar4th/e593)andankle(Apley's9thle67)are
alsoinvolved.Pathology

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Enthesitisi.e.inflammationoftheinsertionpointsoftendons,
ligamentsorjointcapsuleonboneisoneofthehallmarksofthis
entityofdisease.
Primarilyaffectsaxial(spinal)skeletonandsacroiliitisisoftenthe
earliestmanifestationofA.S..

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

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aorticvalvedisease,carditisandpulmonaryfibrosisalsooccur.
Pathologicalchangesproceedinthreestages?
Inflammationwithgranulationtissueformationanderosionof
adjacentbone.
Fibrosisofgranulationtissue

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Ossificationofthefibroustissue,leadingtoankylosisofthejoint.
Radiologicalfeaturesofankylosingspondylitis
Radiographicevidenceofsacroiliacjointisthemostconsistent
findinginankylosingspondylitisandiscrucialfordiagnosis.The
findingsare:-

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SclerosisofthearticulatingsurfacesofSIjoints
Wideningofthesacroiliacjointspace
Bonyankylosisofthesacroiliacjoints
Calcificationofthesacroiliacligamentandsacro-tuberousligaments
Evidenceofenthesopathy-calcificationattheattachmentofthe

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muscles,tendonsandligaments,particularlyaroundthepelvisand
aroundtheheel.
X-rayoflumbarspinemayshow:-
Squaringofvertebrae:Thenormalanteriorconcavityofthe
vertebralbodyislostbecauseofcalcificationoftheanterior

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longitudinalligament.
ftLossofthelumbarlordosis.
Bridging`osteophytes'(syndesmophytes)
Bamboospineappearance

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184.Trueaboutavascularnecrosisoffemur

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a)Affectedsidehipallowsweightbearing
b)Asymptomaticcasesmayoccur
c)Radionucleotidescanshowincreaseduptakeduetonewbone
formationintheareaaroundtheinfarct
d)Trendelenburgsigninnegative

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e)Noneoftheabove
CorrectAnswer-A:B:C
Ans.is'a'i.e.,Affectedsideofhipallowwt.bearing;'b'i.e.,
Asymptomaticcasesmayoccur&'c'i.e.,Radionucleotidescan
showincreaseduptakeduetonewboneformationinthearea

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aroundtheinfarct
CausesofAVN
ldiopathic(mostcommon)
Infection-septicarthritis,osteomyelitis
Hematologicalmalignancies-leukemia,lymphoma

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Alcohol,corticosteroids
SLE
Pregnancy
Cassionsdisease
Hyperlipidemia

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Perthesdiseas
Ionisingradiation
CLINICALFEATURES:
Pain
Deceaserangeofmotionespeciallyinternalrotationfollowedby

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abduction.

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

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Radiologicalfindings:
MRIisthemostreliablewayofdiagnosingmarrowchangesand
boneischaemia

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185.Trueaboutpectusexcavatum
a)Morecommoninfemale

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b)Inseverecases,mitralvalveprolapsemayoccur
c)Maybepresentatbirth
d)Seeninmarfansyndrome
e)Impairmentofrespiratoryfunction
CorrectAnswer-B:C:D:E

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Ans.is'b'i.e.,Inseverecases,mitralvalveprolapsemayoccur;
'c'i.e.,Maybepresentatbirth;'d'i.e.,SeeninMarfansyndrome
i'e'i.e.,Impairmentofrespiratoryfunction
PectusExcavatum
Alsocalledfunnelchest'isthemostcommonchestwalldeformity.

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Malesareaffectedmorethanfemales(4:1).
Pectusexcavatumarisesfromimbalancedorexcessivegrowthof
thelowercostalcartilages.
Typicallythedefectisdiagnosedwithinthefirstyroflifeand
worsensovertime.

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Depressionmayrangefrommildlydepressedsternumtosternal
depressionabuttingthevertebralcolumnwithdisplacementsof
mediastinalstructures.
OtherconditionsassociatedwithPectusExcavatum:
Scoliosis

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Marfan'ssyndrome
Mitralvalveprolapse
Congenitalheartdiseases

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186.Apersonhasinjuryondorsalsurfaceof
proximalinterphalangealjointofright

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middlefinger.Whichofthefollowingcan
occur
a)Ruptureoflateralligament
b)Buttonholedeformity
c)Malletfinger

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d)Lacerationofthecentralslipoftheextensor
e)Noneoftheabove
CorrectAnswer-A:B:D
Ans.is'a'i.e.,Ruptureoflateralligament;'b'i.e.,Buttonhole
deformity;'d'i.e.,Lacerationofthecentralskipoftheextensor

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Injurytodorsalsurfaceofproximalinterphalangealjoint(zone
II)maycause:-
Ruptureofcentralslipofextensorexpansion-causingButtonhole
deformity.
ThisresultsinlossofactiveextensionofthePIPjointandpersistent

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flexionofthePIPjoint.
AnteriordislocationofPIPjointmaycauseruptureofbothcentral
clipaswellaslateralligament.

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187.Pregnancyaggravateswhichofthe
followingcondition(s)-

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a)Hypertension
b)Anaemia
c)Rheumatoidarthritis
d)Acne
e)All

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CorrectAnswer-A:B
Ans.is'a'i.e.,Hypertension;&'b'i.e.Anaemia
Importantmedicalconditionswhichareaggravatedin
pregnancy
Congenitalheartdiseases

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Rheumaticheartdiseases
Non-rheumaticvalvularheartdisease
Anemia
Pulmonaryhypertension
Renalfailure

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Hypertension

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188.Truestatementregardingmagnesium
sulphateuseineclampsia&pre-
eclampsiais/are?
a)Usedforthetreatmentofhypertension

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b)Canbeusedcontinuousintravenousaswellasintermittent
intramuscular
c)In>95%ofcasessuccessfullycontrolsseizuresofeclampsia
d)Toxicitycanbetreatedbystoppingfurtheradministrationand
givingcalciumgluconate

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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

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canbetreatedbystoppingfurtheradministrationandgiving
calciumgluconate&`e'i.e.,Administrationiscontinuedfor24
hoursafterdelivery
MAGNESIUMSUPHATEINECLAMPSIA&PRE-
ECLAMPSIA:

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Indicatedtopreventseizuresassociatedwithpre-eclampsia,andfor
controlofseizureswitheclampsia
In>95%ofcasessuccessfullycontrolsseizuresofeclampsia.
Dose:4-5g(dilutedin250mLNS/D5W)IVincombinationwith
either:

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Upto10g(10mLofundiluted50%solution)dividedand
administeredIMintoeachbuttockor

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AfterinitialIVdose,1-3g/hrIV.
MgSO4iscontinued24hoursafterdeliverytopreventpost-partum
eclampsia

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Monitoring:
Throughouttheadministrationofmagnesium,thepatientneeds
continuousclinicalmonitoringformagnesiumtoxicity
Toxicityismanifestedbylossofdeeptendonreflexes(patellar),
decreaseinrespiratoryrate,oliguriaandalteredmentalstatus.

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Comparatively,lossofdeeptendonreflexesappearstobethe
earliestofallthesignsanditoccurswhenthemagnesiumlevel
exceeds5mmol/L.
ToxicityofMgSO4ismonitoredby:
Urinaryoutput,

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Respiratoryrate,
Kneejerk

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189.Finding(s)ofatrophicvaginitisis/are
a)LowpHofvagina
b)Occurduetoestrogendeficiency

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c)Frequentintercourseisuseful
d)Intercoursecausespainlessbleeding
e)Estradiolvaginalringishelpful
CorrectAnswer-B:E
Ans.b)Occurduetoestrogendeficiency;e)Estradiolvaginal

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ringishelpful
AtrophicVaginitis
Alsocalledsenilevaginitis,isthethinningofvaginalwalldueto
decreasedestrogenlevels.
Mostcommonaftermenopause,butmayalsodevelopaftersurgical

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removalofovaries.
Thereisatrophyofvulvovaginalstructure'
TheacidityofvaginaisdecreasedcausingincreaseinpH.
Importantclinicalfeaturesare:-
Dryvagina

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Thinningofvaginalwall
Shorteningandtighteningofvaginalcanal
Dyspareunia
Spotting(bleeding)afterintercourse
Purulent,oftenbloodtingeddischarge

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Painorburningwithurination
FrequentUTIs
Urinaryincontinence
Treatmentincludes:

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Intravaginalapplicationofestrogencream,estradiolvaginalringand

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Systemicestrogentherapy

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190.Feature(s)ofHELLPsyndrome
a)Lowplatelets
b)IncreasedASTandALT
c)Decreasedlactatedehydrogenase

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d)Increasedconjugatedbilirubin
e)Hemolysis
CorrectAnswer-A:B:E
Ans.a)Lowplatelets;b)IncreasedASTandALT;e)Hemolysis
HELLPsyndromeisanacronymforHemolysis(H),Elevated

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liverenzymes(EL)andLowPlateletcount(LP)of<
1,00,000/mm3
ClinicalFeatures:
Manifestedbynausea,vomiting,epigastricorrightupperquadrant
pain,alongwithbiochemicalandhaematologicalchanges.

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Parenchymalnecrosisofliveriauseselevationinhepaticenzymes
(ASTandALT>70IU/LandLDH>600IU/L)
Theremaybesubcapsularhematomaformation(whichmayneed
CTscanning)andabnormalperipheralsmear.
Eventuallylivermavrupturetocausesuddenhypotension,dueto

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hemoperitoneum

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191.Riskfactorsforabruptioplacentais/are
a)Traumaticseparationoftheplacenta
b)Mutigravida
c)Diabetes

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d)Gestationalhypertension
e)Submucousfibroid
CorrectAnswer-A:B:D:E
Ans.a)Traumaticseparationoftheplacenta;b)Mutigravida;d)
Gestationalhypertension;e)Submucousfibroid

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ETIOLOGY:
PrimarycauseofAPisuncertain
Severalassociatedconditionsidentified:
Increaseinage&parity:1.3-1.5%
Pre-eclamsia:2.1-4%

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Chronichypertension:1.8-3%
Pretermrupturedmembranes:2.4-4.9%
Multifetalgestation:2.1%
Cigarettesmoking:1.4-1.9%
Cocaineabuse:NA

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Folicaciddeficiency
Priorabruption:10-25%
Uterineleiomyoma:NA
Hydromnios:2%

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192.Allis/aretrueaboutHIVinpregnancy

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except
a)Verticaltransmissiontotheneonateisabout15-30%
b)HAARTtherapyofpregnantwomanreduceschanceof
transmissiontoneonates
c)Zidovudinetherapyshouldbegiventoneonates

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d)Electivecaesareansectionreducestheriskofvertical
transmission
e)ZidovudineisgiveninplaceofstavudineinHAARTtherapyif
motherisanaemic
CorrectAnswer-E

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Ans.(e)ZidovudineisgiveninplaceofstavudineinHAART
therapyifmotherisanaemic
ManagementofHIVinpregnancy:
Antepartum:-
Mostpatientswillbeasymptomatic.

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Patientrequiresobstericcare+HIVcare.ConsultHIVspecialist.
MTPoptionisoffered.
Nutritionalsupplementincludingmicronutrients.
Routineantenatalinvestigation+BaselineCBC,LFT,RFT.
InvestigationsofSTDs,TB,Toxoplasmosis,Cytomegalovirus.

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CD4count&vitalloadineachtrimester.IfCD4count<200,
prophylacticAntibioticsareindicated.
Counselagainstunprotectedcoitus.
USG-Routine+Fetalwellbeingassessment.
Avoidinvasiveprocedures.

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AntiRetroviralTherapy(ART)
ACTG076regimen:-(AIDSClinicalTrialGroup)
Zidovudine(AZT)
Reductionoftransmission:-25.5%to8.3%
CDCThairegimen:-

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Zidovudine(AZT)
Reductionoftransmission:-50%
HIVNET012regimen:-
Nevirapine
Reductionoftransmission:-47%

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PETRAstudy:-Zidovudine(AZT)+Lamuvidine(3TC)
Reductionoftransmission:-69%
INTRAPARTUMMANAGEMENT
ElectiveLSCSreducesperinataltransmissionupto50-80%.
DuringDelivery:-

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AvoidARM
AvoidVaginaltears
AvoidInstrumentaldelivery
RestrictEpisiotomy
Avoidfetalscalpelectrode/fetalbloodsampling

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POSTPARTUMMANAGEMENT:
Washnewbornafterbirth,especiallyface.
Mouthsuctionisavoided
Avoidhypothermia
AntiRetroviralTherapy(ART)

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Allvaccinestoasymptomaticchildren&onlyinactivatedvaccinesto
symptomaticchildren
Newborntesting
ELISATESTfalsepositiveupto18months
Beforethattoconsidernewbornpositive2testsmustbepositive

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fromHIV1culture,p-24antigen,PCR

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193.Truestatementaboutvacuumextraction
ofbaby-
a)Pressureismaintainedb/w5kg/cm2to8kg/cm2
b)Donewhencervixisfullydilated

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c)Centreofcupshouldbeplaced1cminfrontofposterior
fontanelle
d)Cuprimshouldbeplaced3cmfromtheanteriorfontanelle
e)Alltheabove
CorrectAnswer-B:D

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Ans.(b)Donewhencervixisfullydilated;(d)Cuprimshouldbe
placed3cmfromtheanteriorfontanelle
INDICATIONSOFVENTOUSEDELIVERY:
Fetalheartrateabnormalities
LowfetalscalppH

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Non-progressivelabourin2ndstage
Maternalexhaustion
Cervixshouldbefulldilated.
Thepressureiskeptbetween0.2kg/cm2,to0.8kg/cm2
Theflexionpointisfoundalongthesagittalsuture,approximately3

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cminfrontoftheposteriorfontanelandapproximately6cmfromthe
anteriorfontanelBecausecupdiametersrangefrom5to6cm,when
properlyplaced,thecuprimlies3cmfromtheanteriorfontanel

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194.Truestatementaboutprimary
dysmenorrhea-

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a)Painstarts2-3daybeforemenstruationandstopsafter1dayof
menstruation
b)Painbeginsafewhoursbeforeorjustaftertheonsetofa
menstrualperiodandmaylast48to72hours
c)MaybeassociatedwithPsychologicalfactors

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d)GnRHantagonistsarealwaysusedin1stlinetreatment
e)All
CorrectAnswer-B:C
Ans.is'b'i.e.,Painbeginsafewhoursbeforeorjustafterthe
onsetofamenstrualperiodandmaylast48to72hours;&'c'

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i.e.,Maybeassociatedwithpsychologicalfactors
Primarydysmenorrheaoccursduringovulatorycyclesandusually
appearswithin6to12monthsofthemenarche.
Painindysmenorrheabeginsafewhoursbeforeorjustafterthe
onsetofmenstruationandusuallylasts48-72hours.

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AssociatedSymptoms
Nauseaandvomiting
Fatigue
Diarrhoea
Lowerbackache

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Headache
Behaviouralandpsychological
Treatment
NSAIDsarethedrugsofchoicefortreatmentofprimary

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dysmenorrhea,

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OCPs

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195.Whichofthefollowingstatement(s)is
trueaboutabdominalincisioninwomen
forvarioussurgicalprocedures-
a)Paramedian:bestincision

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b)Transverseincisionshouldbeonlyusedinexceptionalcases
c)Cherneyincisionisusefulinuro-gynaecologicalprocedures
d)Marylandincisionprovideimprovedaccesstothepelvicside
wall
e)Rutherford-morrisonisparticularlyusefulforapproaching

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ovarianmasses
CorrectAnswer-C:D:E
Ans.is'c'i.e.,Cherneyincisionisusefulinuro-gynaecological
procedures;'d'i.e.,Maylardincisionprovideimprovedaccess
tothepelvicsidewall;&'e'i.e.,Rutherford-Morrisonis

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particularlyusefulforapproachingovarianmasses.
Factsaboutabdominalincisionsinobstetrics
MostcommonlypreferredincisionsMidlineverticalincisionor
suprapubictransverseincision(Pfannenstielincision).
Paramedianormidlinetransverseincisionarenotusedexceptin

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exceptionalsituations..Maylardincisionprovideimprovedaccessto
pelvicsidewall.
Cherneyincisionisusefulfor:
Oncologicalsurgery
Complexurogynaecologicalprocedures(ifincisionisplacedlower).

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Rutherford-Morrisonisparticularlyusefulforreachingtheovarian
massesinpregnancy(especiallyin2ndhalf).

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196.Ahighgradesquamousintraepithelial
lesionisnotedwithpap,next
managementincludes?

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a)Warthim'shysterectomy
b)Localexcision
c)Colposcolicstudyandbiopsy
d)HPVDNAtesting
e)Liquidbasedcytology

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CorrectAnswer-C
Ans'is'c'i.e.,Colposcolicstudyandbiopsy
Forhighgradeintraepitheliallesions(HSIL),firststepistodo
colposcopyandbiopsy.
Moderatetoseveredysplasia(CIN-II&CIN-III)(HSIL):

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Treatmentoptionsare:
Localdestructivemethods
Cryosurgery
Fulguration/electrocoagulation.
Laserablation

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Excisionofabnormaltissue
Coldknifeconisation
Laserconisation
LLETZ
LEEP

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NETZ
Surgery:
Therapeuticconisation

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Hysterectomy
Hysterectomywithremovalofvaginalcuffifcarcinomainsitu

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extendsintovaginalvault

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197.Screeningtestusedinfirsttrimesterfor
aneuploidy?
a)PAPP-A&estradiol
b)PAPP-A&AFP

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c)PAPP-A&betaHCG
d)BetaHCG&inhibin
e)Estradiol&AFP
CorrectAnswer-C
Ans.is'c'i.e.,PAPP-A&betaHCG

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1sttrimesteraneuploidyscreening:
Humanchorionicgonadotropin(eitherintactorfree(-hCG).
Pregnancy-associatedplasmaproteinA(PAPP-A).
FetalDownsyndromein1sttrimester:
Higherserumfreebeta-hCGlevel.

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LowerPAPP-Alevels.
Trisomy18&13:
LoweredlevelsofbothHCGPAPPP-A.
2ndtrimesteranalytes:
Serumintegratedscreening.

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Accuracyofaneuploidydetection:
Greateroncombinationwith,
SonographicNTmeasurement.

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198.Absolutecontraindicationofmedical
abortion?

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a)RHD
b)Ectopicpregnancy
c)Hypersensitivitytoprostaglandins
d)Corticosteroidtherapy
e)Porphyria

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CorrectAnswer-B:C:E
Ans.is'b'i.e.,Ectopicpregnancy;'c'i.e.,Hypersensitivityto
prostaglandins;&'e'i.e.,porphyria
Absolutecontraindicationofmedicalabortion:
Allergiestomifepristone/misoprostol

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Inheritedporphyria
Chronicadrenalfailure
Knownorsuggestedectopicpregnancy
Undiagnosedadnexalmass

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199.Vaginalprolapsefollowingabdominal

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hysterectomyis/arecausedbydamage
of
a)LevelIsupport
b)LevelIIsupport
c)LevelIIIsupport

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d)Urogenitaldiaphragm
e)Alltheabove
CorrectAnswer-E
Ans.e)Alltheabove
Vaginalprolapsecanbedividedinto:-

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LevelI:damagecausesuterinedescent,enterocele,vaultdescent'
LevelII:damagecausecystocele,rectocele
LevelIII:damagecausesurethrocele,gapingintroitusanddeficient
perineum
Themiddlepartofvaginaissupportedbytheurogenitaldiaphragm

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200.Contraindicationofcombinedoral
contraceptive(COC)include(s)-
a)Severehypertension
b)Ischemicheartdisease
c)Pre-menstrualtension

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d)Activeliverdisease
e)All
CorrectAnswer-A:B:C:D
Aps.is'a'i.e.,Severehypertensiorr;'b'i.e.,Ischemicheart
disease;&'d'i.c',Activeliverdisease

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ContraindicationsofOCPs(WHOguidelines)
Absolute:
Thromboembolismevent,cerebrovascularaccident,coronaryartery
disease,
Breastcancer,

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DM(>20yearsduration)
Impendingmajorsurgery
Hyperlipidaemia
Pregnancy
Lactation(<6weekspostpartum)

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Activeliverdisease,hepatoma
Uncontrolledhypertensionorwithvasculardiseases
>35yearsoldandheavysmoker(>20cigarettes/day)
Migrainewithaura
Diabeticnephropathy/neuropathy/retinopathy

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Structuralheartdiseasewithpulmonaryhypertension,AForSABE.

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Relative:
Lactation(6weeks-6months)
Controlledhypertension
Undiagnosedvaginalbleeding

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Migrainewithoutaura
Gallbladderdisease
Age>35yearsandlightsmoker(<20cigarettes/day)
DMwithvascularcomplications.

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201.Chronicuseofcombineoral

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contraceptive(COC)helpsinallexcept
a)Dysmenorrhea
b)Breakthroughbleeding
c)Menorrhagia
d)Migraine

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e)Anaemia
CorrectAnswer-B:D
Ans.b)Breakthroughbleeding&d)Migraine
OCPS
ADVANTAGES:

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

Controlsfertility
TreatsMenorrhagia&polymenorrhoea.
Relievedysmenorrhoeaandpremenstrualtension
Preventsanaemia
Lowerschancesof

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Fibrocysticdisease
Ovariancyst
Ovarian,uterine&anorectalmalignancy
PID
Ectopicpregnancy

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Usefulinacne,PCODandendometriosis
PreventRA
NoncontraceptivebenefitsofOCPs:
Cyclestabilization
Cureofmenstrualdisorder-usefulinmenorrhagia&polymenorrhea

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Preventsanemia.
Reducestheincidenceofectopicpregnancy.
Protectionagainstcancer?Ovarian,Endometrial
Benigntumour-Benignbreastdisease,Ovarianfunctionalcyst,
Fibromyomauterus

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

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202.ContraindicationsforIUCD
a)Postabortalsepsismorethan1yearago
b)Presentcervicitisandvaginitis

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c)PasthistoryofectopicPregnancy
d)Unknowncauseofvaginalbleeding
e)Severedysmenorrhea
CorrectAnswer-B:C:D:E
Ans:b)Presentcervicitisandvaginitis;c)Pasthistoryof

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ectopicPregnancy;d)Unknowncauseofvaginalbleeding;e)
Severedysmenorrhea
ContraindicationsforplacingIUCDare:
Suspectedpregnancy
PID

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Presenceoffibroids
MenorrhagiaanddysmenorrhoeaofcopperTisused.
Severeanemia
Diabeticwomenwhoarenotwellcontrolled.
Heartdisease

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Scarreduterus
Previousectopicpregnancy
LevonorgestrelIUCDinbreastcancer
Preferablyavoiditsuseinunmarriednulliparouspatientbecauseof
theriskofPID.

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203.Whichofthefollowingstatement(s)
is/aretrueaboutcystsinovaryexcept-
a)Follicularcystisleastcommonamongfunctionalcyst
b)CorpuslutealcystsareoftenassociatedwithPregnancy
c)Dermoidcystaregermcelltumor

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d)FibromaofovaryisassociatedwithMeig'ssyndrome
e)Thecaleutincystisseeninassociationwithhydatiformmole
andGnRHanalogueuse
CorrectAnswer-A
Ans.a)Follicularcystisleastcommonamongfunctionalcyst

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Functionalovariancysts:
Benignmassintheovary
Thesecystsare:-
Follicularcyst:Mostcommonfunctionalovariancyst.Itisofsmall
size,rarelyislargerthan8cm.

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Corpusluteumcyst:Maybeassociatedwithpregnancyandpersist
upto14weeksasnormalphysiologicalstructure.
Thecaluteincysts:Leastcommonoffunctionalovariancysts.
Usuallybilateralandoccurwithpregnancy,includingmolar
pregnancies.associatedwithmultiplegestations,molar

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pregnancies,choriocarcinoma,diabetes,Rhsensitization,
clomiphenecitrateuse,humanmenopausalgonadotropin-human
chorionicgonadotropinovulationinduction,andtheuseofGnRH
analogues.
Allteratomas,includingbenignmatureteratoma(dermoidcyst),are

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germcelltumors.

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Combinationofanovarianfibromawithascitesandhydrothorax
(usuallyrightsided)isknownasMeig'ssyndrome.

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204.Dermatologicmanifestationoflithium
is/are-

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

a)Rash
b)Psoriasisexacerbation
c)Acneiformeruptions
d)Pustulardermatoses
e)Pemphigus

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CorrectAnswer-B:C:D
Ans.(B)Psoriasisexacerbation(C)Acneiformeruptions
(D)Pustulardermatoses
[Ref.NeenaKhannap.45;KDT7e/ep.449]
Dermatologicalsideeffectsoflithium

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Acneiformeruptions
ExacerbationOfPsoriasis
DLE
Pustulardermatosis
Alopecia,thinning&dryingofhair

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Itchingskin

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205.Subepidermalblistersis/areseenin-
a)Pemphigusvulgaris
b)Pemphigusvegetans
c)Pemphigoid

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d)Dermatitishepetiformis
e)Pemphigusfoliaceus
CorrectAnswer-C:D
Ans.(C)Pemphigoid(D)Dermatitishepetiformis
[RelNeenal(hanna5e/ep.76]

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Subepidermal(Dermo-epidermal)
Functional(AtBasallamina)
Junctionalepidermolysisbullosa
Bullouspemphigoid
Toxicepidermalnecrolysis

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Dermolytic(BelowBasallamina)
Epidermolysisbullosaacquisita
Epidermolysisbullosadystrophica
DermatitisHerpetiformis
Deepburns

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Porphyriacutaneatarda

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206.Desmogleinisassociatedwith?
a)Arrhythomogenicrightventricularcardiomyopathy
b)Hypertrichosis
c)Pemphigusvulgaris

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d)Psoriasis
e)Keratodermawithwoolyhair
CorrectAnswer-A:C:E
Ans.(A)Arrhythomogenicrightventricularcardiomyopathy
(C)Pemphigusvulgaris(E)Keratodermawithwoolyhair

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Desmoglein:
Pemphigusfoliaceus,
pemphigusvulgaris(mucocutaneoustype)paraneoplastic
pemphigus
Staphylococcalscaldedskinsyndrome

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Bullousimpetigo
Striatepalmoplantarkeratoderma

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207.Drugsknowntotriggermalignant
hyperthermia-
a)Halothane

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b)Succinylcholine
c)Pancuronium
d)Fentanyl
e)Propofol
CorrectAnswer-A:B

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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):

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Succinylcholine
Halothane
Isoflurane
Enflurane
Sevoflurane

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Desflurane
Methoxyflurane
MAOinhibitors
TCA
Phenothiazines

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Lignocaine

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208.Whenwillyoususpectmalignant
hyperthermiainpostappendectomy
patientshiftedtoICUwithhighfever&-
a)Hypotonia

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b)Seizure
c)Masseterspasm
d)Metabolicacidosis
e)Hypokalemia
CorrectAnswer-B:C:D

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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:

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Theconditionoccursduringorimmediatelyafteranaesthesiaand
maybeprecipitatedbypotentinhalationagents(enflurane,
halothane,isoflurane),orsuxamethonium.
Clinicalfeaturesare:-
MassetersPasmIfapatientdevelopsseveremasseterspasm

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aftersuxamethonium,thereisasignificantpossibilityofmalignant
hyperthermia.
Tachycardiaandarrhythmias
Riseinend-tidalCO,(firstsign)
Increasedtemperature&unexpectedchangeinBP.

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Seizuresagitationandmusclerigidity

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209.Whichofthefollowingis/areusedin
bupivacainetoxicity-
a)CaC12
b)Bretylium

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c)Intralipids
d)Esmolol
e)Epinephrine
CorrectAnswer-B:C:E
Ans.(B)Bretylium(C)Intralipids(E)Epinephrine

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[Re!.MorganAnaesthesiaSth/ep.273-74;Ajayyadav5'h/ep.144;
Miller6th/ep.933;Leel3th/ep.384;BarashAnaesthesia6,h/ep.
545]
Managementofbupivacainetoxicity
Ensureadequateoxygenation,whetherbyfacemaskorby

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intubation.
Anticonvulsantssuchasbenzodiazepinesandbarbituratesarethe
drugofchoiceforseizurecontrol.
Propofolcanalsobeused.
Succinylcholineissometimesalsousedtoterminatethe

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neuromusculareffectsofseizures.
ForunresPonsivebupivacainetoxicity,intravenouslipidor
cardiopulmonarybypassmaybeconsidered.
Forarrhythmias,amiodaroneistheDOC.Bretyliumandesmololcan
alsobeused.

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210.Anaesthesiausedforinductionis/are-
a)Propofol
b)Thiopentone
c)Ketamine
d)Diazepam

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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]

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Intravenousinducingagents:
Thiopentone
Methohexitone
Propofol
Etomidate

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Ketamine
Benzodiazepines

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211.Whichofthefollowingcriteriais/are
usedforsettingmechanicalventilatorfor
adultinICU-

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a)Age
b)Gender
c)Weight
d)Height
e)Underlyingconditionofpatient

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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

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basedongenderandheight.
WomenIBW(lbs)=105+5(Heightininches-60)
MenIBW(lbs)=106+6(Heightininches-60)
Settingsalsodependatypesoflungdisease,i.e.whetherthe
patientisnormalorwithrestrictivediseaseorwithobstructivelung

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disease

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212.Trueaboutendotrachealtube-
a)Noncuffedtubeisusedinpediatricagegroup
b)MadeofPVC&disposable
c)Canbeputeitheroralornasalaccordingtodifferentsituations

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d)CuffedPVCtubes-lowpressure,lowvolume
e)Moretendencytogotorightbronchusthereby
CorrectAnswer-A:B:C:E
Ans.(A)Noncuffedtubeisusedinpediatricagegroup
(B)MadeofPVC&disposable(C)Canbeputeitheroralor

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nasalaccordingtodifferentsituations(E)Moretendencytogo
torightbronchusthereby
[Ref:MorganAnaesthesiap.320-25;AjayYedav5'h/ep.43-46;Lee
l3th/ep.205-09]
Endotrachealtubesaremainlyoftwotypes.

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CuffedEndotrachealTube:
CuffPressureshouldnotexceed30cmH2O(22mmHg)toprevent
ischemicdamagetotrachealmucosa.
Twotypes,basedoncuffpressureandvolume.
LowPressure,Highvolume:-

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Inthiscuffhashighvolume&lowpressure.
Becauseoflowpressurethesetubesproducelesstrachealinjury,
thereforesuitableforprolongedsurgeries.0
Morecommonlyusedthanhighpressurelowvolumetube.
Thesetubesaremadeupofpolyvinylchloride

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Highpressure,lowvolume:
Madeupofredrubber.
UncuffedEndotrachealTube:

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Inchildren(lessthanl0yearsofage)uncuffedtubesshouldbeused
andthereshouldbeslightteakoninspiratorypressureof30cmIIrO

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213.Trueaboutendotrachealintubation-
a)HeadtraumapatientpresentingwithaGCSscore8orless
shouldbeintubated
b)Doneinpatientswithincreasedriskofaspiration
c)Canbeusedinpatientwithfullstomach

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d)Incervicalinjury,patientneckisstabilizedbeforeintuvation
e)Doneinpatientswhoneedanaesthesia
CorrectAnswer-A:B:C:D:E
Ans.(A)HeadtraumapatientpresentingwithaGCSscore8or
lessshouldbeintubated(B)Doneinpatientswithincreased

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riskofaspiration(C)Canbeusedinpatientwithfullstomach
(D)Incervicalinjury,patientneckisstabilizedbeforeintuvation
(E)Doneinpatientswhoneedanaesthesia
[RefLeel3tt'/ep.208;MillerVh/ep./586;CSDTl4th/ep.814]
Endotrachealintubationisusedtomaintainapatentairwayin

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operationtheateraswellasoutsidetheoperationtheater:-
IndicationsforEndotrachealIntubationintheoperatingroom
include:
Theneedtodeliverpositivepressureventilation.
Protectionofrespiratorytractfromaspirationofgastriccontents.

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Surgicalprocedureinvolvingtheheadandneckorinnon-supine
positionsthatprecludemanualairwaysupport.
Almostallsituationsinvolvingneuromuscularparalysis.
Somenon-operativeindicationsare:
Tracheobronchialtoilet(pulmonarytoilet).

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Profounddisturbanceinconsciousnesswiththeinabilitytoprotect
theairways.

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214.Whichofthefollowingis/arefeature(s)of
epiduralanaesthesiathanspinal
anaesthesia-

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a)Smallersizeofneedleisused
b)Drugusedislessinconcentration
c)Lesschanceofspinalheadache
d)Onsetofactionisdelayed
e)Densityofanaestheticagentislessinepiduralthanspinal

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CorrectAnswer-B:C:D:E
Ans.(B)Drugusedislessinconcentration(C)Lesschanceof
spinalheadache(D)Onsetofactionisdelayed(E)Densityof
anaestheticagentislessinepiduralthanspinal
[RefMorganAnaesthesiap.959,969;AjayYadav5'h/ep.162;

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MillerVh/ep.1626]
Epiduralanaesthesia:
Sloweronsetofaction
Lessreliable
Difficult

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DurationcanbeprolongedbyrepeatedlyinjectingLAbyanepidural
catheter.
Canbeusedforupperabdominal,thoracic&necksurgeryaswellin
additiontosurgeriesperformedbyspinalanaesthesia.
PDPHisunlikelybecauseduraisnotpierced->so,thereisnoCSF

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leakage.
Epiduralneedlesarelargerthanspinalneedles.

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215.Feature(s)ofcrohn'sdiseaseis/are-
a)Pipestemcolon
b)Pseudosacculation

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c)Lossofhaustrasion
d)Cobblestoneappearance
e)Stringsignofkantor
CorrectAnswer-B:D:E
Ans.(B)Pseudosacculation(D)Cobblestoneappearance

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(E)Stringsignofkantor
RadiologicalfindingsofCDare:-
EarliestchangesareaPhthouslesionsorerosions(centralflecksof
bariumsurroundedbyatranslucenthalo).Theselesionsarealso
knownasTargetlesionsorBull'seye.

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StringsignofKantor:-Greatlynarrowedterminalileumdueto
inflammationandfibrosis.
'Creeping-faf"sign(OnCT):-Inflammatorychangesintheadjacent
mesentericfat.
Combsign:-Prominentvasarectaofmesentericvessels.

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Discontinuousinvolvement(Skipareasarepresent).
Cobblestoneappearance
Raspberryrosethornappearance
Pseudosacculation

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216.Neoadjuvantchemotherapystandsfor-

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a)Chemotherapyalongwithsurgery
b)Chemotherapybeforesurgery
c)Chemotherapyaftersurgery
d)Chemotherapyalongwithradiationtherapy
e)Chemotherapyafterradiationtherapy

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CorrectAnswer-B
Ans.B.Chemotherapybeforesurgery
[Ref:Katzung13th/ep.919-20;chemoth.com/neoadjuvant-
chemotherapy]
NeoadiuvantchemotherapyreferstoCombinationofChemotherapy

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andsurgery/radiotherapyinwhichchemotherapyisgivenpriorto
surgery/radiotherapy.

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217.Trueaboutconcomitant
chemoradiotherapy-
a)Chemotherapyandradiotherapybothgivensimultaneously

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b)Radiotherapyactslocoregionallyandchemotherapyacts
againstdistantmicrometastases
c)Radiotherapyactsassensitizingagent
d)Chemotherapymayactassensitizingagent
e)None

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CorrectAnswer-A:B:D
Ans.(A)Chemotherapyandradiotherapybothgiven
simultaneously(B)Radiotherapyactslocoregionallyand
chemotherapyactsagainstdistantmicrometastases
(D)Chemotherapymayactassensitizingagent

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Concomitantchemoradiotherapy
Radiotherapyandchemotherapyaregivensimultaneously.
Threeclinicalrationalessupporttheuseofchemotherapydelivered
concurrentlywithradiation.
First,concomitantchemoradiotherapycanbeusedwithorgan-

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preservingintent,resultinginimprovedcosmesisandfunction
comparedwithsurgicalresectionwithorwithoutadjuvanttreatment.
Second,chemotherapycanactasaradiosensitizer,improvingthe
probabilityoflocalcontroland,insomecases,survival,byaidingthe
destructionofradioresistantclones.

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Third,chemotherapygivenaspartofconcurrentchemoradiation
mayactsystemicallyandpotentiallyeradicatedistant
micrometastases.

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218.Whichofthefollowingis/aretrueabout
brachytherapythanteletherapy-

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a)Moreeffectiveincarcinomacervix
b)Sameproportionofradiationisdeliveredtoboth-tumour&
normaltissue
c)Betterthanteletherapyforlarge&bulkytumour
d)Deliverhigherdoseofradiationtotumour

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e)Lessdamagetonormaltissue
CorrectAnswer-A:D:E
Ans.(A)Moreeffectiveincarcinomacervix(D)Betterthan
teletherapyforlarge&bulkytumour(E)Lessdamagetonormal
tissue

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Advantageofbrachytherapyisthatitdelivershighradiationdoseto
tumorlocallywithhighlocalcontrol.
Damagetonormaltissueislessastheirisrapidfall-offofradiation
aroundthesource.
Thistechniqueisparticularlyusefulintreatingcancersofcemix,

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uterus,vaginaandcertainHandNcancers.
Itcanalsobeusedtotreatbreast,brain,skin,esophageal,soft
tissue,lung,bladderandprostatecancer.

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219.Featuresofstrontium89incomparison
tophosphorus-32-

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a)Longert-1/2
b)Deeperpenetration
c)EmitsbetarayswhileP-32emitsalpharays
d)Lessertoxicity
e)None

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CorrectAnswer-A:D
Ans.(A)Longert-1/2(D)Lessertoxicity
[ReJ:ReviewofRadiologybySumerSethiCh/ep.184;Harrison
l9h/ep.363e-3;Bonica'sManagementofPuinbyScottFishmanp'
655]

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Half-lifeofP-32is14.3daysandstrontium-89is50.5days.
SofttissuepenetrationofP-32is8mmandstrontium-89is2.4mm.
BothP-32andStrontium-89emitB-rays.
P-32ismoderatelytoxicwhereasstrontiumhaslowtoxicity.

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220.Maximumscoreinminimentalstatus

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examinationis-
a)10
b)15
c)20
d)25

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e)30
CorrectAnswer-E
Ans.E.30
[Ref:KaplanandSadockp.2537]
Themini-mentalstatusexaminationoffersaquickandsimplewayto

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quantifycognitivefunctionandsteenforcognitiveImpairment.
Ithelpstoconfirmthepresenceofcognitiveimpairmentandtofollow
theprogressionofdementia.
Ittestsindividual'sorientation,attention,calculation,recall,
language,andmotorskills.Eachsectionofthetestinvolvesa

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relatedseriesofquestionsorcommands.
TheindIVIdualreceivesonepointforeachcorrectanswer.The
individualcanreceiveamaximumscoreof30points,i.e.,
MMSEis30pointprogrammetoevaluatecognitivefunction.

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221.Trueaboutgeneralizedanxietydisorder

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?
a)Insomnia
b)Clearhistoryofpasttraumaticevent
c)Excessiveanxietyandworry
d)Benzodiazepinesisdrugsofchoice

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e)None
CorrectAnswer-A:C:D
Ans.(A)Insomnia(C)Excessiveanxietyandworry
(D)Benzodiazepinesisdrugsofchoice
[Ref:NirajAhujap.90-91;KaplanandSadock11'h/ep.409]

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Generalizedanxietydisorder:
Characterizedbyexcessiveanxietyandworrywhicharepersistent
&generalizedandnotrestrictedtoanyspecificsituationorobject.
Excessiveanxietyworryoccurforatleast6months.
Worryisdifficulttocontrolandisassociatedwithatleastthree

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symptomsfromthefollowing:
Selflessnessorfeelingkeyedup
Difficultyconcentrating
Muscletension
Easilyfatigued

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Irritability
Sleepdisturbance
Anxietyandworrycausesignificantdistressandimpairmentis
social,occupational,orotherdailyfunctioning.
Treatment:

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Benzodiazepine-Drugofchoice.

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222.Essentialcriteriaformajordepression
areallexcept-
a)Delusionofgrandeur
b)Lossofpleasure

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c)Insomnia
d)Hypersomnia
e)Anorexia
CorrectAnswer-A
Ans.A.Delusionofgrandeur

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[RefNirajAhaiap.7l-72;KeplarnandSadsckp.357]
Diagnosticcriteriaformajordepression
5ormoreofthefollowingsymptomsshouldbepresentmostofthe
dayforatleast2weeks:-
Depressedmood

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Lossofinterestorpleasureinallactivities.
Decrease/increaseappetiteorloss/gainofweight.
Insomniaorhypersomnia(Increasedordecreasedsleep).
Psychomotorretardationoragitation(decreasedorincreased
psychomotoractivity).

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Fatigueorlossofenergy(weaknessorlethargy).
Feelingsofworthlessnessorexcessiveguilt.
Diminishedconcentration
Recurrentthoughtsofdeathorrecurrentsuicidalideationorsuicidal
attempt.

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223.TruematchofEEGpatterninsleepEEG-
a)K-complexisseeninstageIofNREMsleep
b)Wakingstateshowalphawave
c)Alpha-waveoccurinonsetofsleep
d)ThetawaveisthepredominantwaveinstageIofNREMsleep

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e)StageIII-NREMsleepshowshighamplitudeslowwaves
CorrectAnswer-B:D:E
Ans.(B)Wakingstateshowalphawave(D)Thetawaveisthe
predominantwaveinstageIofNREMsleep(E)StageIII-NREM
sleepshowshighamplitudeslowwaves

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[RefNirajAhajap.132-34;Kaplan&Sedaockp.534]
Fullawakeandalertstate=Betarhythm
Awake,eyesclosedandmindwanderingbutwithlessattentiveness
=Alpha-rhythm
Stage1NREM=Thetarhythm

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Stage2NREM=Sleepspindles,Kcomplex
Stage3&4NREM(Deepsleep)=Deltarhythm
REMsleep=Betarhythmandsometimesalsoreappearanceof
alpharhythm-.

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224.Naltrexoneis/areusedfor-

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a)Alcoholdependence
b)Opioiddependence
c)Cocainedependence
d)Cannabistoxicity
e)None

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CorrectAnswer-A:B:C
Ans.(A)Alcoholdependence(B)Opioiddependence
(C)Cocainedependence
[Ref:Katzungp.56-t;NiruiAhuia7h/ep.42,44,132;Pharmacology
bySatoskarp.165]

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Naltrexone:
Antagonistonallopioidreceptors)
Morepotentthannaloxone.
Givenorally.
Usedasamaintenancedrugforopioidaddicts-opioidblockade

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therapyofpostaddict.
Usedtodecreasecravinginchronicalcoholism.

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225.Whichofthefollowingis/arefeature(s)of
nicotinewithdrawal-
a)Weightloss

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b)Irritability
c)Impairedconcentration
d)Anxiety
e)Insomnia
CorrectAnswer-B:C:D:E

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Ans.(B)Irritability(C)Impairedconcentration(D)Anxiety
(E)Insomnia
Diagnosticcriteria{iaofnicotinewithdrawal:
Fourormoreofthefollowingsignsshouldbetherewithin24hours
ofwithdrawal

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Dysphoriaordepressedmood
Anxiety
Decreasedheartrate(bradycardia)
Insomnia
Difficultyconcentrating

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IncreasedaPPetiteorweightgain
Irritability,frustrationoranger
Restlessness.
invalidquestionid

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